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A Roadmap to Address the Growing Challenge of Untreated Depression
Identifying, Engaging, Treating, and Activating a Complex and Costly Population
Prior to the COVID-19 pandemic, half of Americans [1] reported having a mental or substance use disorder at some point in their lives, with one in five [2] adults experiencing mental illness last year. Individuals with behavioral health conditions have a medical spend that is up to 6 times higher than the rest of the population, driven in large part by increased medical costs for comorbid chronic physical conditions, with depression impacting nearly every major medical comorbidity.[3,4]
While people with behavioral health conditions comprise only 23 percent of the insured population, they account for 60 percent of the total cost of care.[3] Further, recent analysis of claims data by Milliman found that members in the “high-cost” behavioral health subgroup comprised only 5.7% of the total population analyzed, yet accounted for 44% of total healthcare costs.
The COVID-19 pandemic has only increased vulnerability for depressive symptoms throughout the U.S. due to loss of employment, traumatic stress, social isolation, and fear of catching the virus. The pandemic is both exacerbating existing behavioral health conditions and creating new ones, with 53% of U.S. adults reporting that their mental health has been negatively impacted by stress over the coronavirus.[5] This looming mental health crisis in America could result in upwards of $140 billion of additional spending on behavioral and physical healthcare by the end of. 2021.[4]
The looming mental health crisis in America could result in upwards of $140 billion of additional spending on behavioral and physical healthcare by the end of 2021.
Compounding this issue are the barriers to behavioral health engagement that have been an ongoing issue for many Americans. Access to care is limited for many, with 56 percent [6] of counties in the U.S. without a psychiatrist and 64 percent [7] of counties having a shortage of mental health providers. The pandemic is creating additional shortages as providers face economic challenges and rural hospitals run on limited capacity or close altogether. Of course, patients are suffering from economic challenges as well, further exacerbating barriers related to affordability of care and social determinants of health such as food insecurity, transportation and housing.
While healthcare payers have made many notable improvements in member engagement and expanding access to behavioral healthcare, complex barriers to care persist for many individuals, resulting in unaddressed conditions or insufficient treatment. As attention to the growing problem of unaddressed and insufficiently treated depression and the connection between mental and physical health takes on increasing urgency, identifying and engaging this population is critical to mitigate a significant rise in healthcare needs that result from the pandemics, economic crises and natural disasters that impact our society.
Let’s take a closer look at some of the challenges in healthcare surrounding identifying, engaging, treating and activating individuals with unaddressed behavioral health conditions, including depression, and how Ontrak, a leading AI and telehealth-enabled behavioral health company, is successfully overcoming these challenges.
4 Key Challenges to Addressing Untreated Depression
Depression is often under-diagnosed and/or insufficiently treated in primary care.
Treating depression requires a whole-person approach to understand each member’s individual barriers and challenges.
Despite notable progress, health plans may not have the behavioral health resources, expertise, or network access/ availability required to engage complex members.
Technologies and apps alone frequently fall short of promoting long-term engagement or improvement for members with moderate or severe depression diagnoses.
A Unique Approach to Engagement in and Treatment of Depression
In 2017, more than one-third of those suffering from an episode of major depression in the U.S. went untreated.[8] Primary care is often a first step in recognizing the need for care for depression, however primary care frequently has insufficient resources and training to address the needs of patients whose cases are moderate or severe, says Dr. Judy Feld, National Medical Director at Ontrak. Treatments such as therapy and medication need time to be effective and should be delivered alongside interventions that address behavioral and social needs. According to Feld, additional health services, such as therapists and community resources, are frequently needed to align members with appropriate healthcare delivery resources that support lifestyle changes and improved health outcomes.
Lisa Rivera, RN, a care coach at Ontrak, notes that primary care often has high competing demands with tight capacity, so doctors may simply not have the time to fully understand complex contributors to a member’s depression. It takes informed and longitudinal oversight for treatment to be effective. Says Dr. Feld: “Over-treatment can be as deleterious as under-treatment. If people are not well connected to coordinated treatment in the healthcare system, they may be seeking care with multiple providers, receiving care that could be sub-optimal.”
The COVID-19 pandemic has only increased vulnerability for depressive symptoms throughout the U.S. due to loss of employment, traumatic stress, social isolation, and fear of catching the virus.
Solution: Ontrak understands the challenges of care engagement and treatment coordination, especially when considering individuals with both depression and chronic medical conditions. Our “whole person”, approach addresses these challenges through:
Targeting: Using AI and predictive modeling, Ontrak identifies individuals with depression – with a clinical diagnosis or a diagnosis imputed with a high degree of accuracy – who are not engaging in the level of care required to address their condition or progress in treatment.
Engagement: Ontrak builds trust using a “whole person approach” that aligns with each member’s concerns and challenges, including understanding their total health needs, identifying and removing barriers to care, and other influences impacting access and adherence. Ontrak offers highly-trained member enrollment specialists, care coaches, and community care coordinators who employ motivational interviewing and evidence-based techniques to help members navigate their care.
Treatment: Dedicated care coaches coordinate care through the Ontrak program, which is tightly integrated with a network of professional therapists and psychiatrists trained in the Ontrak program, and help members stay engaged throughout their treatment journey.
