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class="mck-o-container--wrapped mck-o-container--mobile-spacing mdc-u-grid mdc-u-grid-gutter-xxl"><section data-layer-region="article-body-header" class="mdc-u-grid mdc-u-grid-col-md-12 mck-u-animation-blur-in-400 byline-share-container"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-8 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-8 mdc-u-ts-9"><span> </span><span class="AuthorsByLine_mck-c-authors-byline__author__XdrlD"><span class="AuthorsByLine_mck-c-authors-byline__no-wrap__Ced0j"><a data-component="mdc-c-link" href="/our-people/erica-coe" class="mdc-c-link-inline___7DRrt_8032924 mdc-c-link-inline--secondary___YKoOK_8032924"><span class="mdc-c-link__label___Pfqtd_8032924">Erica Coe</span></a> </span></span><span class="AuthorsByLine_mck-c-authors-byline__author__XdrlD"><span class="AuthorsByLine_mck-c-authors-byline__no-wrap__Ced0j"><a data-component="mdc-c-link" href="/our-people/kana-enomoto" class="mdc-c-link-inline___7DRrt_8032924 mdc-c-link-inline--secondary___YKoOK_8032924"><span class="mdc-c-link__label___Pfqtd_8032924">Kana Enomoto</span></a> </span></span><span class="AuthorsByLine_mck-c-authors-byline__author__XdrlD"><span class="AuthorsByLine_mck-c-authors-byline__no-wrap__Ced0j"><a data-component="mdc-c-link" href="/our-people/carlos-pardo-martin" class="mdc-c-link-inline___7DRrt_8032924 mdc-c-link-inline--secondary___YKoOK_8032924"><span class="mdc-c-link__label___Pfqtd_8032924">Carlos Pardo Martin</span></a><span> </span></span></span><span class="AuthorsByLine_mck-c-authors-byline__author__XdrlD"><span class="AuthorsByLine_mck-c-authors-byline__no-wrap__Ced0j">Nikhil Seshan</span></span></div><div class="mdc-u-grid-col-md-start-8 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-8 mdc-u-grid-col-lg-end-11 ArticleContent_mck-c-article-content__share-tools__kWRRw"></div></section><section class="mdc-u-grid mdc-u-grid-col-md-12 mck-u-animation-blur-in-400"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-11"><div data-component="mdc-c-description" class="mdc-c-description___SrnQP_8032924 mdc-u-ts-5"><div class="mck-u-links-inline">The public, private, and social sectors can all play a role in improving access and outcomes for those with behavioral health conditions.</div></div></div></section><main data-layer-region="article-body" class="mdc-u-grid mdc-u-grid-gutter-xxl"><div class="mdc-u-grid mdc-u-grid-col-1 mdc-u-grid-col-md-12"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-11"><div class="mdc-o-content-body mck-u-dropcap"><div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="DownloadsSidebar_mck-c-downloads-sidebar__iFmyt mck-o-xs-right-span"><div data-layer-region="downloads-right-rail"><h3 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924 mdc-c-heading--title___5qyOB_8032924 mdc-c-heading--border___K8dj3_8032924"></h3><div><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_8032924"><a data-component="mdc-c-link" href="#/download/%2F~%2Fmedia%2Fmckinsey%2Findustries%2Fhealthcare%20systems%20and%20services%2Four%20insights%2Funlocking%20whole%20person%20care%20through%20behavioral%20health%2Funlocking-whole-person-care-through-behavioral-health.pdf%3FshouldIndex%3Dfalse" class="DownloadsSidebar_mck-c-downloads-sidebar__download-link__fPqFQ mdc-c-link___lBbY1_8032924" target="_self" data-layer-event-prefix="Download Link" data-layer-action="click" data-layer-report-type="" data-layer-file-name="unlocking-whole-person-care-through-behavioral-health" data-layer-report-name="unlocking-whole-person-care-through-behavioral-health>"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mdc-c-icon--size-md___yi5fA_8032924 mck-download-icon"></span><span class="mdc-c-link__label___Pfqtd_8032924"> (8 pages)</span></a></div></div></div></div> <p><strong>The growing burden from behavioral health conditions</strong> is causing significant strain on American lives and livelihoods. Before COVID-19, approximately one in four Americans had a mental illness or substance use disorder.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="6b6ce6aa-e348-48f1-81d7-9ee29c19686b"><sup class="FootNote_footnotesup__e73z_">1</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="6b6ce6aa-e348-48f1-81d7-9ee29c19686b" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Substance Abuse and Mental Health Services Administration, <em>Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health</em> (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55), Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2020, samhsa.gov.</span></span></span></a></span> Taking into consideration the traumatic nature of COVID-19, the related economic constriction, and prolonged social isolation experienced by many Americans, the pandemic’s impact could—without intervention—increase the prevalence of behavioral health conditions by as much as 50 percent.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="07acbd23-f5b7-451e-9acb-bb3891bdd35d"><sup class="FootNote_footnotesup__e73z_">2</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="07acbd23-f5b7-451e-9acb-bb3891bdd35d" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Erica Hutchins Coe, Kana Enomoto, Patrick Finn, John Stenson, and Kyle Weber, “<a href="/industries/healthcare/our-insights/understanding-the-hidden-costs-of-covid-19s-potential-impact-on-us-healthcare">Understanding the hidden costs of COVID-19’s potential impact on US healthcare</a>,” September 4, 2020, McKinsey.com.</span></span></span></a></span></p> <p>In our publication, “<a href="/industries/healthcare/our-insights/a-holistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-global-covid-19-pandemic">A holistic approach for the US behavioral health crisis during the COVID-19 pandemic</a>,” we highlighted four potential actions healthcare leaders can consider to address related behavioral health challenges. Now, we examine how those actions could be coupled with efforts to promote access to care, improve patient outcomes and experience, increase affordability, and drive net savings in healthcare costs through whole person care.</p> <h2>Addressing systemic challenges through whole person care</h2> <p>Individuals with behavioral health conditions often face difficulty accessing treatment,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="0c61d3d0-a6e8-4c36-9e8d-8b2835fc7fd9"><sup class="FootNote_footnotesup__e73z_">3</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="0c61d3d0-a6e8-4c36-9e8d-8b2835fc7fd9" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Ryan McBain et al., “Growth and distribution of child psychiatrists in the United States: 2007–2016,” <em>Pediatrics</em>, December 2019, Volume 144, Number 6, p. e20191576, pediatrics.aappublications.org.</span></span></span></a></span><span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="6ba20462-d42c-4307-9de6-e8eba5966de7"><sup class="FootNote_footnotesup__e73z_">4</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="6ba20462-d42c-4307-9de6-e8eba5966de7" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Monica Malowney et al., “Availability of outpatient care from psychiatrists: A simulated-patient study in three U.S. cities,” <em>Psychiatric Services</em>, 2015, Volume 66, pp. 94–6, ps.psychiatryonline.org.</span></span></span></a></span> high out-of-pocket costs,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="06ea661b-5186-49f0-bfed-c243fca3161f"><sup class="FootNote_footnotesup__e73z_">5</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="06ea661b-5186-49f0-bfed-c243fca3161f" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Wendy Yi Xu et al., “Cost-sharing disparities for out-of-network care for adults with behavioral health conditions,” <em>JAMA Network Open</em>, 2019, Volume 2, Number 11, p. e1914554, jamanetwork.com.</span></span></span></a></span> non-guideline-based care,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="cc459a4a-7083-413f-97e7-13b4458531d2"><sup class="FootNote_footnotesup__e73z_">6</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="cc459a4a-7083-413f-97e7-13b4458531d2" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Jeffery Epstein et al., “Variability in ADHD care in community-based pediatrics,” <em>Pediatrics</em>, December 2014, Volume 134, Number 6, pp. 1136–43, pediatrics.aappublications.org.</span></span></span></a></span> and multiple forms of discrimination,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="6cfb9281-30eb-4fa8-afc0-5227f67c4e6c"><sup class="FootNote_footnotesup__e73z_">7</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="6cfb9281-30eb-4fa8-afc0-5227f67c4e6c" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">“Survey: Americans becoming more open about mental health,” American Psychological Association, May 1, 2019, apa.org.</span></span></span></a></span><span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="d13816b5-babf-4ffc-8d17-e331f7375645"><sup class="FootNote_footnotesup__e73z_">8</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="d13816b5-babf-4ffc-8d17-e331f7375645" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline"><em>Americans’ views on policies to address prescription drug prices, the opioid crisis, and other current domestic issues</em>, a joint report from Politico and Harvard T.H. Chan School of Public Health, July 2018, static.politico.com.</span></span></span></a></span> leading to meaningful disparities in healthcare outcomes and affordability. In addition, in both government and commercially insured populations, around 60 percent of healthcare spend is attributable to the roughly 23 percent of the population diagnosed with behavioral health conditions.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="333ff9dc-2ee4-4a6a-b420-0058f28690c8"><sup class="FootNote_footnotesup__e73z_">9</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="333ff9dc-2ee4-4a6a-b420-0058f28690c8" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Erica Hutchins Coe and Kana Enomoto, “<a href="/industries/healthcare/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health">Returning to resilience: The impact of COVID-19 on mental health and substance use</a>,” April 2, 2020, McKinsey.com.