The prevalence of behavioral health conditions

For the report, Evernorth analyzed claims data from over 6 million individuals ages 0 to 64 between Jan. 1, 2021, and Dec. 31, 2022. Any behavioral diagnoses were defined using International Classification of Diseases 10th Revision codes, and chronic medical conditions were defined by using Clinical Classifications Software developed by the Agency for Healthcare Research and Quality.

Evernorth found that the prevalence of behavioral health conditions increased by 4% from 2021 to 2022. Increases in prevalence varied by condition, with the largest increase occurring with attention-deficit hyperactivity disorders, personality disorders, and autism spectrum disorders. All of these conditions grew by over 10% between 2021 and 2022.

Although the prevalence of behavioral health conditions is growing, many patients are not getting the care they need. Currently, data from Mental Health America suggests that over 50% of adults with a behavioral health condition are not receiving treatment.

According to the report, it takes an average of 11 years after the onset of mental health symptoms before a person will seek treatment. Among patients who eventually meet with a treatment provider, delays in care can range from six to eight years for mood disorders and nine to 23 years for anxiety disorders.

Having a behavioral health condition can also be quite costly for patients. The report found that 22% of patients with a behavioral health condition account for 41% of all healthcare spending.

One potential driver of these outsized costs is that patients with behavioral health conditions are more likely to have other comorbidities. In total, 87% of patients with behavioral health conditions have one or more medical conditions, including circulatory, endocrine, or musculoskeletal disorders.

When behavioral health conditions are untreated, other medical conditions may worsen, leading to increased costs. According to the report, patients with both a medical and behavioral health condition face two to three times higher medical costs than patients without a behavioral health condition.

However, effective behavioral health treatment can reduce this cost. For example, patients with Type 2 diabetes and major depressive disorder who receive behavioral treatment save $1,649 per member per year on care compared to patients without sufficient behavioral care.

"The mind and body are intrinsically connected," said Eva Borden, president of behavioral health at Evernorth. "It's something that plan sponsors must take into account. Employee mental health is being challenged like it never has been before, and this impacts the workplace."

A need to improve behavioral healthcare

According to the report, over 150 million people live in areas that have a shortage of behavioral health professionals. Over the next few years, experts say the United States will be short between 14,280 and 31,109 psychiatrists, psychologists, and social workers. Because of this severe shortage of behavioral health providers, many patients face difficulty accessing timely care.

"Improving care begins with recognizing the long and chaotic road to finding effective treatment," said Doug Nemecek, CMO for behavioral health quality, integration, and clinical operations at Evernorth. "Finding a therapist who has demonstrated effective treatment for someone's specific behavioral health condition is not easy."

In the report, Evernorth outlines four steps to create a "robust ecosystem" that is "critical for guiding care and achieving measurable outcomes" in behavioral health:

1. Identify and engage with patients early on

"The most critical part of enabling someone to seek care is identifying the need in the first place," Evernorth writes. Some ways this may happen include through patient self-identification, provider referral, online resources, or plans using artificial intelligence to predict patient needs.

Once patients are identified, providers should use a personalized approach to engage with patients and understand their preferences, clinical needs, and more.

2. Carefully assess patients to make the right care recommendations

Using meaningful data, personalized screening tools, and machine learning techniques can help providers identify care that will best meet a patient's needs and improve both cost and quality outcomes.

Continually assessing patient's preferences, potential care options, and outcomes can create refined care pathways.

3. Match patients to the most effective providers

"Finding the right provider and right level of care is key to improving clinical and quality outcomes," Evernorth writes.

Patient-to-provider matching can help patients find providers meet their specific demographic (e.g. age, gender, ethnicity) or personal experience (e.g. parent, veteran) preferences. According to research, measurement-based provider matching can significantly improve patients' mental health outcomes. Patients who stay with their providers also have a second visit an average of 35 days earlier.

4. Routinely measure outcomes

According to Evernorth, "transparent outcomes based on multidimensional qualitative and quantitative metrics" are key to creating a measurement-based care system. Some metrics to consider including are time to care, medication adherence, evidence-based screening, total cost of care, and patients' quality of life.

"Curating a guided behavioral journey that invites more patients with behavioral health needs into care and simplifies the journey is critical," Evernorth writes. (Plescia, MedCity News, 6/1; Evernorth news release, 5/31)