Milliman Behavioral Health Advisor
Why healthcare costs are considerably higher for patients with
chronic medical conditions and comorbid
psychological disorders
Our research shows that there are significant levels of comorbid behavioral disorders
among members who suffer from chronic medical conditions.
Our soon-to-be released Milliman research report,
“Chronic conditions and comorbid psychological
disorders,” details the healthcare cost impact of comorbid
depression and anxiety on patients who have chronic
medical conditions. The findings of the report show that for
patients with chronic medical conditions, costs are
significantly higher for those who also have comorbid
depression or anxiety. Dr. Roger Kathol of Cartesian
Solutions, Inc. ™, co-presented on this topic with me at
this week’s Society of Actuaries Health Conference in Los
Angeles. He did a great job explaining causes of this cost
increase and highlighted other negative effects of
comorbid behavioral disorders on chronic disease
patients.
Depressed Diabetics – An Example of Behavioral
Differences
Is This An Opportunity for Change?
Our research shows that there are significant levels of
comorbid behavioral disorders among members who
suffer from chronic medical conditions. And far too often,
they are unidentified, untreated, or ineffectively treated. A
system of segregated physical and mental healthcare
contributes to this issue. We challenged the health
actuaries in attendance at our session to consider new
innovative solutions to this problem in their organizations
and their healthcare products. There were a lot of heads
nodding, which I was pleased to see. I believe that there is
more momentum gathering for integrated medicalbehavioral approaches, which I believe is just what we
need in the U.S healthcare delivery systems.
Dr. Kathol indicated that depressed diabetics have higher
probabilities of experiencing specific symptoms such as
daytime sleepiness, blurred vision, shakiness, and pain in
the hands and feet than their non-depressed counterparts.
They have a significantly lower level of control of their
HbA1c levels. Depressed diabetics also have a greater
probability of having 3 or more cardiac risk factors than
non-depressed diabetics (61.3% to 35.0%).
In addition to experiencing higher probabilities for
troublesome and even dangerous symptoms, depressed
diabetics are less likely to have good self-care. Medication
non-adherence among depressed diabetics is 30% to 50%
higher than in their non-depressed counterparts. Diabetic
patients with depression are also less likely to eat healthy,
less likely to exercise consistently, and more likely to
smoke than non-depressed diabetic patients. The
increased likelihood of troublesome symptoms, lack of
self-care, and other undesirable health outcomes
associated with comorbid depression in diabetics
undoubtedly contribute to the increase in costs associated
with this population.
The Behavioral Health Advisor is a monthly publication by Steve Melek, designed to
bring interesting and informative behavioral health topics to the forefront. Melek is a
leading professional in combining actuarial expertise with behavioral health knowledge.
He consults on effective integration of medical and behavioral healthcare, efficiency in
delivery and successful health outcomes, predictive modeling, and collaborative
research with other disciplines.
May 2008
Stephen P. Melek, F.S.A., MAAA
Principal & Consulting Actuary
Direct: 303 299.9400
Steve.Melek@milliman.com
milliman.com