Social determinants and collaborative health care: Improved outcomes, reduced costs

Implications and opportunities for health plans and states

Traditionally, physical health has been the primary clinical and financial focus of US health care stakeholders. However, new research shows that a collaborative care model with not one, but three factors can dramatically influence a person’s health status and associated health care costs: physical health, behavioral health, and social determinants.

Three key factors to improving health care and costs

Ultimately, we all want two things for our health care: improved outcomes and reduced costs. How do we achieve that? Research has shown that health care models that integrate physical health, behavioral health, and social determinants may further improve individual and overall outcomes, and provide the cost savings that health plans and states are looking for.

This paper reviews some of the individual and collective impacts that physical health, behavioral health, and social determinants have on individuals and the US health system; examines how collaborative care models can help to improve outcomes and lower costs; discusses challenges to implementing integrated care; and suggests implications and opportunities for health plans.

Why focusing on physical health alone is not the only answer

For many years, physical health has been the primary clinical and financial focus of US health care stakeholders: providers, payers, life sciences companies, employers, people receiving services, and US federal and state governments.

Still, achieving and maintaining good health depends, in part, on people making conscious decisions to engage in positive behaviors–eating healthy foods and exercising are obvious choices—and to avoid risky behaviors such as smoking and heavy drinking. Some less recognized and/or acknowledged behavioral health risks—among them mental health conditions, substance abuse, and stress management–can have a disproportionally detrimental impact on physical health and health care costs, especially when they are not properly treated. Our paper delves into some impressive statistics on this topic.

Physical, behavioral health are linked

Despite US health care’s history of treating physical health conditions independently from behavioral health, the two are most definitely linked. Up to 70 percent of physician office visits are for issues with a behavioral health component. A similar percentage of adults with behavioral health conditions also have one or more physical health issues. Having a chronic condition puts people at risk for a behavioral health condition and vice versa.

People with combined chronic medical and behavioral health conditions cost the health care system significantly more than those with only a chronic medical condition. For example, annual health care costs are much greater for adults who have diabetes or heart disease and depression. Unfortunately, the current fragmented state of mental health, substance use, and medical services results in inadequate care for those with mental illness.

(1) Kessler et al., NEJM. 2005;352:515-23

Social determinants directly and indirectly shape health

Scientists have found that the conditions in which we live and work have an enormous impact on our health. Social determinants, some of which individuals can do little or nothing to control, can, directly and indirectly, shape physical and behavioral health. Among these influencers are income, education, living and working conditions, transportation availability, and environmental factors (e.g., lead paint, polluted air and water, dangerous neighborhoods, and the lack of outlets for physical activity). Case in point: While research suggests that chronic stress can have direct physiologic effects on health, it also may affect health-related behaviors. For example, children who experience stressful circumstances, especially on a daily basis, are more likely later in life to adopt—and less likely to discontinue—risky health behaviors like smoking and drug or alcohol abuse that may function as coping mechanisms.

That being said, many policymakers, program administrators, clinicians, and advocates have suggested that coupling behavioral and physical health services through collaborative care models would not only improve health outcomes for Medicaid beneficiaries, it would also help to reduce costs.

Examine our paper that dives into the challenges and benefits of collaborative care.

(2) “A New Way to Talk About the Social Determinants of Health,” Copyright 2010 Robert Wood Johnson Foundation

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