July 2020
Vincent Nelson, M.D., Vice President, Medical Affairs, Blue Cross Blue Shield Association

A behavioral health crisis has been building in the US workforce for years. In any given year, one in five adults will experience a diagnosable mental health condition, and more than half will go untreated.¹ While those statistics present a sizeable enough issue, comorbidity and siloed care make the challenge that much greater. The reality is those diagnosed with a chronic condition are twice as likely to have a behavioral health condition, and vice versa.² And, the healthcare costs for treating individuals with behavioral and chronic medical conditions are 2-3X higher than for those without behavioral health conditions.³

Addressing the challenge takes a more comprehensive, more integrated approach—one aimed at valuing and treating behavioral and physical health together and connecting primary and behavioral care providers; one built around a network of coordinated, multidisciplinary care models; one that favors innovative partnerships and virtual care platforms; and one that supports the full continuum of conditions, from the most severe to everyday stressors. This is a full health approach.

CONFRONTING COMORBIDITY FULL ON

Simply put, comorbidity is the tendency of certain conditions to lead to other conditions. It helps to understand which behavioral health conditions have the most adverse impact on overall health. When these behavioral and mental health conditions are not effectively treated, they can also impair self-care and adherence to medical and mental health treatments. As mentioned above, this is a major issue, and it comes at a cost.

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Employees with untreated depression and a chronic illness have monthly healthcare costs that average $560 higher than those with just a chronic disease.⁴ But the cost isn’t just fiscal, this can also lead to increased absenteeism, decreased productivity and engagement.

Treating behavioral and physical health together, and educating employees on healthy habits, can be more efficient and effective. In fact, research has shown that up to 17 percent annual savings are possible by integrating care.⁵

COLLABORATING TO BETTER COORDINATE CARE

A critical piece in solving the comorbidity puzzle is proper coordination of care. This includes better supporting and empowering primary care providers (PCPs) to identify signs and have the resources to address behavioral and mental health, and connecting them to behavioral health providers (BHPs). This is one way that new digital platforms are helping integrate care. Many of these platforms make it easier for health plans to share claims data and to provide predictive analytics that spot patients who could have a behavioral or mental health condition, so employers or their primary care provider can reach out early on.

For example, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working with Quartet Health, a leading mental healthcare technology and services company, to build a healthcare system that treats behavioral and physical health together. They are accelerating integration by supporting primary care doctors in identifying patients with underlying behavioral health conditions, connecting patients to the right care sooner and coordinating care with behavioral health providers to treat all of a patient’s conditions. Quartet Health’s digital platform not only helps identify, screen and diagnose patients, but it also enables both primary and behavioral health providers to coordinate a mix of collaborative care, face-to-face care, teletherapy and digital cognitive behavioral therapy as needed and track a patient’s progress.⁶

“One of the greatest values for the employee is that the platform connects the PCP and BHP virtually,” explains Susan Foosness, senior business operations advisor, Blue Cross NC. “This enables a level of collaboration that usually doesn’t happen, and both primary and behavioral providers appreciate that. It also lessens the burden on the member to coordinate their own healthcare.”

It is evident that the scale of this issue demands the large-scale support of national networks that seamlessly connect primary care providers with behavioral health specialists. Healthcare partners should be coming forward with ways to integrate care and demonstrating that they’re concerned about the whole health of your employees. And employers can play a role in making this happen, by asking their health plan if they are working to advance integrated, collaborative care models. If the answer is yes, employers should find out how to help scale these models and make them accessible to employees and their families.

INTEGRATING CARE ALL IN ONE PLACE

Another way care is being integrated is through emerging sites of care that facilitate treating the whole person. One example of this has been developed by Blue Cross and Blue Shield of Kansas City. It’s called Spira Care™ and these new care centers have basically reinvented the doctor’s office and member experience by combining commonly needed services, like adult and pediatric primary care, condition management and behavioral health consultations, all in one place and at either no or low cost (HSA eligible). With a care team that includes physicians, nurse practitioners, behavioral health clinicians, health coaches and care guides, they’re able to coordinate care to give members a more proactive role in their total health.

BlueCross BlueShield of Western New York and BlueShield of Northeastern New York are taking an incentivized approach. Along with education and support, they provide financial incentives—in the form of stipends—for primary care providers that have behavioral health specialists as part of their pediatric primary care. They also provide incentives for providers to implement behavioral health screenings into electronic medical records, and for primary doctors to complete training in psychiatric counseling. This is just the beginning of incentivizing integrated care. It speaks to the broader idea of identifying opportunities to embed behavioral health into   health and wellness programs. For example, asthma, diabetes and heart disease have higher rates of comorbidity with depression and other mental health conditions. Disease management programs for these chronic conditions would lend themselves to integrated behavioral healthcare.

