Integrating mental and behavioral health into specialist care

At the same time that more and more Americans are facing chronic illnesses, the number of patients seeking help for mental health issues has increased – estimates suggest that mental health spending will exceed $280 billion in 2020. These challenges go hand in hand given. Patients with depression and anxiety are more likely to face more serious chronic illnesses. The relationship also works in the other direction. For example, more than half of Medicare beneficiaries who manage COPD, a population I work with frequently, are also experiencing depression or anxiety. In turn, depression and anxiety are associated with a greater chance of acute COPD exacerbations.

Dr. Abi Sundaramoorthy: ©Welllinks

But typically, when a COPD patient sees their doctor, the consultation is focused on a condition in their medical record. They may be given some exercise and reminded about the importance of taking their medication, but they often leave without discussing, for example, how depression limits their ability to take their medication regularly or how anxiety keeps them stuck at home. This is not the fault of the provider – our system has been isolated for many years.

It is imperative to recalibrate how we provide care and how we think about the interconnected relationships between physical and mental health. While frameworks such as the Collaborative Care Model provide guidelines for clinicians to integrate mental and behavioral health services with primary care, we must consider the ways in which we can implement this model in specialized care settings, particularly for patients with complex chronic conditions. The complex needs of these patients account for nearly 90% of the nation’s $3.8 trillion annually in healthcare costs; developing the infrastructure to better manage your health will not only improve outcomes, but also responsibly reduce costs by focusing on preventive care.

To consider the practical implementation of this model, consider again COPD, which costs the health care system $49 billion. annually.When a patient with COPD experiences loss of appetite and energy, the underlying cause of these symptoms is not always immediately obvious – fatigue is a symptom of COPD It is depression. If given the resources and support to take a holistic approach, a provider may begin with a comprehensive patient assessment, including a mental health screening, and may find that the patient reports severe but untreated depression and anxiety. We could then direct the patient to resources, including mental health professionals, with the understanding that addressing a patient’s symptoms can improve COPD management. For example, improving medication adherence reduces the risk of an acute exacerbation requiring hospitalization and the system expense associated with such an episode, with research finding COPD-related hospitalizations costing our system more than $15 billion annually. And it works on the other side of the equation too. With visibility into the specialist care the patient is receiving, your mental health professionals may be better equipped to coordinate the entire care team.

Virtual and digital healthcare solutions are uniquely positioned to help develop the connective tissue to support a kind of Collaborative Care Model for specialized care, especially in value-based settings. By providing greater access to resources like a healthcare coach, virtual solutions not only help reassure patients, but also provide regular touchpoints between patients and healthcare professionals where additional issues, including mental health challenges, may arise. from the texture of rich, ongoing conversations.

Virtual tools also help to reduce the fragmentation between physical care and mental health care. Digital dashboards can increase real-time data sharing and analysis among service team members, improving care coordination and the ability to collaborate on issues in real time. Incorporating clinically validated triggers into a platform’s interface and onboarding process can quickly identify that a patient is at risk for mental health issues such as depression or anxiety, and digital pathways can refer patients to the care and support of who need.

Finally, including mental health resources and peer support groups in a virtual care resource helps patients combat loneliness and stigma, key inhibitors for many in treating chronic illnesses. Building trust and community also empowers patients to better manage their health – mental and physical.

Virtual health platforms are some of the best tools we have for tailoring care to each patient’s specific health situation, incorporating a thorough understanding of mental health care and chronic disease management. By offering resources and providing patients with channels to engage with expert professionals, we are able to bridge gaps in care to treat each patient individually and comprehensively, while reducing costs across our system.

Dr. Abi Sundaramoorthy is an Internal Medicine Hospitalist in Tampa, as well as the Chief Medical Officer at Wellinks.

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