The Key to Beating the Mental Health & Addiction Crisis? Caring for the Person, Not Just Treating the Condition

By: Corbin Petro, CEO & Co-Founder of Eleanor Health

In his first State of the Union address earlier this month, President Biden summarized his administration’s comprehensive plan to address the mental health and addiction crisis that has led to more than 250,000 lives lost to overdose, suicide, and alcohol-related conditions over the past year in the United States. 

Suzanne could have been part of this statistic. At 38 years old, Suzanne had severe alcohol use disorder, alcohol-induced liver disease, diabetes, bipolar disorder with severe chronic depression and annual manic episodes requiring psychiatric hospitalization, chronic suicidal thoughts, and social isolation. Fear that she might attempt suicide led her to call 911 and present to the emergency department (ED) - where she felt safe - about once a week, with 13 ED visits in the past four months. 

For the first time in history, President Biden’s speech voiced support for harm reduction services that are not widely available and oftentimes stigmatized, despite evidence of their effectiveness. Notably, President Biden also underscored the importance of treating mental health conditions such as depression and anxiety, particularly for our nation’s youth. Biden called on policymakers to expand access to medications, fund syringe exchange programs, and revisit regulations on telehealth. 

But, if implemented, will these solutions stem the tide? And more importantly, would these solutions work for someone like Suzanne? 

We know that many people with mental health conditions do not seek treatment. In fact, only one out of every 10 individuals with a substance use disorder receives treatment. Moreover, while people with behavioral health conditions, including substance use disorders, constitute only 5.7% of insured populations, they account for 44% of total healthcare costs, which are largely driven by increases in emergency department use and inpatient utilization. The current system is not meeting the needs of the people who need it most. 

At the most fundamental level, we need to get more people access to better care. While Biden’s proposed actions represent steps in the right direction, the solution to the mental health and addiction crisis depends on the healthcare system working for people like Suzanne. While change in policy is important, it is our responsibility as providers and payers to work collaboratively to challenge traditional payment models and rethink how treatment for mental health and addiction is delivered and reimbursed.

Fee-for-service models need to become a thing of the past, replaced by population health management models that align human and financial incentives to allow for personalized, cost-effective care based on patients’ risk levels. These models enable provider organizations to address  the physical, social, economic and other life  conditions that affect health and to focus on prevention. 

For payers, a shift towards population-based care means actively seeking out a solution to address the needs of its highest-cost, highest-need members, of which 57% have a diagnosed behavioral health condition, building a data infrastructure that allows for the identification of these members, and reworking reimbursement structures to support capitation and shared risk.

For providers, it means developing whole-person, evidence-based, blended care models that match the clinical severity of the populations they serve, deliver outcomes across large populations, not just targeted, well-defined segments, and substantially reduce the total cost of care. It also means developing a compassionate, harm reducing infrastructure to support the engagement of members that others cannot reach and who the health system would otherwise avoid. 

It is easy to discern the benefits of these models for payers and providers, but let’s approach a shift towards population health models from the lens of a patient. Remember Suzanne, from above? A trusted relationship developed through an outreach-driven population health model saved her life. 

In partnership with Suzanne’s insurance, a team member at Eleanor Health reached out to her following a visit to the ED to perform a wellness check and offer a consultation with a health advocate. Nobody had ever called to check in on Suzanne before, much less asked if she needed any support after a stressful ED visit.

Within one week of joining the Eleanor Health community, she received a comprehensive psychiatric evaluation, an initial nurse care management visit, and connection to an individual therapist and peer support coach. She asked if there was a way she could talk to at least one person each day, as the less lonely she felt, the less likely she was to drink. While she wanted to get out of her house, her anxiety held her back from coming to a clinic, so her team put together a care plan that included telemedicine and meeting at a coffee shop near her home. Her care plan was comprehensive and coordinated.

Three months later, Suzanne was visiting the ED 75% less, and no longer needed daily interactions with her care team. Her liver function returned to normal and her blood sugar began to stabilize. She began taking walks and going to a coffee shop alone. While she did not remain completely abstinent from alcohol, she achieved her goal of drinking less, and instead of penalizing her, her care team continued to invest in the relationship. She has stayed with Eleanor longer than she had ever been with any other healthcare provider.  

Addiction and mental illness are diseases that affect more than 40 million Americans every day, plus the tens of millions of family members and friends that love them. That’s half of American families. Given the impact of COVID-19 on the growth and exacerbation of behavioral health conditions, including substance use disorder, the number of people impacted will only grow and could drive billions of additional healthcare spending in 2022. 

Imagine if the health care system worked for people like Suzanne.  Consider the impact we could make if payers and providers committed to risk-based, population health partnerships that held us accountable not only to improving access to care, and reducing cost of care, but as importantly, to delivering better outcomes for individuals like Suzanne, who are traditionally stigmatized and underserved. 

Eleanor Health is leading this evolution - and it’s working for Suzanne and so many others. We're excited to continue our mission to change how we treat, pay for, and deliver care to those suffering from addiction and mental illness. With a new $50M Series C financing led by General Catalyst, including participation from existing investors Warburg Pincus and Town Hall Ventures, as well as new participation from NorthPond Ventures and Rethink Impact, we are excited for the next phase of our growth and impact.

About the Author

Corbin Petro is the CEO & Co-Founder of Eleanor Health, a provider of evidence-based, whole person care specializing in addressing the unique complexities of individuals and populations with substance use disorder and mental health needs. Eleanor Health leverages proprietary technology and data-driven insights, compassionate teams, and value-based payment to deliver superior clinical and financial outcomes, making it the ideal solution to meet the needs of all stakeholders - patients, providers, and health plans.