Frequently Asked Questions

Are integrated physical and mental condition services in complex patients economically advantageous?

There is now indisputable evidence that the integration of physical and mental condition services can be associated with a reduction of the total cost of care for complex and/or comorbid patients if programs are properly configured. Cost savings become evident after the first year of integrated service implementation when the patient's health has had a chance to improve and health service needs have stabilized. Importantly, return on investment directly through lower health spending and indirectly through increased productivity can be substantial and persist over time (see Tables below). Savings accrue to both purchasers of care and health plans through reduction in claims costs and administrative simplification. Physical and mental condition integration can also reduce un- or under-reimbursed clinical care in complex patients for care delivery/accountable care organizations by decreasing the need for these patients to use medical services because their health has stabilized and illness complications are reduced.

Integrated Depression/Chronic Medical Illness Case Management
(Net Savings $136 to $201 Per-Member-Per-Month)

Medical Costs: $175 to $222 per-member-per-month decrease
- Inpatient Care: $129 to $170 per-member-per-month decrease
Pharmacy Costs: $21 to $40 per-member-per-month increase
- Antidepressant Costs: $8 to $11 per-member-per-month increase
Net Cost: $136 to $201 per-member-per-month decrease
Net Medical Cost Reduction with 3:1 return on investment
Average work days gained per month--3.95
Improvement in work performance--11.2%

Hyong, Un MD: www.academyhealth.org/2006/tuesday/611/unh.ppt
http://www.aetna.com/news/0816.htm;

Four Year Direct Health Care Cost Savings in Depressed Medical Patients with Integrated Care (IMPACT)
Cost Category	4-year Costs in $US	Integrated Care Service Use in $US	Usual Care Service Use in $US	Savings in $US
IMPACT program cost		522	0	522
Outpatient mental health costs	661	558	767	-210
Pharmacy costs	7,284	6,942	7,636	-694
Other outpatient costs	14,306	14,160	14,456	-296
Inpatient medical costs	8,452	7,179	9,757	-2578
Inpatient mental health / substance abuse costs	114	61	169	-108
Total health care cost	31,082	29,422	32,785	-$3,363
Unutzer et al. Am J Managed Care 2008.

The majority of data demonstrating cost savings relate to those with comorbid depression and medical illness. The literature, however, also now reports numerous examples of cost saving in medical patients with other mental conditions, including those with unexplained somatic complaints, delirium, chemical abuse/dependence, and anxiety disorders (see Table below).

Integration of Health Care Delivery in Patients with Various Mental Conditions
(Improves Clinical Outcomes and Lowers Cost)

Depression and diabetes: 2 months fewer days of depression/year; projected $2.9 million/year lower total health costs/100,000 diabetic members (Katon et al, Diab Care, 2006)
Panic disorder in PC: 2 months fewer days of anxiety/year; projected $1.7 million/year lower total health costs/100,000 primary care patients (Katon et al, Psycholog Med, 2006)
Substance use disorders with medical compromise: 14% increase in abstinence; $2,050 lower annual health care cost/patient in integrated program (Parthasarathy et al, Med Care, 2003)
Delirium prevention programs: 30% lower incidence of delirium; projected $13.3 million/year reduction in IP costs/30,000 admissions (Inouye et al, Arch Int Med, 2003)
Unexplained physical complaints: no increase in missed general medical illness or adverse events; 9% to 53% decrease in costs associated with increased healthcare service utilization (summary of 8 experimental/control outcome studies)

Katon et al, Diab Care 29:265-270, 2006; Katon et al, Psycholog Med 36:353-363, 2006; Parthasarathy et al, Med Care 41:257-367, 2003; Inouye et al, Arch Int Med 163:958-964, 2003

Most "integrated care" consultation specialists target only patients, members, employees, or enrollees with depression and a concurrent chronic medical illness. Through Cartesian Solutions, Inc.™ assistance, it is possible to expand the scope of individualized clinical support by introducing complexity- rather than disease-based methodology. This allows organizations and companies to target the most needy and expensive in the population that they serve. Thus, care management programs that adopt a complexity-based approach and integrate medical and mental condition support are able to maximize return on investment while improving overall health and function in those most needing augmented health services.

For more information or to set up an appointment contact: Mary Kathol, Director of Project Implementation.

Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com

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