Overview
The behavioral health series examines how mental health and substance use disorders affect health, costs, and care delivery. It covers diagnosis, treatment, access barriers, regulation, emerging innovations, and strategies health plan sponsors can use to improve outcomes and affordability.
Key Finding From Each Paper
- Introduction to the Behavioral Health Article Series: Behavioral health has implications beyond direct behavioral health spending. People with behavioral health conditions can have substantially higher overall healthcare costs, creating opportunities for integrated care and other interventions to improve outcomes and potentially reduce total costs.
- Behavioral Health Care: Diagnosis and Treatment: Behavioral and physical health are closely connected. About 70% of patients with a behavioral health disorder also have a medical comorbidity, making accurate diagnosis and coordinated treatment especially important.
- When Substance Use Becomes a Disorder: Causes, Consequences, and Costs: Substance use disorder is a neurobiological condition with significant health, financial, and social consequences. Trauma is an important risk factor, and integrated treatment for substance use and co-occurring mental health conditions may improve outcomes.
- Behavioral Health Barriers to Care: Access problems are multifaceted and systemic. Stigma, provider shortages, fragmented care, insurance complexity, affordability, and quality issues can prevent people from receiving appropriate behavioral health treatment, even when they have insurance coverage.
- Behavioral Health Regulation: U.S. behavioral health regulation is divided among federal, state, and local governments. Key areas include mental health parity, required benefits, preventive services, network adequacy, provider oversight, workforce development, and crisis response.
- Innovation in Behavioral Health: Genomics, AI, digital therapeutics, telehealth, wearables, and advances in drug and electrical therapies may improve behavioral health diagnosis, treatment, and access. However, emerging technologies, particularly AI, require clinical oversight and continued evaluation.
- Developing and Evaluating Behavioral Health Solutions: Health plan sponsors can address behavioral health through care management, provider management, benefit and premium strategies, and crisis management. Evaluation should consider both financial results and effects on health, access, satisfaction, and quality of life.
Podcast
Developing and Evaluating Behavioral Health Solutions
Acknowledgements
The researchers’ deepest gratitude goes to those without whose efforts this project could not have come to fruition: the Project Oversight Group for their diligent work overseeing, reviewing, and editing this report for accuracy and relevance.
Joan C. Barrett, FSA, MAAA, Chair
Kenneth Avner FSA, MAAA
Craig Cartossa ASA, MAAA
Gary Claxton
Stoddard Davenport, MPH
Greg Fann FSA, MAAA, FCA
William Olaprath FSA, MAAA, CERA
Luis Maldonado FSA, MAAA
Dan Mulhern FSA, MAAA
William Olaprath FSA, MAAA
Rebecca Owen FSA, MAAA, FCA
Margie Rosenberg FSA, Ph.D.
Sudha Shenoy FSA, MAAA, CERA
Keith Walter FSA, FCIA
David Wierz
At the Society of Actuaries Research Institute:
Achilles Natsis, FSA, MAAA
Barbara Scott, Sr. Research Administrator
FAQs
Behavioral health conditions are associated with physical health, healthcare utilization, productivity, and total healthcare costs. The paper suggests that better prevention, identification, treatment, integrated care, and crisis management may create opportunities to improve outcomes and manage costs.
Diagnosis generally progresses from identification and evaluation to an initial treatment plan, followed by monitoring and reevaluation. Treatment may include psychotherapy, medication, or both, depending on the condition, severity, comorbidities, patient characteristics, and clinical judgment.
Substance use disorder involves recurrent substance use that causes significant impairment. Treatment can include inpatient or outpatient programs, medications, therapy, and support groups. Integrated approaches may be particularly important for patients with co-occurring mental health conditions or trauma.
Major barriers include stigma and discrimination, provider access and shortages, difficulty navigating fragmented systems, insurance complexity, affordability, care-management challenges, and limitations in quality measurement. Addressing them generally requires coordinated clinical, health plan, public health, and policy responses.
Regulation is shared across federal, state, and local governments. Federal requirements address areas such as parity and health plan standards, while states oversee areas including Medicaid administration, provider licensing, insurance requirements, network adequacy, and aspects of crisis response.
Genomics, AI, telehealth, digital therapeutics, wearables, personalized medicine, and advances in drug and electrical therapies could improve diagnosis, treatment, monitoring, and access. The paper cautions that technologies such as AI should currently supplement rather than replace clinical judgment.
Health plan sponsors can use care management, provider management, benefit and premium strategies, and crisis management. Solutions can be evaluated through clinical research, actuarial analysis, experience studies, dashboards, member surveys, and other measures of financial and nonfinancial value.