How does behavioral disorder treatment affect direct medical cost?

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What happens when you leave a physical wound unattended and festering? In most cases, sepsis sets in. Here’s news – It’s the same with mental trauma.

Left untreated, one runs the risk of developing comorbidities including cardiovascular and respiratory diseases, gastrointestinal and genitourinary disorders, and chronic pain conditions including migraines and arthritis.

For healthcare providers and payers, untreated behavioral health (BH) disorders are the stuff of nightmares because of the higher cost of treatment associated with treating –

Patients with BH disorders because they exhibit a higher severity of disease
Patients with severe chronic medical conditions because they are more likely to suffer from BH disorders

The economic cost of untreated mental illness is more than $100 billion each year in the U.S. alone, with both providers and payers facing the brunt of this expenditure.

Does Treatment Received Mean Cost Decreased?

Having established that untreated mental/ BH disorders result in higher financial costs, I’d now like to highlight an equally important aspect of this topic – Why, and by how much, does receiving treatment for BH disorders reduce medical and pharmacy costs?

The ‘why’ part is easily answered. The correct evidence- and measurement-based treatment plan assists in decreasing the likelihood of recurring symptoms, hospitalizations, substance abuse, suicides and other forms of self-harm, and damaged relationships.

The answer to the ‘by how much’ part is as follows –

According to an NCBI-NLM-NIH study, adults with a BH condition incur 2.8 to 6.2 times greater medical costs than those without one. This is explained, partially, by the correlation between BH disorders and comorbid chronic conditions. That said, the following isn’t exactly news to you –

Globally, as many as 50% of people with chronic pain also suffer from behavioral health (BH) disorders, particularly depression and/ or anxiety
Depression and anxiety, two of the most common mental health conditions in the world, cost the global economy a whopping $1 trillion each year

Anyhow, back to the study I was citing. During its course, researchers found one or more outpatient behavioral health treatment (OPBHT) visits to be associated with lower medical and pharmacy costs during 15- and 27-month follow-up periods.^[1]^/^[2]The study spotlighted the following numbers –

For the 15-month group, the mean per member per month (PMPM) cost for those who made OPBHT visits was $571 compared to $686 for those who didn’t
◦ Savings between $915 and $2,565 per person for those who made one or more visit
For the 27-month group, the mean PMPM was $391 for those who received OPBHT compared to $464 for those who didn’t
◦ Savings between $1,134 and $3,321 per person for those who made one or more visit

Right Action at The Right Time

The figures I’ve mentioned above show that the requirement for pharmacy and medical services decreases when individuals receive/ have access to the behavioral care they need. The outcome – improvement in individual health at lower cost.

While the inference is clear, there’s one more statistic that I’d like to share that’ll drive the point home irrefutably. Here goes – where direct medical cost is concerned, a combination of in-patient visits, prescription medications, and office-based visits has been found to account for a whopping 90% to 93% increase in it!

The question we need to ask here is, “What can be done to reduce or eliminate this combination that’s escalating costs?” The answer is rather simple – Encourage individuals who need behavioral care to seek it, and ensure they have access to it when they start searching for it.

Providers as well as payers will find value in “promoting OPBHT as a part of a population health strategy can help improve overall medical spending.”^[3]

A Remedial Solution In Urban Health

Clearly, medical and pharmacy costs increase when BH conditions are left untreated. To correct this situation, BH disorders need to be accurately and differentially diagnosed to deliver proper care and treatment. Only through the delivery of correct and timely integrative care can both providers and payers lower the high cost of untreated mental illness.

Urban Health is a path-breaking evidence- and measurement-based, AI-guided therapy and care enabling solution that is redefining the delivery of integrative mental healthcare at scale cost effectively. The solution assists provider care teams in treating and/ or reducing the severity of mental illness in patients by –

Deploying clinically validated assessments to identify, and risk stratify, BH disorders
Helping care teams make informed treatment decisions through timely triage assessments that –
◦ Predict the course of illness
◦ Determine the kind, and level, of care a patient requires
◦ Carry out suitable interventions
Implementing measurement-based care to personalize actionable insights-led treatment plans

Urban Health helps users (patients) adhere to their medication regimens and remember their appointments by sending automated timely notifications. It also assists physicians with understanding whether patients are sticking to the recommended treatment, and to what extent.

Cost-related benefits include –