A new report, “Integration of Health Care in Maine: Implications From the Multiple Chronic Conditions Project: Impact of mental illness and/or substance abuse on diabetes intervention and outcomes,” highlights how integrating behavioral and physical health may benefit those with chronic health conditions. The report, funded by the Agency for Healthcare Research and Quality (AHRQ), focused on Medicaid recipients living in Maine. As explained in the report, 3 in 4 working-age Americans report having a chronic health condition, and over half of Americans have more than one chronic health condition. For those on Medicare, payments more than quadruple for those with three or more chronic health conditions versus one single condition. Meanwhile, nearly 1 in 5 Americans suffer from some form of mental illness, with rates even higher among those receiving Medicaid. Those with mental illness are more likely to also have some form of chronic medical condition.
The study reported a variety of findings, such as that “a significant portion of the cohort, including those with diabetes and multiple medical co-morbidities, has no visits to any primary care provider in the 2 year baseline” and that “fragmentation of Primary Care (utilization of different primary care practices) is higher” for those in worse health, such as “the various behavioral health groups, those with multiple medical co-morbidities and those with more complicated diabetes.” The report also found that fragmented primary care was associated with higher medical/surgical costs, higher use of services, and the development of additional complications during follow-up care. However, moving from fragmented primary care to continuous care “protects against developing worse diabetes in the follow-up years.” The study also found that a single behavioral health diagnosis is the equivalent of at least three chronic medical conditions in terms of cost, and that “at every level of medical co-morbidity, the BH [behavioral health] groups have higher medical expenditures”. Meanwhile, those with a behavioral health diagnosis also experienced increased emergency room use, admission and readmission to hospitals, days spent in the hospital, and outpatient and specialty visits. In their conclusion, the study’s authors emphasize the need for person-centered care over a disease-specific approach.