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

It’s a critical time for employers regarding their behavioral health benefits. Evidence suggests that the COVID-19 pandemic will accelerate the demand for behavioral health care in years to come, and employees and their families have a growing need for faster, easier access to mental health support.1

Four in 10 U.S. adults reported feeling anxious or depressed during the pandemic.1 In addition, about 85% said mental health issues were disrupting their daily life.2

Help is clearly needed, and employers are seeking effective ways to respond. Offering integrated medical and behavioral benefits that can address the full spectrum of health and well-being may be the key to this unprecedented situation. 

“We have seen a significant increase for behavioral health care needs in all of our communities. These numbers are unprecedented,” says Stacie Grassmuck, Director of Behavioral Health Product and Innovation at UnitedHealthcare. “Our goal is to help these members wherever they are on their health care journey -- whether they start with medical case management or a therapist.”

Integrated medical and behavioral benefits connect systems and processes to help ensure mental health needs are addressed across diverse service experiences. This means being able to proactively screen and identify employees that may benefit from mental health support, even before the need for such support has been considered.

“It’s typically the medical spend that increases when behavioral health is not addressed,” Grassmuck says. “When we work directly with members to get them into appropriate behavioral health treatment, we’re likely to see savings on the medical side.”

UnitedHealthcare uses a range of innovative offerings to provide employees access to quality care including digital and web resources such as myuhc.com® and liveandworkwell.com; mobile apps* including Talkspace®, AbleTo** and Sanvello™; advocacy support with access to behavioral health clinicians; and employer toolboxes with resources to help with culture, stigma and other related topics. In 2020, 56% of UnitedHealthcare’s behavioral health visits took place virtually.3  

Right care at the right time

Addressing behavioral health care needs at all points of engagement, and connecting health solutions across medical, behavioral and pharmacy services is key to providing comprehensive support. UnitedHealthcare health plans are designed to guide employees to the best support using a framework that includes:

Guided member experience

Through advocacy and other interactions, employees are directed to the right behavioral health care option at the right time. For example, case management is performed on a single, integrated platform. This gives a “whole-person view” and allows clinical teams to better coordinate outreach and care.

Improved access to care

Creative strategies connect employees to providers and resources. These strategies span from virtual care solutions to tools for self-management of symptoms.

Demonstrated performance and value

Performance for all programs is measured through data sources such as claims and aligned with strategies to help support the mental health needs of employees.

National presence, local impact

National behavioral health expertise, through resources such as virtual visit providers and advocacy support, is brought to local markets to provide market-specific solutions.

Finding behavioral health care opportunities among those with comorbid conditions

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.4 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.5

Consider the example of a hypothetical employee, Joe.*** In a wellness visit, Joe’s 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 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, in which Joe screens positive for depression. Thanks to integrated medical and behavioral benefits, a process begins to help Joe find mental health support. 

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 diagnosis 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.

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. 

“Someone with depression or anxiety may struggle more to manage a chronic health condition, leading to the 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.”

For every $1 put into scaled-up treatment for common mental disorders, there is a return of $4 in improved health and productivity.6 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.7

Integrated health benefit solutions and programs in action

Consider the impact of LifeSolutions, a Behavioral Health Solutions program, on cost and outcomes. An evaluation found the program resulted in 25% lower medical costs.8 Beyond costs, LifeSolutions participants demonstrated 15% greater improvement in depression screening scores compared to non-participants.9

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 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 or almost 70% agreed to a referral to a behavioral health or Employee Assistance Program (EAP) service.10

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

*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).

For employees, integrated behavioral and medical benefits creates fewer hand-offs and builds a more connected experience. Advocate4Me® representatives are trained to connect employee callers to clinical support through referrals to medical and behavioral clinicians and related programs.

Employers can view the overall health of their 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 Manager™. This comprehensive look at health data helps employers to consider plan design changes or deploy targeted interventions if needed. 

For Joe, after months of virtual therapy and a prescription from his provider, he is feeling better and is aware of his risk for depression. He now uses the Sanvello app to log his daily emotions and to connect anonymously with others who relate to his experience. Joe feels good about being able to monitor his mental health with the help of the app. He is confident that he has the tools and resources he needs to get additional support if his symptoms change.      

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

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.

* Availability of offerings varies.
** This is AbleTo’s Therapy360 program. AbleTo is majority owned by OptumHealth Holdings, LLC, a UnitedHealthcare affiliate.
***This hypothetical case scenario is intended to be used for illustrative purposes only

2Kaiser Family Foundation. The implications of COVID-19 for mental health and substance use. kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-10-for-mental-health-and-substance-use/. Feb. 10, 2021

 

Footnotes

  1. The Implications of COVID-19 for Mental Health and Substance Use. Kaiser Family Foundation brief, Feb. 10, 2021.
  2. U.S. Census Bureau, Household Pulse Survey, 2020.
  3. AI@Work Study: Volume Two, Mental Health at Work Requires Attention, Nuance, and Swift Action, y Oracle and Work Intelligence, 2021.
  4. 2020 UnitedHealthcare Employer & Individual claims
  5. Azocar F, Bargman EP, Smolskis JM, Groat TD. Enhanced methodology for estimating integrated medical-behavioral costs. Optum® internal report. January 2017.
  6. Ibid.
  7. World Health Organization. Mental health in the workplace. who.int/teams/mental-health-and-substance-use/mental-health-in-the-workplace. Accessed July 2021. 
  8. Optum CSG Healthcare Analytics; Ly, August 9, 2018.
  9. LifeSolutions program evaluation. Completed by Optum Healthcare Analytics, November 2019.
  10. Ibid.

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.