Seniors with chronic conditions are already typically health plans’ costliest members. But those with depression – a common comorbidity for chronic disease – can rack up several thousand dollars more in annual medical bills than those who aren’t depressed, especially from emergency department visits and hospital admissions.
Desperate to keep its chronically ill seniors healthier and therefore less expensive, one payer and senior care provider is trying to funnel those at highest risk of depression into mental health care earlier. Figuring out who they were was surprisingly easy, executives said: They were often the patients who’d never used behavioral health services, and who were unaware that their Medicare Advantage plans already offered virtual counseling and medication management at no additional cost.
“We tried to cast a fairly wide net” to find “how much of our population is silently struggling,” said Robert McAlonan, director of behavioral health at VNS Health, a New York-based insurer and nonprofit healthcare provider that’s been targeting these patients with extra outreach for about a year.
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A Tech-Forward Approach to Outreach
As part of that effort, VNS Health partnered with Vitalic Health, a geriatric behavioral health tech company in which it has a financial stake. Vitalic combed through VNS Health’s claims to flag the seniors who’d never billed for mental health services and could benefit from them and called them by phone to inform them of their mental health offerings, occasionally using artificial intelligence and automated messaging for scheduling and follow-ups. (Vitalic offers virtual counseling and psychiatric care with mental health coaches, nurse practitioners and other clinicians.)
VNS Health, which has about 55,000 Medicare Advantage members, said this simple outreach has significantly reduced emergency department visits and hospital admissions among chronically ill beneficiaries over the past year. And in a smaller, six-month pilot of about 140 patients, emergency department visits dropped from 17% to 12.9%, and hospital admissions sank from 4.3% to 2.9%. Within a smaller group of depressed patients whose symptoms improved from moderate or severe to mild during the pilot, inpatient hospital stays and emergency department visits dropped from 41% pre-pilot to 18% in the three months after enrolling in behavioral health services.
Timing the Intervention
There are a few crucial points in a chronically ill senior’s life when they’re most vulnerable to depression, and therefore most likely to sign up for mental health services. Seniors experiencing chronic pain and issues like stomach or headaches are “more likely to say yes right now” when outreach coordinators call, as are those who recently became caretakers to a spouse, or who lost a loved one, said Vitalic Health’s head of clinical, Michelle Hoy. But just about a year into their partnership, Vitalic and VNS Health are still analyzing beneficiaries’ claims to identify other patterns in depression risk, they said.
As a payer and provider, VNS Health already has its own staff of healthcare workers. But it decided to partner with Vitalic instead of standing up its own geriatric mental health care division to “get it off the ground quickly,” said McAlonan. And Vitalic already had its own specialized team of mental health clinicians trained in geriatric care, meaning they wouldn’t have to delay the outreach by hiring anyone new. “Operationally, building it internally sometimes can take longer than partnering,” he said.