</span></span></span></a></span></p> <div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="lightest-grey" data-module-category="" data-module-gradient-position="bottom-right" class="mck-c-inline-module-container SideBar_mck-c-sidebar__bgimg-wrapper__Qj4Dt mck-o-sm-left-span SideBar_mck-c-sidebar__sidebar-wrapper__Dpjw2 SideBar_mck-c-sidebar__sidebar-wrapper--istablet__IQ6ii mck-u-screen-only mck-c-module-wrapper" data-layer-region="sidebar"><div class="SideBar_mck-c-sidebar__epoAm mck-o-md-center"><div class="SideBar_mck-c-sidebar__share-icons-wrapper__9gB_c"><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_8032924 mdc-c-link-container--display-column___X0HDD_8032924 SideBar_mck-c-sidebar__share-icons___eQy6"><div data-component="mdc-c-dropdown-menu" class="mdc-c-drop-down"><button data-component="mdc-c-button" aria-label="" type="button" id="button_id" class="mdc-c-button___U4iY2_8032924 mdc-c-button--ghost mdc-c-button--size-medium mdc-c-drop-down__rootmenu___yJzvz_8032924" aria-expanded="false" aria-haspopup="menu"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mdc-c-icon--default___f-hQM_8032924 mdc-c-icon--size-md___yi5fA_8032924 mck-share2-icon"></span></button><div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="white" data-module-category="" class=""></div></div><button data-component="mdc-c-button" aria-label="Expandable Sidebar" type="button" id="button_id" class="mdc-c-button___U4iY2_8032924 mdc-c-button--ghost mdc-c-button--size-medium SideBar_mck-c-sidebar__toggle-btn__EL8iE" aria-expanded="false" data-layer-event-prefix="UI Item" data-layer-action="click" data-layer-category="sidebar" data-layer-subcategory="open" data-layer-text="open sidebar"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mdc-c-icon--radial___y3csX_8032924 mdc-c-icon--size-xxl___cL3ZT_8032924 mck-plus-no-circle-icon"></span></button></div></div><div class="SideBar_mck-c-sidebar__content-outer__UdWCq"><div class="SideBar_mck-c-sidebar__eyebrow__5GSEq"></div><div class="SideBar_mck-c-sidebar__content__raEwe"><h2 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924 mdc-u-ts-3 SideBar_mck-c-sidebar__content-heading__NJekY"><div>The future of behavioral health</div></h2><div class="SideBar_mck-c-sidebar__content-description__4p9iI mdc-u-ts-7"><div class="mdc-o-content-body"><p>Investing in prevention and early intervention programs is key to mitigating the movement from lower needs to high needs. Changes such as: including behavioral health screenings in preventative physical health appointments, providing school-based mental well-being and substance use education, and preventing social isolation though peer support can help create an environment that provides benefits to both behavioral and physical health.</p> <p>In the video below, three vignettes illustrate how behavioral healthcare is experienced today, and what it may look like in the future when evidence-based prevention, treatment, and recovery supports are used to address whole person care.</p></div></div></div></div></div></div>  <p>All stakeholders—including public, private, and social sectors—can play a role in addressing these disparities. Establishing the groundwork for whole person care will require addressing supply-demand inequities in behavioral health services, expanding equitable access to evidence-based models of care, and investing in behavioral health at parity with other health conditions.</p> <h3>1. Expand equitable access to evidence-based behavioral health services</h3>  <p>More than 60 percent of the US population lives in counties with an insufficient supply of psychiatrists, with only 40 percent of all psychiatrists accepting any form of insurance<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="53f6ac21-1619-434e-8c3f-b07d9c5cf916"><sup class="FootNote_footnotesup__e73z_">10</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="53f6ac21-1619-434e-8c3f-b07d9c5cf916" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Analysis of providers who submitted at least one claim (based on data from Compile.com for all lines of business and Medicare Provider Utilization and Payment Data) compared to Psychiatrists identified NPPES NPI registry using primary taxonomy code.</span></span></span></a></span> and 20 percent not accepting new patients,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="2db40125-19f5-4f5b-acc3-1a80fdfad0db"><sup class="FootNote_footnotesup__e73z_">11</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="2db40125-19f5-4f5b-acc3-1a80fdfad0db" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Lindsay Kalter, “Treating mental illness in the ED,” Association of American Medical Colleges, September 3, 2019, aamc.org.</span></span></span></a></span> according to our <a href="https://csbh-dashboard.mckinsey.com/#/data-insights?chart=SC&geo=County&lob=All&metric1=pct_psych_noins&tab=Map">Vulnerable Populations Data Hub</a>. As such, commercially insured consumers are between five times and six times more likely to use out-of-network providers for their behavioral health needs than for physical healthcare.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="19d398c6-12f9-4b7e-8b63-1e0e16ec21da"><sup class="FootNote_footnotesup__e73z_">12</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="19d398c6-12f9-4b7e-8b63-1e0e16ec21da" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Stoddard Davenport, TJ Gray, and Stephen Melek, “Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement,” Milliman, November 20, 2019, milliman.com.</span></span></span></a></span> This disparity leads to higher out-of-pocket costs and significant barriers to care for patients with mental health and substance use disorders. This is compounded by the fact that payers are struggling to expand their networks of behavioral health professionals.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="cb42d5c6-07ca-436a-9b60-0ab19f40f3cc"><sup class="FootNote_footnotesup__e73z_">13</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="cb42d5c6-07ca-436a-9b60-0ab19f40f3cc" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Susan Busch and Kelly Kyanko, “Incorrect provider directories associated with out-of-network mental health care and outpatient surprise bills,” <em>Health Affairs</em>, June 2020, Volume 39, Number 6, pp. 975–83, healthaffairs.org.</span></span></span></a></span></p> <p>Potential strategies to address the overall lack of access to behavioral health services include the following:</p> <ul> <li>In rural areas, where the shortage is starkest, telehealth services could provide behavioral health access to the underserved. Between January and October 2020, there was an increase of 59 percentage points nationally in the proportion of psychotherapy services delivered via telehealth.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="b5e60ee4-39e4-4b61-808d-c4f14ac4f413"><sup class="FootNote_footnotesup__e73z_">14</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="b5e60ee4-39e4-4b61-808d-c4f14ac4f413" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Based on analysis of a data sample from 115,000 behavioral health providers providing services to over 20 million individuals in the United States with Commercial, Medicaid, or Medicare insurance (underlying data from compile.com).</span></span></span></a></span><span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="2491bcfb-c291-4ebd-b17c-421217f88bce"><sup class="FootNote_footnotesup__e73z_">15</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="2491bcfb-c291-4ebd-b17c-421217f88bce" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Telehealth visits are remote visits provided via telecommunications technologies for behavioral healthcare.</span></span></span></a></span></li> <li>Expanding the capabilities of non-specialists to practice at the top of their license<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="089aceda-a2b0-4a62-825a-37f82ed4328d"><sup class="FootNote_footnotesup__e73z_">16</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="089aceda-a2b0-4a62-825a-37f82ed4328d" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Practicing at the “top of their license” implies maximizing the amount of time providers spend on the highest-complexity activities commensurate with their training and experience.</span></span></span></a></span> and deliver care to patients with more complex needs (for example, models such as Project ECHO)<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="5a5e159e-2cc1-4b7f-93fa-0a914e16777e"><sup class="FootNote_footnotesup__e73z_">17</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="5a5e159e-2cc1-4b7f-93fa-0a914e16777e" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">“Project ECHO,” University of New Mexico School of Medicine, 2021, hsc.unm.edu.</span></span></span></a></span> may decrease wait times for specialty behavioral healthcare and increase in-network accessibility.</li> <li>The expansion of community-based crisis services can offer services that may currently be available only in emergency departments and correctional facilities and potentially deliver better outcomes. Deploying mental health co-responder models instead of, or in partnership with, law enforcement can help route patients to community-based services and reduce overreliance on emergency sites of care.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="77632e25-6a0f-4c99-a60b-c4623aade17f"><sup class="FootNote_footnotesup__e73z_">18</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="77632e25-6a0f-4c99-a60b-c4623aade17f" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">RL Scott, “Evaluation of a mobile crisis program: Effectiveness, efficiency, and consumer satisfaction,” <em>Psychiatric Services</em>, September 2000, Volume 51, Number 9, pp. 1153–6, ps.psychiatryonline.org.</span></span></span></a></span></li> <li>Increased access to evidence-based treatments, such as the use of cognitive behavioral therapy, could reduce healthcare spend while providing higher quality of care and a better experience for individuals with depression.</li> </ul> <div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="mck-c-disruptor1up mck-o-md-center mck-u-inline-module-border-top mck-u-inline-module-border-bottom mck-u-screen-only" data-layer-region="disruptor-1up"><div class="mdc-u-grid mdc-u-grid-gutter-md mdc-u-grid-col-lg-12 mdc-u-grid-col-md-12 "><div class="mdc-u-grid-col-md-span-12"><header data-component="mdc-c-header" class="mdc-c-header"><div class="mdc-c-header__block___i1Lg-_8032924"><h3 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924"><div>Would you like to learn more about our <a href="/industries/healthcare/how-we-help-clients">Healthcare Systems & Services Practice</a>?</div></h3></div></header><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_8032924 mdc-c-link-container--display-column___X0HDD_8032924 mck-c-disruptor1up__content Disruptor1Up_mck-c-disruptor1up__content--links__VV4lE mdc-u-grid-gutter-md"><a data-component="mdc-c-link" href="" class="mdc-c-link-cta___NBQVi_8032924"><span class="mdc-c-link__label___Pfqtd_8032924">Visit our Center for Societal Benefit through Healthcare page</span><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mck-link-arrow-right-icon"></span></a></div></div></div></div> <h3>2. Invest in behavioral health at parity with other health conditions</h3> <p>To adequately support behavioral health consumers, a major element is addressing the long-term supply-demand imbalance—where the demand for behavioral health services far outstrips the availability of timely, affordable, and high-quality care. Strategies to help achieve this balance by expanding the supply of behavioral health services may include reexamination of reimbursement rates, investing in workforce development initiatives, supporting new care delivery models, and strengthening provider networks.</p> <p>The United States is facing a significant behavioral health workforce shortage. For example, as of 2018, 192 million Americans lived in counties with an insufficient<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="0d2daed0-537b-416d-a2b4-1d1794b752b6"><sup class="FootNote_footnotesup__e73z_">19</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="0d2daed0-537b-416d-a2b4-1d1794b752b6" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Insufficient supply is defined as less than 16 psychiatrists per 100,000 residents in any given county from Richard Cooper et al., “Economic and demographic trends signal an impending physician shortage,” <em>Health Affairs</em>, 2002, Volume 21, Number 1, pp. 140–54, healthaffairs.org.