Advanced Analytics to Reduce Costs: Bridging the Behavioral Health Care Gap

Health care spending in the United States will reach $6.2 trillion by 2028, or 63% more than the $3.8 trillion spent in 2019, according to projections from the Centers for Medicare and Medicaid Services (CMS).

This rapid rise in health care spending is fueled by an aging population and an increase in the number of Americans with chronic conditions such as hypertension, hyperlipidemia (high cholesterol), lung disease, cancer, and diabetes. A study by the Stanford University School of Medicine estimates that 86% of US health care costs go toward treating patients with one or more chronic diseases. An analysis by Rand concludes that Americans with five or more chronic conditions—a group that comprises only 12% of the population—account for 41% of total health care spending in the United States.

Aging and risk factors (such as cigarette smoking, obesity, lack of physical activity, and excessive alcohol or drug use) undoubtedly are major reasons behind the increase in US spending on chronic conditions. By 2030, when the youngest baby boomers will be over the age of 65, older adults will comprise 21% of the American population, up from 17% today, according to the US Census Bureau.

There is another factor, however, that has a significant but easily overlooked impact on spending to prevent, manage, and treat chronic conditions. Research by global consulting and actuarial firm Milliman Inc into how people with behavioral health conditions contribute to total health care spending shows:

• The most expensive 10% of the study population accounted for 70% of total health care costs.
• 57% of this high-cost group also had diagnoses for behavioral health conditions and/or received behavior-specific treatment.
• This group of high-cost patients who have behavioral health issues comprised only 5.7% of the total study group yet accounted for 44% of total health care costs.
• Only 4.4% of total health care costs for the entire study population was for behavioral health treatment.

This data suggests a strong correlation between behavioral health issues and spending on health care. Unfortunately, lack of quantitative data on behavioral health care makes it exceedingly difficult to close this care gap. Therefore, it is imperative that providers and payers apply advanced analytics to identify patients at risk upstream and intervene to prevent avoidable care utilization costs.

Hidden Costs Associated With Behavioral Health Issues

Total cost of care traditionally focuses on physical health care such as annual exams, blood tests, and medical procedures. True total cost of care, however, must reflect behavioral health care costs along with physical health care costs. There is an inextricable link, for example, between mental health issues and chronic diseases. Research shows that people with chronic physical illnesses are twice as likely to experience depression and anxiety than people with no chronic conditions.

Even mild-to-moderate mental health issues can lead to behavioral choices that eventually may cause or worsen chronic conditions. A mildly depressed person may not have the motivation to exercise and could subconsciously engage in other unhealthy habits. They also may be less likely to take prescribed medications. These behaviors can cause or worsen debilitating chronic conditions, leading to prolonged and costly episodes of care.

If people with mild-to-moderate mental health challenges could be more readily identified, they would be relatively easy to treat. This, in turn, would result in lower total costs for medical care because their chronic conditions could be better managed or even averted with education and preventative care.

There is a lack of behavioral health quantitative data in the right format for traditional reporting and analytics systems. This makes it virtually impossible to treat the whole person because clinicians and behavioral health professionals lack critical and comprehensive information.

This can lead to providers focusing on their areas of specialty while ignoring or disregarding behavioral health issues or social determinants of health (SDoH) such as income level, living conditions and ethnicity—all of which can impact a person’s physical health and the amount we spend on healthcare.

The Advanced Analytics Solution

Providers and payers can fully track cost of care, recognize opportunities to decrease costs, and increase positive health outcomes by harnessing the power of advanced analytics. Clinical data, claims data, historical data and SDoH data can be analyzed to identify patients at increased risk of behavioral health problems. Clinicians then can intervene with these patients to offer referrals and treatment options.

Combined with artificial intelligence (AI), an advanced analytics health care platform empowers health care organizations to proactively address behavioral health problems to mitigate future costs and increase health equity.

Bridging the behavioral health care gap has been challenging because no behavioral health predictive modeling tools or behavioral health provider comparison tools have been commercially available for patients with mental health issues. Fortunately, advanced analytics platforms now are available to help identify patients at risk upstream, provide insights into type of intervention and timing, and reduce cost and care utilization.

Advanced analytics are essential for providers and payers to effectively manage behavioral health conditions as part of a value-based care strategy that rewards improved patient outcomes and lower health care costs.