Report Links High Healthcare Costs to Patients With Both Behavioral, Physical Health Conditions

A new report from health policy researchers reveals high healthcare costs linked to individuals with untreated behavioral health conditions in addition to physical conditions.

The report is from the HR Policy Association—an organization of chief human resources officers of the largest corporations doing business across the globe—and its healthcare think tank, The American Health Policy Institute, as well as The Path Forward, a private sector initiative to drive market-based improvements in behavioral health treatment and healthcare equity.

The research identifies the prevalence of patients with behavioral health conditions (mental health conditions and substance use disorders) within the total patient population and among the highest-cost patients; the contribution of individuals with these behavioral health conditions to total healthcare costs; and the levels of spending on physical (medical/surgical) and behavioral health treatment.

The report was developed by Milliman, Inc., an independent actuarial and research institution. Milliman researchers analyzed 2017 claims data for 21 million individuals with 12 months of eligibility for commercial medical and prescription drug coverage, aged 2 through 64, from all 50 states and D.C., across all care settings.

A few of the report’s key findings include:

• 5.7 percent of the entire study population—high-cost patients with both conditions—accounted for 44 percent of all healthcare spending
• 50 percent of all patients with behavioral conditions had less than $68 of total annual spending for behavioral treatment.
• Researchers also contend that the study provides a baseline for estimating impact of COVID-19 on behavioral healthcare.

The Path Forward-focused report provides recommendations to address the current deficiencies in behavioral healthcare, provide equity and reduce total health care costs, and recommends specific steps employers, health insurers, and providers can take to ensure implementation of five key reforms.

These include increased access to affordable and effective in-network specialty behavioral providers; early detection of behavioral conditions and tracking of clinical outcomes; use of “collaborative care” (as defined in the CoCM reimbursement codes) in primary care settings; expanded access to tele-behavioral health services; and parity law compliance.

Timothy J. Bartl, CEO of HR Policy Association said in a statement, “Providing access to quality, affordable healthcare to employees and their dependents is a top priority for chief HR officers of large employers. This illuminating report, commissioned by the Path Forward, will help our members better understand that relatively few individuals who have mental health or substance use disorders are getting the treatment they may need for their overall well-being.  Further, this report provides valuable information for employers as these untreated individuals are having a major impact on overall healthcare spending.”