</span></span></span></a></span> supply of psychiatrists.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="4eb43620-eda0-44fc-997f-772bc9b2e0b3"><sup class="FootNote_footnotesup__e73z_">20</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="4eb43620-eda0-44fc-997f-772bc9b2e0b3" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Based on analysis of location of providers with a primary taxonomy of psychiatry in the NPPES NPI registry and population estimates.</span></span></span></a></span> Data also suggest that nationwide, approximately half of all psychiatrists do not accept any insurance, including Commercial, Medicare, and Medicaid.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="115fb0d5-2b1e-4202-912f-9c48f6c5a1ed"><sup class="FootNote_footnotesup__e73z_">21</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="115fb0d5-2b1e-4202-912f-9c48f6c5a1ed" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Based on analysis comparing the number of psychiatrists identified in NPPES NPI registry who did not bill a claim (2018) or are not in enrolled in Medicare (as of September 2020) to the number of psychiatrists that have billed a claim in the past year or have provided services to Medicare beneficiaries.</span></span></span></a></span></p> <p>Although behavioral health has been a top bipartisan policy issue for more than a decade, behavioral health providers are often reimbursed at lower rates than non-behavioral health providers: compared with Medicare-allowed amounts, average 2017 in-network physician reimbursement rates for behavioral health office visits were lower than for primary care office visits and medical/surgical specialist office visits.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="802d5faa-37b7-4b40-be23-777adc464bcb"><sup class="FootNote_footnotesup__e73z_">22</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="802d5faa-37b7-4b40-be23-777adc464bcb" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Based on two most commonly billed office visit CPT codes; Stoddard Davenport, TJ Gray, and Stephen Melek, “Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement,” Milliman, November 20, 2019, milliman.com.</span></span></span></a></span> These disparities in reimbursement rate between behavioral health and primary care grew from 20.8 percent in 2015 to 23.8 percent in 2017.</p> <p>At the same time, the rate of out-of-network care utilization increased from 15 percent to 17 percent of adult behavioral health office visits (versus roughly 3 percent of primary care visits). For children, the rate of out-of-network utilization is 10 times higher for behavioral health than for primary care. Addressing reimbursement disparities could help expand networks in the short term and attract more professionals to the behavioral healthcare field in the long term, thereby supporting overall access to behavioral health services.</p> <p>In addition to reimbursement at parity, further investments in treatment, prevention, and early intervention services, such as the Collaborative Care Model (CoCM) or Screening, Brief Intervention, and Referral to Treatment (SBIRT),<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="84d64cbc-b678-40a0-8c52-899c51b6a847"><sup class="FootNote_footnotesup__e73z_">23</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="84d64cbc-b678-40a0-8c52-899c51b6a847" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Jürgen Unützer et al., “Long-term cost effects of collaborative care for late-life depression,” <em>American Journal of Managed Care</em>, February 2008, Volume 14, Number 2, pp. 95–100, ajmc.com.</span></span></span></a></span><span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="23f12eec-9b10-492c-b499-ca8a17321423"><sup class="FootNote_footnotesup__e73z_">24</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="23f12eec-9b10-492c-b499-ca8a17321423" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">“Screening, brief intervention, and referral to treatment (SBIRT),” Substance Abuse and Mental Health Services Administration, September 15, 2017, samhsa.gov.</span></span></span></a></span> could help mitigate exacerbations of latent mental health conditions and substance use disorders. These and other investments in behavioral healthcare could support an acceleration of advancement, quality, and access to improved whole person care.</p> <h2>Additional actions to build a holistic approach to healthcare</h2> <p>As highlighted in “<a href="/industries/healthcare/our-insights/a-holistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-global-covid-19-pandemic">A holistic approach for the US behavioral health crisis during the COVID-19 pandemic</a>,” the following four actions may be integral to implementing whole person care, in addition to the two foundational actions described above.</p> <h3>3. Strengthen community prevention</h3> <p>Focusing on prevention, early intervention, and reducing stigma across communities could help alleviate the steady growth of preventable events, such as suicides. Workplace programs such as wellness seminars and personalized feedback could help educate employees on the signs of psychological distress and available treatment options. In schools, a holistic mental well-being and substance use education could offer children a framework to understand their behavioral health, and could help with early identification while reducing stigma associated with mental illnesses and substance use disorders.</p> <div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="mck-c-disruptor1up mck-o-md-center mck-u-inline-module-border-top mck-u-inline-module-border-bottom mck-u-screen-only" data-layer-region="disruptor-1up"><div class="mdc-u-grid mdc-u-grid-gutter-md mdc-u-grid-col-lg-12 mdc-u-grid-col-md-12 "><div class="mdc-u-grid-col-lg-span-4 mdc-u-grid-col-md-span-5 Disruptor1Up_mck-c-disruptor1up__image___2Gc4"><picture data-component="mdc-c-picture"><img alt="A holistic approach to addressing the US behavioral health crisis in the face of the global COVID-19 pandemic" src="/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/a%20holistic%20approach%20to%20addressing%20the%20us%20behavioral%20health%20crisis/standard-holistic-behavioral-health-1199590908.png?cq=50&mh=145&car=16:9&cpy=Center" loading="lazy"/></picture></div><div class="mdc-u-grid-col-lg-span-8 mdc-u-grid-col-md-span-7"><header data-component="mdc-c-header" class="mdc-c-header"><div class="mdc-c-header__block___i1Lg-_8032924"><h3 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924"><div>A holistic approach for the US behavioral health crisis during the COVID-19 pandemic</div></h3></div></header><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_8032924 mdc-c-link-container--display-column___X0HDD_8032924 mck-c-disruptor1up__content Disruptor1Up_mck-c-disruptor1up__content--links__VV4lE mdc-u-grid-gutter-md"><a data-component="mdc-c-link" href="/industries/healthcare/our-insights/a-holistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-global-covid-19-pandemic" class="mdc-c-link-cta___NBQVi_8032924"><span class="mdc-c-link__label___Pfqtd_8032924">Read the article</span><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mck-link-arrow-right-icon"></span></a></div></div></div></div> <h3>4. Integrate behavioral and physical health</h3> <p>Low integration of physical and behavioral healthcare may lead to delayed diagnosis of behavioral health conditions and prevent the delivery of whole person care.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="09d740f1-ed56-4fea-b701-84e199535daa"><sup class="FootNote_footnotesup__e73z_">25</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="09d740f1-ed56-4fea-b701-84e199535daa" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">“SAMHSA – Behavioral health integration,” Substance Abuse and Mental Health Services Administration, samhsa.gov.</span></span></span></a></span> Embedding mental healthcare managers into primary care clinics could help support a patient’s regular primary care clinician while improving behavioral health screening and treatment in conjunction with the management of their physical health conditions.</p> <h3>5. Leverage data and analytics</h3> <p>Developing proper data and analytics infrastructures to deploy value-based contracting could help reduce overall healthcare spend and provide a better behavioral healthcare experience, including for those already in treatment. Additionally, predictive analytics could help identify individuals who might benefit the most from the use of evidence-based treatment like cognitive behavioral therapy.</p> <h3>6. Address unmet health-related basic needs<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="d69a7ca5-a26b-4674-b72b-c3801802418d"><sup class="FootNote_footnotesup__e73z_">26</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="d69a7ca5-a26b-4674-b72b-c3801802418d" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Also referred to as social determinants of health or social needs, including income, employment, education, food, housing, transportation, social support, and safety. These basic needs, if unmet, can negatively impact health. In addition, factors such as race, ethnicity, gender and sexual orientation, disability, and age can influence health status.</span></span></span></a></span></h3> <p>Individuals with poor mental health are 1.9 times as likely to report not receiving the healthcare they need, and 2.5 times as likely to report having multiple unmet social needs.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="6594946f-15b8-498e-b29c-8ccdedcec243"><sup class="FootNote_footnotesup__e73z_">27</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="6594946f-15b8-498e-b29c-8ccdedcec243" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Erica Hutchins Coe, Jenny Cordina, Kana Enomoto, and Elena Mendez-Escobar, “<a href="/industries/healthcare/our-insights/insights-on-mental-health-from-a-2019-mckinsey-consumer-survey">Insights on mental health from a 2019 McKinsey Consumer survey</a>,” February 14, 2020, McKinsey.com.</span></span></span></a></span> By activating home- and community-based services, wraparound approaches can help address the various needs faced by children with behavioral health conditions.</p> <div data-module-category="" class="PullQuote_mck-c-pullquote__DbaQ5 mck-o-md-center"><blockquote data-component="mdc-c-blockquote" class="PullQuote_mck-c-blockquote__6n21p PullQuote_mck-c-blockquote--hide-quotes__CpGpg mdc-c-blockquote mdc-c-blockquote--is-quotes___TozKo_8032924"><p>Scaling evidence-based, accessible, affordable, equitable behavioral healthcare could reduce US healthcare spending annually by $185 billion</p></blockquote></div> <h2>Potential impact of whole person care</h2> <p>If taken together, these six actions could improve the quality of care and experience for the millions of individuals with behavioral health conditions. As illustrated in Exhibit 1, these actions could also reduce total US healthcare spending annually by $185 billion. This figure represents around 6 percent of total healthcare spend in the United States.