Managed Care Best Practices The Road From Diagnosis to Recovery: Access to Appropriate Care

BACKGROUND: Depression is a painful, functionally impairing, and frequently recurring condition. A costly illness for employers, depression contributes to reduce functioning, decreased work productivity, and absenteeism. In addition, costs associated with comorbidities in people who have depression are higher when they are compared with the costs in people who do not have depression. In patients with either coronary or cerebral vascular disease, depression significantly increases the risk of cardiovascular morbidity and mortality. OBJECTIVES: To highlight some of the challenges faced by primary care providers when they deliver mental health services and to provide an overview of an integrated behavioral health and medical benefit plan implemented as one solution to improve overall depression outcomes and reduce associated depression costs. SUMMARY: Because of the high prevalence and significant impact of depression, the U.S. Preventive Services Task Force recommends screening adults for depression in clinical practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up. However, depression appears to be only partially recognized and inadequately treated in primary care due somewhat to several challenges that primary care practitioners face when they manage a mental health diagnosis along with comorbid medical illnesses. CONCLUSIONS: Integrating the medical and behavioral health benefits in a health plan allows for depression screening and the opportunity to direct patients to seek treatment when needed. Preliminary results of this effort in one managed care plan show reduced use of hospital services, days gained at work, and improved adherence to antidepressant therapy. A different component of this plan design includes patient care coaching as well as support of primary care's efforts by providing expert telephone consultation about treatment plans and allowing billing for adequate time spent with depressed patients.