Results and Social Return on Investment: $3.6 Million

The results of the model have been strong. Patients who are offered behavioral health care are happy to know that the service is available. Some report that they are coping just fine and don’t need the service; however, many have something that they want to discuss and are very grateful that someone is there to provide immediate support for their concerns.

The types of behavioral healthcare treatment provided vary greatly depending on the patient. Because the behavioral health consultation approach is a generalist model, the behavioral health specialists are able to address a wide range of patient concerns. Consistently, however, patients are able to take the treatment plan developed during the behavioral health consultation and start using it right away. One patient who received behavioral healthcare treatment said, “It’s hard, but I am trying. I did speak with my sisters and my boyfriend about my problems, and I feel less alone. I am using the list you gave me of things I can do each day to help myself. Thank you for taking the time to listen and help.”

In a 2009 study of healthcare expenditures, the Agency for Healthcare Research and Quality found that mental disorders and trauma-related disorders were two of the top five most costly conditions. These two conditions also represented the largest increase in expenditures from 1996 to 2006. The money spent on mental disorders alone rose from $35.2 billion in 1996 to $57.5 billion in 2006 (Soni 2009). Mental health care is currently costing the healthcare system a staggering amount — but how much more does it cost when mental health issues go untreated?

The few studies that have examined the direct and indirect costs of integrated behavioral health care from a societal perspective have found that collaborative (integrated) care was associated with overall cost savings (Katon 2008). These findings are further substantiated by emerging evidence showing that unemployment is reduced and economic productivity increased as a consequence of case management approaches for depression (Rost, Smith, and Dickinson 2004; Schoenbaum et al. 2001).

It should be noted that costs initially increase because the model itself increases the likelihood that a patient’s behavioral health issue will be identified and addressed. As stated previously, more than 3,600 behavioral health patients were served by HFP’s model in 2008. HFP reports that it spent $61,892 (a portion of a multi-year grant from the Aetna Foundation) during that year to train clinicians and coordinate the successful implementation and development. A very conservative estimation is that HFP’s model has saved the system approximately $3.7 million.

The following formula was used to calculate the social return on investment of HFP’s behavioral health integration model (CHC = community health center). The formula takes a number of cost savings generated by the integrated model and adds them together to calculate the total amount saved by this innovation.

When developing this formula, a number of assumptions were made. First, it is assumed that a percentage of patients with untreated behavioral health issues will ultimately seek emergency care. A conservative estimate of 5 to 15 percent of the 3,600 patients was used. It is also documented that a patient with an untreated behavioral health issue is more likely to use additional health services, so the estimated cost of additional health center visits is factored into the equation. It is also assumed that a small percentage of patients may miss work as a result of a decrease in functionality and an increase in physical health ailments brought on by behavioral health issues.

When taking into account that a significantly greater number of patients may use the emergency room because of untreated behavioral health issues (15 percent of all patients as opposed to 5 percent), this figure skyrockets to $11.7 million. It should be stressed that this equation is based on extrapolation and estimates of the following:

• The cost of 5 to 15 percent of 3,600 patients visiting the emergency room for their untreated behavioral health condition
• The cost of patients returning to the community health center for subsequent primary care visits as a result of their untreated behavioral health condition
• The cost savings of a behavioral health specialist being able to see up to 12 patients during the workday, as opposed to four
• The cost of 10 percent of patients missing work as a result of decreased functionality brought on by a mental health issue

In 2008, there were nine behavioral health specialists trained and working in HFP member health centers with the integrated model. Based on HFP’s budget of $61,892 for the model during that year, it costs approximately $6,877 to train each specialist. This does not include cost of the clinical staff itself, which the clinic absorbs. On average, an on-site behavioral health specialist is paid $78,000 per annum (including benefits). The budget of $61,892 does not include the actual cost of behavioral health consultations, which average a reimbursable cost of $150.
The impact of the model can also be measured in patient satisfaction. During 2007, more than 2,000 people received behavioral health services in participating health centers. The organization launched a small pilot patient satisfaction survey. When asked how much they were helped by the service, the patients rated it 3.56 (on a scale of 1 to 4). When asked if they would recommend the service to friends and family, patients gave the service a 4.0 rating. For more survey results see the appendix.