An analysis of health care spending on people with chronic medical and behavioral comorbidities suggests that integrated care models have the potential to reduce costs significantly, according to a report from actuarial firm Milliman Inc. commissioned by the American Psychiatric Association. In integrated models, psychiatric and primary care physicians and other behavioral health providers coordinate care for a defined population. While the approach has been shown to improve patient health, this report reveals its potential economic impact.

Key findings include:

Only 14 percent of people with insurance are receiving treatment for mental health or substance abuse disorders, but they account for more than 30 percent of total health care spending.

• The total spending for those with behavioral health issues is estimated to be $525 billion annually; total health care spending is estimated to be $1.7 trillion annually.

Because of fragmented care, general medical costs for treating people with chronic medical problems, as well as mental conditions, are two to three times higher than those for treating people with physical health conditions only.

• The additional health care costs incurred by people with behavioral comorbidities were estimated to be $293 billion in 2012.

Effective integration of medical and behavioral care could save $26 billion to $48 billion annually in general health care costs.

• Integrated medical and behavioral health models, in which psychiatric physicians and other mental health specialists work closely with patients' primary care providers, expand access to quality care and leverage limited resources.

• When patients' mental illnesses are effectively addressed, they are better able to fully participate in programs to manage their chronic medical illnesses, decreasing their risk for continual and new medical problems.

Most of the projected reduced spending is associated with facility and emergency department expenditures in hospitals.

• In comparing the health care costs of people with behavioral health conditions against those without, people with behavioral health conditions spend a greater proportion of total medical dollars on facility-based services rather than professional services, like physician appointments.

For more, go to Integrated Care or read "The Evolution of Mental Health Care" in the October issue of Trustee.