Care Management Blog

Physicians and their staff have long been advised of the quality of life improvements afforded through the implementation of care management, wellness and prevention programs for its Medicare patients.  But do they really understand what is to be gained financially?  

Hello Everyone and Happy Belated Labor Day!  We hope everyone enjoyed the long weekend as the summer winds to completion (I for one am not thrilled, but hey, at least we have football!) In this blog, I'll cover an area that is ripe with opportunity for improving overall quality of life through expanded care coordination efforts: Behavioral Health. Estimates show that approximately 65 million Americans are afflicted with a behavioral health condition, 13 million of whom are Medicare beneficiaries. The projected health care costs associated with these conditions is $57 billion - yes, that is billion with a “b” - a staggering amount that puts the behavioral health-related spend on a level playing field with cancer. For many years, and particularly within the Medicare community, these conditions were rarely addressed.  Older adults, mostly affected by preexisting chronic conditions, generally look to their primary care physicians to provide treatment. Unfortunately, this community of providers were limited in their ability to identify – or even acknowledge – a patient’s behavioral issues, as the diagnosis and management of these issues was restricted to settings that specialized in mental health.  This resulted in upwards of two-thirds of qualified Medicare beneficiaries failing to receive the appropriate care. The downstream impact on physical outcomes, in hindsight, is rather obvious – for example, a depressed patient may not feel motivated to take the actions recommended by their doctor in association with their chronic physical ailment.  If we intend to effectively address the physical conditions, we first need to effectively address the behavioral ones.