</p> <div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="mck-c-inline-module-container mck-o-md-center"><div class="mck-c-content-header"><div class="ContentHeader_mck-c-content-header__eyebrow__cBTe_"></div></div><div class="mck-u-inline-module-border-bottom"><picture data-component="mdc-c-picture" class="Exhibit_mck-c-exhibit__image__pyIDm"><source media="(min-width: 768px)" srcSet="/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/unlocking%20whole%20person%20care%20through%20behavioral%20health/svg_wholepersoncare_exhibit1.svgz?cq=50&cpy=Center"/><img alt="Implementing six key actions could lead to savings of $185 billion through whole person care." src="/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/unlocking%20whole%20person%20care%20through%20behavioral%20health/svg_wholepersoncare_exhibit1.svgz?cq=50&cpy=Center" loading="lazy"/></picture></div><div class="mck-u-sr-only"></div></div> <p>As part of this overall savings, an estimated increase of $60 billion in behavioral health outpatient spend (for example, through increased reimbursement rates, additional visits) is necessary to effectively implement the various interventions. However, we found that this increase is far outweighed by the potential for spend reduction of $35 billion in behavioral sites of care and $210 billion in physical sites of care, leading to $185 billion in net savings opportunity. Capturing this opportunity may require an additional $65 billion in incremental operating expenses, but could possibly lead to an estimated return of $3 for every $1 invested.</p> <p>The savings impact of these interventions varies across the behavioral and physical health needs spectrum. For example, when considering the impact of integrating physical and behavioral healthcare, we see a difference in savings across different member cohorts. For those with high behavioral health needs,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="ab4cb94b-fe32-42e9-b2cd-ad4f88cf76e5"><sup class="FootNote_footnotesup__e73z_">28</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="ab4cb94b-fe32-42e9-b2cd-ad4f88cf76e5" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Individuals with acute behavioral health conditions (for example, schizophrenia, bipolar disorder with psychosis), or having high acuity behavioral health utilization (for example, inpatient visit, emergency department visit) AND presence of disorders (for example, PTSD, substance use, eating disorders).</span></span></span></a></span> savings due to this intervention are estimated to be 12 percent of baseline spend, while members with mild or moderate needs might only see estimated savings of 8 percent. These disparities result from differences in spend among behavioral and physical sites of care for each cohort, as well as different estimates for savings rates across sites of care for each cohort (Exhibit 2).</p> <div data-component="mdc-c-module-wrapper" data-module-theme="default" data-module-background="transparent" data-module-category="" class="mck-c-inline-module-container mck-o-md-center"><div class="mck-c-content-header"><div class="ContentHeader_mck-c-content-header__eyebrow__cBTe_"></div></div><div class="mck-u-inline-module-border-bottom"><picture data-component="mdc-c-picture" class="Exhibit_mck-c-exhibit__image__pyIDm"><source media="(min-width: 768px)" srcSet="/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/unlocking%20whole%20person%20care%20through%20behavioral%20health/svg_wholepersoncare_exhibit2.svgz?cq=50&cpy=Center"/><img alt="A holistic approach to health is key to realize full savings." src="/~/media/mckinsey/industries/healthcare%20systems%20and%20services/our%20insights/unlocking%20whole%20person%20care%20through%20behavioral%20health/svg_wholepersoncare_exhibit2.svgz?cq=50&cpy=Center" loading="lazy"/></picture></div><div class="mck-u-sr-only"></div></div> <p>While it may seem intuitive to focus on the cohorts with the highest potential for savings (for example, individuals with high behavioral health needs and complex physical health conditions), year-to-year movement of individuals between cohorts means that enhancements should likely occur across all segments. In a claims analysis of employer-sponsored members,<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="ebd66c11-3e5c-426b-a764-105d24f12836"><sup class="FootNote_footnotesup__e73z_">29</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="ebd66c11-3e5c-426b-a764-105d24f12836" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Analysis includes claims data from International Business Machines Corporation’s Truven MarketScan Commercial Database. Any analysis, interpretation, or conclusion based on these data is solely that of the authors and not International Business Machines Corporation.</span></span></span></a></span> we found that 50 percent of behavioral health high-needs members were in a lower behavioral health-needs cohort, with 25 percent having no previous behavioral health diagnosis the previous year. Instead of waiting until people reach the point of crisis, we can take a holistic approach across all populations from screening and preventative care to more intensive services for patients with serious mental illnesses and substance use disorders.</p> <h2>The need for action</h2> <div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="lightest-grey" data-module-category="" data-module-gradient-position="bottom-right" class="mck-c-inline-module-container SideBar_mck-c-sidebar__bgimg-wrapper__Qj4Dt mck-o-sm-left-span SideBar_mck-c-sidebar__sidebar-wrapper__Dpjw2 SideBar_mck-c-sidebar__sidebar-wrapper--istablet__IQ6ii mck-u-screen-only mck-c-module-wrapper" data-layer-region="sidebar"><div class="SideBar_mck-c-sidebar__epoAm mck-o-md-center"><div class="SideBar_mck-c-sidebar__share-icons-wrapper__9gB_c"><div data-component="mdc-c-link-container" class="mdc-c-link-container___xefGu_8032924 mdc-c-link-container--display-column___X0HDD_8032924 SideBar_mck-c-sidebar__share-icons___eQy6"><div data-component="mdc-c-dropdown-menu" class="mdc-c-drop-down"><button data-component="mdc-c-button" aria-label="" type="button" id="button_id" class="mdc-c-button___U4iY2_8032924 mdc-c-button--ghost mdc-c-button--size-medium mdc-c-drop-down__rootmenu___yJzvz_8032924" aria-expanded="false" aria-haspopup="menu"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mdc-c-icon--default___f-hQM_8032924 mdc-c-icon--size-md___yi5fA_8032924 mck-share2-icon"></span></button><div data-component="mdc-c-module-wrapper" data-module-theme="light" data-module-background="white" data-module-category="" class=""></div></div><button data-component="mdc-c-button" aria-label="Expandable Sidebar" type="button" id="button_id" class="mdc-c-button___U4iY2_8032924 mdc-c-button--ghost mdc-c-button--size-medium SideBar_mck-c-sidebar__toggle-btn__EL8iE" aria-expanded="false" data-layer-event-prefix="UI Item" data-layer-action="click" data-layer-category="sidebar" data-layer-subcategory="open" data-layer-text="open sidebar"><span data-component="mdc-c-icon" class="mdc-c-icon___oi7ef_8032924 mdc-c-icon--radial___y3csX_8032924 mdc-c-icon--size-xxl___cL3ZT_8032924 mck-plus-no-circle-icon"></span></button></div></div><div class="SideBar_mck-c-sidebar__content-outer__UdWCq"><div class="SideBar_mck-c-sidebar__eyebrow__5GSEq"></div><div class="SideBar_mck-c-sidebar__content__raEwe"><h2 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924 mdc-u-ts-3 SideBar_mck-c-sidebar__content-heading__NJekY"><div>Methodology for estimating savings impact of behavioral healthcare interventions on US healthcare spend</div></h2><div class="SideBar_mck-c-sidebar__content-description__4p9iI mdc-u-ts-7"><div class="mdc-o-content-body"><p>The $185 billion savings estimate provided in this paper derives from academic literature of behavioral health interventions and our analysis of their impact on member cohorts across the behavioral and physical health needs spectrums.</p> <p><em>Member cohorts considered in the model.</em> Patient populations across Commercially-insured, Medicare, and Medicaid lines of business were divided into 14 member cohorts based on their behavioral healthcare needs (for example, high needs, mild/moderate needs, diagnosed but not treated, treated but not diagnosed, healthy) and physical healthcare needs (for example, complex needs, specialty chronic needs, primary care treatable needs, healthy). These classifications were largely based on behavioral and physical health diagnoses and utilization from healthcare claims data.</p> <p><em>Research literature.</em> To determine how various behavioral health interventions could impact healthcare spend for the above cohorts, we reviewed the relevant academic literature concerning these interventions. Based on the studies cited throughout this paper and others, we estimated the savings impact across sites of care for each member cohort. Examples include:</p> <ul> <li><em>Integration of physical and behavioral healthcare:</em> Through a stepped collaborative care program, care managers were embedded in the patient’s primary care clinic. These care managers would support the primary care physician by conducting mental health and substance use screenings, monitoring patient progress, and adjusting treatment plans tailored by a stepped-care treatment algorithm. For individuals with mild/moderate behavioral health needs and those who are diagnosed but not treated, these measures led to an increase of approximately 41 percent in behavioral outpatient spend (due to additional care received by patients), but also to a decrease in behavioral inpatient spend by 64 percent, physical inpatient spend by 26 percent, and behavioral and physical health prescription spend by 9 percent.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="37e69d45-9837-4024-a650-ee83d7963b0b"><sup class="FootNote_footnotesup__e73z_">1</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="37e69d45-9837-4024-a650-ee83d7963b0b" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Jürgen Unützer et al., “Long-term cost effects of collaborative care for late-life depression,” <em>American Journal of Managed Care</em>, February 2008, Volume 14, Number 2, pp. 95–100, ajmc.com.</span></span></span></a></span></li> <li><em>Expanded care navigation:</em> In this intervention, care managers combined patient education with logistical support to coach patients on interacting effectively with their providers and helped them overcome barriers to attending medical appointments. This intervention resulted in decreased spend across several sites of care, including a 13 percent decrease in physical emergency care spend and 17 percent decrease in behavioral health outpatient spend.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="b2c57d5d-b054-4ebd-a8ba-d93c8cd51789"><sup class="FootNote_footnotesup__e73z_">2</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="b2c57d5d-b054-4ebd-a8ba-d93c8cd51789" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">Benjamin Druss et al., “Budget impact and sustainability of medical care management for persons with serious mental illnesses,” <em>American Journal of Psychiatry</em>, November 2011, Volume 168, Number 11, pp. 1171–8, ajp.psychiatryonline.org.</span></span></span></a></span></li> </ul> <p><em>Medical and pharmacy claims data.</em> We used medical claims data from a range of sources to estimate the impact of the measures above on member spend across lines of business.