Cost Prevention Versus Cost Containment: The Value of Behavioral Health Services

At the 2021 Fall Managed Care Forum, Mark Carlson, MD, and Steve Girardeau, PsyD, LP, from Mental Health Systems MN, jointly spoke about the potential value of behavioral health services across the entire health care model.

Describing the scope of the spiraling health care costs problem, Drs. Carlson and Girardeau cited statistics showing that 75% of the monies spent on health care in the U.S. are for treatment of chronically ill patients, and some of the largest health care expenses are preventable hospitalizations, unnecessary emergency room visits, and ineffective treatment of “super-users” (the estimated 5% of Americans who consume 50% of health care spending).

Drs. Carlson and Girardeau then explained how engaging patients in behavioral health services could have far-reaching implications for the entire health care enterprise, with the caveat that empowering patients to seek these services is a difficult endeavor. Patients with serious mental health diagnoses comprise approximately 41% of super-users, and account for health care spending of approximately $87,236 per person per year.

“Patients do not want the illness or condition they have been diagnosed with,” they noted, adding that educational materials are given at ineffective times and behavioral health referrals are often “blocked by myth and stigma.”

To better engage patients in their own health and medical care, which will directly impact patient functioning and health care costs, Drs. Carlson and Girardeau recommended “appealing to patients’ better thinking and emotions” to develop trusting relationships with providers. “Challenge assumptions that patients know what is best for them and will follow a logical course of action,” they said. “Keep in mind that it is easier to do nothing than to do something – especially when you are being forced into something.”

After prescribing additional health care services, the presenters went on to describe how this request fits within the context of rising health care costs. “While per capita spending on mental health has continued to rise, the money is not going to increased outpatient therapy rates,” they noted. “Behavioral health interventions save money through prevention of costs.”