Behavioral health care costs represent roughly 10 percent of total health care expenditures with the other 90 percent expended on medical surgical disorders. In conducting PARETO studies of medical surgical claims, our associates have consistently found that 15 percent of the enrollees represent approximately 80 percent of the claims expenditures including 5 percent who consume 40 percent of the expenditures. It is estimated that chronic behavioral health problems, largely undiagnosed and untreated, are involved in 70 percent of these cases. This means that if behavioral health issues were totally absent in the remaining 85 percent of claimants, they would have a bearing on more than 50 percent of total health expenditures. Case records indicate that the single most frequent behavioral health problem is substance use disorder.