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FOR IMMEDIATE RELEASE: Depression Management Program Produces Investment Return Depression can have a chilling effect on any health plan's bottom line. The illness is estimated to cost the health care industry upwards of $30 billion a year. But managing depression like other chronic conditions can provide a healthy return on investment and cut outpatient visits, emergency room use, and inpatient admissions. The reason that depression costs are so high is that the majority of patients with the illness are not effectively diagnosed and don't receive adequate treatment, says Sam Toney, MD, president and chief medical officer of Health Integrated, Inc., a Tampabased company that runs a depression disease management program. Two-thirds of patients with depression never receive treatment, he says. "It's a pervasive problem, and one of significant proportion, both from a perspective of the sheer numbers of people that are impacted by this and the dollars that are attached to the problem," Toney says. The latest research indicates that depression costs the U.S. $83 billion annually in lost productivity and health care treatment costs. Depression can also complicate the treatment of other chronic conditions, he adds. Between 25 percent to 35 percent of diabetic patients have depression as a comorbidity, while anywhere from 25 percent to 30 percent of cancer patients have depression. Patients who have survived a heart attack are the most susceptible, with between 40 percent and 65 percent suffering from depression. Once someone has depression, Toney says, it makes it much harder for other chronic medical problems to be treated. Depression can decrease motivation to participate in medical treatment and it can impair cognitive abilities such as concentration and problem solving. "So you can imagine if a patient has a medical condition for which they require ongoing complex treatments, if there is a depression in the picture, the ability to understand, to comprehend, to be engaged at all in their treatment is impaired." Many health plans do offer coverage for behavioral health conditions like depression, but Toney contends that the traditional approach is insufficient. Health plans tend to be reactive to the problem, and not proactive, he explains. Traditional approaches usually ignore any treatment or diagnoses rendered by providers who are not psychiatrists, psychologists, or social workers, he says. That happens, despite the fact that most depression is treated in the primary care setting. "There isn't any proactive approach to identifying who these people are, there isn't any approach to educate them and to monitor and manage their condition on a continuous, ongoing basis," says Toney. The traditional approach to managing depression has not been effective, he contends, because the focus has been on whether it is appropriate for the patient to be receiving care, rather than on encouraging and facilitating treatment. Only about onethird of the people with depression actually receive treatment, he says, and only a minority of the people who are treated for depression receive an adequate amount of care. Health Integrated's depression disease management program is different because it proactively identifies health plan members who need treatment, Toney says. The program actively locates both members who have been diagnosed with depression and those who have a high risk of developing the illness. "On the very front end of the equation, what we are doing is seeking those members out, screening them for either the appropriateness of being enrolled in a program like this or screening them for the presence of depressive symptoms to begin with," he says. Candidates for the disease management program are identified through claims data, he says. Health Integrated looks at particular diagnostic categories and pharmaceutical codes and places individuals in one of several categories. Some members have definitive depression because they have already been diagnosed with the condition. Other members might not have the illness yet, but they are in the process of developing it or are at high risk for having the illness. After reviewing claims data, Health Integrated screens individuals by telephone, Toney says. Members are first sent a letter letting them know that Health Integrated will be calling. Once the member is on the phone, he or she is asked to participate in a questionnaire regarding his or her health status. "If they agree, we then proceed with the depression screening tool to determine whether or not they might have evidence of a depressive disorder." Health Integrated uses validated industryrecognized tools to screen members, such as the Hamilton Depression Scale, he emphasizes. Members who meet the criteria for participating in the program are invited to join, Toney says. The members can be given incentives to participate, such as reduction or elimination of copayments for visits or gift certificates. But Health Integrated always gets members' consent to participate before going further, he says. "We don't proceed with any of these steps without patient buy-in and consent." About 60 percent of the members that Health Integrated is able to contact end up enrolling in the depression management program, he says. Once the members are enrolled in the program, they are managed in a different way, Toney continues. The program does not focus on utilization management or certifying the appropriateness of care for payment. Rather, the approach is to focus on the patient and engage him or her in the treatment plan. Using a number of clinical assessments, program enrollees are clinically stratified to determine their risk level, Toney says. The number of contacts with Health Integrated varies, depending on the risk level. Nurses or clinicians make outbound telephone calls to members to establish a relationship with them, he says, and to monitor and support them in navigating the health care system. Educational materials on depression are sent both by the mail and the Internet. A specific care plan for each patient is developed, Toney says, based on the problems that Health Integrated identifies. The company then works with providers in several ways. All providers are sent post-assessment updates on the patients that are enrolled in the program. They also receive educational materials to assist them in making the diagnosis and treating depression. In many cases, Toney says, physicians are doing everything they can to treat depression. They are writing the correct prescriptions, determining the correct dosages, and referring patients to psychotherapy. It then becomes an issue of the patient's readiness to change and to accept responsibility for managing their own care. Health Integrated works with the patients to make that happen, he says. When Health Integrated's disease managers recognize that there is an opportunity to enhance the treatment plan, such as a medication is not at the optimal dose, then one of the company's medical directors may contact the patient's health care provider to discuss the case and the opportunities for enhancing treatment. The medical director may also monitor the case and contact the patient directly. The processes that the depression program is based on are similar to those used by other disease management programs, Toney acknowledges. But using the disease management model is still a new approach for monitoring and managing the treatment of depression, he says. Using a disease management approach for depression does appear to be effective. Toney says a six-month study of approximately 500 members of a Midwest health plan found a return on investment of 1.5 to 1. Preliminary results of the study showed a decrease in outpatient visits related to depression, a decrease in outpatient visits for other medical problems, a drop in emergency room use, and a decline in medical inpatient days per thousand. Not only are costs lowered, but the people enrolled in the depression management program are making greater progress in getting better, he says. In depression treatment, the goal is to push the illness into remission, Toney explains. "We have a significant percentage of the population enrolled who reach remission, as defined by the Hamilton Depression Scale." For more information call 877-267-7577 or visit the website at www.healthintegrated.com. |