Integrating medical and behavioral benefits may help deliver a better health plan experience

As comprehensive behavioral health benefits become a greater priority for employees when evaluating their benefit plan options, it’s become increasingly important for employers to reassess what they provide and communicate these offerings to employees and their families.

A recent survey found investing in mental health is seen as very important by 1 in 2 employees. In addition, 42% of employees with access to mental health benefits are less likely to leave their employer, compared to only 27% without it.1

For Generation Z, behavioral health benefits appear to be critical for employers from a workforce recruitment and retention perspective, as 60% of Gen Z employees surveyed in a recent report said mental health resources were important in selecting an employer, and 57% say they are important when deciding to stay at an employer.2

“Since the pandemic, there is a greater awareness of behavioral health benefits among employers,” said Dr. Rhonda Randall, EVP and Chief Medical Officer for UnitedHealthcare Employer & Individual. “It’s more important than ever for employers to communicate with employees that there are behavioral health benefits available to them.”

The increased attention to behavioral health needs also may be an opportunity for employers to reiterate the connection between physical and mental health. At UnitedHealthcare, integrating medical and behavioral benefits is designed to help support physical and mental health needs --- a whole-person approach to help improve outcomes and experiences for employees while lowering costs.

Behavioral health conditions may be linked to chronic health conditions

One area that highlights this need is employees who have co-occurring medical and behavioral conditions. Evidence has shown that mental health conditions such as depression are strongly associated with the risk of serious chronic diseases and health conditions, including diabetes, hypertension, stroke, heart disease and cancer.3

UnitedHealthcare claims data has shown that members with comorbidities have claims costs that are, on average, twice the claim costs for members with medical conditions alone.[i] Plus, in an average group plan population, about 14% of members experience both medical and behavioral conditions, amounting to 28% of the cost of care for everyone.5

3 key takeaways for co-occurring conditions

  1. In an average group plan population, about 14% of members experience both medical and behavioral conditions, amounting to 28% of the cost of care.
  2. Behavioral health conditions, when left untreated, may increase the risk, accelerate the progression, complicate the management and worsen the outcome when co-occurring with chronic diseases and other health conditions.
  3. Members with co-occurring medical and behavioral conditions may be less likely to manage their medical condition if the behavioral condition is left untreated.

When employers integrate medical and behavioral benefits, it’s designed to enable a more seamless experience in guiding employees to the type of care and management of their conditions they may need.

“When an employee has integrated benefits, we’re able to take a more holistic approach to their care starting with a screening for depression and anxiety,” says Stacie Grassmuck, Director of Behavioral Health Product and Innovation at UnitedHealthcare Employer & Individual. “If a behavioral health condition is left untreated, it’s likely that we’ll see an increase in emergency room visits and hospital stays. This becomes even more critical when an employee has co-occurring conditions.”

The COVID-19 pandemic has accelerated an already growing need for behavioral health care that, if unmet, may lead to higher demand for other medical services as well. For every 10 people in a doctor’s office, 7 seek care for reasons related to behavioral health.6

Behavioral health conditions, when left untreated, may increase the risk, accelerate the progression, complicate the management, and worsen the outcome of co-occurring chronic diseases and health conditions.7 For example, 15% to 25% of cancer patients suffer from co-occurring depression.8

“We know members are less likely to take care of their chronic health condition if they also have a mental health condition,” says Dr. Martin H. Rosenzweig, Chief Medical Officer of Optum Behavioral Health, which supports UnitedHealthcare’s behavioral health benefits. “For example, a member with diabetes experiencing symptoms of depression may be less motivated to check their glucose levels.”

Offering solutions to help address co-occurring needs

With increased adoption due to the pandemic, virtual behavioral health services may expand access to treatment for more than 53 million Americans. This increased access may translate into reduced medical costs. Even a 1% increase in treatment for behavioral health disorders may yield as much as $2.4 billion in medical cost savings annually. These savings largely come from the fact that individuals with behavioral health conditions often have other medical conditions.9

To help employees who may need support for their medical and behavioral health, employers can turn to solutions that identify high risk employees through claims-based predictive modelling. UnitedHealthcare offers a virtual behavioral therapy and coaching program for qualifying employers that proactively identifies, engages and treats high-risk individuals with co-occurring medical conditions and mental health needs through an 8-week evidence-based care plan.

