Just under a quarter of people have been diagnosed with a behavioral health condition, but these patients account for a growing piece of total healthcare spending, according to a new report from Evernorth.
The analysis found that the 22% of patients who have a behavioral health condition drive 41% of healthcare spend, in large part because many also have a comorbid medical condition. Of the patients with a behavioral health condition, 87% also had an underlying medical condition such as circulatory issues, musculoskeletal conditions or cancer.
In tandem, the study found that half of patients with behavioral health needs are not actively being treated for those conditions, which can lead their medical issues to worsen as well. This makes a more robust system that identifies behavioral health conditions earlier and offers patients personalized pathways to care crucial to addressing these challenges, according to Evernorth.
“Improving care begins with recognizing the long and chaotic road to finding effective treatment,” said Doug Nemecek, M.D., chief medical officer for behavioral health quality, integration and clinical operations at Evernorth, said in a release. “Finding a therapist who has demonstrated effective treatment for someone’s specific behavioral health condition is not easy. For one, the demand for care is much higher than the supply of providers, which often leads to delays in care, poor patient outcomes, and higher health care costs.”
Between 2021 and 2022, the prevalence of behavioral health conditions grew by 4%, according to the report. The study found the largest growth in diagnoses for attention deficit hyperactivity disorder, followed by personality disorders and autism spectrum disorder, all of which were up by 10% in that window.
Based on the findings, Evernorth's team laid out three key themes items for employers, health insurers and other stakeholders as they weigh solutions to address these issues:
1. Better care means acknowledging that finding care is often difficult
Access to behavioral health care is a major challenge across the country, especially as diagnoses for these conditions continue to rise. Evernorth's study said that it takes a patient on average 11 years from the onset of symptoms to receive treatment for their behavioral health need.
These delays range from between six and eight years on average for mood disorders and nine to 23 years for anxiety-related conditions, according to the report.
There are multiple factors behind these care delays, according to the report. For one, north of 150 million people live in regions where there is a shortage of behavioral health professionals. A majority of psychologists (60%) said they were not taking on new patients. In addition, finding the right match between patient and provider to make treatment work is also a significant challenge, according to the report.
2. The care journey in behavioral health is very personal
The report sorts behavioral health patients into four "persona" categories that reflect how they typically interact with the healthcare system. The largest group, accounting for 39%, are "silent sufferers," which reflects that large numbers of behavioral health patients never receive treatment at all. The next largest segment, "willing engagers," are the opposite, however, and are more proactive about seeking care. They account for 33% of patients.
Eighteen percent of patients are "self-directed seekers" and reach out to medical providers about treatment for their behavioral health needs. More than half of these patients have just one visit related to their behavioral health condition per year, which suggests they may not know the full extent of any diagnoses, according to the report.
In the smallest group, accounting for 10%, "complex copers" are managing behavioral conditions along complex medical needs. The study found that there is significant opportunity for cost savings associated with better care management in this population. For instance, when patients with comorbid diabetes and major depressive disorder were provided with sufficient behavioral health care, it led to $1,649 in medical savings per patient per year.
Evernorth's analysts said in the report that using these personas can make it easier for stakeholders to model more individualized patient care journeys.
3. There's still work to be done in building a robust ecosystem for behavioral health
More effectively addressing behavioral health care means making a seamless, connected experience for the patient, according to the report.
"The distinct care journeys demonstrated by the patient personas emphasize the opportunity to connect care in a seamless manner," the authors wrote.
The report emphasizes four steps to creating a more coordinated, robust model for behavioral health. One, early detection is crucial, as earlier treatment can drive improved outcomes. Next is assessment and recommendation that ensures "precision along care pathways," according to the report.
Once those care pathways are defined, the patient can then be matched with a provider that will best fit their needs. And then finally, transparent measures are critical to benchmarking success. For example, the report found that patients who receive outpatient treatment for behavioral health can see savings of $2,565 each over a 15-month diagnosis period.