With rising costs and still limited access to safe, effective, and affordable care, healthcare companies and insurers are taking steps towards fighting back the costs. We spoke with the Evernorth Health Services team about their strides following the increasing demands on the healthcare systems and received their input on how to navigate the constant evolution of the behavioral healthcare ecosystem, issues and journey.
Doug: Through the pandemic, and even since its acute impacts have subsided, we continue to see an increase in the number of people with behavioral health conditions who are in need and reaching out for help, with a 4% increase in prevalence from 2021 to 2022 alone.1 From a cost perspective, 22% of those people with mental health conditions drive 41% of the total medical spend2 , with significant cost driven by individuals with comorbidities. We know from our studies that 87% of people with behavioral health conditions also have physical medical conditions.2 When someone has a comorbid condition combined with a behavioral health condition, their spend is 2-3x higher than those who have the same medical conditions that do not have a behavioral health condition.3 Because of this, we want to make sure that we get people to high quality behavioral healthcare treatment to improve their vitality and to decrease costs. In another study conducted by Evernorth last year, it was found that when newly diagnosed individuals connected to outpatient behavioral treatment, there is an associated medical and pharmacy savings up to $2565 over the 15 months after they receive their behavioral health diagnosis.3
Melissa: Yet 32% of individuals are still unhappy with their behavioral health solutions. 5 This is why we developed and invested in our Evernorth Guided Behavioral Care solution which helps an individual understand the behavioral health options available to them, starts them on the journey and follows up to ensure the care and treatment selected is right for them will drive improved clinical outcomes. At the population level, it is addressing total medical cost and member satisfaction, key concerns of employers and health plans who buy behavioral solutions.
Melissa: While we are cheering for the fact that people are speaking more openly about therapy, we know there are options for those in need of care that are less clinical like meditation/mindfulness, peers support and coaches. Most people don’t know where to start on their behavioral healthcare journey. They often do not know what providers to go to and may not know what is best for them. We’ve found that only a portion of individuals go to behavioral health specialists for assistance, while many seek treatment with their medical providers. When this occurs, there are individuals who typically get a behavioral medication from their medical provider and more than half have just one behavioral health encounter a year.6 There are other individuals who see their medical provider primarily for their physical condition, typically for a chronic medical condition, and their behavioral condition surfaces multiple times. Our studies have shown that effective behavioral health treatment can improve medical spend. For example, patients with type II diabetes and major depressive disorder (MDD) who receive sufficient behavioral treatment show $1,649 PPPY medical savings compared with the patients who receive insufficient behavioral care.7
And lastly, there are silent sufferers who either go undiagnosed or their behavioral condition surfaces once with a medical provider, but their likelihood of engaging in behavioral treatment is low.8 These customer journeys highlight the importance of early identification through predictive modeling and collaboration with medical colleagues, so we don’t have to wait for people to ask for behavioral assistance, but use our data and relationships to meet them where they are.
It's also important to move away from conceptualizing behavioral care as outpatient therapy only. That’s why we have cultivated different options for individuals and work with our behavioral health navigators who work with individuals to help them understand which of these options will work best for them based on their condition and their current needs.
Doug: The opportunity we see now is to truly personalize care for individuals as we leverage our data, including what we know about individuals across pharmacy, medical and behavioral health, along with what we have learned directly from members about their preferences. We are focused on how we help individuals access the best care for them to meet their needs and optimize their health outcomes, then collecting data to understand their ability to then engage and get that care they need.
Melissa: We continue to expand our network, especially with a focus on diversity in order to meet every individual’s preference and clinical needs. We are able to demonstrate quick access to virtual and in-person care and report on that to clients so they can see that individuals are getting quick access to care.
In addition to that, we have said it prior, but section partnership is critical. We are trying to make sure that the care provided is helping people achieve their goals and making fundamental improvements that enhance their quality of life and engagement in their communities.
Doug: Measurement based care and access to high quality care are the fundamentals to making sure everyone is getting the best possible behavioral health care. By partnering in new ways with the right providers, and offering the full spectrum of supports, we can help everyone and meet their needs and have optimal behavioral health care by capturing data to make sure people are getting the care they need, when they need it, and achieving the desired outcomes.