A national managed behavioral healthcare organization wanted to estimate the amount of money it could save a large self-insured private manufacturer if it implemented an integrated medical-behavioral care management program, rather than continuing its current carve-out approach to behavioral healthcare.

Uncoordinated care creates problems

The current system for managing members with chronic medical conditions who also have a co-occurring behavioral disorder divides their treatment into two silos. Their medical conditions are managed by their care management team, including personal nurses and case managers, while their comorbid behavioral disorders—such as depression, anxiety, or substance abuse—are often undiagnosed, undertreated, or mistreated. Even when behavioral conditions are properly treated by a behavioral specialist, there is little or no collaboration with the medical care management team.

Identifying the patient pool

Using the employer’s detailed historical claims and membership data, Milliman identified employees and their covered dependents who were treated for any of 10 chronic or severe medical conditions—arthritis, hypertension, chronic pain, diabetes, asthma, ischemic heart disease, COPD, malignant cancer, congestive heart failure, and stroke. We also identified individuals within this member set with comorbid depression and/or anxiety disorders. 

Of the roughly 20,000 participants in the plan, we separated the members with chronic medical conditions into 10 different cohorts and then further separated members with comorbid depression or anxiety from those lacking these disorders. We then analyzed healthcare utilization and cost patterns in detail to determine the savings potential in improving the comorbid patients' health by switching to integrated medical-behavioral care management.

Scientific findings and research on the adverse impact of depression on productivity, absenteeism, and disability were used to project other non-healthcare savings for the employer.

Projecting the potential savings

Our analysis of this patient group showed that individuals suffering from chronic medical conditions and a comorbid psychological condition were much costlier than their "no psych comorbidity" counterparts. We estimated that reducing these healthcare costs by just 10% could save the employer almost $1 million annually, while another $750,000 per year could be saved in reduced absenteeism, fewer and shorter disabilities, and increased productivity.

Although integrated programs of comorbid medical and behavioral disorder identification and treatment increase short-term costs, our research showed these additional costs may be easily offset by future savings from reduced healthcare and other employer costs. Our analysis of the scope of these up-front costs and potential payoffs helped the employer to fully understand all of its options and evaluate future modifications to its plan.