Claims analysis says 50% have comorbid conditions

Depression, anxiety linked to chronic conditions

At Eden Prairie, MN-based Cigna, claims data have revealed a clear link between mental and physical health of employees.

"We have done claims analysis on everyone we insure and really see the connection between health of the mind and health of the body," says Peggy Audley, director of depression disease management for Cigna's behavioral health unit.

The company's data showed that 50% of employees with chronic medical conditions have a comorbid behavioral health condition, she reports. "Diabetics have double the rate of depression over the general population," adds Audley. "If you do not look at the whole person, your medical costs are going to go up."

Cigna has developed a broad array of programs to emphasize an integrated approach to care, including a depression program that went live in January 2006. "There is a big gap out there: 83% of employees with symptoms of depression or anxiety don't go to a therapist or psychiatrist," says Audley. "Instead, they go to a primary care provider, where they maybe get eight minutes with a doctor who doesn't have the time to look at the causes behind the problem, side effects of medication, or follow-up care."

Claims from the primary care setting are screened for diagnoses of depression and anxiety. "Anxiety plays a big part in a person's ability to function well, so we look at both of those," says Audley.

About half of these individuals have a chronic condition as well, such as asthma, chronic obstructive pulmonary disease or diabetes, notes Audley. "Chronic health conditions have 2.5 higher costs than those without depression," she says. "Those are high risk people, so we do a telephone coaching program using behavioral clinicians. We are truly integrating the behavioral with the medical."

Referrals also are taken from case managers, who now screen every employee they work with for depression, says Audley. "We coordinate work life referrals and Employee Assistance Program referrals. We also work with primary care providers and give them direction on how to manage the depression," she says.

Questions about depression are included in the health risk assessment completed by all employees, and employees are asked if they would like a follow-up call. "If the person screens positive for depression, then the case manager has some information about how receptive the person is to taking a referral," Audley says.

If given appropriate treatment, many employees with depression will get better quicker, says Audley. "Our first-year results showed an 82% improvement in presenteeism, and absenteeism decreased by 81%," she says. "We are seeing and hearing some wonderful stories of improvement, because people are able to get the correct treatment."

"De-stigmatize" depression

At Overland Park, KS-based Sprint, a "holistic approach" is taken for employee health, says Collier Case, director of health and productivity. In early 2005, a "depression awareness campaign" was initiated with the goal of better detection and treatment, reduced absenteeism, and lowered direct medical costs, he says.

Depression was "de-stigmatized" by openly educating employees on available resources and treatments, through a survey about knowledge of depression created by Golden Valley, MN-based OptumHealth Behavioral Solutions, a brochure sent electronically emphasizing that "mental health matters," developed by the Mid-American Coalition on Health Care, and a webcast featuring an expert on depression that could be viewed by employees from desktops, says Case. "A traditional return on investment was not conducted in the time immediately following our initiative, but by the end of the year, 1,800 people had viewed the webcast," he says.

Comparative information for Sprint's 60,000 employees showed a 10% increase in number of patient visits for depression in 2005 over 2004 while use of anti-depressants remained constant, and Employee Assistance Program claims related to stress/emotional/psychological needs increased to 58% from 50% in 2004.

Conditions with high levels of co-morbidity with depression are targeted, including heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, asthma, cancer, hypertension, stroke, arthritis, and chronic pain, says Case. Medical and pharmacy claims data are used to specifically target unrecognized behavioral needs in the chronic medical population, and outreach is done with individuals likely suffering from depression, says Case.

Disease management nurses are trained to identify signs of depression, ask appropriate questions, and direct employees to available resources.

"Identified members receive a letter and program brochure advising them to expect a call," says Case.


For more information about helping employees with depression, contact:

  • Peggy Audley, Director of Depression Disease Management, Cigna, Eden Prairie, MN. Phone: (952) 996-3060. E-mail:
  • Collier Case, Director Health and Productivity, Sprint, Overland Park, KS. E-mail:
  • The Mid-America Coalition on Health Care links major employers with health care delivery stakeholders to address the rising costs of health care and the health and wellness of employees. For more information, contact: The Mid-America Coalition on Health Care, One West Armour Blvd., Suite 204, Kansas City, MO 64111. Phone: (816) 753-0654. Fax: (816) 531-0575. E-mail: