High Spending on Patients With Behavioral Health Disorder and Multiple Comorbid Conditions

The continued segmentation of the US healthcare system has resulted in a majority of spending on behavioral health disorders being attributed to treatment of the physical comorbidities. Researchers from Emory University sought to identify opportunities for population health management through the analysis of treatment of and spending on behavioral health disorders.

In a study published in Health Affairs, the authors wrote that policies should better advance the integration of behavioral health and primary care. One in 4 Americans have multiple medical conditions, and this patient population is driving up healthcare spending in the United States. In addition, more than 15% of adults have at least 1 behavioral condition, and there is likely some overlap between patients with behavioral health issues and physical diseases.

“We were interested primarily in determining how much of total spending among adult behavioral health patients is attributable to treatment for nonbehavioral comorbidities,” the authors wrote.

The researchers used data from the Medical Expenditure Panel Survey from 2010 to 2013 and focused their analysis on Medicare, Medicaid, and dual eligible enrollees. These beneficiaries have disproportionate spending attributed to behavioral health. The study analysis only included people who had been treated for a mental or substance-related disorder.

The authors found that 15.5% of adults were treated for a behavioral health disorder during the time period studied. In addition, all beneficiaries (Medicare, Medicaid, and dual eligibles) had a high degree of comorbidity with more than half of adults having at least 4 comorbid physical conditions in addition to their behavioral disorder.

The cost of treating patients with any type of behavioral disorder averaged a total of $672.4 billion from 2010 to 2013. Only 15% ($101.2 billion) of that spending was attributed to behavioral health—related care, though. The authors found high spending among patients with multiple comorbidities. The majority (80.4%) of the average spending for adults treated for a behavioral health disorder was spent on patients with 4 or more comorbid conditions.

“The results of our study underscore the association between increased numbers of physical comorbidities and increased behavioral health spending among US adults treated for one or more behavioral health disorders,” the authors wrote.

With primary care becoming the “de facto mental health system” for behavioral health conditions, there is a great need for collaborative care models, the researchers wrote. They added that care delivery models that are evidence-based and take into account the whole person, such as patient-centered medical homes, should have the best chance of managing care of these patients.

“To address gaps in care, future policies will require greater integration of value-based payment and delivery models to support shared responsibility between primary care and behavioral health care providers across all payers,” the authors concluded.