Evaluating the Cost of Mental Illness: A Call for a Cost-Effective Care Coordination Model

Evaluating the Cost of Mental Illness: A Call for a Cost-Effective Care Coordination Model

ARTICLE IN PRESS INVITED PERSPECTIVE Evaluating the Cost of Mental Illness: A Call for a Cost-Effective Care Coordination Model Jie Chen, Ph.D. ental...

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Evaluating the Cost of Mental Illness: A Call for a Cost-Effective Care Coordination Model Jie Chen, Ph.D. ental illness is a major public health concern in the United States. Untreated mental illnesses are associated with high mortality rates; increased risk of developing major chronic diseases, including heart disease, diabetes, asthma, and hypertension; and accelerating progression of coexisting physical illness and amplifying their disability.1 Sixty-eight percent of adults with a mental illness have one or more chronic physical conditions.2 It is estimated that monthly costs for a patient with a chronic disease and depression are $560 more than for a patient with a chronic disease without depression.3 A recent study showed that the overall cost of mental illness reached $201 billion in the United States in 2013, topping the list of the most costly conditions.4 Most of the existing studies used cross-sectional study design to estimate mental healthcare costs. In this issue of the American Journal of Geriatric Psychiatry, Bock et al.5 examined the impact of depressive symptoms on healthcare expenditures for elderly populations (aged ≥ 75 years). The authors used multicenter longitudinal data (Leipzig, Bonn, Hamburg, and Mannheim; Germany) collected during base years 2012– 2013 (N = 1,195) and at a 1-year follow-up (N = 951). Using this two-wave cohort study, the authors used a hybrid random effect model to examine the association between depressive symptoms (measured with the short form of the Geriatric Depression Scale) and healthcare cost, controlling for demographic information, socioeconomic status, and coexisting physical conditions. Results showed the presence of depressive symptoms was significantly associated with higher


total healthcare costs (including higher costs for inpatient and outpatient treatments) and higher costs of informal care. Specifically, authors estimated that the average total cost (the sum of total healthcare costs and informal care costs) were €425 higher among the elderly with depressive symptoms compared with the elderly with less depressive symptoms. Among those with depressive symptoms, elderly populations encountered €540 higher costs in the follow-up year. Findings of this study emphasize the economic impact of depressive symptoms among the elderly. This is one of a few studies examining mental healthcare costs using a longitudinal approach. Bock et al.5 concluded that appropriate interventions to treat depressive symptoms are necessary to reduce healthcare costs. In the United States, laws such as the Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act of 2010 (the ACA) have created new financial protections and incentives for effective provision of mental healthcare. Treatment and prevention of mental illness has been considered an essential benefit under the ACA. There is also an increased awareness of the impact of social determinants of mental health. The need to address healthcare access and underlying social determinants of health will require a multisectorintegrated mental healthcare system to target “population health.”6 Public health and health promotion programs became a vital part of hospitals’ effort to focus on the primary goal of benefiting the community at large. Research suggests the partnership

Received November 6, 2016; accepted November 8, 2016. From the Department of Health Services and Administration School of Public Health, University of Maryland, College Park, MD. Send correspondence and reprint requests to Associate Professor Jie Chen, Department of Health Services and Administration School of Public Health, University of Maryland, 3310E School of Public Health Building 4200 Valley Drive, College Park, MD 20742. e-mail: [email protected] © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jagp.2016.11.004

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ARTICLE IN PRESS XXXX between hospital systems and public health has the potential to address some of the root causes of poor health (e.g., Recovery After an Initial Schizophrenia Episode project, collaborative care model, and Mental Health Research Network). Accountable care organization models provide hospitals financial incentives to implement innovative care coordination to ensure that patients “get the right care, at the right time.”7,8 Such care coordination models include improving the use

of a patient-centered medical home, clinician–patient continuity, team-based approaches, use of community hospital-based support, specialized outpatient programs for high-risk patients, home visits, patient navigation to link primary care and specialty care, and referral tracking systems. Evidence of cost effectiveness of such care coordination for individuals with mental illness and coexisting physical conditions is highly needed.

References 1. Walker ER, McGee RE, Druss B: Mortality in mental disorders and global disease burden implications: a systematic review and metaanalysis. JAMA Psychiatry 2015; 72:334–341 2. Substance Abuse and Mental Health Services Administration: Can we live longer? Integrated healthcare’s promise. Available at: www.integration.samhsa.gov/Integration_Infographic_8_5x30 _final.pdf. [Accessed November 6, 2016] 3. Melek S, Norris D: Chronic conditions and comorbid psychological disorders. Seattle: Milliman, 2008. Available at: http:// us.milliman.com/insight/research/health/pdfs/chronic-conditionsand-comorbid-psychological-disorders/.[Accessed November 6,2016] 4. Roehrig C: Mental disorders top the list of the most costly conditions in the United States: $201 billion. Health Aff (Millwood) 2016; 35:1130–1135


5. Bock J, Hajek A, Weyerer S, et al: The impact of depressive symptoms on health care costs in late life: longitudinal findings from the AgeMooDe study. Am J Geriatr Psychiatry 2016; 204:247– 254 6. Costich JF, Scutchfield FD, Ingram RC: Population health, public health, and accountable care: emerging roles and relationships. Am J Public Health 2015; 105:846–850 7. Khullar D, Chokshi D: Toward an integrated federal health system. JAMA 2016; 315:2521–2522 8. Centers for Medicare and Medicaid Services. Accountable Care Organizations. Available at: https://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/ACO/index.html?redirect=/aco/. [Accessed on Nov 30 2016]

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