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Integrated care Featured

12:17pm EDT February 26, 2002
It makes sense -- our emotional well-being affects our physical health. But within the sphere of employee benefit plans, there has traditionally been a separation between the two.

For those charged with managing a company's employee benefits plan, the question is not merely academic. Breaking down the barriers between physical and behavioral health care delivery systems can improve clinical outcomes for employees while reducing medical costs for companies. And that has a positive effect on the bottom line.

Behavioral health disorders affect up to 25 percent of the work force, drive as much as 60 percent of physician office visits, are a leading cause of disability and absenteeism, and often constitute the top spending in pharmacy plans as medications to treat behavioral health disorders become more available and more commonly used.

Behavioral health as a workplace issue

The U.S. Surgeon General has identified depression as second only to heart disease in the magnitude of the burden it creates for society.

Those who suffer from it often struggle to carry out their workplace responsibilities while coping with a debilitating illness that presents no obvious outward signs. Fortunately, it is treatable.

But the costs associated with not responding to depression can be staggering -- at a personal level as well as at a financial level. The Wall Street Journal estimated recently that depression's annual toll on U.S. businesses amounts to $70 billion in medical expenditures, lost productivity and associated costs.

An integrated approach -- one that treats body and mind -- offers the best course for treating depression and other illnesses. But that approach will fail unless a company's health care benefit plan promotes it.

Working together

The health care professionals who serve a company's employees -- doctors, pharmacists, and behavioral health providers -- must work together across the continuum of care, from prevention to treatment to recovery.

While an illness like depression might be seen as a matter for behavioral health professionals, primary care physicians play a large role in its diagnosis and treatment. Industry data show that up to 70 percent of all antidepressants are prescribed by a patient's primary care physician.

Conversely, when a patient receives treatment for depression from someone other than the primary care physician, it's important the physician be aware of and engage in that treatment. This collaborative approach helps primary care physicians and behavioral health providers work together to treat the whole patient.

Sharing vital information

Sharing information is also important when it comes to medications, especially if the patient is receiving multiple medications that could interact in harmful ways.

Employee benefit managers should make certain their company's health care delivery system allows for data integration among pharmacy, behavioral health and medical plans. Some health insurers are deploying Internet-based technology to make sharing information more seamless while ensuring patient confidentiality.

Disease management programs

Because patients with certain physical conditions are at greater risk for developing depression, an integrated approach to health care should include well-developed disease management programs. Patients with diabetes or heart disease should be screened for depression early for improved clinical outcomes for the patient and employer savings through lower disability costs, decreased absenteeism and improved productivity.

Depression and diabetes. Stress and heart disease. The mind-body connection is undeniable. Understanding all the factors that contribute to health and illness means better prevention, more accurate diagnoses, more effective treatment and a faster, safer return to work for employees.

As companies recognize the benefits of an integrated behavioral health-medical services program in the prevention and resolution of problems that adversely affect their employees and workplace, they will increasingly look to organizations that have the experience, clinical expertise, and technological capacity to build and deliver integrated programs. Colette Edwards, M.D., is vice president and senior medical director of CIGNA HealthCare of Ohio. CIGNA is one of the nation's leading providers of health benefit programs, with managed care networks serving 45 states, the District of Columbia and Puerto Rico. CIGNA provides medical coverage through managed care and indemnity programs to more than 13.3 million people, including more than 250,000 in major Ohio markets. Reach Edwards at (800) 541-7526.