Challenges of Medication Management for Mental Health

The mental health crisis did not happen overnight. Rates of depression among adolescents and young adults increased by over 50% between 2005 and 2017. Today, more than one in five adults currently have a mental condition. As far back as 2004, mental health medications already accounted for up to 35% of pharmacy spending for payers. By 2019, mental healthcare treatments and services cost the U.S. $225 billion.

While the mental health crisis grew, a lesser-known, but equally consequential, crisis evolved right under our noses: medication-related problems resulting from non-optimized medications. When patients are not on the safest or most appropriate medication for their unique needs, their medications can do more harm than good. And nowhere is that more evident than in mental health medication therapy where issues such as polypharmacy, low adherence to treatment, and gaps in the transition of care, result in poor patient health outcomes and high cost of care.

In this article, we will examine the impact medication mismanagement has on individuals with mental health conditions and offer scalable ways care teams can provide proactive care, preempting costly medication-related problems before they occur.

Challenges in medication management for mental health patients

Mental health conditions are difficult enough for individuals. And yet, patients with mental conditions often face challenges out of their control that affect their ability to achieve their personal goals of therapy. Without support from their health plan or provider, in many cases, these patients will experience rising costs of care, low quality of life, and poor health outcomes.

Polypharmacy

Psychiatric polypharmacy, or the use of two or more psychiatric medications in the same patient, is a major obstacle to successfully managing mental health conditions. Researchers estimate that, in psychiatric outpatient settings, about 60% of patients meet this definition of polypharmacy. The prevalence is similar for people with depression while for nursing home residents with dementia, it’s about 33% who receive two or more psychotropic types of medications.

While it can be appropriate for many patients to use multiple medications to achieve success in managing their mental health conditions, polypharmacy can also cause medication-related problems, such as adverse events and consequences for patients’ safety, as well as result in increased health expenditure.

In a study published in Psychiatric Services, a journal of the American Psychiatric Association, researchers found that adults with schizophrenia receiving clozapine monotherapy had fewer disease-related emergency department visits than those receiving antipsychotic polypharmacy. Total Medicaid payments were significantly lower for the monotherapy group, by an average of $21,233.

Undertreatment

While polypharmacy can increase cost of care and decrease positive health outcomes, over half of patients with mental health conditions are undertreated for their condition. In many cases, patients delay seeking care due to the stigma and ramifications that can accompany a mental health diagnosis. Another study found that half of Medicaid members who have schizophrenia did not have a claim for an antipsychotic medication.

In some cases, patients with chronic conditions and mental health conditions also experience undertreatment. One 2015 to 2019 survey found that 79% of patients with chronic pain conditions also had moderate to severe mental health conditions. 40% of those patients, however, had never received mental health treatment, likely due to the perception that mental health conditions are secondary to chronic conditions.

Managing drug interactions and potential side effects

Adverse drug events (ADE) involving psychiatric medications are responsible for an estimated 90,000 emergency department visits. They represent another major challenge in mental health management and can lead to medication non-adherence, increased patient morbidity, and increased healthcare use.

For instance, patients susceptible to benzodiazepine-related drug interactions have a higher rate of healthcare utilization and significantly higher healthcare costs ($3,076 higher per year) compared to patients with appropriate benzodiazepine prescriptions.

Low adherence to therapy

Over 50% of people with major mental health conditions don’t adhere to their medication therapy, often due to stigma, care access, and affordability.

Several studies looking at the impact of adherence on health costs found that while adherence can increase medication costs, overall it decreases total health costs. For instance, one study published in Pharmacotherapy revealed that being adherent to antipsychotics decreased individual total health costs by $23,927.

Another study found that patients who were non-adherent to antidepressants had an increased rate of hospitalization and ED visits. Furthermore, they experienced increased depression severity and a decrease in remission rates, which resulted in increased medical and total healthcare utilization.

Substance misuse

One additional layer of complexity for managing behavioral medications is the possible co-occurrence of substance use disorder (SUD).

More than one in four adults living with serious mental health conditions also experience substance misuse. Mental health professionals can find it challenging to strike the balance between prescribing psychiatric medications (which sometimes have a high risk of abuse) and treating the substance misuse condition.

Moreover, SUD is associated with higher health expenditures. In a study from the Journal of Substance Abuse Treatment, researchers found that people with SUD had higher Medicare costs, by about $56,000 over a six-year period, compared to those without SUD.

Patients with co-occurring mental health conditions and SUD typically use more medical services compared to patients with mental health conditions or patients with SUD.

Misprescribing

The opioid epidemic, with a cost estimated at over $1.021 trillion, highlighted the impact of misprescribing, another barrier to the successful management of behavioral health medications.

Although several factors have led to this complex crisis, one of the major driving forces was initially the misprescribing of opioid medications. Since the beginning of the crisis, the number of opioids prescribed has peaked and then decreased. But, according to the CDC, prescribing remains high, with the yearly quantity of opioids prescribed high enough to medicate every American around the clock for three weeks.

