CVS Health Survey Reveals 4x Gap in Physician-Patient Mental Health Perceptions

Addressing data surprises is part of CVS's mental health support strategy for customers, including its Aetna health plan members.

You know an issue needs attention when it has a designated month.

May is Mental Health Awareness Month and viewing it that way may sound pessimistic. But a realistic picture of American behavioral health is needed to improve it.

CVS Health adds to that picture via its recurring survey of mental health perceptions. The retailer's sixth survey since April 2020 reveals nuances across age groups, treatment preferences, and between providers and their patients.

In an exclusive interview with HealthLeaders, CVS Health's Cara McNulty, DPA, president of Mental Well-Being & Behavioral Health, added insight to the data and its biggest surprises.

Topline results: Perception versus reality

The latest CVS Health data is based on a national online Harris survey conducted March 7–24, 2023. Harris polled 3,400 people over the age of 18, as well as physicians and pharmacists. Respondents were those who had previously agreed to participate in CVS surveys. Age breakdowns included: Gen Z/Young Millennials (18-32 years), Older Millennials (33-40), Gen X (41-56) and Boomer+ (57+ years of age).

Gaps between Boomers and Gen Z are no surprise. But individual differences might be, such as how accurately individuals perceive their own mental health needs at any given time.

• Gen Z concerns are higher than the national average. While more than two in five Americans (42%) expressed concern about their mental health, that number increased to six in 10 (60%) among respondents aged 18-32.
   
• Physicians report 4x greater declines in patient mental health than their patients. One in 10 Americans (14%) said their mental health had declined since 2022, but their providers don't agree. Nearly six in 10 physicians (56%) believe their patients' mental health has gotten worse.
   
• Worried for others, but not seeking self-help? Two-thirds of survey respondents (67%) said they knew a lot of people with mental health struggles. But only 12% regularly see a mental health professional themselves.

The reasons for the disconnects—between providers and patients, patients and "other people"—are likely varied but perhaps not as unexpected as they seem.

McNulty—a 25-year healthcare veteran—shares her own experiences.

"Often we assume that people know what they're thinking and feeling. But most of us have no clue. Even with my own anxiety, I didn't have a clue."

She adds: "We are feeling the impacts of COVID, of pandemic socialization over the past three years. We're perhaps even immune to it. But physicians continue to see the impact and disruption when patients come in to see them and for reasons other than mental health."

Generational data differences

The CVS Health/Harris poll data showed that 95% of Boomers believe society should take mental health and mental illness more seriously. This is compared to 83% of Gen Z.

This also surprised McNulty.

"The Boomer age group felt that mental health was as important as physical health, which in the past hasn't been case," she notes. "This is not a population that grew up talking about this, but they see with the pandemic how their own mental health and that of their family and loved ones has been affected."

Other generational gaps involved technology, with notable contrasts between Gens Z and X:

• Technology for mental health information. Nearly 30% of Gen Z respondents stated they rely on technology for mental health information, the most of any age group.
• Technology for mental health access. More Older Millennial respondents, however, appear to use technology to actually access care—85% agree that digital health has made mental health services more accessible.

• The social media effect. Gen Z and Boomers also differ in the belief that social media has negatively impacted their mental health—58% versus 22%, respectively.

How CVS applies the data, including for Aetna members

CVS applies the Harris poll data to understand and address the country's diverse mental health needs—for all its customers and for the subset who have Aetna coverage. CVS Health acquired Aetna in 2017.

"We are casting a wide net to ensure people get help at the point of care," says McNulty, who detailed CVS' mental health services in a press release associated with its survey data.

CVS' mental health virtual visits have exploded, from less than 200,000 in 2019 to approximately 30 million by the end of 2022. More than 1,100 CVS MinuteClinic locations also offer depression screenings.

The screening includes the two-item Patient Health Questionnaire (PHQ-2), which asks: "Over the last 2 weeks, how often have you been bothered by the following problems? 1. Little interest or pleasure in doing things. 2. Feeling down, depressed or hopeless."

Based on the results and the person's health plan, CVS Health offers support at the individual and population health levels. CVS' Resources for Living Team connects Aetna members to their employers' resources first, then to plan benefits—a triage approach that reflects shifts in who pays and provides services and in what order.

"For Aetna members," McNulty notes, "we can go a step further. Taking what we are seeing in claims, trends, and environmental factors as an overlay and then looking at predictive factors to deploy services that are age specific, clinically sound, and culturally appropriate."

As a specific example, McNulty returns to that surprise Boomer belief in the importance of mental health and its implications.

"With this population, we make sure that Aetna solutions include mental health needs during situations like joint replacement. We're not waiting for someone to be in crisis."

She adds: "If a customer is not an Aetna member, we still support them. We just don't have details on what their plan sponsor resources are. If they are uninsured, we help connect them to local resources."

"As an industry, we haven't always felt comfortable addressing the mental health side. At CVS Health, we take it as an imperative. That some people are half served, half supported—that's absolutely not good enough. No one needs to suffer, no one needs to do this alone."

"Focusing on this work every single day is the right thing to do."