This month’s edition of Health Affairs features an article focusing on patients with high mental health costs — and how they incur 30 percent more costs than other high-cost patients. This research helps to make the increasingly compelling case for earlier identification and intervention to address mental illnesses — if we’re concerned about saving money.
For their Health Affairs article, Claire de Oliveira and her colleagues examined a large group of Canadian patients to determine if and why individuals with mental health conditions were costlier to treat than those without mental health conditions. They found that the average cost for a “mental health high-cost patient” was roughly 33 percent greater than the average cost for other high-cost patients.
In the United States, mental disorders frequently rank among the highest in direct medical spending. We pay a high price for mental illnesses. We should care where and for whom that spending goes, and what we’re getting for our money.
So what should we do about this?
In doing their analysis, the authors uncovered some information that leads us to an obvious answer — we should intervene early.
The Case For Early Intervention
First, high-cost mental health patients are much younger than other high-cost patients.
The authors found that 79 percent of high-cost mental health patients were under the age of 60. But only 39.7 percent of other high-cost patients were under age 60.
Chronic diseases affecting the heart, lungs, and other organs are often diseases of aging. But half of all mental illnesses begin by the age of 14, three-quarters by the age of 25. For individuals with mental illnesses, the costs often start adding up early.
Our work at Mental Health America bears this out. We have an online mental health screening program we began in April 2014. It allows people to use evidence-based tools to screen for common mental health conditions. As of December, 2015 more than 830,000 people had completed at least one screening.
Among the more than 400,000 screenings conducted between May and October of 2015, 66 percent of individuals were under the age of 25; 36 percent under the age of 18. Sixty-six percent of those screened also scored as positive or in the moderate to severe range for a condition. But 65 percent of this “positive” group (across all ages) told us that they had never been diagnosed with a mental health condition.
While not everyone from our sample who screens positive will progress to later stage mental illness, the paper provides a warning about the costs to come — if we don’t intervene early and effectively.
Second, the researchers suggested that high-cost mental health patients did not (yet) manifest other chronic diseases.
Their data suggested that only 10 percent of mental health high-cost patients had a hospitalization that wasn’t related to mental health needs. They explain this in part because of the young age of the high-cost mental health patients.
This disparity in utilization of non-mental health hospitalizations among high-cost mental health patients could also be due to the increased mortality rates among younger individuals with mental illness. Americans with major mental illness die on average 14-32 years earlier than the general population.
There may be another answer. Mental illnesses could precede other chronic conditions, which in turn become more costly as people age. Revisiting our screening population above, while only 13 percent of those who screened reported having another other chronic condition, those who did report having a physical health condition were slightly older (on average 25-34 years old). Among the reported comorbid physical health problems were chronic pain, heart disease, pulmonary disease, and diabetes.
Either explanation supports the case for early intervention — and for integrated health care services.
Third, high-cost mental health patients were more likely to be hospitalized than were non-mental health high-cost patients.
The disproportionate use of hospitalizations among high-cost mental health patients is a result of our failure to act early. Not too long ago, schizophrenia was thought to be a lifetime sentence of profound disability, with little hope of being able to participate in the community. But we are learning more about schizophrenia every day, and what we are learning highlights the importance of intervening early.
Early intervention around psychosis has long-term positive effects, including a reduction in hospitalizations for five years or more. When services are offered in the community, not in a hospital setting, individuals live more independent lives. This has the added benefit of holding down costs.
Advancing Public Policy To Promote Early Intervention
The health and mental health care delivery systems in Canada and the United States are, of course, different, and the payment systems are, too.
But there is no reason to believe that the underlying conclusions of this paper aren’t widely relevant. As chronic diseases, mental illnesses do strike earlier than most. They are often serious. They are increasingly associated with other chronic diseases as people age. And they are expensive.
The solution isn’t expensive. We just need to intervene before Stage 4, at the earliest stages of the disease process. The time is right to implement new policies. Respected authorities have called attention to the importance of early intervention. New initiatives supporting early identification and intervention are included in HR2646 and S1945, which are being considered in Congress this year.
We can act on what we now know about the importance of early intervention. We can promote mental health screening for children and adults, public education to recognize the early warning signs of mental illnesses, and an integrated health care system that incentivizes coordinated community-based services.
If we do, we might just save a few dollars, and, more importantly, save some lives.
from Health Affairs Blog http://ift.tt/1nKsFJx
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