Program Uses AI to Improve Outcomes, Reduce Costs in Behavioral Health

The prevalence of mental illness is extremely high, affecting one in five Americans. Furthermore, costs for people with behavioral health conditions are about three and a half times higher than costs for people without such conditions. A presentation at AMCP Nexus 2023 discussed a program that uses an artificial intelligence (AI) platform to optimize medications, improve outcomes, and reduce spending.

The presentation was led by Caroline Carney, MD, MSc, FAMP, CPHQ, president and chief medical officer of Magellan Behavioral Health, and Yoona Kim, PharmD, PhD, cofounder and chief executive officer of Arine.

Increasing rates of polypharmacy are a major contributor to the overall problem, the speakers said, highlighting that 60% of adults with a behavioral health condition are on two or more psychotropic medications. Polypharmacy increases the risk of drug interactions, side effects, and health care utilization. Another factor contributing to poor outcomes and high costs is nonadherence to prescribed medications. Nonadherence often leads to treatment failure, rehospitalizations, poor quality of life, increased comorbidities, and increased risk of suicide. Further complicating the problem is untreated and undertreated behavioral health conditions, often due to racial disparities, stigma associated with these conditions, and misdiagnoses.

The presentation detailed a Magellan program called Navigate Whole Health, a prescriber-level program which aims to address these frequent medication-related problems in people with behavioral health conditions. The program uses AI to identify target prescribers, then applies algorithms to generate ideal care plans. The system automatically generates treatment recommendations and patient education. Finally, new data from clinical outcomes go back into the system to continuously improve the algorithms.

“[We] go beyond just telling providers to change a medication and instead provide them with recommendations explaining what the problem is, why it’s a problem, and the evidence-based literature supporting the change,” the speakers explained. The program tracks provider engagement and acceptance of recommendations, following up with providers as needed. Providers implemented the recommendations about 50% of the time.

Magellan’s program has proven successful by reducing behavioral health polypharmacy by 45% to 55%, increasing medication adherence by 20%, lowering average daily morphine milligram equivalents by 20%, and saving $360 to $840 in pharmaceutical costs per enrolled member per year.

The speakers highlighted many other ways that AI can enhance health care outcomes and reduce costs, such as models that predict risk for suicide or substance use, automated audits of medications to optimize outcomes, and alerts regarding high-risk prescriptions or duplicate medications.


Carney, C Kim Y. Using Medication Intelligence to Improve Behavioral Health Outcomes. Session R5. Presented at AMCP Nexus 2023; Oct. 16‒19, 2023; Orlando, Fla.