Shoveling Money Down Growing Behavioral Health Gaps?

“Take out your number two pencils. You will need them.” Calculating future expenses stresses all managers and directors. In the ever-changing world of healthcare, making the time to accurately budget costs can cause headaches, nausea, dizziness, and palpitations. (Please do not operation heavy machinery while thinking about budgets.) Estimating the financial impact of the growing behavioral health gaps may be the final straw.

Today’s blog gathers data points from recent studies, reports, and presentations from around the healthcare industry and offers a starting point for your various budget models. Make the time to verify your models are sporting the most current data. Challenge your assumptions, because margins are thin and getting thinner.

Once you are comfortable with the expense models, this blog suggests options for bridging growing behavioral health gaps in your organization, payers or providers.

The Numbers

• Adults with coronary artery disease and depression or anxiety have $5,700 higher direct annual medical costs¹
• Patients with depression have at least double the lifetime cost of care¹
• Depression is undiagnosed 24% of the time, on average, among patients with chronic medical conditions.²
• Comorbid depression is undiagnosed 30% of the time in primary care settings.³
• Those with depression took 33% more sick days than those with medical-only conditions and
  • 105% more sick days if they had a comorbid medical condition.⁴
• Depression drives a 238% increase in lost productivity costs.⁵
• Members with a diagnosis of depression have 171% higher medical costs per member per month (PEPM).⁶ 

On average for each year, patients with breast cancer and a comorbidity of mood and adjustment disorders had

• 9.4% more ambulatory visits ⁷
• 2.3% more hospital admissions ⁷
• 5.4% more hospital bed days ⁷

Men with prostate cancer and mood or adjustment disorders had

• 6.7% more ambulatory visits ⁷
• 2.9% more hospital admissions ⁷
• 8.4% more hospital bed days ⁷

Workers Compensation Impact

• Duration of time out increases 57% when the injured worker is depressed ⁸
• 10% of claims with psychosocial issues cause 60% of claim costs⁸
• Most mental health professionals do not understand workers’ compensation. The players are the patient and the therapist, and it is like sitting on a two-legged stool. They do not fathom that, in workers’ compensation, the stool has five legs, with the other three occupied by the employer, the treating physician and the claim adjuster. ⁹
• It can take a claim adjuster weeks, in rare cases, months, to find a psychologist and schedule an appointment.⁹
• Everything is paper-based (for workers compensation), which wastes claim adjuster time and increases expense.⁹

Growing Behavioral Health Gaps

Here is the unasked question. How can the healthcare industry rebuild their internal behavioral health capacity? If some health systems struggle with a 50% vacancy rate for defined behavioral health positions, payers can face even greater pressures for building their behavioral health expertise.

Facing an inconsistent influx of complex claims for a growing list of chronic conditions taxing internal, medically-focused capacity.

As many as 32 million individuals will gain access to behavioral health coverage for the first time by 2020, according to HHS, while gaps of trained experts widen. Processing those claims with the accuracy enjoyed by medical claims is exciting and terrifying.

• When should we hire? Should we hire?
• What specialties and sub-specialties do we need?
• What are acceptable/unacceptable reimbursement metrics?
• What service codes will cause the biggest headaches?

Options

Outsourcing gives both long- and short-term options for addressing recruitment of behavioral health professionals. It varies from complete outsourcing of all major pre-authorizations to partial/seasonal outsourcing, based on an insurer’s internal workflow and bandwidth of full-time employees.

• Frees up medical directors and other administrators and carry less administrative burden
• Creates more efficiency when processing claims and uniformity when applying medical necessity criteria
• Uniformly meets new cyber-security protocols
• Meets state and federal regulations
• Lowers recruitment and search expenses

Filling the growing behavioral health gaps can cripple many attempts for improving care. BHM offers a network covering the sub-specialties your organization needs to grow. 6 of the top 10 largest health plans entrust BHM for behavioral health peer reviews. CLICK HERE to learn more about how BHM helps your organization curb behavioral health costs.