For Lasting Improvements, People with Behavioral Health Challenges and Chronic Illness Need A Personalized, High-Touch Approach to Care

By Jonathan Mayhew

The U.S. is facing a crisis in behavioral health, and healthcare models that emphasize care for the whole person are critical to make a lasting change. Telehealth solutions have expanded rapidly since the start of the pandemic, but virtual care alone is not sufficient to drive durable changes, especially for vulnerable populations who face myriad barriers to care.

While our attention has focused on COVID-19, the numbers of people struggling with behavioral health challenges have been surging in the U.S. Compounding this, these debilitating conditions make these individuals less likely to engage in preventive care and more likely to suffer from the consequences of co-existing chronic diseases – such as hypertension, obesity, heart disease and diabetes. Experts predict these conditions will also balloon in the years following the pandemic. 

In fact, one study showed 68% of people with a mental health issue also had chronic medical conditions and conversely, people with chronic illnesses were twice as likely to experience a mental health problem. These challenges, often exacerbated by socio-economic and cultural barriers to care, mean these individuals often don’t access preventive care until their conditions become so severe, they wind up in the emergency room or undergo costly inpatient stays.

A soaring struggle with behavioral health

Over the past year, more Americans have reported struggling with behavioral health issues such as depression, anxiety, and substance use disorder. The stressors are significant – millions of Americans have faced illness, grief, and isolation, as well as job loss and the cascade of events that can follow. For those lucky enough to keep their jobs, the stress of running a home, educating children, and working longer hours can be overwhelming. For those who actually had COVID-19, nearly 1 in 3 report neurological or mental health conditions within six months of diagnosis. A 2020 report from McKinsey showed 63% of respondents reported some level of anxiety or depression, and 25% reported issues with substance use. These rates are even higher among communities of color, and COVID-19 has only intensified the crisis. It’s no wonder psychologists are reporting an increase in patients, particularly for anxiety and depression.

Meanwhile, as support systems have evaporated, the epidemic of substance use disorder has only grown. More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to data from the Centers for Disease Control and Prevention (CDC). In fact, that report showed overdose deaths rose 28.8 percent in the 12 months between September 2019 and September 2020, overshadowing the modest decrease seen in 2018.

Although COVID-19 caused many would-be patients to avoid hospitals and emergency departments, visits and admissions for behavioral health crises actually rose, according to a study published in the February 3 issue of JAMA Psychiatry. A review of CDC data showed 6 million visits over the past year involved behavioral health, suicide attempts, overdoses, and domestic violence or neglect.  

Meeting and treating individuals where they are

Significant barriers and challenges prevent many people with behavioral health issues and co-morbid chronic conditions from getting the care they need. Stigma, shame, cultural mores, health literacy, and previous negative experiences cause many people to distrust the healthcare system. Further, external socio-economic barriers such as cost, accessibility, and disparities in health equity prevent many from attaining care. 

The pandemic led many health plans to expand digital solutions to ease access while offering members the comfort of receiving care in the privacy of their own home. But these services, alone, are not adequate, particularly for health plan members who are struggling with a multitude of health problems, which may often be undiagnosed. These members can be hard to identify and harder to engage. Once found, they need a persistent and personal, human touch to guide them into a program of care that best serves them.

An effective health care model will meet individuals where they are along the continuum of readiness to change, whether they are beginning to realize they could use some help or are actively thinking about steps to take. 

Here are four steps health plans can take to help accomplish this: 

• Deploy predictive analytics using claims data and other medical information to identify health plan members likely to have unaddressed behavioral health issues on top of other chronic illnesses. By targeting this population directly, members can be pinpointed who would most benefit from this care model. 

• Reach out to members with empathetic engagement specialists who focus on what matters to the member and care coaches who are specially trained to work one-on-one with them to establish a trusting, supportive relationship. 

• Once engaged, care coaches must be persistent in helping members prioritize problems and health goals, identify solutions, and guide them to the providers, specialists, and community resources they need. Along with medical and behavioral health care, they need help connecting with community support services and assistance with transportation, housing, and food insecurity, and proper support to overcome literacy and language barriers.  

• To achieve lasting improvements in behavioral and physical health, members must be encouraged to actively participate in identifying their needs and managing their health with their providers. A whole-person approach that builds trust and encourages self-efficacy can double engagement among this hard-to-reach population.  

• Lastly, durable change does not happen overnight. Long-term behavioral change requires long-term guidance and care beyond what many solutions currently on the market provide. Behavioral health challenges are developed, many times, over years and require adequate time to realize change that directly and significantly affects quality of life. 

Helping people develop a plan for improved health, well-being and self-sufficiency will result in lasting behavioral change, reduce costs to the healthcare system, and most importantly, save lives. 

Jonathan Mayhew is Chief Executive Officer, Ontrak. He leads all aspects of Ontrak’s business. He joined the company in April 2021 from CVS where he was Chief Transformation Officer. Jonathan brings deep experience in building and leading multi-billion-dollar healthcare businesses at Aetna and Cigna, and a proven track record of delivering record growth for public companies. Jonathan’s passion is to transform behavioral health for vulnerable populations.