Because mental health treatment is “carved out” from medical benefits, and generally sold separately to insurance customers by insurers such as UnitedHealth Group, Anthem, Aetna, Humana, and Blue Cross and Blue Shield, that means that when treatment is improved, the improvement is not seen at the bottom line.

That’s despite the fact that many insurers are using contracts with accountable care organizations, which coordinates care and takes other actions to improve the outcome for the patient and lower costs for the insurer.

Kennedy said in the report, “If you carve it out, it means you don’t see the benefit on the books.”

But that could be changing: Cigna, for its part, is planning to evaluate an evidence-based approach to treatment for substance abuse to see whether it can convert to a value-based payment system, rather than the current fee-for-service model. Should it prove successful, Cigna and other insurers could then develop guidelines that could be utilized in mental health provider protocols.

In the report, Kennedy said, “It’s not in our culture to think of about this whole person health. But that is where the money is. The people who get their arms around it in the business world are going to be the people who make the biggest killing in terms of health care.”