Powerful for Payers: The Value of Collaborative Behavioral Care

Concurrent behavioral and physical health conditions are debilitating to the individual, and costly to the health care system, with a substantial negative impact on medical outcomes. And the payer feels those costs acutely. Individuals with comorbid medical and behavioral conditions have additional health care costs of $293 billion per year 1, and are three times more likely to be hospitalized. They are also less likely to adhere to treatment, and ultimately, less likely to recover.

It is clear that identifying behavioral health conditions early and triaging those patients to the additional care they need is in the best interest of every health care stakeholder.

But you can’t manage what you do not measure. To fine tune predictive models and more accurately anticipate and control costs within an insured population, payers need a 360-degree view of the patient, including how the physical and behavioral are interacting.

In an article about its recent pilot program focused on mental health, Aetna acknowledges the powerful role of technology in taking on the challenges behavioral health presents to the health care system. Aetna’s pilot, which extended technology-enabled cognitive behavioral therapy to employees through employers, was able to achieve a 55 percent reduction in depression scores within the study group.

Maine’s HealthInfoNet is harnessing patient and population data to yield the measurable benefits of integrated behavioral health care. The state’s health information exchange (HIE) pairs clinical and claims data to advance care coordination efforts and enrich predictive modeling. In some cases, HealthInfoNet’s analytical efforts have enabled a 15 percent reduction in ED visits and 13 percent reduction in 30-day readmissions. The HIE is targeting providers, pharmacy organizations and payers as essential stakeholders in supporting ongoing health care advancements.

Technology can also assist by bringing a patient’s needs into sharp focus. Polaris’s technology systematically measures, monitors and manages behavioral health risk at the individual and population health levels for the mutual benefit of payers, providers and their patients.

For payers, specifically, it gathers behavioral health information from population members to stratify high-risk patients, as well as to better identify trends, predict the risk of repeat utilization and project costs within insured populations.

Finally, it facilitates the payer’s participation in the joint quest to drive improved quality, lower costs and better outcomes.