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Depression and Disease Management
Beyond the Stigma to Identification and Treatment
With the economic burden of depression and its co-morbidities estimated at $83 billion annually–hitting employers hardest in the form of lost workdays, compromised productivity and workplace accidents–the healthcare industry is formalizing programs for early identification, adequate treatment and medical adherence of individuals with depressive disorder.
This is no small task, given the challenges of screening depression severity, overcoming the stigma of mental illness, and educating primary care physicians on the value of this initiative. In its August 2005 online survey, the Healthcare Intelligence Network (HIN) asked its audience for details on current and planned initiatives for depression and disease management.
The Hidden Target
The Disease Management Association of America recently reported that 70 percent of chronic physical conditions, including cancer, diabetes, cardiovascular disease and multiple sclerosis, are coupled with depression. More than 90 percent of the 58 respondents to the HIN survey are now or will soon target depression in their disease management efforts.
More than half of survey respondents–63.8 percent–told HIN they have depression management programs in place. Nearly half of these programs are currently integrated with an existing disease management initiative, but 20 percent of respondents offer a standalone depression management program.
Another popular approach among five respondents is to provide both standalone and integrated programs, which offer the ability to carve out a more intense approach when necessary.
Of those with no program in place, 50 percent intend to target this condition within the next 12 months. Almost half of respondents with programs– 45.2 percent–report an average enrollment duration of 0 to 12 months.
Responses to the survey came from across the healthcare industry: one-fifth of respondents were from health plans, while 60 percent of responses were split evenly among behavioral healthcare providers, disease management companies, employers and hospitals/health plans. Other industry segments weighing in included healthcare consultants and non-profit agencies.
While all concur on the need to focus on this condition, respondents’ strategies for identifying members for participation and choices of screening, stratification and educational tools vary widely.
Claim Data, HRAs and Referrals Top Identifiers
Overwhelmingly, the review of health claims data is the number one method of identifying members who may be in need of specialized services. Seventy-two percent of respondents with established programs review members’ health claims for evidence of depression, followed by nearly 68 percent of respondents who look equally to Health Risk Assessments
(HRAs) and referrals by primary care physicians (PCPs).
Also subject to heavy scrutiny are pharmacy data (55.3 percent) and members’ responses to direct mail questionnaires (almost 13 percent). As these statistics indicate, many respondents are looking to more than one source to determine the target population.
Screening and Stratification Tools
Once they have identified possible participants, respondents appear to favor an individualized approach to assessing the severity of the depression. Nearly 33 percent use tools developed in-house to assess depression severity.
Close behind is the PHQ-9 questionnaire, a dual-purpose tool used by 25 percent of respondents that establishes a temporary depressive diagnosis as well as symptom severity levels through analysis of the same nine questions.
The SF-12 Health Survey (part of the “Short Form” Health Survey family) is in use by 20 percent of responding organizations, and the Hamilton Depression Scale, a 17-item scale that evaluates depressed mood, vegetative and cognitive symptoms of depression and comorbid anxiety symptoms, is favored by 13 percent of survey-takers.
Other instruments in use among respondents are shown in the box below.
Getting the Message Out
Respondents are using a wide range of educational materials and resources–alone or as part of a multi-barrelled approach–in their campaigns to launch or maintain their depression disease management programs.
Print materials are employed by almost 84 percent of programs, with telephonic tools and online resources used by nearly 75 percent and 65 percent of the programs, respectively. More than a third have developed toolkits, and slightly more than 10 percent depend on webinars to convey their educational messages.
Face-to-face counseling and case manager’s visits are also employed on the educational front, and one respondent even organizes an annual depression management summit for its members.
Because many of these depression management initiatives are relatively new, it is difficult for respondents to identify the most effective educational effort. Almost a third of respondents who shared elements of their communication efforts said that telephonic efforts seemed to be most effective.
Several said that a combination of tools is the best approach. “Individualized phone intervention tends to yield the best results, but calls are limited to those requiring one-on-one case management,” noted one respondent. “Eye-catching written educational materials with consisting messaging have also impacted member outcomes and results.”
Another program takes the same multi-faceted approach. “It’s not necessarily the material itself, but the follow-up coaching in response to or in conjunction with the material that creates change and results,” said one respondent.
Looking to the Future
“It’s too early to tell,” was the overall response of participants asked to quantify the results of their depression disease management programs. Many reported increased detection of depression, and a few said that ROI in the form of increased engagement in treatment decreased hospitalizations and reduced readmissions is beginning to trickle in.
“It’s still too early to tell, however (the program’s) greatest value seems to be not as a stand-alone product, but as an integrated piece with other medical management programs such as diabetes,” offered one respondent.
Another respondent concurs that in most cases, depression cannot be treated in isolation. “This problem is linked to a lot of other situations that are the source of the problem, e.g., chronic illnesses (cancer, heart disease, obesity/diabetes, etc.), dysfunctional families, etc. Some of the solution is addressing the source of the problem.”
Said another: “Detection isn’t sufficient. You must have a focused outreach program. Members are concerned about confidentiality and don’t typically readily respond to outreach. Clients (employers) clearly assume depression management is a core aspect of a behavioral health program.”
Related Resource
Depression management programs are aiming to address the multi-pronged effects of depression through comprehensive care management. In HIN’s special report, “Depression Disease Management: Healthcare’s New Frontier,” based on a recent audio conference and two in-depth case studies on depression management programs, you’ll hear about the broad array of depression disease management programs, with details on their approaches to treatment length, pharmaceutical trials, staff roles and patient responsibility.
This report also contains a seven-page “For More Information” section providing a wealth of additional resources for depression disease management programs. This resource is available from the HIN bookstore: http://store.hin.com/product.asp?itemid=3188. For further healthcare resources, please visit the HIN bookstore at http://store.hin.com or call toll-free 888-446-3530.
