Harry is a 52-year-old diabetic with chronic bipolar disorder and substance abuse problems. He visits the emergency room more than three times per year, when his health deteriorates to the point where he requires immediate life-saving measures.
When Harry forgets or neglects to take his bipolar medication, he drinks more and his diabetes gets worse. His addiction counselor talks to him about his drinking problem, but assumes that Harry’s medical doctor is taking care of his diabetes. He does not fully realize the impact Harry’s drinking has on his diabetic condition. When Harry’s blood sugar gets out of control, he appears to be psychotic and so his psychiatrist increases his medication for mental illness.
Harry would most likely be part of the top 5 percent of the U.S. population that, according to the Department of Health and Human Services, accounts for nearly half of the $1.9 trillion in annual health care expenses. With multiple chronic conditions, he costs seven times the amount that a patient with one chronic condition would cost. His story demonstrates exactly what’s wrong with our current, costly health care system.
First, there is a lack of coordination. Medical health care providers typically do not have the expertise to identify or treat patients with mental illness or substance abuse issues, even though these conditions may be complicating their physical condition.
Conversely, mental health providers do not usually have the expertise to identify or treat medical illnesses such as diabetes, neurological disorders, and cardiovascular disease, although these very illnesses may be complicating the mental illness.
With this in mind, the real issue is not that either group lacks experience, education, or expertise to effectively treat the problems they are supposed to treat. The issue is that without basic coordination between a patient’s medical and mental health professional, the best solutions that can be reached are sub-optimal in both cost and effectiveness because neither one of them are seeing the whole picture.
The second problem with the health care system is that too often we treat health issues with the wrong tools. Change in health behavior is essential to recovery and bringing down health care costs. Doctors may tell a patient that they need to lose weight, stop smoking, or cut back on alcohol, but very rarely do they help them implement those changes. However, behavior change is an area that mental health providers understand very well.
If the mental, medical, and social service providers worked together, the recovery rates could improve and costs could be cut drastically. Each illness, mental or physical, could be treated appropriately and effectively and the impact of one illness on any of the others would be well known and documented.
Consider the potential impact on Harry’s story: Instead of spending $3,000 –10,000 for each ER visit ($15,000 - 50,000 per year for five visits), regular treatment with mental health and substance abuse professionals could be provided for under $6,000 for the entire year. Primary medical care may average $1,200 per year or less. Furthermore, paraprofessionals who can help Harry follow his treatment regimens at home can cost as little as an additional $5,000 per year (Total of $12,200 per year).
If this more effective coordinated community care prevents three ER visits per year, and keeps Harry’s illnesses from increasing in severity, it could cut his medical bills significantly,with the added consideration that he would be receiving better care.
While the complete integration of all health services is an idealistic goal at this point, it’s a direction we need to move in. Up to this point, we’ve been fishing with hand grenades instead of lines and lures. We’re fighting a losing battle as long as we continue to treat a problem only when it walks into the ER, without sufficient follow-up or support for healthy behaviors.
Now, more than ever before, we have an opportunity to improve quality of life by addressing problems earlier on in the process. We can make it easier for the average person to receive timely care in an emergency room by reducing the number of “frequent flyers.” And, so importantly, we can lower insurance premiums by reducing the number of recurring, problematic cases that drive costs upwards. Preemptive care and extensive lifestyle assistance are the fastest and most effective ways to make this dream a reality.
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