Living with a serious illness or chronic medical condition can take a toll on emotional well-being, putting your employees with such conditions at risk of developing increased stress and serious mental health issues. Employees with diabetes, for example, are two to three times more likely to experience depression than those without diabetes. Employee depression, in turn, can have an impact on employers in terms of increased medical spend and reduced productivity.

Mental health conditions can intensify physical health symptoms and hamper medical treatment and recovery. It’s no surprise that health care costs for people with a chronic medical illness and a mental health condition are two to three times higher than the average costs for those who have the medical condition alone.

Mental health conditions such as depression can also lead to additional costs for employers because of their impact on workforce productivity. One study estimates that the median cost of lost productivity for a single employee with depression is nearly $3,200 annually.

Integrated health benefits can help employers curtail these costs by providing a more holistic care experience for their workforce. According to the most recent Value of Integration study, Cigna Healthcare’s employer clients with integrated benefits saved an average of $862 per year for each member diagnosed with diabetes and depression. For members with conditions that require a specialty medication along with depression, these integrated benefits saved employers an average of $17,476 per year. The study compares the costs for customers who use Cigna Healthcare medical, pharmacy, and behavioral benefits with Cigna Healthcare medical customers who receive behavioral and pharmacy benefits from other entities.

“From years of practice, I’ve seen how chronic illness and depression can be a vicious cycle,” says Dr. Rodgers Wilson, national medical executive for behavioral health at Evernorth, the health services division of The Cigna Group. “Having a chronic condition can make someone depressed, which makes it difficult to focus on managing the chronic condition, so things start to get worse, which makes the person feel more depressed. This downward spiral makes the total cost of care go higher and higher. So it is important to have an integrated treatment plan to address both depression and chronic disease at the same time. It’s better for both the individual and the employer sponsoring the plan.”

We talked with Dr. Wilson to better understand how these issues, and how integrating medical, pharmacy, and behavioral treatment plans, can benefit employers and employees.

What should employers know about the impact behavioral health issues like depression have on their workforce, especially for workers also living with a chronic medical condition?

Employers are likely already aware that depression is one of the top three issues facing the workforce today. Almost 1 in 10 American adults are dealing with a depressive illness each year, and most of them are ages 18 to 50. On a related note, depression is the leading cause of disability for people ages 15 to 44. This age group contains both Millennials and Gen Z, who together make up over one-third of the U.S. labor force.

Depression can affect workers of any age, and it can cost businesses dearly – not just from increased medical spend and disability costs, but also in terms of productivity. We’ve mentioned the yearly $3,200 median productivity cost for one employee with depression. Given the prevalence rates, plus the fact that those living with chronic conditions – which is about 60% of all U.S adults – have two to three times higher rates of depression than people without those conditions, and noting that two-thirds of people with depression do not seek or receive proper treatment, those productivity costs can add up substantially.

What advice do you have for employers to best support workers who are living with a chronic or complex medical condition and also struggling with depression?

Having to live with a chronic or complex medical condition can literally change the way people live their everyday lives — both at home and at work. They may not be able to do some of the things they used to do or eat some of the foods they used to enjoy. It’s easy, and completely normal, for them to get sad and discouraged at times, and sometimes those feelings can lead to symptoms of depression. In fact, about one-third of people with a chronic illness experience depression. And, caring for a loved one with a chronic condition can be both a physical and emotional strain, so employees who do so would have their own physical and mental health needs to take care of as well.

Employers should let employees know that it’s OK to not be OK. Fortunately, there has been increasing awareness of behavioral health issues during the pandemic, yet there is still a stigma around depression and other mental health conditions. So it is important for business leaders to normalize conversations around maintaining good mental health and encourage their workforce to seek help when needed. This includes encouraging them to be open to having a depression or mental health screening if their doctor or health plan recommends it.

Fortunately, depression and other mental health issues are also chronic conditions that can be treated. Including comprehensive behavioral health benefits as part of the employer health plan offering can help connect employees to any specialized care they or their family members need, either through in-person or virtual appointments. What’s more, having a holistic benefits package that includes an employee assistance program, work-life services, health and wellness programs, and caregiving resources can help all employees maintain good mental health by addressing any work-, life- or family-related issues that can lead to undue stress or anxiety.

An employee’s mental health is part of the solution to managing a chronic condition. 80% of people who are treated for depression actually see improvements within four to six weeks. We cannot separate mental health from physical health. When co-occurring physical and mental health conditions are addressed together through care coordination, this leads to better clinical outcomes.

During the pandemic many companies have recognized the importance of mental health in addition to physical health, and are offering benefits to help their employees manage both. But it is equally important to let employees know that they have these resources available to them, as well as how to access them. Employers should consider including regular reminders of their health plan benefits and programs in their business communications, along with the contact telephone number and website address to request services.

Business leaders can become a role model by notifying their teams about how they are taking care of their own physical and mental health needs. Leaders should also be flexible with work schedules to enable employees to keep their appointments with primary care providers and mental health professionals, which typically take place during regular business hours.

How do Cigna Healthcare’s integrated benefits help people living with co-occurring depression and other behavioral health issues?

There is significant value in the triple integration of benefits – medical, pharmacy, and behavioral health, which includes mental health and substance use services. It enables routine behavioral health screenings to be conducted at various touchpoints on the medical side of care for people with chronic conditions, to help detect any potential co-occurring depression as early as possible. It allows us to set up an integrated treatment plan aimed to help each customer sustain balance between their physical and mental health. This treatment plan includes physical and behavioral care when needed, available through in-person or virtual appointments, as well as seamless care coordination and continuous engagement between medical and behavioral health practitioners.

Integrating the pharmacy benefit additionally enhances care through comprehensive management of prescription medication if it is needed. In the United States, medication errors are estimated to harm at least 1.5 million patients per year. The integration of medical and behavioral pharmacy data helps eliminates risk of these errors, as well as speed up the prior authorization process to help people get the medications they need faster. And, enabling all of the treating clinicians to have access to this integrated data would help them be aware of each other’s treatment plans so they can better coordinate their patient’s care and support.

In short, integration allows for a more simple care experience for patients to help manage depression and other behavioral health issues, which helps them better manage their chronic medical conditions.

We work to promote the importance of maintaining good mental health to all of our Cigna Healthcare clients, regardless of whether they have integrated benefits. We understand the true value of enabling holistic health care for each individual — which includes having medical, behavioral and pharmacy services working alongside one another. As your consultative partner, we're dedicated to helping you have the most productive, healthy workforce possible, and providing the necessary solutions for achieving that goal.