Offering Employees Behavioral Health With Primary Care Improves Outcomes, ROI

Since the pandemic, demand for behavioral healthcare has been on the rise. The National Institute of Mental Health estimates that one in five adults in the United States live with mental illness. The behavioral health market is expected to grow to $105 billion by 2029, up from about $77 billion in 2021, according to Fortune Business Insights.

Employers continue to seek ways to support their employees with quality behavioral healthcare amidst a provider shortage. Options an HR decision-maker might consider include adding behavioral health services through their employer-sponsored primary care solution if available, contracting separately with a point solution or offering access to community resources through their plan design.

“It doesn’t have to be all or nothing,” says Erin Thase, Ph.D., licensed psychologist and Marathon Health National Director of Behavioral Health. “They might take a multifaceted approach to best meet people where they are. But the power of combining behavioral health with primary care for a total population health management approach is where employers find value and a return on investment.”

Mental and physical health are intrinsically linked. “You can’t disentangle primary care and one’s mental health,” says Jeff Wells, MD, CEO and Co-founder of Marathon Health. “If I’m not sleeping well and I’m stressed, my diabetes will be poorly controlled. I won’t exercise, which will lead to increased obesity and joint pain. Then I’m going to have a higher probability of a back surgery. All of these just add up to higher healthcare costs.”

The ability for primary care and behavioral health providers to collaborate leads to better health outcomes overall, both physically and mentally.

In addition, it enables increased access and engagement. “If an employer offers behavioral health through an existing benefit with their primary care health center, the level of familiarity and trust makes it more likely patients will engage in an area where there’s often stigma,” says Marathon Health Senior Product Manager Elizabeth O’Neill.

With more people receiving the care they need, healthcare costs go down. Offering behavioral healthcare at work drives savings of 30% per member per year (PMPY) for those who engage with the service, according to Marathon Health data. Savings increase for members who utilize both primary and behavioral care services, resulting in 45% savings PMPY.

St. Johns County School District added Marathon Health behavioral health services in 2019, and switched to virtual access in 2022, which contributed to a large increase in year-over-year total and unique member visits.

“It really is an attractive situation for our employees so they don’t have to step away from their classrooms,” says Becky Cromwell, Senior Account Manager with the Bailey Group and Benefits Consultant to the school district. “They’re not trying to figure it out after hours. They can do a session while they’re on a down period on campus or in the morning before school starts.”

Beyond the convenience factor, Kristen Orlando, LMHC, Behavioral Health Specialist for the school district, notes how virtual services make many patients feel more comfortable opening up to their provider. “With this increased feeling of safety, the provider can understand their world much more explicitly and help them achieve optimal results from counseling,” Orlando says.

Employees on the school district’s medical plan, as well as their spouses and dependents age 12 and older, enjoy free access to Marathon Health services.

J Wynn, Director for Benefits and Salaries for SJCSD, notes the integrated approach benefits their staff. “An employee may come in for one reason, and our primary care provider can pick up on that and orchestrate a meeting or care with a behavioral specialist, or vice versa,” Wynn says.

The school district’s top three mental health diagnoses since 2019 are:

• Adjustment disorder with mixed anxiety and depressed mood
• Other specified anxiety disorders
• Adjustment disorder with anxiety

The employee population has made positive progress on managing these conditions, with a 16% reduction in patients at high risk according to the GAD-7 Anxiety Scale, and a 1.1% reduction in patients categorized as high risk on the PHQ-9 Depression Scale, according to Marathon Health data.

“The collaborative and comprehensive model of offering both behavioral and primary care is crucial,” Orlando says. “Members are able to receive services all under one roof, and because the providers communicate about patient progress, or conversely patient regression, their physical and mental health is better managed.”

The school district is on track to hit 1,400 behavioral healthcare appointments by the end of 2023. As a growing school district, Wynn believes these numbers will continue to increase. “The stigma is definitely much, much better than it used to be,” she says. “People are seeking it out more openly.”

Orlando says she’s continually impressed by how St. Johns County School District has embraced behavioral health. “They do a great job of encouraging employees to engage in behavioral services by advertising in areas such as staff break rooms, sending emails about behavioral health webinars and speaking about mental health with de-stigmatized language,” she says. “This open and accepting mind regarding mental health spreads awareness and motivation for employees to utilize the service.”