This contributes to a higher total cost of care for patients and health systems. Just as persons with diabetes see blood sugar skyrocket when they stop taking their medication, Barton said that those with chronic behavioral health conditions will likely have an acute psychiatric episode that potentially requires stabilization when treatment needs are unmet. These patients are less likely to have primary care relationships and are associated with social determinants of health (SDOH) challenges (eg, financial, housing and food insecurities, transportation challenges).
Whereas acute forms of mental health and SUDs are characterized by their shorter duration and warrant emegency medical stabilization, more serious chronic illnesses require long-term medication, therapy, and case management to achieve lasting recovery and remission.Ĭhris Barton, LCSW, Director of Integrated Systems of Care & Network Innovation, Horizon BCBSNJ, noted that the need for long-term management is a critical issue facing populations with chronic behavioral disorders. The lack of care coordination is of particular concern for patients with serious mental illness (SMI) and substance use disorders (SUDs). "The compartmentalized reimbursement often separating physical and behavioral health services makes it exponentially more difficult to communicate across systems electronically.” ”All these issues combine with the confusing and complex electronic medical record web that exists today," he said. Some of this extends from the idea that behavioral health costs only represent about 6% to 7% of total medical expenses while overlooking the fact that underlying behavioral health issues contribute to a significant amount of the total health care spend of the member,” said Nickolas Carros, DSW, LCSW, senior director, Clinical Behavioral Health Services, Horizon BCBSNJ.
"At the highest level, the lack of recognition and accounting for the profound impact of behavioral health on individuals’ physical health has led to a deprioritization of behavioral health coordination in primary physical health settings. Uncertainty about confidentiality standards and privacy laws can make it hard to relay information between behavioral health and primary care.
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However, stakeholders from Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) note there are barriers to integration, such as inadequate training on how to manage mental health disorders. Despite the cost- and health-related burden caused by behavioral health issues, physical and mental health services continue to be siloed.īy contrast, evidence shows that integrating behavioral health into primary care creates marked improvement of clinical outcomes and cost savings. Behavioral health and substance abuse management have been challenged for decades by lack of investment and fragmented care systems.
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