Mental health, substance abuse driving health care costs
But it's not what you think: spending for mental health and substance use makes up a small fraction of total health care spending.
An extensive study of 21 million people with commercial health insurance shows that Americans with mental health conditions and substance use disorders in addition to physical health problems are outsized drivers of total health care costs, according to a new report.
Yet health care spending for mental health and substance use behavioral issues make up a small fraction of total health care spending, the report states.
Related: Risk of employee mental health conditions remains ‘alarmingly elevated’
The study was commissioned by The Path Forward for Mental Health and Substance Use, a private sector initiative aimed at driving market-based improvements in behavioral health care, and conducted by the Milliman Inc., an actuarial and consulting firm in Seattle.
The findings paint a stark picture of the disparity between physical and mental health benefits. For instance:
- Out of the 21 million insured Americans studied, the 10% of patients who had the most expensive health care costs accounted for 70% of annual total health care costs
- 57% of the most expensive patients had mental health or substance use disorder issues
- Half of the people studied who had mental health or substance use behavioral issues had less than $68 of their total health care costs go toward behavioral treatment
- The next 25% of those studied, a full quarter of those with behavioral issues, saw only $68 to $502 of their total spending go to behavioral treatment
Among the study’s major takeaways, according to The Path Forward’s report, is that employers, health insurers and health care providers should focus on significantly increasing access to affordable and effective in-network specialty behavioral providers.
In addition, employers, health insurers and providers should work to detect behavioral issues and track clinical outcomes early. And they should use type of collaborative care in primary care settings that will address both the behavioral and physical problems, according to the report.
Among its other benefits, the study, which analyzed 2017 health insurance claims data, also serves as “a baseline” for estimating the impact of COVID-19 on behavioral health care, The Path Forward said in am August 13 news release.
“While the … report did not study the effect of COVID-19 on mental health, its analysis of 2017 claims data provides a baseline for estimating the potential subsequent impact of the pandemic on the treatment of behavioral conditions and medical spending,” said Andy Keller, the president and CEO of Meadows Mental Health Policy Institute, in a statement in the release.
Referring to increased risks of suicide and mental illness during the pandemic, Keller added, “Given that American health systems were failing to meet these [behavioral helath] needs pre-pandemic, it is imperative that we muster the resolve to revamp delivery systems top to bottom.”
In responses to the study by experts released by The Path Forward, Arthur Evans, Jr., the American Psychological Association chief executive officer, said: “If we focus more on intervening with individuals when they first begin showing signs of a behavioral health condition, even before they have a behavioral health diagnosis, we can improve health outcomes, as well as minimize the need for and cost of care later.”
Dr. Maurizio Fava, psychiatrist-in-chief at Massachusetts General Hospital, said, “Health equity demands that the evidence-based reforms set forth by the Path Forward be implemented nationwide.”