With 90% of the nation’s $3.8 trillion in annual healthcare spend going to chronic and mental health conditions, treating mental health as a co-occurring condition in addressing a member’s overall health has never been more important.
The CDC predicts that more than 50% of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime. Unfortunately, mental health issues are underdiagnosed, especially at lower levels of disease, due to the difficulty in accurately identifying and attributing symptoms and the stigma associated with getting diagnosed. COVID has brought to light the urgency of addressing mental health at all levels of need, not just for those who have an official clinical diagnosis. Services cannot be limited to the select few who have a severe mental health disorder, or resources to navigate a system where demand is high and supply is low; but must also encompass and include people earlier in their disease process (e.g., with less severe and/or persistent symptoms), and those who are less resource savvy.
Right care, right time is a major challenge
Connecting patients with the right mental health services before a crisis has long been a major challenge, but with new advancements in AI, it’s now possible. Prealize’s ConsumerConnect solution identifies the patients most at-risk for behavioral health challenges upstream of that diagnosis occurring. With up to 12 months additional lead time for plans and providers to connect with their most at-risk members provides the opportunity to build trust and reduce stigma, improving patient engagement and connecting patients with the right care at the right time. This means getting patients to the appropriate level of care they need, and not letting their condition worsen by being left unmanaged. For example, ConsumerConnect can identify a patient at risk of bipolar disorder, who should be connected to a psychiatrist, versus a patient with high-risk levels of stress can be connected with lighter-touch telehealth solutions or and self-directed resources.
Treating the whole person and their chronic illness
60% of Americans living with at least one chronic disease like cardiovascular disease, diabetes, obesity, and arthritis, and people who suffer from a chronic illness are more likely to also suffer from depression. Notably, depression co-occurs in 17% of cardiovascular cases, 27% of diabetes patients, more than 40% of individuals with cancer and in up to 85% with chronic pain. Ignoring mental health in a patient’s overall treatment can lead to lower medication and treatment adherence, increased risk for substance abuse and a domino of social consequences and barriers, such as homelessness, incarceration, and victimization.
For patients suffering with a chronic illness, their mental health treatment must accommodate the specific needs they have. For example, a patient dealing with chronic pain and depression needs practical tips on pain management and strategies to promote positive thinking. Understanding a patient’s co-occurring chronic conditions and condition risk makes Prealize ConsumerConnect even more impactful, as it allows plans and providers to craft a nuanced, personalized outreach strategy based on need. To treat one without the other can corrode member trust and worsens health outcomes.
Earlier intervention improves engagement
Overlooking mental health in the treatment of chronic illness can lead to an exacerbated form of the chronic illness. Take Maggie, a 55-year-old woman living with chronic pain, tobacco use disorder, and depression, who has experienced recent gained weight and is steadily using more and more opiates to manage her pain. Maggie’s depression made it hard for her to combat her physical pain with proactive solutions like exercise and weight loss, and her risk for opiate addiction continued to rise. Maggie was on track for major health expenses and worsening conditions and wasn’t receiving any communications from her plan. As a result of ConsumerConnect, Maggie received outreach from her plan and was connected with individual therapy. Over her first few months of treatment, she had the right support to pursue smoking cessation and steadily reduce her dependence on opiates for pain management. Over the course of the next year, Maggie stopped smoking, traded opiates for a pain management alternative, and reduced her health care costs.
While Maggie’s story is an important one and speaks to the importance of treatment regardless of when is occurs, we know that being able to reach Maggie even earlier in her journey would have made a significant difference in her overall quality of life. Imagine being able to reach Maggie even before her she started using opiates or gained weight. With up to an additional 12 months of lead time before a condition or diagnosis hits the claim, health plans and providers can reach Maggie upstream and change her health trajectory for the better, with lower risk of condition worsening or quality of life further diminishing. That lead time is also critical to helping Maggie take action. When we ask patients to change, it can feel like we’re asking them to summit Mt. Everest without any preparation. Prealize ConsumerConnect offers additional lead time and upstream targeting that increases engagement by 20% by asking patients to take smaller and few steps, which makes the mountain easier to climb.