Behavioral health has a data problem. Health plans are sitting on the solution

Health plans have poured resources in data analysis for years. They have mapped the trends in chronic diseases, rushed over prescription data and chased savings at all corner of the health system. But with regard to behavioral health, these same health plans often fly blind.

It is not that the data is not there. Health plans are already sitting on years of complaints, pharmacy and clinical data that can tell them that risks serious behavioral health problems, which are currently treated for them and what works really. The problem is how health plans examine all this data.

Or, more importantly, what he tries to tell them.

Behavioral health has long been a reflection after the one on the health system. He was sculpted, reorganized and depressed over the decades. Now, the United States is found in the midst of a behavioral health crisis that even massive investments in the pandemic era in access to mental health could not brake. It is a crisis which is particularly acute among young people, and which does not seem to disappear.

This is because access to him alone is not enough to make people need it. Health plans have many programs and advantages designed specifically to combat the behavioral health crisis. What they missed historically is the ability to identify, measure and interpret the data of these programs between the populations. Without this, health plans are stuck in the face of an ongoing crisis which costs them dearly and their members.

In 2024, behavioral health conditions led around $ 3.5 billion to excessive ED use. It is not a sign of a functional system. It is the symptom of a data interpretation problem.

This is not a new health problem

Two decades ago, pharmaceutical companies faced a similar challenge: they had products that could help specific patients of patients, but they were almost entirely on doctors to connect points. The consumer was not even part of the equation – the salespeople were the main messengers, providing information on drugs to the clinicians in the hope that the prescriptions would take place.

When the regulations moved, the pharmacy swivel. The industry adopted a direct model to consumers who were focused on understanding precisely that needed treatment, exactly where they were on their trip and what message would motivate them to look for a script.

Today, a newly diagnosed patient with rheumatoid arthritis sees a different message from someone who has managed the disease for 30 years. This sophisticated segmentation model has transformed how health care organizations engage people. The objective is no longer to expand access. It is to conduct action.

Health plans can bring the same approach and the same precision to understanding behavioral health trends in their members of members in a responsible and ethical manner – not at the market, but to help their members to engage with the services to which they already have access, thanks to advantages for which they already pay.

Health plans have all the data necessary to understand which members need help, when and which programs or advantages are best suited to meet the needs of members. They no longer need data. They need ways to extrapolate, organize and interpret it. They need means to transform the data they already have for claims, graphics, prescriptions, portable devices and other sources in intelligence. Members are already expecting their plan to analyze their data for drug interactions or recharging reminders. The same expectation extends to behavioral health.

Think about it this way: all other aspects of health have been rigorously analyzed, to the point where complications, hospitalizations and costs can be predicted with precision. But with regard to behavioral health problems, most health plans and providers cease to analyze after the screening phase.

For example, if a diabetes management program has experienced high registration by a 50% drug membership rate with emergency service visits to climb regularly, would that not indicate a problem of social determinant or underlying or not detected behavior? Depression is a hidden engine of non-compliance, while an analytical engine, supplied by AI, could identify the risks of risks and pool data to better understand the dead angles over time.

In addition, an annual development rate of depression screening, for example, is often considered a measure of success. But mental health is not an annual phenomenon. It is dynamic, fluid, subject to fluctuate according to social and environmental factors.

I could get a screening today and not lift red flags with my health plan or my primary care doctor. My world could go to the back tomorrow, and none would have the slightest idea. This is currently happening in communities across the country; People develop days of depression, weeks or months after their last screening, and the health system has no idea.

But people constantly share their information on health care, in a way that goes far beyond questionnaires. We record our moods and lifestyles with applications, we carry out devices that follow our health and fitness measures, we have appointments with the doctor outside of our annual doctors. All these data, sewn together, has a complete image – or at least, fully enough for health plans to connect the points.

The opportunity before health plans is not to collect more data. Rather, it involves applying a strategic objective to the data they already have.

Behavioral health intelligence is the missing layer in the analysis battery – that which allows you to see the previous annual screenings, intermittent hospitalizations and unique therapy meetings to surface the models that predict the risk, reveal the gaps of the program and show which interventions actually work. Whether they are fed by the traditional analysis of population health, predictive modeling or AI and automatic learning, the tools to do this are easily available. What is necessary now is a desire to apply them.

The issues are too high for behavioral health analyzes to remain a black box. It is time for health plans to start treating it with the same analytical discipline as physical health.

Photo: Pixelliebe, Getty Images

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