<span class="FootNote_footnote-holder__tjRqy"><a aria-label="footnote" href="javascript:void(0);" class="FootNote_footnote-wrapper__AIRwL undefined FootNote_bottom__9aoSL FootNote_inactive__VZfCp" aria-describedby="f967561b-6a93-48bc-aea3-9fe85ae37a39"><sup class="FootNote_footnotesup__e73z_">3</sup><span class="FootNote_notch-wrapper__b_5NS"><span class="FootNote_notch__omKtY"></span></span><span class="FootNote_tooltip__QtrbA mdc-u-mt-2"><span class="FootNote_footnote-content__r2OVl"><span id="f967561b-6a93-48bc-aea3-9fe85ae37a39" aria-hidden="true" data-module-theme="light" class="FootNote_footnote-text__VjKgO mck-u-links-inline">The specific claims data sources we used include: 2018 data from complete anonymized Managed Medicaid claims data from one state (Medicaid), CMS Limited Data Set (LDS) claims (Medicare), and International Business Machines Corporation’s Truven MarketScan Commercial Database (Commercial).</span></span></span></a></span> Members for each line of business were segmented based on the member cohorts described previously, and spend data was apportioned appropriately. Claims sources were adjusted to be representative of the national 2020 population using membership weighting (Definitive Healthcare), membership updates (McKinsey Enrollment Projection Tool), rate updates (Substance Abuse and Mental Health Services Administration—for example SAMHSA), pharmacy estimates (SAMHSA), and insurance administration estimates (SAMHSA).</p></div></div></div></div></div></div> <p>COVID-19 has exacerbated the behavioral health crisis facing people across the world, as stressors such as high rates of infection, grief and loss, social isolation, and unemployment have grown. Stresses experienced by frontline healthcare workers have further brought to light the salience of these challenges. We now have the chance to reexamine whole person care by addressing social determinants of health, integrating physical and behavioral healthcare, and meeting people where they are. Efforts to boost this concept could send far-reaching ripple effects into society. These effects could include improved quality of life and reduce premature mortality due to chronic disease, suicide, and overdose for individuals. Additionally, employers could see benefits in the form of improved employee engagement and reduced absenteeism, workplace injury, and disability. Finally, society as a whole stands to benefit the most through improved life expectancy, educational achievement, workforce participation, and community engagement, along with reduced criminal justice involvement and homelessness.</p> <p>Healthcare leaders have a chance to help scale evidence-based solutions, advancing innovation and investing in whole person care. Taking these actions can create meaningful change to save lives, advance economic prosperity, and prioritize health for future generations.</p></div><div class="container-placeholder"></div></div></div><div class="mdc-u-grid mdc-u-grid-gutter-xl"><section role="contentinfo" data-layer-region="article-about-authors" class="mdc-u-grid mdc-u-grid-col-md-12 AboutAuthor_mck-c-about-author__nRJzu"><div class="mdc-u-grid-col-md-start-2 mdc-u-grid-col-md-end-12 mdc-u-grid-col-lg-start-3 mdc-u-grid-col-lg-end-11"><h5 data-component="mdc-c-heading" class="mdc-c-heading___0fM1W_8032924 mdc-c-heading--title___5qyOB_8032924 mdc-c-heading--border___K8dj3_8032924 mdc-u-align-center"></h5><div data-component="mdc-c-description" class="mdc-c-description___SrnQP_8032924 mdc-u-ts-8 mck-u-links-inline mck-u-links-inline--secondary mdc-u-mt-5"><div><p><a href="/our-people/erica-coe"><strong>Erica Coe</strong></a> is a partner in McKinsey’s Atlanta office and co-leads the <a href="/sitecore/service/notfound.aspx?item=web%3a%7b7a6990ca-f9c8-4e94-a5f0-6033ed632d1c%7d%40en">Center for Societal Benefit through Healthcare</a>. <a href="/our-people/kana-enomoto"><strong>Kana Enomoto</strong></a> is a senior expert in the Washington, DC, office and co-leads the <a href="/sitecore/service/notfound.aspx?item=web%3a%7b7a6990ca-f9c8-4e94-a5f0-6033ed632d1c%7d%40en">Center for Societal Benefit through Healthcare</a>. <strong>Carlos Pardo Martin</strong> is a partner in the New York office. <strong>Nikhil Seshan</strong> is a consultant in the Philadelphia office. </p> <p>The authors would like to thank Chandra Yueh, Lukas Ruiz, Brad Herbig, Allyson Zucker, Pranay Orugunta, Razili Lewis, Uzoma Ononogbu, Andrew Linzer, and Kevin Collins for their contributions to this paper.</p> <p>This article was edited by Elizabeth Newman, an executive editor in the Chicago office.</p></div></div></div></section><section class="mdc-u-grid mdc-u-grid-col-md-12 mck-u-screen-only"><div 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type="application/json">{"props":{"pageProps":{"locale":"en","dictionary":{},"sitecoreContext":{"route":{"name":"Unlocking whole person care through behavioral health","displayName":"Unlocking whole person care through behavioral health","fields":null,"databaseName":"web","deviceId":"fe5d7fdf-89c0-4d99-9aa3-b5fbd009c9f3","itemId":"9617104e-fb7a-4b47-80b8-edeaee09d957","itemLanguage":"en","itemVersion":1,"layoutId":"ae753eb4-a035-40b4-83bf-4b4438df6742","templateId":"683910db-02ba-40ba-92e7-726c880160a9","templateName":"ArticleJSS","placeholders":{"jss-main":[{"uid":"232bb7e9-289f-492d-a916-2b6185e44a84","componentName":"ArticleTemplate","dataSource":"","fields":{"data":{"articleTemplate":{"title":{"jsonValue":{"value":"Unlocking whole person care through behavioral health"}},"sEOTitle":{"value":"Whole person care through behavioral health"},"description":{"jsonValue":{"value":"The public, private, and social sectors can all play a role in improving access and outcomes for those with behavioral health conditions."}},"sEODescription":{"value":"The effects of integrating physical and behavioral healthcare could include improved quality of life and reduced premature mortality."},"displayDate":{"jsonValue":{"value":"2021-02-24T00:00:00Z"}},"body":{"value":"[[DownloadsSidebar]]\n\u003cp\u003e\u003cstrong\u003eThe growing burden from behavioral health conditions\u003c/strong\u003e is causing significant strain on American lives and livelihoods. Before COVID-19, approximately one in four Americans had a mental illness or substance use disorder.[[footnote 1]] Taking into consideration the traumatic nature of COVID-19, the related economic constriction, and prolonged social isolation experienced by many Americans, the pandemic\u0026rsquo;s impact could\u0026mdash;without intervention\u0026mdash;increase the prevalence of behavioral health conditions by as much as 50 percent.[[footnote 2]]\u003c/p\u003e\n\u003cp\u003eIn our publication, \u0026ldquo;\u003ca href=\"/industries/healthcare/our-insights/a-holistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-global-covid-19-pandemic\"\u003eA holistic approach for the US behavioral health crisis during the COVID-19 pandemic\u003c/a\u003e,\u0026rdquo; we highlighted four potential actions healthcare leaders can consider to address related behavioral health challenges. Now, we examine how those actions could be coupled with efforts to promote access to care, improve patient outcomes and experience, increase affordability, and drive net savings in healthcare costs through whole person care.\u003c/p\u003e\n\u003ch2\u003eAddressing systemic challenges through whole person care\u003c/h2\u003e\n\u003cp\u003eIndividuals with behavioral health conditions often face difficulty accessing treatment,[[footnote 3]][[footnote 4]] high out-of-pocket costs,[[footnote 5]] non-guideline-based care,[[footnote 6]] and multiple forms of discrimination,[[footnote 7]][[footnote 8]] leading to meaningful disparities in healthcare outcomes and affordability. In addition, in both government and commercially insured populations, around 60 percent of healthcare spend is attributable to the roughly 23 percent of the population diagnosed with behavioral health conditions.[[footnote 9]]\u003c/p\u003e\n[[sidebar 1]] [[video 2]]\n\u003cp\u003eAll stakeholders\u0026mdash;including public, private, and social sectors\u0026mdash;can play a role in addressing these disparities. Establishing the groundwork for whole person care will require addressing supply-demand inequities in behavioral health services, expanding equitable access to evidence-based models of care, and investing in behavioral health at parity with other health conditions.\u003c/p\u003e\n\u003ch3\u003e1. Expand equitable access to evidence-based behavioral health services\u003c/h3\u003e\n[[MostPopularArticles 5]]\n\u003cp\u003eMore than 60 percent of the US population lives in counties with an insufficient supply of psychiatrists, with only 40 percent of all psychiatrists accepting any form of insurance[[footnote 10]] and 20 percent not accepting new patients,[[footnote 11]] according to our \u003ca href='https://csbh-dashboard.mckinsey.com/#/data-insights?chart=SC\u0026amp;geo=County\u0026amp;lob=All\u0026amp;metric1=pct_psych_noins\u0026amp;tab=Map'\u003eVulnerable Populations Data Hub\u003c/a\u003e. As such, commercially insured consumers are between five times and six times more likely to use out-of-network providers for their behavioral health needs than for physical healthcare.[[footnote 12]] This disparity leads to higher out-of-pocket costs and significant barriers to care for patients with mental health and substance use disorders. This is compounded by the fact that payers are struggling to expand their networks of behavioral health professionals.[[footnote 13]]\u003c/p\u003e\n\u003cp\u003ePotential strategies to address the overall lack of access to behavioral health services include the following:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eIn rural areas, where the shortage is starkest, telehealth services could provide behavioral health access to the underserved. Between January and October 2020, there was an increase of 59 percentage points nationally in the proportion of psychotherapy services delivered via telehealth.[[footnote 14]][[footnote 15]]\u003c/li\u003e\n \u003cli\u003eExpanding the capabilities of non-specialists to practice at the top of their license[[footnote 16]] and deliver care to patients with more complex needs (for example, models such as Project ECHO)[[footnote 17]] may decrease wait times for specialty behavioral healthcare and increase in-network accessibility.\u003c/li\u003e\n \u003cli\u003eThe expansion of community-based crisis services can offer services that may currently be available only in emergency departments and correctional facilities and potentially deliver better outcomes. Deploying mental health co-responder models instead of, or in partnership with, law enforcement can help route patients to community-based services and reduce overreliance on emergency sites of care.[[footnote 18]]\u003c/li\u003e\n \u003cli\u003eIncreased access to evidence-based treatments, such as the use of cognitive behavioral therapy, could reduce healthcare spend while providing higher quality of care and a better experience for individuals with depression.\u003c/li\u003e\n\u003c/ul\u003e\n[[disruptor1up learnmore]]\n\u003ch3\u003e2. Invest in behavioral health at parity with other health conditions\u003c/h3\u003e\n\u003cp\u003eTo adequately support behavioral health consumers, a major element is addressing the long-term supply-demand imbalance\u0026mdash;where the demand for behavioral health services far outstrips the availability of timely, affordable, and high-quality care. Strategies to help achieve this balance by expanding the supply of behavioral health services may include reexamination of reimbursement rates, investing in workforce development initiatives, supporting new care delivery models, and strengthening provider networks.