Examining the Impact of Behavioral Health Costs on Overall Health Care Spending

Examining the Impact of Behavioral Health Costs on Overall Health Care Spending

[Music] so recently milaman released a study titled titled how do individuals with behavioral health conditions contribute to physical and total health care spending how was the study conducted and were there any trends you were especially interested in learning more on the more recent study that i think you’re referring to was really meant to look at the impact that people with these illnesses have on medical costs total medical costs and so in this study milliman picked only the year 2017 to look at this data the most recent year they have data in their databases and there they looked at 21 million people um these again commercially insured population the to and what we did was we looked at or they looked at um the 10 most expensive patients that mostly met you know mostly driven by physical medical costs so we looked at that and what percent did that 10 have on driving or accounting for total medical spending total healthcare spending so that 10 of the population drove contributed costs whatever term you want to use 70 percent of all healthcare spending so 10 of the 21 million people um contributed 70 of the costs for the 21 million people now then the purpose of the study was to look at the behavioral health subgroup both in the high cost population and in the total 21 million lives that were measured their claims and the in the in the top 10 percent 57 of that group had a mental health or substance abuse diagnosis which is very high much higher than any of us expected and that subgroup in the of the 10 contributed 44 of all health care spending uh so for the even though this was you know 10 it was basically less than six percent of the total population of 21 million accounted for 44 of all health care spending for that population now if you imagine that spread out over the whole healthcare population for all beneficiaries medicare medicaid we would expect the medicaid numbers would be even more dramatic than these numbers because there’s typically a lot higher prevalence of serious and moderately ill mental health substance problems in medicaid just by the nature of the insurance so that would basically mean if you look at the whole u.s healthcare popular you know over three and a half trillion dollars a year spending basically six or seven percent of the population that have one of these these comorbid illnesses are going to drive almost half of all those spending based on study findings a significant gap was represented between those suffering from behavioral health conditions and their ability to afford treatment with 50 percent of all those with these conditions having less than 68 dollars of total annual spending what factors contribute to this gap and how can these lack of coverage options impact overall health and healthcare spending so the other finding that really wasn’t the focus of this study it wasn’t a study on disparities as much as a study to look at the outsize impact that a mental health condition might have on medical spending was how little care specialty care these people got so for the whole population of the of the um of the behavioral group who had a behavioral diagnosis or got treated for a behavioral problem 50 of the group got less than 68 a year of of specialty behavioral treatment and about 25 got less than 500 somewhere between 68 and 500. so essentially 75 of this population got limit almost none or very little specialty behavioral treatment despite them being diagnosed by a licensed healthcare professional who felt they warranted a diagnosis and warranted treatment so that was a bit of a surprise we as i mentioned these two earlier earlier millamon studies showed a lot of disparities in access but we didn’t measure the percent of the population how little or how much care they got so those two findings that were unusual uh not been reported much there’s been a as you probably know a lot of data show that a small percent of chronic medically ill patients drive a big impact of total health care costs but there’s been less attention paid to what percent of that group has mental health and subsidies problems and as you look at the report that millerman did it’s interesting that the majority of these costs are driven by people with mild to moderate mental health substance abuse problems there’s commonly a misconception it’s the more the patients with the more severe mental illnesses like psychosis or schizophrenia are the ones that drive these costs that’s not true they represent a very small percent of prevalence or particularly for the commercial population but even for other beneficiary other insurance beneficiaries so they’re um the and those are people that probably could be the easiest to treat and yet weren’t and weren’t getting that treatment so i think the main takeaway for health care policy leaders on the provider side or the health plan side or employers is that if you want to have an impact on total medical spending you better identify this group early and and provide some specialty intervention sooner

Of the top 10% considered high cost from an overall cohort of 21 million, a recent study by Milliman found that 57% of this high-cost group had a mental health or substance abuse diagnosis. This behavioral subgroup was shown to contribute to 44% of all health care spending, said Henry Harbin, MD, leading behavioral health expert and adviser to The Bowman Family Foundation.