Activation: Upon graduation, members have overcome barriers to care, realized durable behavior changes, and are actively managing their health by staying engaged with their PCP, behavioral provider(s) and health plan. Ontrak successfully engages members with unmet care needs that result from health system resource barriers, socioeconomic barriers, and individual barriers to care, delivering triple aim results with proven cost savings, improved health outcomes and high satisfaction with the health care experience.
Challenge 2: Treating depression requires a whole-person approach to understand each member’s individual barriers and challenges
According to Dr. Feld, successful depression treatment usually requires a longer-term commitment, a full assessment of the individual’s medical, psychological, social and environmental ecosystem, and the collaborative effort of multiple healthcare resources to enable durable behavior change and improvement in health outcomes.
Solution: Ontrak provides a personalized, whole-person approach that helps members overcome barriers to care and produces durable outcomes.
Designated Ontrak care coaches leverage evidence-based techniques, such as motivational interviewing, to help members identify and address the root causes of their depression. Care coaches guide members through the Ontrak program for up to 52 weeks to help keep them engaged through the sustained intervention that is required to produce lasting results. Additionally, Ontrak provides in-market community care coordinators, who help members address barriers related to social determinants of health, such as food insecurity, transportation and housing.
Notes Lisa Rivera: “Ontrak is effective because care coaches guide members through progressive steps of the program and build a strong, consistent relationship, which is essential to keeping members engaged. A wide array of resources is made available to members to address their condition from multiple fronts, including therapists, psychiatrists, substance abuse counselors, and community supports. Our whole-person approach focuses on skill-building, such as coping skills, that empower the member to play an active role in their treatment.” The end result of this integrated approach is that members develop durable behavior change through care that is pervasive and longitudinal, instead of episodic.
Challenge 3: Despite notable progress, health plans may not have the behavioral health resources, expertise, or network access/availability required to engage complex members.
Many plans struggle with being able to allocate the necessary resources to identify, engage and ensure these members are receiving timely, coordinated and appropriate treatment. A recent Deloitte survey found that 58% of health plan/health system CFOs are moderately or not prepared for consumer engagement in the future, while 48% cited “allocation of resources based on historical risk experiences” as a top challenge to preparing for the future. Additionally, 38% cited having “more important organizational priorities”.[9] Staggering numbers indicate the opportunity to drive significant reduction in healthcare costs: In the U.S., the economic burden of major depressive disorder is estimated to exceed $210 billion annually. Of these costs, 45% were due to direct costs, 50% to workplace costs, and 5% to suiciderelated costs. [10]
Further, a recent report from McKinsey estimates that the prevalence of new behavioral health conditions could increase by 50% by the end of 2021, resulting in $100 to $140 billion in additional healthcare spending. [4]
Solution: Ontrak’s integrated suite of interventions complements health plans’ existing behavioral health programs to identify and engage members who require a high-touch, sustained approach to engagement.
Ontrak’s advanced analytics combined with human connection identifies and engages members who may not have been participating in behavioral health care due to myriad and complex barriers to care.
• Ontrak’s robust suite of coordinated services includes:
− Member engagement specialists
− Nurse-delivered virtual care coaching
− Therapist and psychiatrist visits offered both in-person and via telehealth
− Pharmacotherapies − Local in-market Community Care Coordinators
− Digital tools and resources
• There are proven cost savings of 40% – 50% in the enrolled populations
− Significant medical cost savings are driven in large part by utilization reduction in ER visits, inpatient admissions, and re-admissions
Challenge #4: Technologies and apps alone frequently fall short of promoting long-term engagement or improvement for members with moderate or severe depression diagnoses.
Solution: Ontrak’s “fingerprinted” approach personalizes interventions over a sustained period of up to 52 weeks, allowing members to connect with the program in a supportive manner that provides sufficient time to empower lasting behavior change. Boots on the Ground: Community Care Coordinators, are critical to the whole-person approach for each member and create the conditions for success in the program. Diverse Approaches: Members have access to a wide array of evidence-based engagement approaches that can be chosen to best suit their lifestyle.
The lived-experience of success as a result of participation in the program promotes enduring self-management and treatment adherence.
Conclusion
Many people with depression aren’t receiving adequate care for their condition due to a variety of barriers related to health system resources, socioeconomic conditions, and individual circumstances. A large portion of this group also have chronic medical comorbidities, resulting in significant inflation of healthcare costs that could be prevented with appropriate engagement and intervention.
By design, the Ontrak program helps members address the underlying barriers to care and untreated behavioral conditions that cause or exacerbate chronic medical conditions, empowering and enabling them to manage both their behavioral and physical health.
The program takes the same member-centered approach to engagement regardless of the health issues or circumstances that drive members into the program, which is why Ontrak has continued its impressive growth trajectory and seen repeated success both before and during COVID-19.
Ontrak’s unique approach to this problem has found success by:
• Leveraging advanced analytics to identify this hidden population with an unmet need for behavioral healthcare
• Building trust with members and connecting their goals to actions that promote better health
• Taking a sustained, whole-person approach that meets members where they are and incorporates support for social determinants of health
• Providing strong provider network integration and collaboration
The healthcare community must act now to address the rapidly growing behavioral health concerns in our communities. By leveraging technology and integrating care, we can seize the opportunity to greatly improve health outcomes, bend the rising cost trend, and promote resiliency during and after these challenging times.
