While congress wrestles with which parts of the Affordable Care Act (Obamacare) to keep and which parts to eliminate or replace, it is important to recognize that there are other, well known, effective ways to bring down the overall cost of healthcare without reducing access to care for large numbers of Americans. The two most well known are:
1. Prevention; which can be population-wide and very cost effective and,
2. Early treatment; before it becomes severe and chronic.
Another, less-well known method, is through integrated care for those with multiple severe and chronic conditions with both medical and behavioral health disorders.
A therapist can treat an uncomplicated behavioral health problem such as mild depression with efficiency and effectiveness and can do so independently without coordination with other disciplines. However, if one suffers with a disorder until it is chronic and severe, or it is now accompanied by additional health issues, the cost of treating the disorder skyrockets. If in addition to the high blood pressure, one abuses substances, the disorder becomes even more complex, difficult and costly to treat. Amazingly, the percentage of adult Americans with co-occurring complex behavioral and medical conditions is only about 20%. However, this group consumes 4 times more healthcare dollars than the 80% remainder of the population*.
The group with complex, hard to treat conditions such as severe addictions and chronic mental illness plus a trauma history and a medical disorder often requires integrated care from multiple disciplines to be effective. For instance, treating diabetes and alcoholism in a coordinated fashion will be more effective than treating them separately or treating one and not the other disorder. Behavioral health specialists are beginning to team up with medical doctors to treat these complex cases, sometimes forming business partnerships. These “treatment teams” meet to form integrated treatment plans, keep a combined patient record and may utilize Case Managers to monitor progress. This kind of coordinated treatment of physical and behavioral issues is becoming more common in progressive hospitals systems, but has yet to be fully embraced in all areas.
There is another phenomenon that contributes to complex, severe and chronic disorders in adults. According to the Adverse Childhood Experiences (ACE) study, by the Centers for Disease Control, childhood trauma is associated with complex medical and behavioral health disorders throughout the lifespan of the individual. This is likely because early trauma interferes with the development of the brain and necessary skills to maintain oneself in a pro-social world of people. It also interferes with the development of healthy relationships, which can cause people to avoid help. Childhood is a time when the professional community can take actions to prevent severe and chronic medical and behavioral health disorders from developing by providing sufficient services during these early years. Therefore, providing behavioral health services for children that have experienced early traumatic events helps them develop the skills they need to cope with everyday issues, heal from trauma, and be healthy because of good health habits and preventive healthcare throughout their lives.
Identification of individuals with behavioral issues when they are children also allows such interventions to occur when they can do the most good. Tools are beginning to be available for these childhood identifications, including those for depression, sexual abuse and risk of committing future violent acts (which can be traumatic for the offender as well as the victim). Within my practice, we use an internally developed risk and needs assessment for the identification of children ages 6 to 18 at risk for committing future violent acts (and have conducted research to confirm its utility). Early identification of at-risk children can prevent a lifetime of physical and behavioral issues.
Through preventive care, coordinated behavioral / medical care and childhood behavioral / medical care (identified through the use of proven assessments), overall healthcare costs can be reduced and outcomes improved. I encourage everyone who hasn’t made these practices part of their commitment to healing to take these positive steps toward making healthcare more effective and affordable for everyone.