TOMORROW’S WORKFORCE WANTS CARE TO CHANGE

Each generation has its own idea of what it means to be healthy. Millennials, the future of the workforce, have made it clear that they want whole-person care, but most of them feel they aren’t getting it from their current healthcare benefits. Three-quarters of Millennials (73 percent) say mental healthcare counseling needs to change.⁷ And getting this right is critical as 84 percent of Millennials say their health insurance has impacted their decision to stay with their current employer—while only 54 percent of Boomers agree.⁸

Millennials want seamless care among primary care providers and behavioral health specialists, unlimited access to behavioral health therapies and counseling visits and for their primary care providers to talk to them about their mental health and how to manage it. Also, many are drawn to work cultures that integrate benefits that address a wider range of work stressors. So, it’s key that employers not only talk about the equal importance of mental and physical health with employees, but also demonstrate that through the programs and resources they offer them.

INCLUDING SUPPORT BEYOND TRADITIONAL BENEFITS

Integrating care is about providing solutions for the whole person. That can extend even beyond the coordination of physical and mental healthcare to nontraditional wellness benefits like on-site access to dietitians, fresh fruits in the break room, and access to sleep and resiliency apps. Programs can also extend into non-health benefits such as financial planning and coaching, tuition reimbursement and flexible work hours.

Financial planning makes especially good sense, as 59 percent of employees are more stressed out about their financial situation than any other single issue⁹ and 35 percent of employees say financial stress impacts their ability to do their job.¹⁰ It’s important as you bring in benefits like these, that you talk about them. Speak to the importance of mental health—let employees know the benefits are available and how to access them, and encourage them to use them as needed.

The good news in all this: employers are already making changes. Many employers offer and are interested in knowing what more their Employee Assistance Programs (EAPs) can do. In response to the pandemic, some 93 percent of companies have also encouraged their workers to take advantage of EAP resources like telehealth and virtual mental health programs, according to a recent Business Group on Health survey.¹¹ These programs are a great start. But there is so much more possible.

INTEGRATING CARE: THIS IS HOW

Treat the whole person.

Talk about and model healthcare solutions around the equal importance of physical and mental health. This means finding opportunities to embed mental health into wellness efforts, including chronic disease management programs for conditions like diabetes and asthma, which have high rates of comorbidity with depression and other mental health conditions.

Join networks that work together.

Choose healthcare networks that seamlessly connect primary care providers and behavioral health providers. When medical records, health information and resources are shared across providers, a whole picture of health comes into focus.

Connect the whole continuum.

Support health plan partners that empower primary care providers to collaborate with behavioral health providers. Tell your partner how important this is to your company and help to scale collaborative care models where you can—to make them accessible to your employees and their families.

© 2020 Blue Cross Blue Shield Association. All Rights Reserved. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. The information contained on this website is not intended for individuals located outside of the United States.

¹ Center for Workplace Mental Health, “Making the Business Case,” American Psychiatry Association Foundation, 2020.

² Steven Ross Johnson, Harris Meyer, “Behavioral Health: Fixing a System in Crisis,” Modern Healthcare, 2020.

³ Milliman Research Report, “Potential Economic Impact of Integrated Medical-Behavioral Healthcare, Implications for Psychiatry,” 2014.

⁴ Johnson and Meyer, “Behavioral Health: Fixing a System in Crisis,” Modern Healthcare, 2017.

⁵ Blue Cross and Blue Shield of North Carolina, “Total Behavioral Health,” Webinar, 2019.

⁶ Katherine Hobbs Knutson, “A New Vision for Behavioral Health,” Blue Cross Blue Shield of North Carolina, Health Care Symposium, Williamsburg, 2019.

^7,8 Blue Cross Blue Shield Health of America National Generation Survey, 2019.

⁹ PWC, “PWC’s 9th Annual Employee Financial Wellness Survey,” 2020.

¹⁰ De Beer and Forbes Financial Council, “Financial Wellness, the New Must-Have Employee Benefit,” Forbes, 2020.

¹¹ Alyssa Place, “Mental health and telehealth apps come of age amid coronavirus crisis,” Employee Benefit News, 2020.