Earlier this year, Evernorth, which is the health services division of The Cigna Group, released eye-opening behavioral health research. The key finding: 22% of people have a diagnosed behavioral condition, and they account for 41% of health care spend.
Let that sink in.
A main driver of these disproportionate health care costs is that 50% of adults with a diagnosed behavioral health condition do not receive treatment, which drives up total costs in the long run.
"There’s a number of reasons people are not getting the care that they need. Access to care, long wait times, a fragmented health care system, and social determinants all play a role."Jason Youngblood, director of the well-being center of excellence at Cigna Healthcare, and a licensed behavioral health clinician.
“We need to do better as a health care industry in connecting people to the behavioral health care resources available to them, with a keen focus on driving greater access, improved overall health, and seamless, connected patient experiences," Youngblood added.
Let’s take a closer look at some of the biggest opportunities we see in improving behavioral health care.
Building bridges to greater access to care is key
Finding the right behavioral care provider is one of the top challenges people face in health care. As of March 2023, 160 million Americans lived in areas with a shortage of mental health professionals. The top barriers to access include issues like providers not accepting new patients and long wait times. As a result of these provider shortages, behavioral health provider burnout is a real issue: One study found that 45% reported feeling burned out in 2022, with similar levels reported in 2020 (41%) and 2021 (48%).
At Cigna Healthcare, the health plan division of The Cigna Group, we are on a mission to connect people with the care they need. One key area of focus for us is building our networks by strategically choosing partners who help to increase access. For example, research shows that children and youth are particularly at risk when it comes to mental health, with suicidal ideation and suicide attempts rising sharply among people 17 years old and under. That’s why we added Brightline, a nationwide virtual behavioral health care solution for children and families, to our behavioral health network this year.
The rise in virtual care, as a result of the pandemic, has made access much easier. According to research from MDLIVE, the virtual care platform for Cigna Healthcare health plan members, 57% of respondents said they were open to using virtual care options like telehealth for behavioral health services, but only 25% have done so. Virtual care has opened access to individuals in geo-remote areas of the country (with very long drives) and in urban areas, where even a few miles can be inaccessible.
Digital tools are also helping us to improve access to behavioral care for our customers. For example, Cigna Healthcare's Confide Behavioral Health Navigator is a digital portal that connects individuals to mental health treatment and support whenever they need it, seamlessly and confidentially. It provides individualized, clinically driven guidance and can connect members to a warm and friendly live behavioral health advocate. In addition, we follow up on 100% of interactions to ensure that our members have been connected to support from the right provider.
“We’ve seen that virtual care and digital tools help us address health equity and access and can reduce the number of members who go without care because they lack convenient access to a behavioral health care professional,” said Youngblood.
We also see a big opportunity with provider matching, which takes a data-driven approach to helping individuals get connected to providers who have a particular specialty, language, or ethnicity, to ensure patients get the help they need in a way that is most impactful for them.
A data-informed, proactive approach to connecting people to care experiences
Timely intervention is critical to behavioral health care. That’s precisely why Cigna Healthcare is investing in data-driven identification models as well as real-time outreach to members who need help. Our ability to integrate medical, pharmacy, dental and behavioral health care data, as well as digital and social determinants of health data, allows us to proactively identify customers who may need support. This integrated view allows us to guide customers into care with the right providers, resulting in better health outcomes.
Outreach includes access to 24/7 crisis support, which is key since 35% of all behavioral health crisis calls in 2022 came in after routine business hours, or afterhours. We also proactively outreach to connect individuals to suicide awareness resources, coaching support, and other personalized clinical support. When someone with an eating disorder is having suicidal thoughts, for example, we can proactively offer programs that support their specific needs. We are also investing in data interoperability to drive real-time identification and proactive outreach when a patient visits the emergency room with a mental health issue or suicide ideation.
Our ability to integrate medical, pharmacy, dental and behavioral data helps us better understand what employees are dealing with, in real time, and allows us to help them engage in and prioritize their health. We know that access and cost can often be barriers to care, and we are doing our best to address that through our programs and solutions. For example, our Cigna Total Behavioral Health solution combines inpatient and outpatient case management with specialty coaching and personalized programs focused on specific conditions, such as eating disorder, autism, etc. It helps us identify individuals with depression and anxiety who are not receiving care and navigates them to affordable and convenient digital coaching and virtual care options. Our Total Behavioral Health solution results in 25% higher clinical program engagement, and 27% higher behavioral health claims. This is a key lever to improving overall health and driving down total medical costs.
"Health care’s fragmentation is felt by patients, doctors and plan sponsors," Youngblood said. "At Cigna, we see this as a rich opportunity to provide a more cohesive care journey, as well as a higher standard of health care benefits delivery. Taking a data-informed, proactive approach to behavioral health care allows us to improve accessibility, patient experiences, and outcomes. We’re creating connections to care that pave the way to better health for all people.”
A holistic approach to care – treating and understanding the whole person to improve outcomes
Behavioral health plays a critical role in overall health, including physical health, well-being, and vitality. When a behavioral health problem goes untreated, physical health often suffers. The opposite is true as well: When people struggle with chronic and complex conditions such as diabetes, musculoskeletal conditions, or cancer, to name a few, their physical health can affect their mental health.
“To help individuals achieve their optimal health, it is critical to address physical and mental symptoms together,” Youngblood said. “For example, patients diagnosed with depression are at increased risk of developing chronic physical conditions like diabetes and cardiovascular disease.”
Treating physical conditions and mental health separately can also drive-up health care costs. According to data from Evernorth, oncology patients who do not get behavioral outpatient treatment are twice as likely to have avoidable emergency room visits than those who seek outpatient behavioral care. The additional costs to their plan sponsors average from $173 to $243 per member per year.
To address the fact that nearly 1 in 3 cancer patients also struggle with mental health-related issues such as depression, anxiety, and substance use disorder, Cigna Healthcare has incorporated distress screening into our oncology case management program. We believe that actively addressing problems of distress will help reduce physical and emotional suffering while improving patients’ quality of life, adherence to their treatments, and, ultimately, their health outcomes.
We also know that chronic pain is connected to behavioral health issues like anxiety, depression and substance use. That’s why we offer Cigna Healthcare customers who are suffering from musculoskeletal conditions access to the Pathwell Bone and Joint program, which not only helps individuals get condition-specific care, but also connects them with behavioral health experts if they need help. Our integration of medical and pharmacy benefits also enables real-time data collection to monitor, measure, and manage opioid use by limiting opioid coverage to a predetermined number of days, stepping in with first-time user education and controls, utilization management, and more.
We are looking to our data to better understand how certain conditions and health events affect people’s mental health. For example, losing a pregnancy can have traumatic psychological impacts on women. When left untreated, the trauma can have long-lasting effects on the health and well-being of these women and their families. Our research found that post-miscarriage depression is prevalent in about 11.5% of women who have suffered a miscarriage, yet only about 10% of them receive the full spectrum of treatment (therapy and antidepressants).
“We see this as another area of opportunity to raise awareness and break down stigma,” Youngblood said. “In addition, our data will allow us to precisely identify those who need assistance so we can connect them and their families to the resources and treatment they need to get well.”
Wellness, Mental Health, and Behavioral
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