Integrating medical and behavioral benefits to help achieve whole-person health

Joe* knows his family has a history of heart disease, but he hasn’t tracked his blood pressure for years. In a recent wellness visit, though, the primary care physician refers him to a cardiologist after discovering high blood pressure that may require specialized management.

When Joe calls to find a network cardiologist, an advocate helps him find the specialist, and an alert on the advocate’s dashboard prompts a conversation with a nurse case manager to help support Joe with managing his heart condition. The nurse case manager then follows up with Joe and conducts a behavioral health screening since there may be an association between cardiac disease and the development of depression.

With integrated medical and behavioral benefits, a process begins to help Joe find mental health support because he screened positive for depression. By connecting these two benefits, UnitedHealthcare proactively helps to identify members who may have untreated mental health conditions and helps to engage them in evidence-based care programs and treatment services that have demonstrated value and effectiveness. 

3 Key Takeaways

  1. In an average group health plan population, about 14% of members experience both medical and behavioral conditions, amounting to 28% of the total cost of care. 
  2. Those with a mental health diagnoses who receive behavioral health treatment are 26% less likely to miss work and 36% less likely to be unengaged on the job.
  3. UnitedHealthcare’s cross-program integration of data helps identify members who may need additional behavioral support.

This capability behind the scenes is significant because the prevalence of mental health conditions in the United States is rising. Nearly 1 in 5 adults are affected, while as many as 57% have been without treatment in the past year.Plus, in an average group health plan population, about 14% of members experience both medical and behavioral conditions, amounting to 28% of the total cost of care.2

“It’s typically the medical spend that increases when behavioral health is not addressed,” says Stacie Grassmuck, Director of Behavioral Health Product and Innovation at UnitedHealthcare. “In the last 5 years, behavioral health has emerged as one of the top opportunities for integrating care. When we work directly with members to get them into appropriate behavioral health treatment, we see savings on the medical side.”   

After employees are diagnosed by their provider, the health plan care team can coordinate and align care to help them make informed decisions so they can find appropriate, quality care that may lower their overall costs. UnitedHealthcare claims data shows that members with co-occurring medical and behavioral health conditions — also known as comorbidities — have claims costs that are, on average, twice as high as claims for members with medical conditions alone.3

Employer and employee impacts of comorbid conditions

Managing a chronic physical condition may be challenging enough for employees. Doing so while also navigating the possible challenges of a mental health condition may magnify that difficulty. When Joe connects to a behavioral health advocate, the licensed clinician helps to reinforce the importance of treating the whole body to help Joe stay on his hypertension care path while getting the emotional support he may need.

“Someone with depression or anxiety may struggle more to manage a chronic health condition, leading to need for more acute care, such as ER visits and inpatient admissions,” says Dr. Martin Rosenzweig, Chief Medical Officer at Optum. “Mental health issues may also translate into a lack of medication adherence or a lack of self-care, resulting in potentially serious health complications.”

Medical and behavioral comorbidities also may present difficulties in the workplace, causing missed work and possible lower productivity. The overall drop in performance may amount to a more serious, tangible loss. It’s estimated that unaddressed mental health issues such as depression and anxiety cost the U.S. economy $1 trillion in lost productivity each year.In contrast, those with a mental health diagnosis who receive behavioral health treatment are 26% less likely to miss work and 36% less likely to be unengaged on the job.5

4-step framework for helping to support employees with comorbid conditions

These facts and figures are part of the driver behind a 4-step framework of integrated medical and behavioral benefits designed to help ensure that members with comorbid conditions connect with the support they may need on their health journey.

  1. Identification: Medical condition management focuses on screenings, referrals and algorithms.
  2. Coaching and support: Integrated case teams coordinate medical and behavioral care, co-managing on behalf of employees.
  3. Treatment: Connect employees to tools and solutions that focus on high cost medical conditions occurring at a similar time as stress, anxiety and depression. One solution available in this phase is AbleTo®, which uses licensed clinical social workers to virtually deliver a cognitive behavioral therapy program. AbleTo targets members with comorbid medical and behavioral conditions where the behavioral health condition has not been treated.
  4. Data and reporting: Employers receive dashboards for screenings, referrals and outcomes that help to identify opportunities for improvement.

“Thanks to our broad, data-rich resources, we have unique abilities to help identify opportunities for better care that would otherwise get missed,” Rosenzweig says. “Our cross-program integration of data lets us help identify members who may need additional behavioral support, and then we actively put them in touch with support that has been proven to be effective. When this happens, quality of life improves, and job attendance and performance improve.”

Consider the impact of LifeSolutions, a Behavioral Health Solutions program, on both cost and outcomes. An evaluation found combining with the medical case management program has resulted in 25% lower medical costs.Beyond costs, 10% of participants in LifeSolutions also experienced an improvement in managing their depression compared to non-participants.7

All employees are screened for depression using the Patient Health Questionnaire (PHQ)-9, and those who test positive are referred to a behavioral health or Employee Assistance Program (EAP) service. The following case study evaluated an employee population for behavioral health needs that had members engaged with programs for conditions such as diabetes and heart failure, as well as healthy pregnancy.

