Heart and Mind Connections:

Integrated Strategies for

Greater HealthPresentation to

Senior Leadership

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Agenda

I. Business Costs to Bottom Line

II. Connection Between Heart Disease and Mental Health

III. Opportunity to Improve Outcomes

IV. Behavioral Health Services

V. Next Steps

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Heart Disease: Business Costs

Human cost: No 1. killer of Americans and a leading cause of disability

Financial costs: Key contributor to rising health care and disability expenditures and a prime cause of decreased productivity

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The Costs of Heart Disease and Mental Health

Heart disease is often associated with a mental health diagnosis. In these cases of co-morbidity, the mental health conditions may not be properly diagnosed or may be undertreated.

There is a significant difference in medical health costs for individuals with coronary artery disease (CAD): • In one study, the costs to the employer for the physical health care

of CAD patients without co-morbid behavioral health diagnoses was $883 per member per month.

• These costs rose 54% to $1,358 per member per month for CAD patients with depression or anxiety.1

Individuals with CAD who were treated with selective antidepressants for six months were: • 91% more likely to experience a significant reduction in the cost of

hospital inpatient services • 72% more likely to experience a significant reduction in the cost of

office-based services in the treatment of their disease2

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About Heart Disease and Mental Health

Depression, anxiety, hopelessness, pessimism, hostility and anger have all been linked to heart disease.3,4,5

Depression and anxiety disorders may affect heart rhythms, increase blood pressure, alter blood clotting, and lead to elevated insulin and cholesterol levels. These risk factors often predict, and are a response to, heart disease.6

People with heart disease are more likely to suffer from depression than otherwise healthy people; conversely, people with depression are at greater risk for developing heart disease.7

Those who have heart disease and who are depressed have an increased risk of death after a heart attack compared with those who are not depressed.8

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Fighting Heart Disease: The Role of Behavioral Health Experts

Emotional, psychological and behavioral intervention and support is essential in helping to prevent or manage heart disease.

Behavioral experts can:• identify and manage behavioral health contributors that

can impact heart health, such as depression, anxiety and chronic stress

• support those who are living with heart disease• promote and sustain a healthy lifestyle

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Service Options Offered by ValueOptions

Standard:• 24/7 assessment and referral• Employee assistance program (EAP) • Stress reduction counseling• Depression screening• Intensive case management• Support for family and support systems• Primary care physician (PCP) behavioral health consultation• Educational programs

Enhanced services:• Lifestyle coaching• Tobacco cessation• Nurse line• Integrated care

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Benefits of an Integrated Cardiovascular/Behavioral Health Program

Increased referral rate to the EAP and mental health/substance abuse program

Decreased overall health care and disability costs Enhanced productivity Reduced absenteeism Improved employee perception of their employer’s

commitment to their health and well-being

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Next Steps

Form a multifunctional workgroup to assess needs and assemble programming

Report recommendations to senior management

Obtain final approval to implement recommended plan

Implement, promote, monitor and evaluate plan

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Sources

1 ValueOptions/IHCIS Comorbidity Study, 20032 Group Health Incorporated, www.ghi.com3 Williams R.B. Neurobiology, cellular and molecular biology, and

psychosomatic medicine. Psychosom Med, 1994; 56:308-315. 4 Denollet J., Brutsaert D.L. Personality, disease severity, and the risk of

long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction. Circulation. 1998; 97:167-173.

5 L.D. Kuzansky, K.W. Davidson, and A. Rozanski. The Clinical Impact of Negative Psychological States: Expanding the Spectrum of Risk for Coronary Artery Disease. Psychosom Med, May 1, 2005; 67(Supplement_1):S10-S14.

6 National Heart, Lung and Blood Institute 7 Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease.

Depression and Anxiety, 1998; 8(Suppl 1): 71-9.8 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month

prognosis after myocardial infarction. Circulation, 1995; 91(4): 999-1005.