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Efficient, but separate behavioral, physical healthcare is 'a delusion'

March 5, 2013
by Dennis Grantham, Editor-in-Chief
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Realizing better cost-efficiencies and outcomes is impossible so long as physical and behavioral care remain separated in practice

In a presentation to national and county officials at a recent National Association of County Behavioral Health and Developmental Disabilities Directors (NACBHDD), Roger Kathol, MD, a psychiatrist who is president of Cartesian Solutions (Burnsville, Minn.), attacked “the wall of forced separation between physical and behavioral healthcare.”

This barrier, which exists in many forms—notably in different facilities and payment streams and an almost complete lack of communication or integration—has created what he calls “the delusion that we better serve patients/clients if behavioral health remains autonomous from the rest of healthcare,” he said.

Armed with a series of studies that compared everything from annual treatment costs to average inpatient lengths of stay, Kathol demonstrated that for “at risk” patients—patients who have both a behavioral health condition and a chronic medical condition (e.g., asthma, arthritis, diabetes, heart disease), neither behavioral health nor physical health practitioners are able to function efficiently while separated.

“Eighty percent of patients with behavioral health comorbidities are seen in the general health sector,” said Kathol, adding that, in his work as a consultant to general hospitals, he finds that “there are more people with serious mental illnesses in general medical populations than in the specialty behavioral health sector.” And, he asserts, 30 to 45% of people with these problems get little or no care for them when hospitalized for a medical problem. These,” he said, pointing to a graph, “are the people—the 30% of patients—who cost so much more to treat.”

The problem is twofold, he explained.  It’s not just a matter that the mental illness is untreated or poorly treated due to an absence of services.  “When you don’t treat the mental health problem, you’re spending 80 to 90 percent more on medical services.”

Citing a study of annual treatment costs for insured populations, he said that recent figures show that the average annual medical cost for a treated individual was about $2,700. But if that person has a chronic medical condition, costs double or triple, said Kathol.  “Add on a mental health condition, and you double that figure again,” he asserted.

“This is where we in behavioral health have an opportunity to impact the total cost of care.  This is where we can make the return-on-investment better.”