As Severity Reaches Alarming Heights, How Can Health Systems Manage Risk and Build a Sustainable Future?

The COVID-19 pandemic provoked a period of chronic psychological exhaustion, worry, and loneliness — now, in 2023, research shows that the impacts have given way to unprecedented levels of diagnosed mental health concerns. According to a recent Gallup poll, depression rates are at an all-time high; 29% of US adults report having been diagnosed with depression. For comparison, in 2015 roughly 1 in 5 US adults had a depression diagnosis. Today, it’s close to 1 in 3. Women, young adults, and certain minority groups are experiencing depression rates higher than 34%.

These jarring statistics weigh heavily on health care providers. According to a recent study published in the JAMA Health Forum, utilization and spending rates for mental health care services among commercially insured adults increased by 38.8% and 53.7%, respectively, between 2019 and 2022. While this jump signals a rise in those seeking and attaining much needed behavioral health care, it also represents growing severity across the populations we serve.

To navigate this rising acuity and costs in 2024, health systems must implement effective population risk management. Greater insight into risk, and in particular behavioral health risk, allows systems to deliver more impactful care and anticipate healthcare needs, saving millions of dollars in unnecessary utilization costs.

Reactive Health Care is a Recipe for Disaster

With nearly 55% of those with behavioral health conditions receiving no care combined with the excess utilization of medical services fueled by underlying psychiatric illness, our current healthcare ecosystem is highly reactive, needlessly costly, and results in unnecessary suffering for millions of people. Those with chronic medical conditions like diabetes or heart disease have high rates of psychiatric illness resulting in a vicious cycle where physical illness leads to psychiatric illness and, conversely, psychiatric illness leads to worsening physical illness. Diabetes and heart disease, among many other illnesses, can be effectively managed only when underlying problems like depression or anxiety are proactively detected and effectively treated, ideally by multidisciplinary teams of providers integrating physical and mental health care.

Unfortunately, most health systems — while they recognize the need for “upstreaming” in the patient care journey — don’t know where to start when it comes to identifying behavioral health needs. Behavioral health symptoms are often missed, or only surface during emergency situations, costing patients essential access to timely care and the health system millions of dollars. Without regular and automatic screenings in place to assess the behavioral health of our communities, it’s nearly impossible for providers to establish a proactive baseline of potential risk.

When behavioral health conditions go unaddressed — especially during a time of heightened demand — they often exacerbate medical conditions. The result causes a surge in emergency department (ED) and hospital utilization. According to a Milliman report, patients with comorbid physical and behavioral health conditions contribute 2-6 times the health care costs of those without a behavioral health condition.

Failing to identify behavioral health conditions in a timely manner makes it exceedingly challenging to set appropriate quality benchmarks and determine where to deploy care team interventions to enhance care and reduce costs. Moreover, not having a precise or complete picture of risk can mean substantial forgone revenue opportunities or, even worse, the risk of financial penalties in downside risk arrangements. Without appropriate solutions to these issues, the financial sustainability of our health care systems and wellbeing of our communities are vulnerable.

Embracing Population Risk Stratification

To drive down costs, provide quality care, and allow providers and health systems to be sufficiently reimbursed for the care they provide to their patients, population-wide risk stratification, which involves regular monitoring of specific populations, is required.

By equipping providers with behavioral risk information in real-time — like monitoring levels of anxiety, screening for social determinants of health (SDOH), or collecting patient-reported outcomes like mood and pain — providers can proactively intervene to help clients receive faster and more accurate diagnoses and care. Supplementing providers with this real-time, asynchronous, and scalable information across a patient population leads to more accurate risk scoring and more clarity on the care needed across the patient population.

This data-informed, proactive approach can help health care providers avoid high-cost care and poor outcomes. Early intervention that diverts patients to appropriate lower levels of care can save health care organizations tens of thousands of dollars per high-risk patient and could earn millions in payouts for hitting quality targets in certain at-risk arrangements. In doing so, not only are costs mitigated, but entire health systems can become systemically de-stressed — referral systems and individual providers are unburdened, opening time and capacity for the patients who are truly the best match for their services.

As an example, in looking again at glucose management in patients with diabetes as a paradigm, when behavioral health and psychiatric care are integrated in medical settings, we see that elevated markers such as HgA1C improve, rates of emergency department (ED) visits and inpatient medical admissions decline, and patients as well as providers are much happier.

Achieving Financial Stability in 2024

Despite the overwhelming demand on health systems, financial stability — and effective, timely care — can be achieved efficiently with the support of technology. A variety of digital solutions are available that engage patients in behavioral health resources and education and screen them regularly for behavioral health needs. These automated tools offer providers the insight they need to understand and support the most vulnerable in the populations they serve. Implemented at scale, technology can help health care organizations reduce costs associated with ED visits, hospital stays, and expensive treatments, and improve patient outcomes while enhancing the organization’s success in value-based care.

The financial sustainability of health care systems is closely linked to the understanding and proactive management of behavioral health and the impact it has on population risk. CMS is increasingly rewarding this approach with incentives to provide behavioral health support more broadly. By recognizing the potential for early intervention, health systems are not only stabilizing their financial health but also enhancing the quality of care provided to patients — a paradigm shift that is imperative for the future of sustainable health care.