In a continuing effort to demonstrate that proper psychological care reduces medical costs, the American Psychological Association and Mayo Clinic of Rochester, Minn., are producing an actuarial model showing the benefits of providing psychological services to cardiac patients.
Mayo and the APA believe the model will show that relieving the psychological distress of coronary patients is both cost-effective and results in better health outcomes.
This is the second project the APA has undertaken to prove the value of treating both the mind and body during serious illness. Last year the APA and Blue Cross and Blue Shield of Massachusetts launched a study to assess the benefits of integrating psychological care into treatment for women diagnosed with breast cancer.
In the latest project, the APA and Coopers and Lybrand are using Mayo research-supplemented with national healthcare databases-to build an actuarial model to quantify the benefits of combined psychological and medical treatment. When the model is completed, the APA Practice Directorate will pursue a full-scale demonstration with a statewide healthcare system in Texas that will test the model's predictions, said Henry Engleka, the practice directorate's administrative director.
Engleka declined to identify the system but said the demonstration is scheduled to begin early next year.
Research has shown that "good psychological care reduces costs," but studies have not shown the broader impact of such care, he said.
The model and the demonstration "attempt to quantify in language that purchasers and health systems can understand" that proper psychological care has an impact not only on behavioral health but in medical-surgical outcomes.
For example, a 1995 Mayo study found that cardiac patients with ongoing psychological distress had poorer medical outcomes and increased healthcare costs. Distressed patients were nearly 2.4 times more likely to be rehospitalized than nondistressed patients. And the cost of caring for those patients was $7,358 more than rehospitalized but nondistressed patients, Mayo found.
In some cardiac patients, a "threshhold of distress" results in a second heart attack. "The assumption is if we can treat that distress we should be able to reduce the likelihood of a second event," Engleka said.
Actuarial models can calculate both the reduction in the number of second heart attacks and the projected reduction in utilization of healthcare services.
In projecting utilization, all services provided to the cardiac patient are considered, such as hospitalization, outpatient care and cardiac rehabilitation, he said.
In recent years, healthcare systems have "carved out" mental health benefits in an effort to control costs. As a result, systems have created a barrier to the integration of psychological services with medical-surgical treatment, the APA said.
The model and the demonstration project will force the integration of the historically split areas of behavioral health and medical-surgical services, Engleka said.
The timing of the APA project is good because many states are moving toward requiring parity for mental health benefits in healthcare coverage, and the federal government is moving toward parity incrementally, Engleka said. "Under full parity it becomes easier to access (mental health) benefits," he said.