\u003c/p\u003e\n\u003cp\u003eThe United States is facing a significant behavioral health workforce shortage. For example, as of 2018, 192 million Americans lived in counties with an insufficient[[footnote 19]] supply of psychiatrists.[[footnote 20]] Data also suggest that nationwide, approximately half of all psychiatrists do not accept any insurance, including Commercial, Medicare, and Medicaid.[[footnote 21]]\u003c/p\u003e\n\u003cp\u003eAlthough behavioral health has been a top bipartisan policy issue for more than a decade, behavioral health providers are often reimbursed at lower rates than non-behavioral health providers: compared with Medicare-allowed amounts, average 2017 in-network physician reimbursement rates for behavioral health office visits were lower than for primary care office visits and medical/surgical specialist office visits.[[footnote 22]] These disparities in reimbursement rate between behavioral health and primary care grew from 20.8 percent in 2015 to 23.8 percent in 2017.\u003c/p\u003e\n\u003cp\u003eAt the same time, the rate of out-of-network care utilization increased from 15 percent to 17 percent of adult behavioral health office visits (versus roughly 3 percent of primary care visits). For children, the rate of out-of-network utilization is 10 times higher for behavioral health than for primary care. Addressing reimbursement disparities could help expand networks in the short term and attract more professionals to the behavioral healthcare field in the long term, thereby supporting overall access to behavioral health services.\u003c/p\u003e\n\u003cp\u003eIn addition to reimbursement at parity, further investments in treatment, prevention, and early intervention services, such as the Collaborative Care Model (CoCM) or Screening, Brief Intervention, and Referral to Treatment (SBIRT),[[footnote 23]][[footnote 24]] could help mitigate exacerbations of latent mental health conditions and substance use disorders. These and other investments in behavioral healthcare could support an acceleration of advancement, quality, and access to improved whole person care.\u003c/p\u003e\n\u003ch2\u003eAdditional actions to build a holistic approach to healthcare\u003c/h2\u003e\n\u003cp\u003eAs highlighted in \u0026ldquo;\u003ca href=\"/industries/healthcare/our-insights/a-holistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-global-covid-19-pandemic\"\u003eA holistic approach for the US behavioral health crisis during the COVID-19 pandemic\u003c/a\u003e,\u0026rdquo; the following four actions may be integral to implementing whole person care, in addition to the two foundational actions described above.\u003c/p\u003e\n\u003ch3\u003e3. Strengthen community prevention\u003c/h3\u003e\n\u003cp\u003eFocusing on prevention, early intervention, and reducing stigma across communities could help alleviate the steady growth of preventable events, such as suicides. Workplace programs such as wellness seminars and personalized feedback could help educate employees on the signs of psychological distress and available treatment options. In schools, a holistic mental well-being and substance use education could offer children a framework to understand their behavioral health, and could help with early identification while reducing stigma associated with mental illnesses and substance use disorders.\u003c/p\u003e\n[[disruptor1up readnext]]\n\u003ch3\u003e4. Integrate behavioral and physical health\u003c/h3\u003e\n\u003cp\u003eLow integration of physical and behavioral healthcare may lead to delayed diagnosis of behavioral health conditions and prevent the delivery of whole person care.[[footnote 25]] Embedding mental healthcare managers into primary care clinics could help support a patient\u0026rsquo;s regular primary care clinician while improving behavioral health screening and treatment in conjunction with the management of their physical health conditions.\u003c/p\u003e\n\u003ch3\u003e5. Leverage data and analytics\u003c/h3\u003e\n\u003cp\u003eDeveloping proper data and analytics infrastructures to deploy value-based contracting could help reduce overall healthcare spend and provide a better behavioral healthcare experience, including for those already in treatment. Additionally, predictive analytics could help identify individuals who might benefit the most from the use of evidence-based treatment like cognitive behavioral therapy.\u003c/p\u003e\n\u003ch3\u003e6. Address unmet health-related basic needs[[footnote 26]]\u003c/h3\u003e\n\u003cp\u003eIndividuals with poor mental health are 1.9 times as likely to report not receiving the healthcare they need, and 2.5 times as likely to report having multiple unmet social needs.[[footnote 27]] By activating home- and community-based services, wraparound approaches can help address the various needs faced by children with behavioral health conditions.\u003c/p\u003e\n[[pullquote 1]]\n\u003ch2\u003ePotential impact of whole person care\u003c/h2\u003e\n\u003cp\u003eIf taken together, these six actions could improve the quality of care and experience for the millions of individuals with behavioral health conditions. As illustrated in Exhibit 1, these actions could also reduce total US healthcare spending annually by $185 billion. This figure represents around 6 percent of total healthcare spend in the United States.\u003c/p\u003e\n[[exhibit 1]]\n\u003cp\u003eAs part of this overall savings, an estimated increase of $60 billion in behavioral health outpatient spend (for example, through increased reimbursement rates, additional visits) is necessary to effectively implement the various interventions. However, we found that this increase is far outweighed by the potential for spend reduction of $35 billion in behavioral sites of care and $210 billion in physical sites of care, leading to $185 billion in net savings opportunity. Capturing this opportunity may require an additional $65 billion in incremental operating expenses, but could possibly lead to an estimated return of $3 for every $1 invested.\u003c/p\u003e\n\u003cp\u003eThe savings impact of these interventions varies across the behavioral and physical health needs spectrum. For example, when considering the impact of integrating physical and behavioral healthcare, we see a difference in savings across different member cohorts. For those with high behavioral health needs,[[footnote 28]] savings due to this intervention are estimated to be 12 percent of baseline spend, while members with mild or moderate needs might only see estimated savings of 8 percent. These disparities result from differences in spend among behavioral and physical sites of care for each cohort, as well as different estimates for savings rates across sites of care for each cohort (Exhibit 2).\u003c/p\u003e\n[[exhibit 2]]\n\u003cp\u003eWhile it may seem intuitive to focus on the cohorts with the highest potential for savings (for example, individuals with high behavioral health needs and complex physical health conditions), year-to-year movement of individuals between cohorts means that enhancements should likely occur across all segments. In a claims analysis of employer-sponsored members,[[footnote 29]] we found that 50 percent of behavioral health high-needs members were in a lower behavioral health-needs cohort, with 25 percent having no previous behavioral health diagnosis the previous year. Instead of waiting until people reach the point of crisis, we can take a holistic approach across all populations from screening and preventative care to more intensive services for patients with serious mental illnesses and substance use disorders.\u003c/p\u003e\n\u003ch2\u003eThe need for action\u003c/h2\u003e\n[[sidebar 2]]\n\u003cp\u003eCOVID-19 has exacerbated the behavioral health crisis facing people across the world, as stressors such as high rates of infection, grief and loss, social isolation, and unemployment have grown. Stresses experienced by frontline healthcare workers have further brought to light the salience of these challenges. We now have the chance to reexamine whole person care by addressing social determinants of health, integrating physical and behavioral healthcare, and meeting people where they are. Efforts to boost this concept could send far-reaching ripple effects into society. These effects could include improved quality of life and reduce premature mortality due to chronic disease, suicide, and overdose for individuals. Additionally, employers could see benefits in the form of improved employee engagement and reduced absenteeism, workplace injury, and disability. Finally, society as a whole stands to benefit the most through improved life expectancy, educational achievement, workforce participation, and community engagement, along with reduced criminal justice involvement and homelessness.\u003c/p\u003e\n\u003cp\u003eHealthcare leaders have a chance to help scale evidence-based solutions, advancing innovation and investing in whole person care. Taking these actions can create meaningful change to save lives, advance economic prosperity, and prioritize health for future generations.\u003c/p\u003e"},"isFullScreenInteractive":{"boolValue":false},"hideStickySocialShareBar":{"boolValue":false},"desktopID":{"value":""},"mobileID":{"value":""},"desktopURL":{"value":""},"mobileURL":{"value":""},"desktopPaddingPercentage":{"value":""},"mobilePaddingPercentage":{"value":""},"desktopOverrideHeight":{"value":""},"mobileOverrideHeight":{"value":""},"cerosOembedURL":{"value":""},"cerosRenderMode":{"targetItem":null},"cerosBackgroundColor":{"targetItem":null},"hideByLine":{"boolValue":false},"tableOfContentsTitle":{"value":"TABLE OF CONTENTS"},"accessStatus":{"targetItem":{"key":{"value":"RegisteredUsers"},"value":{"value":"Registered Users"}}},"articleType":{"targetItem":{"displayName":"Article"}},"hasSpecialReport":{"boolValue":false},"contentType":{"targetItem":{"displayName":"Article"}},"sourcePublication":{"targetItem":null},"externalPublication":{"value":""},"excludeFromClientLink":{"boolValue":false},"originalPublishDate":{"jsonValue":{"value":"2021-02-24T00:00:00Z"}},"footnotes":{"value":"\u003col\u003e\n \u003cli\u003eSubstance Abuse and Mental Health Services Administration, \u003cem\u003eKey substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health\u003c/em\u003e (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55), Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2020, samhsa.gov.\u003c/li\u003e\n \u003cli\u003eErica Hutchins Coe, Kana Enomoto, Patrick Finn, John Stenson, and Kyle Weber, \u0026ldquo;\u003ca href=\"/industries/healthcare/our-insights/understanding-the-hidden-costs-of-covid-19s-potential-impact-on-us-healthcare\"\u003eUnderstanding the hidden costs of COVID-19\u0026rsquo;s potential impact on US healthcare\u003c/a\u003e,\u0026rdquo; September 4, 2020, McKinsey.com.\u003c/li\u003e\n \u003cli\u003eRyan McBain et al., \u0026ldquo;Growth and distribution of child psychiatrists in the United States: 2007\u0026ndash;2016,\u0026rdquo; \u003cem\u003ePediatrics\u003c/em\u003e, December 2019, Volume 144, Number 6, p. e20191576, pediatrics.aappublications.org.