Payers and employers often have a blind spot when it comes to addressing inequities in behavioral health. But ignoring mental health care inequities can increase overall health care costs.
An analysis from Deloitte suggested that inequities have led to $320 billion in annual health care spending — “signaling an unsustainable crisis for the industry.” That figure is expected to worsen, too.
U.S. spending on health inequities could balloon to $1 trillion by 2040 if current trends continue, according to Deloitte. The average American’s cost of health care would shoot to $3,000 annually, up from the current cost of $1,000 each year.
Women, young people and the BIPOC community are more likely to experience a behavioral health issue, according to a data brief from Optum Behavioral Health Solutions. Health disparities can lead to premature death and sickness, disproportionately impacting people of color and poor people.
The mental health field is susceptible to racial, ethnic and socioeconomic disparities. For example, Black adults were 2.2 times more likely to have substance use disorder compared to Asian adults in 2021. Inequities are further compounded by stigma and lack of accessible therapies or awareness.
Disparities are deeply impacted by “social determinants of health,” which include where people live, work and play. These determinants are curated by policies, businesses and community services.
“As much as 80% of health outcomes are tied to social and economic conditions,” Yusra Benhalim, senior national medical director of Optum Behavioral Health Solutions, told Behavioral Health Business. “These factors can have a notable impact on health, a person’s function, their quality of life, both their outcomes and the risk.”
Optum Behavioral Health Solutions, part of UnitedHealth Group (NYSE: UNH), is an information and technology-enabled health services business employing 310,000 people worldwide.
Challenges for patients
Health inequities have serious consequences on individuals, and inequities between people of different races and ethnicities have only worsened in recent years.
People with disabilities, who are at a greater risk for social disconnectedness, have an increased risk of anxiety, depression and substance use disorder, according to America’s Health Rankings 2022 annual report.
Females have higher rates of anxiety and depression, as well as other mental health problems, than males.
“Even though the data doesn’t necessarily tell us the why behind the disparity, it can help spark curiosity and our ability to rethink how we’re approaching support for different genders, as well as for those who identify as nonbinary in our communities,” Benhalim said.
For people who speak a language other than English, even finding the right provider can be difficult.
“Not everybody speaks English,” Christina Farr, a health and technology investor at OMERS Ventures, told BHB. “Not everybody has the same cultural frame of reference. It’s really hard and expensive to have to do that work of building for different cultures, languages and populations. You have to raise a fair bit of money to be able to do that.”
OMERS Ventures is an early-stage venture capital firm. Their investments in health technology include Caraway, Oath and WithMe.
Inequities drive expense
A lack of preventative care for people of different demographics can mean increased expenses down the line for payers.
“One of the reasons that [payers] have to care is because a lot of these patients end up in the emergency room,” Farr said. “There is an economic kind of incentive to care.”
Most Americans have employer-sponsored insurance coverage, so employers’ bottom lines are impacted by the cost of inequity.
“The disparities and inequities that affect the general public affect businesses as well,” Jahmal Miller, the chief administrative officer of Dignity Health Mercy Medical Group, told BHB. “What you find is that you’re paying extraordinarily more dollars and investing into an unhealthy workforce, a workforce that is experiencing higher levels of diabetes, or obesity, or any number of issues where we see a lot of disparities and inequities.”
San Francisco-based Dignity Health Mercy Medical Group is a health system offering behavioral health services with over 400 care centers in the US.
Employers often have a knowledge gap when it comes to inequities, Miller said. Because people of color or poor people are most impacted, biases can stop employers from addressing disparities.
“I would encourage business leaders to understand that this is a $1.24 trillion opportunity,” Miller said. “You start to get a real tangible sense that inequities aren’t just about morals and ethics and doing the right thing.”
Value-based care could be part of a plan to address health equity, sources told BHB.
“Value-based care is more aligned with thinking about issues of equity because you’re looking at the patient’s outcome and their whole experience of life,” Farr said. “That’s why you see a lot of health equity advocates focusing on value-based care. It can move the needle in the right direction.”
A value-based approach is a 180-degree shift from traditional fee-for-service models, Miller said.
“Value, which focuses on better outcomes, keeping people out of hospitals and getting the right care at the right time in the right place, is rooted in a model that is counter to what our fee-for-service, high productivity, disease management volume-drive focus has been,” he said.
Transitioning to value-based care alone is not enough, however. A health equity strategy is necessary within the framework of value-based care to address inequities.
“If we’re looking at prevention, primary care, incentivizing better outcomes, and not incentivizing productivity, that means we want to prevent early death for African American families,” Miller said. “We want to prevent early sickness for [people of Asian, Asian American, or Pacific Islander ancestry]. We want to prevent amputations from peripheral artery disease. That’s the benefit of value-based care becoming much more normalized.”