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Behavioral Health Conditions and Total Health Spending

By January 31, 2017Commentary

If you have a lot of serious health conditions, you might be depressed and/or anxious a lot, and if you have a serious mental health issue, you probably aren’t doing your best at managing your health and health care, leading to more general health spending.  A study in Health Affairs looks at prevalence of mental health conditions and the relation to overall health expenses.   (HA Article)   The researchers used MEPS data from 2010 to 2013 to identify prevalence and spending patterns in regard to behavioral health and total health spending.  15.5% of adults used a mental health service in 2013, but the percent is much higher for certain payer subsets, for example, it is 25.3% for Medicaid beneficiaries, 20.9% for Medicare ones and 38.7% for dual eligibles.  The numbers of patients with behavior health conditions is likely understated, as the data only reflects those who sought treatment and have a diagnosis code.  There is undoubtedly much undiagnosed mental health need.

Here is an astounding data point; more than half of these adults who received mental health treatment had four or more physical health comorbidities, for Medicare it is 83% and for dual eligibles, 79.2%.  The most common mental health diagnosis among these patients was depression.  For these patients with a behavioral health diagnosis, total health spending over the study period averaged $672.4 billion annually, but only about 15% was for the behavioral health issues.  Almost half of this was for drugs and another quarter for office visits.  On a per capita basis, for all adults treated for a mental health problem, total spending averaged $18,238.  For dual eligibles, it averaged $35,686.  For the subset treated for depression, for all adults the average was $20,268 and for duals, it was $34,923.  Most of this was accounted for by patients with four or more comorbid conditions.

It is likely that it will be difficult to significantly improve the health of many high-cost patients, and reduce their spending, unless the behavioral component of their health needs is intensively addressed.  It is simply common sense that unless patients are able to function well mentally and emotionally, they are unlikely to be fully engaged in other aspects of their health and health care.  Since it is pretty easy to identify these patients with mental health treatment and a large number of comorbidities, the payers and providers responsible for these patients should develop focused programs to address their behavior health in the interest of improving other health outcomes.

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