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Integrating mental and behavioral health in specialty care


Our health system is too siloed to recognize patient problems that might cross specialties.

At the same time as more and more Americans are contending with chronic diseases, the number of patients seeking help for mental health concerns has increased – estimates suggest that mental health spending topped $280 billion in 2020. These challenges go hand in hand. Patients with depression and anxiety are more likely to face more severe chronic illnesses. The relationship works in the other direction, as well. For example, more than half of Medicare beneficiaries managing COPD, a population I work with frequently, are also experiencing depression or anxiety. In turn, depression and anxiety are associated with a greater chance of acute COPD exacerbations.

Dr. Abi Sundaramoorthy: ©Wellinks

Dr. Abi Sundaramoorthy: ©Wellinks

But typically, when a patient with COPD meets with their provider, the appointment is focused on one condition on their chart. They may be given some exercises and reminded about the importance of taking their medication, but too often they will leave without discussing, for example, how their depression limits their ability to take their medication regularly or how their anxiety keeps them homebound. This is through no fault of the provider — our system has been siloed for many years.

It’s imperative to recalibrate how we deliver care and how we think about the interconnected relationships between physical and mental health. While frameworks like the Collaborative Care Model provide guideposts for physicians to integrate mental and behavioral health services with primary care, we must consider the ways in which we can implement this model in specialty care settings, particularly for patients with complex chronic conditions. The complex needs of such patients drive nearly 90 percent of the nation’s $3.8 trillion in annual health care costs; developing the infrastructure to better manage their health will not only improve outcomes, but also reduce costs responsibly by focusing on preventive care.

To consider the practical implementation of this model, again take COPD, which costs the health care system $49 billion annually.When a patient with COPD presents a loss of appetite and energy, the underlying cause of these symptoms is not always immediately obvious— fatigue is a symptom of COPD and depression. If given the resources and support to take a holistic approach, a provider could begin with a whole-person evaluation of the patient, including a mental health screening, and might find that the patient reports severe, but untreated, depression and anxiety. We could then direct the patient to resources, including mental health professionals, with the understanding that addressing a patient’s symptoms can improve COPD management. For example, improving medication adherence reduces the risk of an acute exacerbation that requires hospitalization and the expenses to the system that such an episode incurs, with research finding COPD-related admissions costing our system over $15 billion annually. And it works on the other side of the equation, too. With visibility into the specialty care treatment the patient is receiving, their mental health professionals can be better equipped to coordinate across the care team.

Virtual and digital health solutions are uniquely positioned to help develop the connective tissue to support a kind of Collaborative Care Model for specialty care, especially in value-based settings. By providing greater access to resources like a health coach, virtual solutions not only help reassure patients, but also provide regular points of contact between patients and providers where additional issues, including mental health challenges, can be surfaced from the texture of rich, ongoing conversations.

Virtual tools also help reduce fragmentation between physical care and mental health care. Digital dashboards can increase real-time data sharing and analysis between members of the care team, improving care coordination and the ability to collaborate on real-time issues. Incorporating clinically validated screeners into a platform’s interface and onboarding process can quickly identify that a patient is at risk for mental health conditions like depression or anxiety, and digital pathways can route patients to the care and support they need.

Finally, including mental health resources and peer support groups into a virtual care resource helps patients combat loneliness and stigma, key inhibitors for many in addressing chronic disease. Building confidence and community also empowers patients to better manage their health—mental and physical.

Virtual health platforms are some of the best tools we have to tailor care to each patient’s particular health situation, incorporating a thorough understanding of both mental health care and chronic disease management. By offering resources and providing patients with channels to engage with specialized professionals, we can bridge gaps in care to treat each patient individually and comprehensively, all while reducing costs across our system.

Dr. Abi Sundaramoorthy is the Chief Medical Officer at Wellinks, a health care company offering the first-ever integrated, virtual COPD management solution, where she brings over ten years of experience in advancing patient safety, optimizing high-value care, and improving physician engagement for both hospital systems and private companies. She also practices as an Internal Medicine Hospitalist with Pioneer Medical Group in Tampa, Florida and serves as an Associate Professor of Medicine at University of South Florida College of Nursing to guide the next generation of healthcare professionals. Previously, she was the Executive Vice President of Clinical Enterprise at Somatus and previously served in several leadership positions at University Hospitals Health System in Ohio, including Chief Medical Officer. She was also recently named a Top 25 Emerging Leader by Modern Healthcare.

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