High-Need, High-Cost Patients: The Role of Behavioral Health

An October 30 Alliance briefing discussed current initiatives to integrate behavioral and physical health care services in order to improve quality of care and reduce overall health care costs.

If you were unable to attend the briefing, here are some key takeaways:

• INTERVENTIONS MUST GO BEYOND THE ELDERLY. Heterogeneity in the high-cost population leads to complications when implementing interventions, Melinda Abrams stated. These interventions must address the non-elderly disabled population, as well as individuals with multiple chronic conditions, she continued.
• FEW INTERVENTIONS SUCCEED. Since high-cost, high-need Medicare beneficiaries have the highest incidence of behavioral health issues, segmenting them into categories allows for better understanding of spending and utilization patterns across similar groups, thus creating the potential for more successful interventions, Jose Figueroa stated.
• COLLABORATION CUTS COSTS. The Collaborative Care intervention, implemented in 18 primary care sites and eight states, integrated behavioral health practitioners into primary care settings, Howard Goldman explained. Results found that Collaborative Care doubled the effectiveness of treatment for late life depression and saw cost savings of over $3,000 for an investment of about $500, he continued.
• ADDRESSING SOCIAL DETERMINANTS OF HEALTH KEY. Without addressing the social determinants of behavioral health, interventions will fail, Jeff Richardson stated. He cited examples from Mosaic Health's program in Baltimore city, where they provide addiction, mental health, pain management and primary care services in a coordinated setting and have implemented collaborative care models with Federally Qualified Health Centers and pediatric practices.
• INTEGRATION REDUCED MEDICAID SPENDING. We need to change the culture of addressing behavioral health and substance abuse issues and dispel the one-size-fits-all myth, Benjamin Miller stated. A program in Colorado, Sustaining Healthcare Across Integrated Primary Care Efforts, made behavioral health providers part of the primary care team and gave them a budget to use at their discretion, moving away from fee-for-service. In 18 months, there was a 5.5 percent reduction in Medicaid spending across the three practices studied, he shared. 

We encourage you to visit http://www.allhealth.org for more information.

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