A Mental Health Diagnosis Raises the Cost of Treating Asthma and COPD by 84%

New analysis from Nomi Health finds that mental health comorbidities raise the cost of treating chronic conditions by 6% to 84%, depending on the condition, a range that carries significant implications for self-funded employer health plans.

A mental health diagnosis raises the cost of treating asthma and COPD by 84%. That number held steady across two years and 230,000 members. Among five major chronic conditions, including diabetes, hypertension, IBS, and heart disease, nothing else comes close.

Asthma and COPD sit at the extreme end of a range that turns out to be surprisingly wide. A mental health diagnosis raises the cost of treating a chronic condition, but how much depends heavily on which condition. Across five major chronic conditions, the range spans 6% to 84%.

Nomi Health analyzed 2023 and 2024 claims data from self-funded employers, splitting members with a chronic condition into two groups: those without a mental health comorbidity and those with one. We then measured what it costs to treat the chronic condition itself (excluding the cost of the mental health condition) across both groups, for each condition separately.

Diabetes sits at the low end, with a modest differential that compressed slightly between years. Asthma and COPD sit at the top, at 84% in both years, with no movement at all.  

Asthma and COPD Carry the Highest Cost Burden

The 84% differential for asthma and COPD is nearly double the differential for ischemic heart disease, triple that of inflammatory bowel disease, and thirteen times that of diabetes. Members managing asthma or COPD alongside a mental health diagnosis cost 84% more to treat for that respiratory condition than members managing it alone, and that number didn't budge between 2023 and 2024.

Across the 230k+ members in this analysis with asthma and COPD and a mental health diagnosis, that differential is a substantial cost driver. And for employers covering younger dependents, it carries additional weight. Asthma is one of the most prevalent chronic conditions in children and adolescents, and Gen Alpha members in this dataset show some of the highest comorbidity cost differentials of any age group, largely because their chronic condition burden is dominated by asthma. Most haven't yet developed diabetes, hypertension, or heart disease. For Gen Alpha, asthma is the cost story.

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Diabetes Shows the Lowest Mental Health Comorbidity Cost Differential.  

At 6-8%, diabetes carries the lowest differential in the dataset by a significant margin. Around 200,000 members per year in this analysis carry both diabetes and a mental health comorbidity. For the most common chronic condition in the dataset, a relatively small cost differential still warrants attention.

Hypertension: The Largest Comorbidity Cost Exposure for Self-Funded Employers

Hypertension sits at 22-25%, a mid-range differential. But it carries the largest affected population by far: over 500,000 members with both a chronic condition alongside a mental health diagnosis in both years. At that scale, a moderate differential generates significant absolute cost. For most self-funded employers, hypertension is likely where the largest dollar exposure sits, even if asthma and COPD carries the more dramatic differential. At that population scale, a 22-25% cost increase adds up fast.

Why Do Mental Health Comorbidities Raise Chronic Condition Costs?

The data doesn't explain why these differentials vary so widely. But the pattern held across two years and millions of members, which suggests something real is driving it.

One observation worth noting: diabetes has one of the longest histories of whole-patient care management in employer health plans, coordinating physical and mental health together. Asthma and COPD, at the other end of the table, have largely been managed as physical conditions in isolation. While our data can't confirm causation, the pattern is consistent enough to be worth taking seriously.

How Self-Funded Employers Can Act on Mental Health Comorbidity Data

The aggregate mental health comorbidity finding, an 18-19% average cost differential, appears in trend reports. The condition-level breakdown typically doesn't. For self-funded employers, a few questions are worth asking now:

Where does a mental health diagnosis drive up your chronic condition costs most?

‍The spread in this data suggests the answer varies significantly by population. A population with frequent overlap between asthma and mental health diagnoses faces a very different cost picture than one where hypertension and mental health diagnoses co-occur most. Start by running a condition-level breakdown of your claims data to see where those combinations concentrate in your population.

How are your chronic condition programs handling mental health?

For conditions where the two are managed separately, our data suggests that the separation has a cost. Map your current chronic condition vendors against your mental health vendors to identify where those programs operate independently and where they connect.

Are your Gen Alpha dependents flagged?

Asthma prevalence is high in younger populations, the comorbidity differential is large, and the cost impact compounds over time. Pull your dependent claims now to identify asthma members who also carry a mental health diagnosis; that population is visible in your data today.

How Mental Health Comorbidity Costs Vary by Generation

The conditions with the highest differentials and the generations with the highest differentials aren't independent questions. To see how the comorbidity cost gap plays out across generations, and why Millennials and Gen Z tell a very different story than Boomers and Gen X, read our previous analysis.

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