The ability to leverage predictive algorithms to analyze data and proactively intervene with the most complex cases and get individuals the help they desperately need before they experience a medical crisis can save costs and save lives.
MedCity News | May 5, 2021
By: Jonathan Mayhew, CEO, Ontrak
Along with illness and heartbreaking loss of too many lives, the Covid-19 pandemic has wrought an unprecedented behavioral health crisis in our country, and further exposed gaps in access to healthcare for certain underserved communities.
Among those experiencing extraordinary barriers to care are individuals who suffer behavioral health conditions such as anxiety, substance use disorder, depression, isolation and loneliness, eating disorders, and ideation about self-harm.
Nearly 51 million U.S. adults experience mental illness per year, yet only 43% of these receive any treatment. Approximately 40% of Americans reported struggling with mental health issues during the pandemic, and nearly 1 in 3 Covid-19 survivors reported a neurological or mental health condition within six months of their diagnosis. These statistics are highest among racial minorities and those covered by Medicaid and Medicare. Many of these individuals are older adults, live alone with no or limited support network, have low incomes, and lack access to reliable internet, computers or smartphones necessary to access online support.
Further complicating the mental health picture is the surge in substance use during the pandemic. More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to data from the Centers for Disease Control and Prevention (CDC), eclipsing the toll from any year since the opioid epidemic began in the 1990s. The CDC states that as of June 2020, 13% of Americans reported starting or increasing substance use to cope with their stress. Tragically, overdoses have also spiked since the onset of the pandemic. The Overdose Detection Mapping Application Program, an initiative jointly launched by local Washington D.C. and Baltimore public health and public safety agencies to share real-time suspected overdose surveillance data across the U.S., shows an 18% increase nationwide in overdoses in the early months of the pandemic compared with those same months in 2019, and the trend continued throughout 2020.
These debilitating challenges, frequently compounded by socio-economic circumstances, make these individuals the least likely to access preventive care and most likely suffer chronic medical conditions like hypertension, diabetes, and chronic pain, which ultimately drive them to emergency room visits and costly in-patient hospitalization.
Concurrently, the pandemic also has given rise to skyrocketing adoption of virtual healthcare, which increases access and availability of providers, convenience and the safety and comfort of seeking help within the privacy of one’s home. However, virtual care, alone, is not enough to bring about durable health outcomes, especially for these most vulnerable and hardest-to-reach individuals.
An effective, integrated solution that combines the benefits of technology with an irreplaceable human touch is urgently needed.
An innovative solution to address these healthcare disparities is one that integrates AI and predictive analytics with high-touch human engagement, and a personalized combination of virtual and in-person behavioral healthcare. This approach has the potential to have a lasting impact for real people: delivering life-changing behavioral health solutions for individuals who would otherwise fall through the cracks of the healthcare system.
We can use these predictive analytics to identify “hidden” populations with unaddressed (and often undiagnosed) behavioral health conditions and co-existing chronic disease and deliver meaningful high-touch human interventions. This method targets some of the hardest to treat patients – those with chronic illness who face myriad barriers to care – and it works.
Once these members are identified, that is when the in-person navigation kicks in. Empathetic care coaches, nutritionists, and other specialists need to engage one-on-one with individuals and build trust through strong interpersonal skills and persistence. This will inevitably result in improved outcomes and quality of life, and significant cost savings for the healthcare payers.
A Milliman Research Report published last year showed that this high-cost behavior group accounts for only 5.7% of the population, but 44% of total spend by payers. The study validated this approach of integrating AI predictive analytics with high-touch human engagement, showing it has the potential to reduce medical costs by as much as 50% by significantly reducing avoidable emergency department visits and hospitalizations.
But cost savings are meaningless if we’re not saving lives.
What is needed is a system that delivers real-world impact for people. Data shows that such an approach has the potential to dramatically reduce in-patient hospitalizations, by more than 60%, while concurrently driving more people to utilize more productive, preventive outpatient services, such as primary care visits and substance use disorder help.
Such an integrated approach, using technology to meet patients where they are while finding the right balance of personalized, one-on-one engagement is the future. That future is now, accelerated by this extraordinary pandemic. The ability to leverage predictive algorithms to analyze data and proactively intervene with the most complex cases and get individuals the help they desperately need before they experience a medical crisis can save costs and save lives. That is a powerful combination.
Photo: SIphotography, Getty Images