Response to treatment and illness recovery is impacted by the brain more than any other organ in the body. This impact starts with the thought that goes into understanding and making decisions about what to do. This is compounded by the physical repercussions most chronic and life threatening disease have on the brain, or the brain can cause. Despite well documented evidence, in multiple conditions, that body and brain health is the bi-directional - one gets worse, the other follows - doctors treating them don’t consider the impact. Illness and injury to the brain is the single largest comorbid, or co-occurring, secondary illness in the entirety of medicine. All of it.
Today, about 70 percent of the US population has a brain health condition or injury - such as depression, anxiety, dementia, Alzheimer's, stroke, Autism, Traumatic Brain Injury - or cognitive impairment caused by drugs - such as Chemo-brain. While the head is attached to the body, the physiologic impact from and to the brain is not considered medically relevant in illness and disease. The function of the brain is critical to recovery from illness or some surgeries, individual response to drugs and other interventions, communication and decision making, adherence to treatment, and the body’s response to physical illness such as the relationship between anxiety or depression and heart disease. The current, ancient, nomenclature that describes what is more often a physiologic response to biologic change in the body as simply “mental” confuses thoughts with physiology.
Call us crazy or stupid, but lowering cost and increasing the quality of care is best done by reducing the incidence and effect of illness. When the brain is effected by a physical condition, people often go from doctor to doctor seeking solutions, which often increases the severity of both conditions, or establishes new ones. Doctors who ignore brain health as a cause or effect of the conditions they treat lose the additional control they have in managing patients and choosing the best treatment plans for them over single condition “cattle shoots” mandated by insurers.
In Clinical Practice
There are not enough Psychiatrists or Neurologists to treat the most severely impacted patients, much less those with mild and moderate conditions that are comorbid to the primary illness the doctor specializes in. Often, the specialist becomes the primary care provider based on the amount of time spent with the patient. Gravitas is an advocate for doctors that need the capability and practice capacity to ensure value-based care by reducing the severity, progression, and secondary effects of the conditions they treat that require customized support technologies, reimbursement, and proven outcomes.
This just in from the real world: Health providers are not well equipped to treat a primary physical condition and mental or cognitive condition that may result because those that write the treatment plans don't know how to. Doctors have said for decades that the insurance provisions for care do not represent real world scenarios because they are written for a single condition, without consideration for the differences in individuals. While Health IT provides the opportunity to support a doctors ability to treat multiple conditions, and the amount of data available to help is tremendous, there is very little progress.
In Being Well, Not Better
The fallout for untreated or poorly treated brain illness becomes a cycle of new conditions, lack of self-awareness or self-management of current conditions, poor at home follow-up, readmission, and dissatisfaction with providers. Treating mild to moderate brain conditions is not complex, but not as easy as just another pill. Assessing the condition type and severity, managing medication, providing good care follow-up, and knowing when a Neurologist or Psychiatrist is needed can improve the overall health of patients.
In Reimbursement and Copays
People pay for more office visit, medications, and test co-pays when they have two or more conditions. The out-of-pocket costs sky rocket when one condition involves the brain and is left undiagnosed, misdiagnosed, or poorly managed, causing condition worsening, new conditions, relapse, readmission, and sometimes mortality. These additional services have tremendous impact on the cost of patient care for readmissions, condition relapse or worsening, and a multitude of new conditions that emerge.