In creating proposed models for value-based reimbursement of specialty provider organizations, one of the goals of our team is to link specialty provider organization “performance” to the total cost of consumer care. This is a bigger goal—but also provides a bigger role for specialty provider organizations in the health care system since behavioral health and long-term care services together are only about 15% of the total health care spend.
I was reminded of this while reading our recent article about the cost of chronic health care conditions—of which the direct and indirect costs of chronic illness total $3.7 trillion, or about one-fifth of the 2018 gross domestic product of $20.50 trillion (see U.S. Economic Burden Of Chronic Diseases Reaches $3.7 Trillion). The direct health care cost of those conditions is $1.1 trillion, about 33% of total U.S. health care spending. What was interesting to me was that this report found the costs for specific chronic diseases but didn’t discuss the costs of behavioral health disorders that commonly co-occur with the specific chronic diseases—and usually raise the costs significantly. We looked at a few of these conditions and found a robust set of research on the behavioral management as a solution.
Diabetes—The total annual cost of diabetes is estimated at $327 billion. Research shows that among adults with diabetes, 10.2% had unrecognized depression (for $2,872 in added cost), 13.6 % had asymptomatic depression ($3,347), and 8.9 % had symptomatic depression ($5,170) (see Trends in Costs of Depression in Adults with Diabetes in the United States: Medical Expenditure Panel Survey, 2004-2011). Successful interventions for behavioral management of diabetes include programs that prioritize frequency of feedback, problem solving, community support, personalized approaches, and screenings for psychological factors (see Effective Strategies For Encouraging Behavior Change In People With Diabetes).
Heart disease—The total annual cost of heart disease is estimated at $555 billion, but consider that the cost of care for health failure increases by 29% when the consumer also has depression (see Depression-Related Costs in Heart Failure Care); and women with depression have annual cardiovascular costs $1,550-$3,300 higher than consumers without depression (see Depression and Cardiovascular Healthcare Costs among Women with Suspected Myocardial Ischemia: Prospective Results from the Women’s Ischemia Syndrome Evaluation). Successful interventions for behavioral management of heart disease are those that help consumers manage poor dietary habits, physical inactivity/low fitness, and smoking (see Foundational Factors For Cardiovascular Disease: Behavior Change As A First-Line Preventive Strategy).
Arthritis—The total annual cost of arthritis is estimated at $304 billion in 2013, but the mean annual total health care costs for coexisting rheumatoid arthritis (RA) and depression are 7.2% higher than RA alone. In addition, consumers with osteoarthritis (OA) and depression have 38.8% higher direct health care expenditures as compared to those without OA (see Healthcare Burden Of Depression In Adults With Arthritis). Successful interventions for behavioral management of rheumatoid arthritis include cognitive behavioral therapy (see Psychosocial Management Of Chronic Pain In Patients With Rheumatoid Arthritis: Challenges And Solutions).
Obesity—The total cost of care for obesity is estimated at $114 billion. Obesity makes it more likely that a consumer will become depressed, and that depression makes it more likely that a consumer will become obese (see Trajectories of Change in Obesity and Symptoms of Depression: The CARDIA Study); 43% of consumers with depression are obese (see Depression and Obesity in the U.S. Adult Household Population, 2005-2010). Successful interventions for behavioral management of weight include training in collaborative goal setting; accountability; nutrition consultation and meal planning; and self-monitoring food intake, weight, and activity (see Behavioral Modification For The Management of Obesity).
Cancer—The total cost of cancer is estimated at $80 billion in 2015, and consumers with cancer and depression had total annual health care costs 113% higher ($235,337) than consumers with cancer but without depression ($110,650) (see How Costly is Depression for Cancer Patients?). Successful interventions for behavioral management of cancer include cognitive behavioral therapy (see Cognitive Behavior Therapy For Patients With Cancer).
The high (and growing) costs of chronic disease—and the very real impact of behavioral health conditions and behavior management—are likely going to reshape care coordination programs and primary care. Payers will be looking for innovative approaches that can demonstrate a return-on-investment in the chronic disease management space.
For more, join OPEN MINDS Senior Associate John F. Talbot, Ph.D. on August 13 at The 2019 OPEN MINDS Management Best Practices Institute for the session Building A Value-Based Sustainability Strategy: How To Develop Innovative Programs & Manage Your Service Line Portfolio, featuring: Faith Richie, Senior Vice President, Development, Telecare Corporation; Kim Scott, Chief Executive Officer, Trillium Family Services; and Jamie Vandergon, LPC, President, Trillium Family Services.