\u003c/li\u003e\n \u003cli\u003eMonica Malowney et al., \u0026ldquo;Availability of outpatient care from psychiatrists: A simulated-patient study in three U.S. cities,\u0026rdquo; \u003cem\u003ePsychiatric Services\u003c/em\u003e, 2015, Volume 66, pp. 94\u0026ndash;6, ps.psychiatryonline.org.\u003c/li\u003e\n \u003cli\u003eWendy Yi Xu et al., \u0026ldquo;Cost-sharing disparities for out-of-network care for adults with behavioral health conditions,\u0026rdquo; \u003cem\u003eJAMA Network Open\u003c/em\u003e, 2019, Volume 2, Number 11, p. e1914554, jamanetwork.com.\u003c/li\u003e\n \u003cli\u003eJeffery Epstein et al., \u0026ldquo;Variability in ADHD care in community-based pediatrics,\u0026rdquo; \u003cem\u003ePediatrics\u003c/em\u003e, December 2014, Volume 134, Number 6, pp. 1136\u0026ndash;43, pediatrics.aappublications.org.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Survey: Americans becoming more open about mental health,\u0026rdquo; American Psychological Association, May 1, 2019, apa.org.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eAmericans\u0026rsquo; views on policies to address prescription drug prices, the opioid crisis, and other current domestic issues\u003c/em\u003e, a joint report from Politico and Harvard T.H. Chan School of Public Health, July 2018, static.politico.com.\u003c/li\u003e\n \u003cli\u003eErica Hutchins Coe and Kana Enomoto, \u0026ldquo;\u003ca href=\"/industries/healthcare/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health\"\u003eReturning to resilience: The impact of COVID-19 on mental health and substance use\u003c/a\u003e,\u0026rdquo; April 2, 2020, McKinsey.com.\u003c/li\u003e\n \u003cli\u003eAnalysis of providers who submitted at least one claim (based on data from Compile.com for all lines of business and Medicare Provider Utilization and Payment Data) compared to Psychiatrists identified NPPES NPI registry using primary taxonomy code.\u003c/li\u003e\n \u003cli\u003eLindsay Kalter, \u0026ldquo;Treating mental illness in the ED,\u0026rdquo; Association of American Medical Colleges, September 3, 2019, aamc.org.\u003c/li\u003e\n \u003cli\u003eStoddard Davenport, TJ Gray, and Stephen Melek, \u0026ldquo;Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement,\u0026rdquo; Milliman, November 20, 2019, milliman.com.\u003c/li\u003e\n \u003cli\u003eSusan Busch and Kelly Kyanko, \u0026ldquo;Incorrect provider directories associated with out-of-network mental health care and outpatient surprise bills,\u0026rdquo; \u003cem\u003eHealth Affairs\u003c/em\u003e, June 2020, Volume 39, Number 6, pp. 975\u0026ndash;83, healthaffairs.org.\u003c/li\u003e\n \u003cli\u003eBased on analysis of a data sample from 115,000 behavioral health providers providing services to over 20 million individuals in the United States with Commercial, Medicaid, or Medicare insurance (underlying data from compile.com).\u003c/li\u003e\n \u003cli\u003eTelehealth visits are remote visits provided via telecommunications technologies for behavioral healthcare.\u003c/li\u003e\n \u003cli\u003ePracticing at the \u0026ldquo;top of their license\u0026rdquo; implies maximizing the amount of time providers spend on the highest-complexity activities commensurate with their training and experience.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Project ECHO,\u0026rdquo; University of New Mexico School of Medicine, 2021, hsc.unm.edu.\u003c/li\u003e\n \u003cli\u003eRL Scott, \u0026ldquo;Evaluation of a mobile crisis program: Effectiveness, efficiency, and consumer satisfaction,\u0026rdquo; \u003cem\u003ePsychiatric Services\u003c/em\u003e, September 2000, Volume 51, Number 9, pp. 1153\u0026ndash;6, ps.psychiatryonline.org.\u003c/li\u003e\n \u003cli\u003eInsufficient supply is defined as less than 16 psychiatrists per 100,000 residents in any given county from Richard Cooper et al., \u0026ldquo;Economic and demographic trends signal an impending physician shortage,\u0026rdquo; \u003cem\u003eHealth Affairs\u003c/em\u003e, 2002, Volume 21, Number 1, pp. 140\u0026ndash;54, healthaffairs.org.\u003c/li\u003e\n \u003cli\u003eBased on analysis of location of providers with a primary taxonomy of psychiatry in the NPPES NPI registry and population estimates.\u003c/li\u003e\n \u003cli\u003eBased on analysis comparing the number of psychiatrists identified in NPPES NPI registry who did not bill a claim (2018) or are not in enrolled in Medicare (as of September 2020) to the number of psychiatrists that have billed a claim in the past year or have provided services to Medicare beneficiaries.\u003c/li\u003e\n \u003cli\u003eBased on two most commonly billed office visit CPT codes; Stoddard Davenport, TJ Gray, and Stephen Melek, \u0026ldquo;Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement,\u0026rdquo; Milliman, November 20, 2019, milliman.com.\u003c/li\u003e\n \u003cli\u003eJ\u0026uuml;rgen Un\u0026uuml;tzer et al., \u0026ldquo;Long-term cost effects of collaborative care for late-life depression,\u0026rdquo; \u003cem\u003eAmerican Journal of Managed Care\u003c/em\u003e, February 2008, Volume 14, Number 2, pp. 95\u0026ndash;100, ajmc.com.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;Screening, brief intervention, and referral to treatment (SBIRT),\u0026rdquo; Substance Abuse and Mental Health Services Administration, September 15, 2017, samhsa.gov.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;SAMHSA \u0026ndash; Behavioral health integration,\u0026rdquo; Substance Abuse and Mental Health Services Administration, samhsa.gov.\u003c/li\u003e\n \u003cli\u003eAlso referred to as social determinants of health or social needs, including income, employment, education, food, housing, transportation, social support, and safety. These basic needs, if unmet, can negatively impact health. In addition, factors such as race, ethnicity, gender and sexual orientation, disability, and age can influence health status.\u003c/li\u003e\n \u003cli\u003eErica Hutchins Coe, Jenny Cordina, Kana Enomoto, and Elena Mendez-Escobar, \u0026ldquo;\u003ca href=\"/industries/healthcare/our-insights/insights-on-mental-health-from-a-2019-mckinsey-consumer-survey\"\u003eInsights on mental health from a 2019 McKinsey Consumer survey\u003c/a\u003e,\u0026rdquo; February 14, 2020, McKinsey.com.\u003c/li\u003e\n \u003cli\u003eIndividuals with acute behavioral health conditions (for example, schizophrenia, bipolar disorder with psychosis), or having high acuity behavioral health utilization (for example, inpatient visit, emergency department visit) AND presence of disorders (for example, PTSD, substance use, eating disorders).\u003c/li\u003e\n \u003cli\u003eAnalysis includes claims data from International Business Machines Corporation\u0026rsquo;s Truven MarketScan Commercial Database. Any analysis, interpretation, or conclusion based on these data is solely that of the authors and not International Business Machines Corporation.\u003c/li\u003e\n\u003c/ol\u003e"},"contributoryPractice":{"targetItems":[{"displayName":"Healthcare"},{"displayName":"SHaPE"}]},"aboutTheAuthors":{"value":"\u003cp\u003e\u003ca href=\"/our-people/erica-coe\"\u003e\u003cstrong\u003eErica Coe\u003c/strong\u003e\u003c/a\u003e is a partner in McKinsey\u0026rsquo;s Atlanta office and co-leads the \u003ca href=\"/sitecore/service/notfound.aspx?item=web%3a%7b7a6990ca-f9c8-4e94-a5f0-6033ed632d1c%7d%40en\"\u003eCenter for Societal Benefit through Healthcare\u003c/a\u003e. \u003ca href=\"/our-people/kana-enomoto\"\u003e\u003cstrong\u003eKana Enomoto\u003c/strong\u003e\u003c/a\u003e is a senior expert in the Washington, DC, office and co-leads the \u003ca href=\"/sitecore/service/notfound.aspx?item=web%3a%7b7a6990ca-f9c8-4e94-a5f0-6033ed632d1c%7d%40en\"\u003eCenter for Societal Benefit through Healthcare\u003c/a\u003e. \u003cstrong\u003eCarlos Pardo Martin\u003c/strong\u003e is a partner in the New York office. \u003cstrong\u003eNikhil Seshan\u003c/strong\u003e is a consultant in the Philadelphia office. \u003c/p\u003e\n\n\u003cp\u003eThe authors would like to thank Chandra Yueh, Lukas Ruiz, Brad Herbig, Allyson Zucker, Pranay Orugunta, Razili Lewis, Uzoma Ononogbu, Andrew Linzer, and Kevin Collins for their contributions to this paper.\u003c/p\u003e\n\n\u003cp\u003eThis article was edited by Elizabeth Newman, an executive editor in the Chicago office.\u003c/p\u003e"},"authors":{"targetItems":[{"template":{"id":"3FBABDB63A094F68B1F8E1BBE1BA124E","name":"Author"},"id":"9E849BBC658F45948FE09D6620AAE257","name":"Erica Coe","authorTitle":{"value":"Erica Coe"},"description":{"value":""},"thumbnailImage":{"alt":"","src":null},"profile":{"targetItems":[{"standardImage":{"src":"/~/media/mckinsey/mckinsey health institute/our people/thumb_erica_1536x1536.jpg","alt":"Erica Coe"},"emailLinks":{"value":"Erica_Coe@mckinsey.com"},"linkedInUrl":{"value":"https://www.linkedin.com/in/ericahutchins/"},"description":{"value":"Advises leading public-, private-, and social-sector healthcare organizations to embrace a holistic approach to care, inclusive of brain health and social determinants of health, and coleads McKinsey Health Institute"},"locations":{"targetItems":[{"name":"Atlanta","displayName":"Atlanta"}]},"firmTitle":{"value":"Partner"},"thumbnailImage":{"alt":"Erica Coe","src":"/~/media/mckinsey/mckinsey health institute/our people/thumb_erica_coe_1536x1536.jpg"},"url":{"path":"/our-people/erica-coe"}}]}},{"template":{"id":"3FBABDB63A094F68B1F8E1BBE1BA124E","name":"Author"},"id":"4B42146D8CFF446A9F6BE75495A8CDB0","name":"Kana Enomoto","authorTitle":{"value":"Kana Enomoto"},"description":{"value":""},"thumbnailImage":{"alt":"","src":null},"profile":{"targetItems":[{"standardImage":{"src":"/~/media/mckinsey/our people/kana enomoto/kana_enomoto_4n0a2499_fc-mask_profile_1536x1152.png","alt":"Kana Enomoto"},"emailLinks":{"value":"Kana_Enomoto@mckinsey.com"},"linkedInUrl":{"value":"https://www.linkedin.com/in/kana-enomoto-68b8a0195/"},"description":{"value":"Leader in mental-health and substance-use policy, data, programs, and practice improvement; brain health expert at the McKinsey Health Institute"},"locations":{"targetItems":[{"name":"Washington DC","displayName":"Washington DC"}]},"firmTitle":{"value":"Partner"},"thumbnailImage":{"alt":"Kana Enomoto","src":"/~/media/mckinsey/our people/kana enomoto/kana_enomoto_4n0a2499_fc-mask_headshot_988x741.png"},"url":{"path":"/our-people/kana-enomoto"}}]}},{"template":{"id":"3FBABDB63A094F68B1F8E1BBE1BA124E","name":"Author"},"id":"AB76B00EEE854397893AF849A3F18BDD","name":"Carlos Pardo Martin","authorTitle":{"value":"Carlos Pardo Martin"},"description":{"value":""},"thumbnailImage":{"alt":"","src":null},"profile":{"targetItems":[{"standardImage":{"src":"/~/media/mckinsey/our people/carlos pardo martin/carlos_pardo martin_standard_profile_1536x1152.jpg","alt":"Carlos Pardo Martin"},"emailLinks":{"value":"Carlos_Pardo_Martin@mckinsey.com"},"linkedInUrl":{"value":"https://www.linkedin.com/in/carlos-pardo-martin-ph-d-52b20212/"},"description":{"value":"Helps health plan and services clients to bring innovations on areas of behavioral health, social determinants of health, and health equity"},"locations":{"targetItems":[{"name":"New York","displayName":"New York"}]},"firmTitle":{"value":"Partner"},"thumbnailImage":{"alt":"Carlos Pardo Martin","src":"/~/media/mckinsey/our people/carlos pardo martin/carlos_pardo martin_headshot_988x741.jpg"},"url":{"path":"/our-people/carlos-pardo-martin"}}]}},{"template":{"id":"3FBABDB63A094F68B1F8E1BBE1BA124E","name":"Author"},"id":"9D7EDEDC5D1B456EA19D2B35F79E6049","name":"Nikhil Seshan","authorTitle":{"value":"Nikhil Seshan"},"description":{"value":""},"thumbnailImage":{"alt":"","src":null},"profile":{"targetItems":[]}}]},"nonPartnerAuthors":{"targetItems":[]},"interactiveToUse":{"targetItem":null},"enableArticleComponents":{"boolValue":false},"relatedArticles":{"targetItems":[{"sourcePublication":{"targetItem":null},"publicationSource":null,"externalPublication":{"value":""},"title":{"value":"Returning to resilience: The impact of COVID-19 on mental health and substance use"},"url":{"path":"/industries/healthcare/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health"},"eyebrow":{"targetItem":{"name":"Article"}},"articleType":{"targetItem":{"name":"Article"}},"contentType":{"targetItem":{"name":"Article"}},"description":{"value":"As governments race to contain COVID-19, it is important to know the actions society can take to mitigate the behavioral health impact of the pandemic and economic crisis."