Capturing The Advantages Of Integrated Care

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Payors are On Board with Integrating Behavioral and Physical Health – New Data Shows It’s Time for Providers to Join Them

By Eric Frieman, Co-Founder and CEO of Forge Health

I have always believed that good mental health is a key component of good physical health.  Until recently, however, the only studies investigating that connection were performed by providers themselves.  These outcomes looked promising, but the lack of third-party-validated data was cause for caution in definitively stating that the connection had been proven.

For this reason, I’m proud to share that Forge Health partnered with a major national payor on a first-of-its-kind retrospective cohort study that used third-party data to addresses the link between mental and physical health in a quantifiable way.  The objective was to determine whether Forge’s intensive outpatient program (IOP) for mental health positively impacted medical services utilization and overall health.  The results were striking: Our patients maintained significant improvement in both medical utilization and overall health outcomes a full year after treatment.

Seventy patients were included in the study, with the primary measurement periods 12 months prior to the date of initial program engagement and 12 months after the date of initial program engagement.  Among the findings, the study revealed a 62% reduction in emergency department utilization, a 39% reduction in all-cause hospital admissions, and a 75% reduction in medical hospital admissions.  The study also showed a 20% increase in primary care office visits, a driver of better health and lower acuity among patients, as well as lower treatment costs and improved patient census for providers.

A clear link between mental and physical health also helps establish business value for payors, who have been excited to see a 494% return on investment (ROI) as part of the study’s findings.  Establishing this ROI is crucial, because while payors are on board with integrated care, they are not on the front lines like physicians, who represent our biggest opportunity to leverage a holistic approach to treatment. 

With the intake process and the wide array of forms that patients fill out during office visits, doctors have unrivaled access to patient mindset and visibility into indicators for behavioral health issues.  While it makes sense for them to capitalize on this to create a more efficient patient care system, demands on their time and attention frequently conspire to create less than ideal conditions for taking consistent action on those indicators.   

Further complicating efforts to treat behavioral and physical health in an integrated way is the fact that mental health and substance use disorders have traditionally been treated separately.  For example, if a patient who was referred to behavioral health professionals for depression was discovered to have an alcohol addiction, the case was often bounced back to the referring physician for an additional referral to substance use treatment.  This type of case management issue creates a poor patient experience, consumes resources that could be applied elsewhere, and disincentivizes follow-up on behavioral health indicators during intake. 

That’s why, at Forge Health, we fully integrate care for psychiatric and substance use disorders.  By bringing these two aspects of behavioral health together, we’re eliminating a divide that has been a source of stress for vulnerable patients, generates paperwork, and creates confusion for practices providing medical care.  Co-occurring disorders such as depression, PTSD, and substance use can now be treated at the same time by a single provider.  It’s a better system for patients, payors, and practitioners alike. 

With this new framework in place, the benefits to both patients and medical practices are easy to see, providing an opportunity to recast the approach physicians take to behavioral health screening.  Today, some practices conduct such screening because they are mandated to do so; others do it because they believe it makes basic sense.  While the acceptance of behavioral health screening is a welcome and necessary development, too often, there is little follow-up when a patient indicates mental health issues on an intake form.  Opportunities to treat patients more effectively, more compassionately, and at a lower cost are missed.  

More than 65 million American adults are currently living with at least one mental health condition, and more than 25 million are living with a substance use disorder.  Anywhere from 60% to 90% go untreated or are treated inconsistently.  According to research, behavioral health treatment accounts for less than 2% of overall commercial health spending, but fully 40% of all health care expenditures are tied to patients with behavioral health conditions – an estimated $752 billion each year.  These costs are both staggering and unsustainable.  It is estimated that integrating behavioral health and medical services for patients with behavioral health conditions could save $68 billion, annually.  

Our hope is that the results of the Forge Health clinical outcomes study will help change the mindset of both physicians and their staff when it comes to patient intake.  The study’s data reinforces the benefits to patients of following up on behavioral health indicators and the advantages for both practices and payors are also clear.  

My own experience has been that roughly twenty percent of primary care physicians are embracing a model that provides individualized mental health and substance use care while addressing social and co-morbid medical needs.  In five years, I believe that figure will exceed fifty percent, and that medical practices without an integrated behavioral health component will be falling behind.  

Primary care physicians today have a unique opportunity to give patients unprecedented support that enables them to lead happy, self-directed lives, and they can achieve this while improving the bottom lines for their practices.  The key is simple: pay attention to indications of mental illness and partner with clinicians that can help patients reap the benefits – both physical and mental – of whole-person care.

Eric Frieman, is Co-Founder and CEO of Forge Health, a leading provider of value-based mental health and substance use care.