Managing Care: Cost Control Strategies in Behavioral Health

Overall, managed behavioral health care has helped contain rising costs by shifting the level of care from more expensive inpatient hospital care to less costly outpatient care.
Overall, managed behavioral health care has helped contain rising costs by shifting the level of care from more expensive inpatient hospital care to less costly outpatient care.

Managed Behavioral Health Care

Managed health care refers to the strategies used by many health plans to control costs of health care while ensuring quality of care and encouraging appropriate use of health care. Managed behavioral health care applies the same principles and strategies to manage behavioral health care costs. Behavioral health care includes treatment for mental health and substance abuse disorders. Behavioral health is usually managed separately from medical care, and often involves different co-pays and benefit limits.

Spending on Behavioral Health

1986 
2003 
2014 
 
 
 
 
 
 
$42 billion 
$121 billion 
$239 billion 

Total US Health Care Spending: $3.5 trillion

1986 
% of Total 2003 
% of Total 2014 
9.7% 
7.5 
6.9 
% of total health care spending
 spent on Behavioral Health
is decreasing 
 
 
 

Growth Rate of Behavioral Health Spending

1986 -2003
2003 -2014
change 
6.4% 
6.4% 
.
 
 
 
 
 

Growth Rate of Overall Health Spending

1986 - 2003
2003 - 2014
change
8.0% 
7.2% 
<0.8%> 
 
 
 
 
 
 

% Behavioral Health Dollars Spent on Prescription Drugs

2003 
2014 
23% 
30% 
 
 
 
 

Proportion of Behavioral Health Dollars Spent on MH vs. SA

1986 
2003
2014
Mental Health  78%
83 %
85%
Substance Abuse  22%
17% 
15%
 
 
 

Spending on Behavioral Health

Spending on mental health and substance abuse treatment in the US is expected to be $239 billion by 2014. It was $42 billion in 1986 and $121 billion in 2003. The rate of growth in spending on behavioral health will be slower than for all health care spending in the next decade and will account for a smaller share of total US health care spending of $3.5 trillion: from 9.7% in 1986 to 7.5% in 2003 and 6.9% in 2014.

The decreased rate of growth in spending on behavioral health care is due largely to the fact that behavioral health care spending will not be impacted by the drastic increases in spending associated with high cost technology that is driving overall health care spending. MRIs, brain scans and surgeries are not required to diagnose or treat behavioral health conditions.

The cost of prescription drugs for behavioral health conditions is a significant portion of behavioral health expense. Spending on prescription drugs is increasing at a faster rate than overall behavioral health spending. Consequently, spending on behavioral health will continue to grow at the same rate of 6.4% after 2003 as it did before 2003. Overall health spending will increase at a slower rate of 7.2% - down from the 8.0% increase prior to 2003. In 2014, 3 of 10, or 30% of behavioral health care dollars will be spent on prescription drugs, up from 23 % in 2003. The use of drug formularies has encouraged many people to switch to generic drugs to save on out of pocket expenses. This has helped slow cost increases for drugs.

Of the total amount of health care spending, 7-10% is for behavioral health. Of that portion, most of the behavioral health dollars appear to be spent on mental health rather than substance abuse treatment; 78% in 1986, 83% in 2003, and 85% is expected in 2014. Substance use disorders typically co-occur with mental health disorders, especially with mood and anxiety disorders, and providers typically code their billing using a primary diagnosis. Since insurance coverage is sometimes more generous for mental health than substance abuse, the mental health diagnosis is typically used as the primary diagnosis for billing purposes, rather than the substance abuse diagnosis. So the numbers are misleading in that regard. While there are differing trends in mental health and substance abuse spending, it is generally more helpful to consider the combined spending for mental health and substance abuse disorders.

Overall, managed behavioral health care has helped contain rising costs by shifting the level of care from more expensive inpatient hospital care to less costly outpatient care. These shifts have worked well for the majority of people with milder mental health conditions such as mild to moderate depression and anxiety. There is some concern that the most severely mentally ill, adults with schizophrenia and bipolar disorders, as well as children with severe disturbances may be experiencing some restricted access to the intensity of services they require as a result of managed care practices. Outpatient services are now more accessible, but more intensive services are not readily available. A small percentage of behavioral health consumers utilize a majority of the more costly and intensive behavioral health services. Most of these truly need the services. There are some who over utilize the services. Identifying those who over utilize and helping them learn to use services appropriately is a function of managing behavioral health care, as is recognizing when a person truly needs more intensive services and ensuring access to those services.

Managed Behavioral Health Care

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Comments 5 comments

kimh039 profile image

kimh039 6 years ago Author

Hi Shirley. Without health it would be difficult to meet basic needs, for sure. Thanks for taking the time to read and for posting the first comment on this hub!


vrbmft profile image

vrbmft 6 years ago from Yucaipa, California

Hi Kim

I'm always amazed at your ability to pull out of cyber space, the data, the numbers. Part of me cares less!!! But I know, these numbers are going to become increasingly important in so many ways.

In 1984, Blue Cross of California published a study that showed folks receiving outpatient mental health services actually experienced 2/3 less medical problems than the general population. The 2/3 deal is kind of interesting, in terms of Eisink"s 2/3 phenomenon. I'm not sure if I spelled his name correctly, but he is the one, years ago, whose research showed 2/3 of the people get better no matter whether or not they have treatment or no treatment or take a handful of almonds three times a day!! BUT my point is this. That study made the headlines in Insurance Newsletter, and then suddenly idsappeared, and I wish I would have save the article. Never saw anything even close to that article since!!

Anywho, the "bad" part of insurance coverage is sometimes people put the responsibility for their mental health, in particular, and services they can receive, in the hands of their policy, even folks who can actually afford to pay for mental health services out of pocket. Over the years, I have not regretted one bit paying top dollar for my therapy.

So anywho, thanks for the informative hub. Always enjoy reading your hubs.

Vern


kimh039 profile image

kimh039 6 years ago Author

You're so incredibly wonderful for saying such awesomely kind things. I'll see if I can find that study! It sounds like Hawthorne effect where people get better just knowing they're being watched/payed attention to. Thanks for enjoying my hub, vern.


epigramman profile image

epigramman 6 years ago

....we have a different health care plan here in Canada and I would say it's one of the best in the world because the government pays for most of our health needs and our health care system was pioneered by one of our great Canadians - Tommy Douglas of the NDP Party - and speaking of behavioral health - I always behave in good health and spirits when I come to visit you my friend and say hello and hope you are well ......please keep in touch and keep thinking those good thoughts ......


kimh039 profile image

kimh039 6 years ago Author

Really? i think that would cost too much in taxes here for us rebel rousers! it would be nice to know that health care needs are taken care of....but there would be too many strings attached. I wouldn't want the gov't to make decisions about my life! affordable private care would be ideal. sending positive thoughts your way, colin. all is well. thanks.

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