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Are We There Yet?

October 12, 2007
by W. Dennis Derr, EdD, SPHR
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This article appeared in the September 19, 2007, edition of Behavioral Healthcare




Are we there yet?
Every parent expects this question when a trip begins. Initially, it reflects excitement but, as the trip drags on, the question becomes irritating.

Integrating behavioral health and wellness has become one long journey with many repeatedly asking this question. At the 3rd Annual World Congress Executive Summit on Innovation in the Cost-Appropriateness of Behavioral Health and Wellness in Atlanta (July 12 to 13), it was obvious the journey still drags on. The meeting discussed the business case for corporate senior managers and health plans to invest in behavioral health and health promotion, as well as explored the possible benefits of integrating behavioral health and wellness programs. Integration is seen as the keystone in building the power of wellness and behavioral health. However, integration in the healthcare industry has been an elusive goal. The silos created by multiple vendors serving the same customer often continue even when brought under one provider roof.

Attendees from both the behavioral health and wellness communities did recognize a number of critical points through the presentations.

First, an estimated 90% of behavioral healthcare takes place outside of formal behavioral health environments, which reflects our silo environment.

Second, behavioral health spending has been reduced so dramatically that it now represents 1 to 3% of total healthcare spending, yet comorbidity of behavioral health disorders with medical illnesses is estimated to be 80%.

Third, when behavioral health-focused disease management, or similar interventions, is combined with medical or health-related services, the return on the dollar spent is very high.

Fourth, behavioral engagement is critical to success, whether engaging the patient or provider. “Motivational engagement” was a popular concept, whether speaking of the patient or the provider in identifying a readiness to change.

Of the major healthcare provider companies presenting at the conference, all are taking similar approaches to reaching out, connecting, engaging, and motivating through some type of integrative model. Whatever it is called, the similarities and intentions of the programs represent quality research-based thinking in design and documented return on investment.

So, based on this high level of agreement, well-constructed research, and demonstrated savings, why aren’t we there yet? That might be the beginning of spirited dialogue that takes more space than allotted here.

W. Dennis Derr, EdD, SPHR, is Director of EAP at Aetna Behavioral Health. He has more than 30 years of experience with EAP and behavioral healthcare, having directed internal programs in both Fortune 500 companies and governments, and has offered consultation to organizations worldwide. Dr. Derr also is a member of

Behavioral Healthcare's Editorial Board.