Why Integrate Healthcare: Co-morbid Behavioral and Medical Conditions

Integrated Behavioral Healthcare

Costs of Behavioral Health Problems in Medical Patients Tell us to Integrate Healthcare 

If we Integrate healthcare (combine medical and behavioral health), we create an opportunity to address how, presently, co-morbid behavioral and medical conditions increase the costs of patient care. In a 2014 article in Medical Economics, the suffering from co-morbid depression with two prevalent medical conditions was estimated at 20%, but the impact on costs of healthcare to be at least 50% higher. Patients were reported to have almost 1/3 of a year spent depressed if not treated for both the medical disorder AND the depression: “Not surprisingly, depression has been shown to increase medical costs in patients with these problems by 50% to 70%, according to recent research published in the Archives of General Psychiatry. In that study, when nurse care managers monitored patients diagnosed with depression and either diabetes or heart disease, the patients had lower mean outpatient costs of $594 per person and 114 more depression-free days compared with patients who received usual care.”

Why Integrate Healthcare: Overlap of Mental Health Problems in Medical Conditions

In the Robert Wood Johnson Foundation Synthesis report on behavioral health problems and medical conditions, similar overlaps were identified. Further, if someone has a chronic medical condition and depression, the study identified that patients were 3 times (YES 3Xs) more likely to not follow physicians’ orders if they had depression than if they didn’t have depression. A key recommendation from the analysis was “Primary prevention efforts will be needed to address common risk factors for comorbid conditions, such as adverse health behaviors and substance use, in their social and environmental contexts. Secondary prevention should include screening for common mental disorders in primary care settings and for common medical health conditions in specialty medical settings.” 

Why the Costs are Greater for Patients with Comorbid Medical and Mental Health Costs

One key problem resulting from the presence of a behavioral health condition co-existing with a medical condition is that patients seem much less likely to engage in health-promoting behaviors. In a Milliman Research Report (Melek and Norris, 2008), the authors reported that patients with chronic medical conditions and depression were 2.1 more likely to eat healthy less than 1x per week, and 1.3 times more likely to eat more than 6 high fat foods per week. [(Melek, S. & Norris, D. (2008). Chronic Conditions and Comorbid Psychological Disorders. Seattle: Milliman.] It seems clear that if we Integrate healthcare, we increase the chance that patients can learn healthier behaviors and stick to the “Dr’s orders.” 

What to Do to Integrate Healthcare?

Clearly untreated (or poorly treated) behavioral health issues within the context of chronic health problems will result in a) more health problems, b) higher costs of care to patients and the system, and c) more emotional suffering for patients.

  • One key solution is to remove the artificial barriers between medical and mental health services. That is, rethink the system: all care is healthcare.
  • Also, the access to behavioral healthcare for medical conditions must happen earlier in the process, and that will more likely be true when behavioral healthcare providers are along side primary care physicians, in the SAME OFFICE.
  • Of course, the two types of care should work together and talk to each other, to make sure that the problems of the whole person are addressed from both perspectives: medical and behavioral health.
  • Finally, targets of behavioral change, management of feelings, and social supports need to occur within the total context of physical health (e.g., a diabetic patients must manage the ideas that lead to more sugar intake, the actions of eating poorly, the feelings of hopelessness, and the relationships that promote health—rather than those bringing donuts everyday).