Living Well with Kidney Disease: Making Mental Health a Priority

What payers, providers, and patients can do 

By Tom Warnes, Ph.D.
Healthmap Solutions Scientific Advisory Board Member 
Published March 16, 2021

The State of Mental Health in the U.S.

In the U.S., nearly one in five adults lives with a mental health issue such as anxiety or depression. As of 2019, 51.5 million American adults aged 18+ were living with a mental health issue, and more than half of those were undiagnosed. When left untreated, these issues can cost the U.S. $100 billion annually in lost productivity, but the personal toll is incalculable. Those struggling with untreated mental health conditions often experience lives upended by lost employment, damaged relationships and homelessness, among other challenges. They also tend to develop or experience worsening medical conditions that make an already difficult situation worse.

The Link Between Kidney Disease and Anxiety and Depression

Any form of life stress can precipitate an episode of anxiety or depression, but being diagnosed with a chronic condition raises the incidence of mental health problems by 25% to 50%, depending on the condition.

Much like mental health conditions, kidney disease often goes undiagnosed in its early stages, when treatment can slow disease progression. Many people learn of their diagnosis when kidney failure drives them into a hospital emergency room and they “crash” into dialysis.

Those living with chronic kidney disease (CKD) or end-stage renal disease (ESRD) are two to three times more likely to develop a mental health issue. For people whose anxiety or depression is left undiagnosed and untreated, their mental health condition can interfere with their everyday life. Tasks such as adhering to their treatment plan and keeping medical appointments become daunting or impossible. Their mental health issue ends up directly contributing to an overall decline in health and increasing their cost of care. The risk of adopting unhealthy lifestyle choices also rises and can lead to further deterioration of health. Untreated depression for someone with CKD or ESRD can more than double that person’s healthcare costs.

How the Health Plan-Provider-Patient Partnership Can Help

Health plans, physicians and patients all have an essential role to play in recognizing the signs and risk factors associated with mental health issues. All have the responsibility to take steps to ensure the patient receives the care they need when they need it.

What Health Plans Can Do:

• Encourage network primary care offices to routinely screen for anxiety and depression through communications, shared tools, clinical registries and even financial incentives.
• Educate and encourage members to be aware of mental health issues and to seek help from a mental health professional or their primary care physician if they feel in need.
• Share articles that reduce the stigma associated with mental health issues.
• Partner with a specialty care management company specializing in “whole person” interventions that include mental health and chronic condition management.

What Providers Can Do:

• Routinely screen patients for depression and anxiety.
• Refer patients to mental health professionals with the same urgency as referrals made to medical specialties.
• Remember that untreated mental health conditions cause unnecessary suffering, lower the quality of medical care outcomes, and cost everyone more.

What Patients Can Do:

• Recognize the signs and seek help when they need it.
• Do their best to manage stress and emotional health by getting enough sleep, exercising, limiting time on devices, and maintaining a healthy diet.
• Talk openly and honestly with their healthcare team about their mental health.

How Healthmap is Helping

At Healthmap, we make early detection, clinically proven interventions, and complex and compassionate care management a priority. We take a whole-person approach to managing kidney disease, including caring for the person’s mental well-being. Our Kidney Health Management (KHM) program uses robust data and advanced technology to identify people at risk for CKD and ESRD and the comorbid conditions, including mental health issues, that often accompany a kidney disease diagnosis.

This includes:

• Using the power of our data and advanced technology to relentlessly screen for mental health issues. The data uncovers changes in patient behavior, such as missed appointments or medication refills, emergency room visits, or previous treatment for anxiety and depression, all of which can be signs of an at-risk patient. We then take appropriate steps to ensure the patient gets proper evaluation and support.
• Conducting a comprehensive mental health assessment when enrolling a patient in our KHM program and during each subsequent interaction.
• Coaching members on how to identify mental health issues, healthy coping skills they can adopt, and when to seek help from a physician or mental health professional.
• Connecting patients to the community support services they may need to alleviate stressors in their lives. We can help patients secure a mental health services referral and direct them to local support groups or community-based programs to overcome barriers to care, such as housing or food insecurity or lack of transportation.
• Remaining in touch with the patient and their provider, ensuring the patient is getting the care they need and that their provider has the most current information.

Good mental health is essential to overall physical health and wellness. Taking a holistic approach to healthcare, as we do through our KHM program, ensures that both the patient’s physical and mental well-being get equal importance when it comes to their care.

We are currently working with health plans to help improve the care, outcomes and experience of their members/patients and better manage care costs. Contact us to learn more about Healthmap’s KHM program.