Cover Story

Increasingly, research has shown that psychosocial variables are related to a number of health outcomes. But until recently, there was little modeling to help predict the financial benefits to health plans when psychological services are delivered to patients with cardiac and other physical health problems. Such actuarial modeling is important, says Geoff Reed, PhD, the APA Practice Directorate's assistant executive director for professional development, because it persuades health plans about the cost-effectiveness of such interventions and helps convince the plans to pay for related services.

APA has now taken an important step toward filling the void in actuarial modeling. In 1999, the Practice Directorate engaged the consulting firm, PriceWaterhouseCoopers (PWC), to develop a model that would predict the cost savings of using psychosocial interventions for cardiac patients. As a basis for the modeling, the Practice Directorate asked PWC to use a 1997 study published in the Archives of Internal Medicine (Vol. 157) by James A. Blumenthal, PhD, professor of medical psychology at Duke University Medical Center in Durham, N.C.

Blumenthal found that stress-management techniques can dramatically decrease the chances that cardiac patients will suffer additional problems. He randomly assigned patients with ischemia to receive a four-month exercise program or a four-month stress-reduction program including small-group sessions, relaxation training and biofeedback. Patients living too far from the study site to participate served as a control group and received conventional care from their own physicians. Over the next three years, the researchers checked annually to see which of the 107 patients had suffered heart attacks, undergone cardiac surgery or died.

The results from the initial three-year review were striking. Only 9 percent of the patients in the stress-management group had additional heart problems, compared with 21 percent of the exercise group and 30 percent of the control group. Those results imply that the stress-management intervention also lowered health-care costs for those patients, says Reed. Blumenthal and colleagues have recently completed a five-year follow-up study of participants, the results of which are currently being analyzed.

The Practice Directorate had PWC analyze the financial outcomes that might be expected based on Blumenthal's clinical results to put a price tag on how much money the intervention would be expected to save. The completed PWC analysis estimated that a cost savings of $5 for every dollar spent on the stress-management intervention would accrue to a health plan in the five-year period following the initial cardiac event, with some "return on investment" starting in the first six months.

Such a promising result has led APA to contemplate a larger-scale demonstration project to replicate Blumenthal's study and show the beneficial cost outcomes predicted by the actuarial model. This project would be carried out in an actual delivery setting where health-care savings could be readily documented.

"Through these efforts, APA is working to enhance the value placed on psychological interventions in real-world health-care systems," says Chris McLaughlin, director of professional development demonstration projects in the Practice Directorate.