Of the more than 150,000 members evaluated, more than 25,000 agreed to a referral to a behavioral health or Employee Assistance Program (EAP) service.The dashboard does not show an entire population has been screened for various reasons including employees who have been recently screened or are currently in care with a behavioral health specialist (therapist and/or psychiatrist).

 

Graphic that shows an example of members being evaluated for behavioral health needs and being referred to an Employee Assistance Program, or EAP.

Advocacy and member experience drive comorbid care

At the core of this integrated care approach is a focus on strong experiences for employers and employees and their families.

For employees, the experience with integrated behavioral and medical benefits creates fewer hand-offs and builds a more connected, end-to-end experience. Advocate4Me® representatives may be the initial point of contact for members navigating their health plan. Advocates are trained to connect members to clinical support through referrals to medical and behavioral clinicians and related programs.

 

Graphic that shows the various behavioral health programs available for employees and their families.

For employers, they can view the overall health of an employee population, including employees with comorbid conditions, and how well health management programs may be working and other performance indicators using UnitedHealthcare’s proprietary software, Health Plan ManagerTM.

By offering a comprehensive look at health data, including physical health, behavioral health and adding pharmacy data, it enables employers to help make design plan changes or deploy targeted interventions if needed. This single technology platform also means that clinical teams may have a seamless “whole-person view” of each member, allowing them to better coordinate member outreach and care.

For Joe, the behavioral health advocate recommends virtual therapy and helps Joe schedule a virtual appointment. Using the care coordination system, the behavioral health advocate updates Joe’s case for his nurse case manager. After 6 months, Joe reports feeling better through virtual therapy and a prescription to help with depression.

“What makes the medical and behavioral integration framework at UnitedHealthcare unique is that it helps to put the member at the forefront of the experience. It’s a ‘member first’ model,” Grassmuck says. “Because we have a relationship with each component of their health — everything from medical to pharmacy to behavioral — we believe we understand their full health spectrum as individuals. This allows us to more effectively connect them to what they need.” 

For more information about medical and behavioral integration, reach out to your consultant, broker or UnitedHealthcare representative.

*This hypothetical case scenario is intended to be used for illustrative purposes only.

Controlling costs through medical and pharmacy integration

UnitedHealthcare research shows that combining pharmacy benefits with medical plans is central to improving outcomes and containing costs. Integrated pharmacy solutions can realize incremental medical savings from $16-25 per member per month.

Managing chronic conditions through medical and specialty benefits integration

Connecting vision, dental, financial protection and medical benefits may help employers potentially lower their costs with targeted interventions, helping improve the health and experience of their employees and their families.

Footnotes

  1. National Institute of Mental Health website, data from 2017 National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration, https://www.nimh.nih.gov/.
  2. Source: Azocar F, Bargman EP, Smolskis JM, Groat TD. Enhanced methodology for estimating integrated medical-behavioral costs. Optum® internal report. January 2017.
  3. Azocar F, Bargman EP, Smolskis JM, Groat TD. Enhanced methodology for estimating integrated medical-behavioral costs. Optum® internal report. January 2017.
  4. World Health Organization. Mental Health in the Workplace: Information Sheet. http://www.portal.pmnch.org/mental_health/in_the_workplace/en/. September 2017.
  5. Optum CSG Healthcare Analytics; Ly, August 9, 2018.
  6. LifeSolutions program evaluation. Completed by Optum Healthcare Analytics, November 2019.
  7. LifeSolutions program evaluation. Completed by Optum Healthcare Analytics, November 2019.
  8. Optum analysis 2019.

Advocate4Me® services should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through Advocate services is for informational purposes only and provided as part of your health plan. Wellness nurses, coaches and other representatives cannot diagnose problems or recommend treatment and are not a substitute for your doctor’s care. Your health information is kept confidential in accordance with the law. Advocate services are not an insurance program and may be discontinued at any time.

AbleTo® offers a personalized program of private, confidential one-on-one coaching and therapy via phone. With next-day access to a nationwide network of 300+ highly trained, clinically supervised therapists (LCSW) and behavior coaches, our program will give you the tools you need to improve your daily life.

The material provided through the Employee Assistance Program (EAP) is for informational purposes only. EAP staff cannot diagnose problems or suggest treatment. EAP is not a substitute for your doctor’s care. Employees are encouraged to discuss with their doctor how the information provided may be right for them. Your health information is kept confidential in accordance with the law. EAP is not an insurance program and may be discontinued at any time. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare or its affiliates, or any entity through which the caller is receiving these services directly or indirectly (e.g., employer or health plan). This program and its components may not be available in all states or for all group sizes and is subject to change. Coverage exclusions and limitations may apply.