Misprescribing also happens with other psychotropic medications, often resulting in tremendous costs for payers and patients. In 2012, antipsychotic use in nursing homes cost about $363 million in Medicare Part D payments. Furthermore, inappropriate use of antipsychotics, especially in older adults, can lead to falls. Overall, medical spending for falls can cost between $754 million (fatal) to $50 billion (non-fatal).

Gaps at the transition of care

To successfully manage their conditions and prescribed medications, patients with mental health conditions may also need higher levels of care coordination. They may need support to make timely appointments with their health care providers for follow-up or reminders to pick up medication refills. To prevent re-hospitalizations, a successful transition from inpatient care to outpatient care also requires support. In many cases, there are changes in therapy that occur and post-discharge medication education is important to ensuring patients are stabilized at home.

In most cases, hospital care managers can offer limited help. But when patients leave the hospital, gaps in care happen and can lead to astronomical costs, between $12 billion and $44 billion. For people with psychiatric conditions, effective care coordination strategies can result in lower early hospital readmissions.

Medication intelligence empowers patients to achieve their goals of therapy

The costs of medication-related problems are staggering and implementing scalable medication management has up until this point been challenging. However, with AI-powered medication intelligence, care teams can implement tools, systems, and algorithms that increase the chance of success in managing mental health conditions in one comprehensive solution.

Identify patients at risk for medication-related problems with predictive analytics.

Predictive analytics can identify high-risk patients so care teams can intervene early to prevent medication-related problems, like treatment failure or adverse drug events.

Arine’s platform analyzes the patient’s social, behavioral, and clinical data to identify at-risk patients, pinpoint drug-related problems or adverse events, prompts timely interventions before the problem leads to a disease complication, and enables care teams to deliver high-impact, low-cost care before the patient needs a costly trip to the hospital or emergency department.

Machine learning ensures that these interventions are even more effective over time, training Arine’s platform with a feedback loop that connects interventions to outcomes.

• A referral to a new in-network PCP
• Alerting her PCP of her untreated mental health conditions.
• Recommending safe and appropriate treatment based on Sarah’s unique needs.

After receiving high-impact, low-cost care, Sarah achieved her goals of therapy and stayed out of the hospital for a full year post follow-up.

Like Sarah, millions of people end up in the emergency department for psychiatric-related diagnoses. When care teams have the tools they need to identify at-risk patients, they can prevent costly problems before they arise and help the patient reach their health goals.

Personalize care with multi-dimensional data.

Medication intelligence looks at the patient as a whole, integrating social determinants of health (SDoH) as well as clinical data to personalize care and ensure they are on the right medication and can access and adhere to their therapy. Once the data has been analyzed, care teams have actionable data insights that help them identify barriers like lack of a primary care physician, lack of a neighborhood pharmacy, or financial issues.

Reduce misprescribing in behavioral health

Medication intelligence can also identify prescribing trends and address two major challenges in managing mental health medications: misprescribing and polypharmacy.

Arine’s Prescriber Analytics Solution uncovers misprescribing patterns and automatically generates prescriber recommendations that care teams can send to prescribers at the click of a button. Arine also tracks the implementation of the recommendations, allowing the care team to measure their impact on outcomes.

One Arine client used Arine’s platform for opioid surveillance and management as well as behavioral health medication optimization. By sending targeted education to a high number of providers in a short amount of time, the client reduced behavioral health polypharmacy by greater than 45%, increased adherence by 20%, and achieved $1500 to $4300 cost savings per member per year.

Optimize therapy and improve adherence

Medication intelligence can also help optimize the dose or dosage to the patient’s specific needs as well as ensure that the patient is receiving the most effective drug. By leveraging social, behavioral, and clinical insights, care teams can pinpoint the best therapy option for the right patient and remove barriers that cause nonadherence, like mail delivery or finding a more affordable drug.

Coordinate care

With medication intelligence, care teams can also improve care coordination for patients taking mental health medications. Arine’s intelligent workflow engines automatically assign tasks to the appropriate care team member. Care teams working in Arine have access to health plan data to connect the patient to covered benefits, like smoking cessation, transportation services, or mail-delivery prescriptions.

Additionally, a medication intelligence platform can support coordination of care with external providers and care teams. Care teams can use data insights to pinpoint patients who are experiencing a transition to intervene early and prevent gaps in care or costly problems before they occur. Care teams can also efficiently communicate care plan changes to providers or refer the patient to other care teams or health plan services to ensure they can access the care they need when they need it.

The importance of scaling to overcome challenges and provide value

The mental health crisis did not appear overnight and no technology solution can make it disappear overnight. By arming care teams with actionable data, Arine helps them support one patient at a time, at scale.

Register for Arine’s webinar on improving behavioral health outcomes to learn more about how medication optimization reduces the cost of care.