Care Transformation Center Blog

The data behind outpatient behavioral health growth


Kelsey Mahler

Many organizations are struggling with timely behavioral health care delivery today, and in many regions, the challenge will only become greater. According to data from our Outpatient Market Estimator tool, the prevalence of health and behavior assessment codes will dramatically increase over the next 5 and 10 years in more than half the states.

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Health and behavior assessment codes are used to bill for services provided to patients who are not diagnosed with a psychiatric problem, but whose cognitive, emotional, social, or behavioral functioning affect prevention, treatment, or management of a physical health problem. Studies show, for instance, that length of stay is longer for heart failure patients with a history of depression, indicating that mental illness affects the treatment of chronic medical conditions.

This means more patients—many with chronic illnesses—have cognitive, social, emotional, or behavioral functions that will impact the treatment of a physical illness.

How does a social or behavioral health issue impact physical health care?

An increase in health and behavior assessment codes matches closely with state-specific data on chronic disease prevalence—so if you’re in a region with higher than average chronic illness, you may expect to see an increased need for social and behavioral health care support. North Dakota, Texas, and Nevada are three states that are positioned to see a particularly large increase in need.

Increased costs: Research shows that monthly costs for a patient with one of ten different chronic diseases and depression are $560 more than for a patient with a chronic disease without depression.

And the difference in costs is due primarily to higher medical—not mental health—expenditures. This can be attributed, at least in part, to the fact that patients with co-morbid mental and physical health problems tend to receive less preventive services, receive worse quality of care across a range of services, and are more likely to have a sedentary lifestyle, smoke, and overeat.

Increased care complexity: Roughly 8.5% of patients report that they don’t even know where to go for mental health service—meaning most will land in the ED instead of in outpatient sites better equipped to meet their needs. An even greater 23.7% of patients report that stigma holds them back from seeking treatment for behavioral health or psychosocial concerns, indicating the current delivery system isn’t meeting their needs from a comfort perspective.

What does this mean for your teams?

The primary care office is usually the patient’s first and central point of contact with the health system. It’s also a major triage point to other outpatient behavioral health services. Therefore, adding behavioral health care support to primary care meets patient needs and increases the likelihood that patients will get timely access to ongoing care.

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