1. Heart and Mind Connections: Integrated Strategies for Greater Health Presentation to Senior Leadership

2. 2 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

3. 3 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

4. 4 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 disease 2

5. 5 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

6. 6 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

7. 7 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

8. 8 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

9. 9 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

10. 10 Sources 1 ValueOptions/IHCIS Comorbidity Study, 2003 2 Group Health Incorporated, www.ghi.com 3 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.