Integrating behavioral health into oncology care improves outcomes, reduces costs

Integrating behavioral health into oncology care improves outcomes, reduces costs

A cancer diagnosis can profoundly impact a person’s life and impact their overall mental health.

About one-third of cancer patients also have behavioral health problems, such as anxiety, depression or substance use disorders, according to research published in Translational Psychiatry. As a result, more payers and providers are looking for ways to better support the behavioral health needs of oncology patients.

“We know that if we want to improve clinical outcomes, providing a comprehensive strategy that integrates behavioral health with oncology care will definitely produce better outcomes,” Dr. Rogers Wilson, national medical director of behavioral health at Evernorth, told Behavioral Health Business. “it is also [provides a] Patients gain a better experience when navigating cancer care. ”

Evernorth is the health services arm of large payments group Cigna (NYSE: CI). It provides a wide range of behavioral health and substance use disorder services, as well as physical health services, including oncology care.

Equity and the business case for oncology, behavioral health integration

A health equity case could also be made to integrate the two professions.

“To ensure equity in cancer care, comprehensive behavioral health care, especially in oncology, is an absolute must,” Yasmin Asvat, MD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Rush University Medical Center, told BHB. “We know that mental health needs disproportionately occur among some of our most vulnerable, underserved populations.”

Rush University Medical Center is a 671-bed hospital in Chicago. It offers residency and fellowship programs in 70 medical and surgical specialties and subspecialties.

Aswat noted that many cancer patients living in underserved areas also face higher stress levels and behavioral health conditions. These factors may contribute to medication adherence challenges and outcomes.

“So it’s not just a case of psychology and psychiatry [integration]. It’s a case of social work,” Aswat said. “It’s a case of care management. This is the case for all support services that will ensure that everyone living with cancer has access to the resources they need. ”

Wilson said providing behavioral health services to oncology patients also makes financial sense.

According to the Evernorth Institute, oncology patients who do not receive outpatient behavioral health services are twice as likely to visit the emergency room as those who do. For those who do not seek behavioral health services, the average additional cost per member per year ranges from $173 to $243.

“Oncology is one of the most expensive diagnoses for our clients and these various employers,” Wilson said. “But one thing we emphasize from the Evernorth Institute is that engaging a person in behavioral health treatment can significantly impact emergency department visits that could otherwise be avoided.”

Implementation model

While the benefits of integration are clear, there is no one-size-fits-all approach.

“There are many models, and to some extent, the model implemented is highly dependent on the resources available to each cancer care delivery organization,” Aswat said.

At Rush University Medical Center, for example, the Support Oncology Program brings together a variety of specialists, including social workers, nutritionists, chaplains, psychiatrists and psychologists, as well as physical medicine and rehabilitation physicians.

“Communication is key here,” Aswat said. “Providers are recommending our services. We are seeing patients and communicating key elements of our recommendations to providers to ensure all team members involved in the patient’s care are on the same page regarding behavioral health, management and goals.”

Some health plans are also beginning to support the integration of behavioral health and oncology. For example, Evernorth has incorporated behavioral health distress screening into its oncology case management program. If patients score high on specific issues, case managers can connect them with behavioral health coaches, who can help schedule outpatient behavioral health appointments in the community.

Another important part of comprehensive care is educating caregivers about oncology and behavioral health.

“We want to make sure behavioral health providers are aware of changes in oncology care and can support patients with oncology diagnoses,” Wilson said. “Not only have diagnoses and treatment options changed, but chemotherapy is also considered. For example, we know that certain chemotherapy can cause psychological complications. Some drugs may cause depression, but at the same time, the person needs to be treated for the cancer diagnosis. So Let those behavioral health providers [knowledgeable] Regarding complications and different treatment options are key. ”

peer support

In addition to traditional behavioral health providers such as social workers and psychologists, nonclinical behavioral health workers may be another resource for cancer patients.

“We connect patients with community support. So consider starting self-help groups and organizations for breast cancer survivors or people who are dealing with issues related to prostate cancer,” Wilson said. “So the community can provide those resources and if a person does need more peer support, our case management nurses can connect the patient to lay care.”

In particular, peer support services may be key to helping certain patient groups, such as adolescents and children.

“You can absolutely train peer supporters who have experienced childhood cancer to provide peer support to teenagers who are experiencing cancer now,” Flourish Labs founder and CEO Obi Felten told BHB. “Oncology patients are extremely immunocompromised, so they That requires long-term hospitalization, isolation from all human contact. So giving them a tablet and giving them peer support in their hospital bed, I’m very interested to see if that works.”

Flourish Labs uses technology to help scale professional peer support. It trains young people to become certified peer support specialists and then pairs them with teens in need.

Peer support can also help patients’ families cope with a cancer diagnosis. This is especially true for pediatric oncology cases in which parents and siblings are involved in care.

“There are patients, but there are also brothers and sisters,” Felton said. “When a child is undergoing cancer treatment, the entire family’s attention is focused on that child, and siblings are often left behind.”

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