},"standardImage":{"src":"/~/media/mckinsey/industries/healthcare systems and services/our insights/returning to resilience the impact of covid 19 on behavioral health/hero-returning-to-reslience.jpg","alt":"Returning to resilience: The impact of COVID-19 on behavioral health"},"heroImage":null,"thumbnailImage":null},{"sourcePublication":{"targetItem":null},"publicationSource":null,"externalPublication":{"value":""},"title":{"value":"COVID-19 and behavioral health: Consequences for companies and employees"},"url":{"path":"/industries/healthcare/our-insights/covid-19-and-behavioral-health-consequences-for-companies-and-employees"},"eyebrow":{"targetItem":{"name":"Podcast"}},"articleType":{"targetItem":{"name":"Podcast"}},"contentType":{"targetItem":{"name":"Article"}},"description":{"value":"The pandemic is exacerbating the US behavioral-health crisis, with stress, social isolation, and unemployment fueling up to $140 billion in added spending. 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Changes such as: including behavioral health screenings in preventative physical health appointments, providing school-based mental well-being and substance use education, and preventing social isolation though peer support can help create an environment that provides benefits to both behavioral and physical health.\u003c/p\u003e\n\u003cp\u003eIn the video below, three vignettes illustrate how behavioral healthcare is experienced today, and what it may look like in the future when evidence-based prevention, treatment, and recovery supports are used to address whole person care.\u003c/p\u003e"}},"aboutTheAuthors":{"jsonValue":{"value":""}},"headline":{"jsonValue":{"value":"The future of behavioral health"}},"footnotes":{"value":""},"showShareTools":{"boolValue":true},"backgroundColor":{"targetItem":{"key":{"value":"Lightest Grey"},"value":{"value":"lightest-grey"}}},"gradientDirection":{"targetItem":{"key":{"value":"Bottom Right"},"value":{"value":"bottom-right"}}},"renderMode":{"targetItem":{"key":{"value":"Collapsible"},"value":{"value":"default"}}},"isAboutAuthor":{"boolValue":false},"background":{"targetItem":null},"image":{"src":null,"alt":""}},{"mediaID":{"value":"2"},"description":{"jsonValue":{"value":"\u003cp\u003eThe $185 billion savings estimate provided in this paper derives from academic literature of behavioral health interventions and our analysis of their impact on member cohorts across the behavioral and physical health needs spectrums.\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003eMember cohorts considered in the model.\u003c/em\u003e Patient populations across Commercially-insured, Medicare, and Medicaid lines of business were divided into 14 member cohorts based on their behavioral healthcare needs (for example, high needs, mild/moderate needs, diagnosed but not treated, treated but not diagnosed, healthy) and physical healthcare needs (for example, complex needs, specialty chronic needs, primary care treatable needs, healthy). These classifications were largely based on behavioral and physical health diagnoses and utilization from healthcare claims data.\u003c/p\u003e\n\n\u003cp\u003e\u003cem\u003eResearch literature.\u003c/em\u003e To determine how various behavioral health interventions could impact healthcare spend for the above cohorts, we reviewed the relevant academic literature concerning these interventions. Based on the studies cited throughout this paper and others, we estimated the savings impact across sites of care for each member cohort. Examples include:\u003c/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\u003cem\u003eIntegration of physical and behavioral healthcare:\u003c/em\u003e Through a stepped collaborative care program, care managers were embedded in the patient\u0026rsquo;s primary care clinic. These care managers would support the primary care physician by conducting mental health and substance use screenings, monitoring patient progress, and adjusting treatment plans tailored by a stepped-care treatment algorithm. For individuals with mild/moderate behavioral health needs and those who are diagnosed but not treated, these measures led to an increase of approximately 41 percent in behavioral outpatient spend (due to additional care received by patients), but also to a decrease in behavioral inpatient spend by 64 percent, physical inpatient spend by 26 percent, and behavioral and physical health prescription spend by 9 percent.[[footnote 1]]\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eExpanded care navigation:\u003c/em\u003e In this intervention, care managers combined patient education with logistical support to coach patients on interacting effectively with their providers and helped them overcome barriers to attending medical appointments. This intervention resulted in decreased spend across several sites of care, including a 13 percent decrease in physical emergency care spend and 17 percent decrease in behavioral health outpatient spend.[[footnote 2]]\u003c/li\u003e\n\u003c/ul\u003e\n\n\u003cp\u003e\u003cem\u003eMedical and pharmacy claims data.\u003c/em\u003e We used medical claims data from a range of sources to estimate the impact of the measures above on member spend across lines of business.[[footnote 3]] Members for each line of business were segmented based on the member cohorts described previously, and spend data was apportioned appropriately. Claims sources were adjusted to be representative of the national 2020 population using membership weighting (Definitive Healthcare), membership updates (McKinsey Enrollment Projection Tool), rate updates (Substance Abuse and Mental Health Services Administration\u0026mdash;for example SAMHSA), pharmacy estimates (SAMHSA), and insurance administration estimates (SAMHSA).\u003c/p\u003e"}},"aboutTheAuthors":{"jsonValue":{"value":""}},"headline":{"jsonValue":{"value":"Methodology for estimating savings impact of behavioral healthcare interventions on US healthcare spend"}},"footnotes":{"value":"\u003col\u003e\n \u003cli\u003eJ\u0026uuml;rgen Un\u0026uuml;tzer et al., \u0026ldquo;Long-term cost effects of collaborative care for late-life depression,\u0026rdquo; \u003cem\u003eAmerican Journal of Managed Care\u003c/em\u003e, February 2008, Volume 14, Number 2, pp. 95\u0026ndash;100, ajmc.com.\u003c/li\u003e\n \u003cli\u003eBenjamin Druss et al., \u0026ldquo;Budget impact and sustainability of medical care management for persons with serious mental illnesses,\u0026rdquo; \u003cem\u003eAmerican Journal of Psychiatry\u003c/em\u003e, November 2011, Volume 168, Number 11, pp. 1171\u0026ndash;8, ajp.psychiatryonline.org.\u003c/li\u003e\n \u003cli\u003eThe specific claims data sources we used include: 2018 data from complete anonymized Managed Medicaid claims data from one state (Medicaid), CMS Limited Data Set (LDS) claims (Medicare), and International Business Machines Corporation\u0026rsquo;s Truven MarketScan Commercial Database (Commercial).\u003c/li\u003e\n\u003c/ol\u003e"},"showShareTools":{"boolValue":true},"backgroundColor":{"targetItem":{"key":{"value":"Lightest Grey"},"value":{"value":"lightest-grey"}}},"gradientDirection":{"targetItem":{"key":{"value":"Bottom Right"},"value":{"value":"bottom-right"}}},"renderMode":{"targetItem":{"key":{"value":"Collapsible"},"value":{"value":"default"}}},"isAboutAuthor":{"boolValue":false},"background":{"targetItem":null},"image":{"src":null,"alt":""}}]},"boxout":{"results":[]},"globalsidebar":{"results":[]},"video":{"results":[{"template":{"name":"Video"},"mediaID":{"value":"2"},"videoID":{"value":"6234980924001"},"headline":{"value":"The Future of Behavioral Health"},"description":{"value":""},"mediaEyebrow":{"value":""},"displayNumber":{"value":""},"hideMediaEyebrow":{"boolValue":false},"displayMode":{"targetItem":{"key":{"value":"Collapsed"},"value":{"value":"Collapsed"}}}}]},"scrollycontainer":{"results":[]},"bespokeinteractive":{"results":[]},"storycontainer":{"results":[]},"interactive":{"results":[]},"sectionheader":{"results":[]},"statementdisruptor":{"results":[]},"fullbleedphoto":{"results":[]},"tocitem":{"results":[]},"quizcontainer":{"results":[]},"generalup":{"results":[]},"twoupmedium":{"results":[]},"accordion":{"results":[]},"factoid":{"results":[]},"promobarwithquote":{"results":[]},"oneupmedium":{"results":[]},"oneupmediumquote":{"results":[]},"gridwall":{"results":[]},"twoupsmall":{"results":[]},"oneclicksubscribe":{"results":[]},"promobar":{"results":[]},"promobanner":{"results":[]},"sectionhero":{"results":[]},"threeuplinklist":{"results":[]},"table":{"results":[]},"explainertooltip":{"results":[]},"isFiveFiftyHorizontalArticle":{"boolValue":false},"fiveFifty":{"results":[]}},"contextItem":{"ancestors":[{"breadCrumbUrl":{"path":"/industries/healthcare/our-insights"},"breadCrumbTitle":{"value":"Our Insights"},"isMiniSite":{"boolValue":false},"displayName":"Insights on Healthcare Systems \u0026 Services","template":{"id":"85FF05307883480F9A4C82123F72FFD8"}},{"breadCrumbUrl":{"path":"/industries/healthcare/how-we-help-clients"},"breadCrumbTitle":null,"isMiniSite":{"boolValue":true},"displayName":"Healthcare","template":{"id":"414C6C64AD35440E9668CF39D8A18CCF"}},{"breadCrumbUrl":{"path":"/industries"},"breadCrumbTitle":{"value":"Industries"},"isMiniSite":{"boolValue":false},"displayName":"Industries","template":{"id":"85FF05307883480F9A4C82123F72FFD8"}},{"breadCrumbUrl":{"path":"/"},"breadCrumbTitle":{"value":""},"isMiniSite":{"boolValue":false},"displayName":"Home","template":{"id":"85FF05307883480F9A4C82123F72FFD8"}}]}}},"placeholders":{"main-area":[],"sidebar-area":[]}}]}},"itemId":"9617104e-fb7a-4b47-80b8-edeaee09d957","pageEditing":false,"site":{"name":"website"},"pageState":"normal","language":"en","pageMetaData":{"alternateLanguages":[{"languageCode":"en","displayName":"English","url":"/industries/healthcare/our-insights/unlocking-whole-person-care-through-behavioral-health"}],"currentLanguage":"en","navigationLink":"industries","activeItemId":"{3A5EE1BB-D67F-492F-B071-5A4C1EA27A2B}","miniSiteId":"{9355FD92-4458-4A6E-931E-5F4B6015ADB1}","officeCode":"","officeDisplayName":"","subscriptionPracticeData":null,"isAlaisedPage":false,"originalHostName":"www.mckinsey.com","updatedDate":"2023-03-04T09:45:28Z","createdDate":"2020-04-24T20:54:43Z","practice":{"isDefaultPractice":false,"name":"Healthcare","code":"N16","stickyTitle":"Sign up for emails on new Healthcare articles","stickySubtitle":"Never miss an insight. 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