Focusing health efforts on people with chronic conditions is a challenge, so behavioral health problems within this group often are overlooked, experts say.

Employers may admit that behavioral health is important, but may not realize how unaddressed problems can drive medical costs. More aggressive behavioral health tactics are being developed to tackle the nexus of mental and physical health.

The prevalence of depression, anxiety and substance abuse in people with chronic conditions can be two to three times that of the general population, and these comorbid psychological conditions can significantly increase the use and length of medical treatment.

One study published recently in Managed Care found that the cost of treatment for common chronic medical conditions increased 300% to 500% for people who have comorbid depression, compared to people who do not.

The fragmented health care system has made it difficult to tackle both mental and physical health head on, but behavioral health integration with health care plans offers a proactive approach, rather than waiting for employees to self-identify.

"We're moving into very tight program collaboration across the medical carriers to get across this comorbid population. This population, on average, has medical costs three to five times higher than those who have the same disorder but without the comorbid depression, anxiety or substance abuse," says Gregory Bayer, CEO of United Behavioral Health. "By treating folks for both the chronic medical condition and the mental health condition, you can actually reduce the medical spend and have better rates of recovery and more complete recoveries."

UBH's high-risk medical intervention program selects plan members with a chronic illness and signs of comorbid depression, anxiety, substance abuse or psychosocial stress. Nurses reach out to this population by phone and guide them into the appropriate treatment plan.

Four large employers offering the HRMI program showed a 7% savings on overall medical costs among participants versus the control group that was not referred to behavioral treatment.

Traditionally, behavioral health products have been a tough sell to employers already strapped for health care dollars, but Bayer says the conversation should focus on what creates waste in the medical system and what interferes with a person's health and wellness.

Research suggests 50% of the U.S. medical spend is driven by the way people, eat, drink, exercise and smoke, Bayer notes. It is important that employers not only provide medical care, but also get to the root of the behavioral problems that cause the some of the health conditions.

Binge eating

While depression, anxiety and substance abuse are the focus of behavioral health programs, eating disorders also are prevalent and drive physical health effects. In the United States, it is estimated that 11 million people are battling anorexia and bulimia, according to the National Eating Disorders Association.

Binge eating disorder is even more common. BED is when a person rapidly overeats and feels unable to stop or out of control - often eating 10,000 to 20,000 calories worth of food during a binge episode. Impulse/control problems drive BED, and sufferers are known to eat secretly, hoard food and struggle to cope with the underlying psychological problems.

HealthMedia, a behavioral health and intervention company, recently hosted a Web seminar on BED's contribution to aggregate medical costs. The group estimates that binge eating is responsible for $33 billion in medical costs and lost productivity.

Not surprisingly, people suffering from BED are more likely to have Type 2 diabetes, high cholesterol, heart disease, high blood pressure, gallbladder disease and stroke, says HealthMedia. HealthMedia estimates that 10% to 15% of mildly obese people have BED, and 25% of extremely obese people have BED. The condition can sabotage weight-loss programs, bariatric surgery and other interventions for obesity.

HealthMedia has a binge-eating pilot that it hopes to offer employers and health insurance companies. It uses online health risk assessments that include questions that would flag binge eating indicators.

"For many people, a major self-motivating tool is recognizing what the triggers are for binge eating ... Many things can lead them to this inappropriate coping strategy," says Richard Bedrosian, HealthMedia's director of behavioral health science. "Another part of our program involves cognitive restructuring. That means changing their beliefs and basic assumptions about themselves and their relationship with food."

Tests of HealthMedia's initial, direct-to-consumer binge-eating intervention program showed a 40% reduction in binge frequency at 90 and 180 days, as well as significant reductions in depression and anxiety. Bedrosian says they are expecting more significant results when they test the tailored version of the program.

"Because of its close association with obesity, binge eating is a massive hidden driver of medical costs and loss of productivity," says Bedrosian. "There is really a need for these far-reaching interventions in order to change this massive public health problem."