Mental health is health
Understanding the business side of care
The young teacher sat there, feeling frustrated. After all the progress he’d made with his therapist on his anxiety, he saw his insurance company had only covered 50% of his appointments—not the 80% he was used to for other health care visits. Since he was getting help for his brain, shouldn’t seeing a therapist be covered the same as seeing a neurologist?
It’s not only patients who are frustrated–providers are frustrated, too. Lower coverage and limited visits mean many patients don’t get all the care they need. Anyone who has been discharged after just 30 days of inpatient substance use disorder treatment knows this all too well.
The need for a more equitable system
With physical health care, the more serious a patient’s condition is, the more health insurance companies typically cover. And not just two or three times more—exponentially more. One reason for this is medical health care has thousands more quantifiable measures of illness that can be billed than mental health care does. This disparity limits providers’ ability to demonstrate to insurance carriers what care their patients need.
If the teacher mentioned above had suffered a physical head injury, every test, blood draw, procedure, and surgery would have been billed separately, whereas his mental health visits probably had only one or two billable charges. That’s despite the duration of mental health care often being long and complicated due to the chronic nature of many mental health conditions.
"There's a translation problem; there isn't a complete language developed to support the span of mental health needs that exist."
Mental health care also takes time and personal attention from care providers, which is exactly why it’s so impactful—but also so economically challenging. The gold standard is still one-to-one care that can’t be easily delivered or streamlined through technology.
"We want our patients to be able to get back to their lives as quickly as possible, and we celebrate when someone feels better," says Ian Macdonald, MHA, MBA, Interim Executive Director at Huntsman Mental Health Institute. "But there isn’t one perfect mechanism to show the before and after in mental health, like seeing a broken bone in an X-ray and then seeing it healed in another. This lack of quantifiable measures of care feeds right back into the economic challenges of mental health care."
The importance of Quantifying care
To remedy these challenges, Huntsman Mental Health Institute, part of the world-class care system at 91Â鶹ÌìÃÀÖ±²¥, is working to better define quantifiable measures of acuity, or sickness.
"We're getting close to the point where we can prove these numbers with research and use them to improve the option that hospitals and insurers have to quantify the cost of care," Macdonald says. "It's where mental health care needs to go."
"Placing a dollar amount on the societal benefits of mental health is the panacea."
A recent study showed that untreated mental health conditions cost the US economy $282 billion every year. But proving out the benefits is harder to measure. This year, Huntsman Mental Health Institute partnered with the to research and quantify the societal and economic benefits of mental health.
"The early indicators are promising," says Mark Rapaport, MD "Building a monetization framework and conducting a socioeconomic impact analysis will help bring more attention and investment in this space, which can dramatically benefit society as a whole.'
There is no health
without mental health
Implementing more sustainable mental health care models pays dividends for our physical health
According to the , when we’re mentally healthy, we’re much less likely to smoke, eat unhealthy food, use substances, and develop heart disease, diabetes, or other kinds of secondary physical ailments. And that’s good business for everyone.
the impact of collaborative care
Another solution to the economic challenges is the integration of behavioral health and medical health services. Huntsman Mental Health Institute now uses the Collaborative Care Model, which brings early mental health care intervention into all 91Â鶹ÌìÃÀÖ±²¥ primary care clinics.
All patients receive a mental health screening at a primary care visit. If care is indicated, behavioral health professionals collaborate with the primary care provider to treat mental health conditions in the same setting as medical problems—reducing stigma and siloed care.
They also make referrals to the next level of treatment. It’s part of a stepped care model where the most effective yet least resource intensive treatment is delivered first, which helps patients get care before symptoms get worse and are harder to treat. Outcome data show that 74% of patients receiving integrated care had clinically significant improvement, with a drop of over 5 points in depression scores. Last year, 17,641 screenings were completed as part of the Collaborative Care program.
Huntsman Mental Health Institute is unique in that it offers two models of care in the integrated health program: 1) Primary Care Behavioral Health and 2) Collaborative Care in both primary care and specialty care settings. Rarely do integrated programs offer both.
It's not only about the money
The economic challenges of mental health care are influenced by more than just dollars and cents. For example, fear and prejudice weigh heavily on decisions to seek care. The brain is difficult to assess and measure. Mental health disorders are complex compared with the average medical condition. And many health systems aren’t keeping up with advances in treatments or using validated methods to measure symptoms and progress.
Huntsman Mental Health Institute is working to change these dynamics by:
- Expanding a continuum of care so patients receive the right level of care for their specific needs.
- Understanding that many patients may only need one visit, while some will need multiple visits with different services across the continuum of care.
- Emphasizing preventive and primary intervention programs, such as school-based care programs.
- Using stepped models of care, such as the Collaborative Care Model first, followed by specialty care when needed.
These approaches help increase access to care while decreasing costs. And that’s better for everyone.