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Trauma is a major problem for Medicaid members. Trauma-informed care may hold the answer.

Color portrait of Mark Pabst By Mark Pabst

When health care providers see a patient, the first question they often ask is, “What’s wrong with you?” But according to a new approach, the question medical professionals should really ask is, “What happened to you?” 

It’s a simple but powerful shift — and one that Aetna is advising physicians to embrace. That’s because boosting a person’s well-being means looking after their physical and mental health. This is certainly the case when it comes to caring for those who have experienced a traumatic event.

Currently, more than 165 million Americans have experienced some form of psychological trauma during their lifetime. Common examples of traumatic events include being the victim of violence or sexual abuse and surviving a natural disaster. Even simply living through grinding poverty can have a lasting impact. In fact, survivors of trauma are more likely to come from populations that rely on programs like Medicaid. Trauma is more common, for example, among people who grew up in the foster care system or who have been incarcerated. 

Studies show that traumatic events can have health effects that last decades after the ordeal is over, and living with trauma often leads to long-term psychological stress and unhealthy coping behaviors. Those who have experienced trauma are also more likely to need health care services like substance abuse counseling, treatment for chronic conditions and mental health support. Yet interacting with the health care system can sometimes be difficult for people who are suffering from the effects of trauma. Survivors of sexual abuse, for example, may be reminded of their ordeal during a visit with an ob/gyn. 

As a result, people who have experienced trauma may not comply with their health care provider’s instructions, like not taking medications as prescribed. Or, they may avoid contact with the health care system altogether. Failing to get care only results in worse health outcomes for trauma survivors and higher costs throughout the system. 

By starting from the lens of “What’s happened to you,” a trauma-informed approach changes the way providers look at their patients. Take, for example, a patient whose chronic physical pain is caused by a severe beating he suffered during childhood. Every time he described the experience to a new pain specialist, he was retraumatized. As a result, he stopped going to appointments and is now dismissed as “non-compliant.” 

However, in a trauma-informed approach, a care coordinator would communicate the important details of this patient’s medical and personal history to each new specialist. This spares him from having to communicate the details himself and relive the traumatic event. The approach removes the major hurdle that caused the patient to avoid seeing specialists in the first place. 

That’s why Aetna is incorporating trauma-informed principles into its Medicaid coverage. Since there is no standard model for identifying providers who are trauma-informed, Aetna is in the process of creating one. This will allow the company to know which medical professionals have an understanding of trauma-informed care and which ones need to receive training. Besides supporting efforts to deliver trauma-informed training, Aetna is also taking the lead in finding ways to incentivize providers to follow trauma-informed principles. That means more medical professionals will soon be trying to answer the question, “What happened to you?” when they see their patients.  

This new approach has major implications, especially in states like California, where some 24 million residents have experienced psychological trauma. As the graphic below shows, not only does trauma-informed care increase patients’ use of appropriate care, like preventive services and mental health treatment, it also decreases the use of care in expensive settings like the emergency room and overnight hospital stays. Such outcomes make the approach a more efficient manner of health care delivery and an effective way to address the staggering costs associated with caring for people living with trauma.

The problem: A majority of Californians live with psychological trauma 

61% of adults in California continue to suffer the effects of trauma they experienced in their childhood 

 

People likely to rely on Medi-Cal suffer from even higher rates of psychological trauma 

90% of children in foster care have experienced trauma 

95% of women in the public mental health system report a history of trauma 

90% of men and women who are formerly incarcerated have experienced trauma 

 

Trauma increases high-risk behaviors 

2.5x more likely to smoke 

3x more likely to be depressed 

4x more likely to use injection drugs 

15x more likely to attempt suicide 

 

Patients with trauma are less likely to follow doctors’ advice 

47% less likely to take medications as prescribed 

27% more likely to miss scheduled doctor’s appointments 

 

Patients with trauma are more likely to access more services in high-cost settings 

Traumatized children are 2.9x more likely to visit the emergency room 

Traumatized adults are 2.2x more likely to be hospitalized 

2.6x more likely to stay longer in the hospital 

Nationwide, trauma costs $671 billion per year in excess healthcare spending and lost productivity. 

 

The solution: Trauma-informed care

In trauma-informed care providers are trained to recognize, understand and respond to the effects of trauma. This improves patient engagement and the use of appropriate care. 

11% decrease in ER visits 

20x more likely to access supportive services 

2x more likely to seek out the mental health services they need 

Research shows a trauma-informed approach costs 34% less than traditional services 

 

We can improve health, reduce costs and save lives by supporting a trauma-informed approach to care. 

The problem: A majority of Californians live with psychological trauma 

61% of adults in California continue to suffer the effects of trauma they experienced in their childhood 

 

People likely to rely on Medi-Cal suffer from even higher rates of psychological trauma 

90% of children in foster care have experienced trauma 

95% of women in the public mental health system report a history of trauma 

90% of men and women who are formerly incarcerated have experienced trauma 

 

Trauma increases high-risk behaviors 

2.5x more likely to smoke 

3x more likely to be depressed 

4x more likely to use injection drugs 

15x more likely to attempt suicide 

 

Patients with trauma are less likely to follow doctors’ advice 

47% less likely to take medications as prescribed 

27% more likely to miss scheduled doctor’s appointments 

 

Patients with trauma are more likely to access more services in high-cost settings 

Traumatized children are 2.9x more likely to visit the emergency room 

Traumatized adults are 2.2x more likely to be hospitalized 

2.6x more likely to stay longer in the hospital 

Nationwide, trauma costs $671 billion per year in excess healthcare spending and lost productivity. 

 

The solution: Trauma-informed care

In trauma-informed care providers are trained to recognize, understand and respond to the effects of trauma. This improves patient engagement and the use of appropriate care. 

11% decrease in ER visits 

20x more likely to access supportive services 

2x more likely to seek out the mental health services they need 

Research shows a trauma-informed approach costs 34% less than traditional services 

 

We can improve health, reduce costs and save lives by supporting a trauma-informed approach to care. 

Aetna is the brand name used for products and services provided by Aetna Better Health and/or its affiliates.

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

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