Here’s an example of how the program works:

  • Fred, 54, is trying to manage his chronic heart condition while battling depression and low energy.*
  • Using claims data and proprietary algorithms, the program identifies Fred as a good candidate for virtual behavioral therapy and coaching.
  • After proactive outreach, Fred enrolls and is provided a personalized program that includes sessions with a therapist, work with a behavioral coach, and education and skills practice.
  • Over the next 8 weeks, Fred meets weekly with his therapist and then his behavioral health coach. Between sessions, he uses a workbook for members with his condition to conduct skill-building activities. In this way, Fred learns how to manage the physical and mental aspects of his health and make lifestyle modifications.

Participants in the program had reduced depression by 56%, anxiety by 51%, stress by 46%,10 pain severity by 17%,11 reduced medication non-adherence by 46%12 and inpatient use by 45%.13

Guidance with a whole-person approach

Integrated medical and behavioral benefits helps to provide employees a better experience with end-to-end support. For instance, advocates are trained to help support inquiries across a wide variety of programs and resources and provide whole-person, proactive guidance across a broad number of health care needs, including emotional health, clinical and complex care support and financial and benefits/claims.

“Take a member who is looking for a provider for back pain. Since back pain can be associated with depression, the advocate starts a conversation about how they are doing and how the back pain is affecting their life,” says Trevor Porath, Vice President, Clinical, Behavioral, and Advocacy Solutions at UnitedHealthcare. “They are trained to understand when and how to have these conversations, and guide members to care who may have a behavioral health condition.”

The advocacy program has initiated more than 31% of clinical program enrollments with providers,14 which has led to over $98 million in annual savings by employees and employers.15

By managing mental and physical health benefits under one roof, employers may better serve their employees’ comprehensive health needs, improve outcomes and reduce costs.

 

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Footnotes

  1. 2021 Health Demand: Delivering the benefits employees want now. Mercer. 2021.
  2. National surveys reveal disconnect between employees and employers around mental health need. McKinsey & Company. Mar. 21, 2021. 
  3. Chronic Illness and Mental Health: Recognizing and Treating Depression. National Institute of Mental Health, 2021.
  4. Azocar F, Bargman EP, Smolskis JM, Groat TD. Enhanced methodology for estimating integrated medical-behavioral costs. Optum internal report. January 2017.
  5. Ibid.
  6. The future of behavioral health (2021). Deloitte Insights. 
  7. Behavioral Health Integration. Substance Abuse and Mental Health Services Administration, 2020. 
  8. Depression. National Cancer Institute, page updated Aug. 26, 2021. 
  9. Breakthrough Behavioral Health Access. Accenture, 2020.
  10. AbleTo book-of-business outcomes, 2019. 
  11. Clinical and Workplace Outcomes from a Virtually Delivered Cognitive Behavioral Therapy Program for Pain. Mochari-Greenberger, H., Andreopoulos, E., Peters, A. and Pande, R.L. (2020), Pain Pract.
  12. Improved Medication Adherence Among Diverse Participants in a Virtual Behavioral Therapy Program for Adults with Chronic Medical Conditions, AbleTo, 2019.
  13. Impact of AbleTo on Per Capita Resource Utilization and Health Spending among Beneficiaries for a Large National Health Plan. Veracity Health Analytics, Boston, MA 2019.
  14. UnitedHealth Group internal analysis, 2019.
  15. UnitedHealthcare Advocate4Me performance reporting, 2019. Results not guaranteed. A Circle of Caring Support.

*Fred is not a real patient. His story reflects the experience of multiple patients. This hypothetical case is intended to be used for illustrative purposes only.

AbleTo is part of Optum and the UnitedHealth Group family of businesses.