1
00:00:00,055 --> 00:00:01,005
- Hello everyone.

2
00:00:01,205 --> 00:00:03,205
I am Mariah Mohammed
with Becker's Healthcare.

3
00:00:03,455 --> 00:00:05,605
Thank you so much for
joining us for this podcast.

4
00:00:06,225 --> 00:00:08,085
We are absolutely thrilled
to be joined today

5
00:00:08,085 --> 00:00:11,205
by Andy Flanagan, CEO of Iris Telehealth.

6
00:00:11,475 --> 00:00:13,405
Andy, thank you so much for
being here today. How are you?

7
00:00:13,855 --> 00:00:15,525
- Thank you, Mariah.
Wonderful to be together.

8
00:00:15,955 --> 00:00:17,365
- Yeah, of course. Uh,

9
00:00:17,365 --> 00:00:20,885
today we will discuss integrating
behavioral healthcare at

10
00:00:20,885 --> 00:00:23,645
scale and how health systems
can set themselves up

11
00:00:23,645 --> 00:00:24,885
for long-term success.

12
00:00:25,265 --> 00:00:27,805
So with that, let's dive right
into our conversation today.

13
00:00:28,105 --> 00:00:31,005
So Andy, what are you hearing
from health system leaders

14
00:00:31,465 --> 00:00:32,765
as their biggest challenges

15
00:00:32,765 --> 00:00:35,245
to providing effective quality behavioral

16
00:00:35,245 --> 00:00:36,645
healthcare to their communities?

17
00:00:37,725 --> 00:00:38,855
- Yeah, thank you, Mariah.

18
00:00:38,885 --> 00:00:41,455
It's a such a localized question,

19
00:00:42,325 --> 00:00:44,015
whether you're in Manhattan

20
00:00:44,355 --> 00:00:46,335
or you're in Visalia,
California, you know,

21
00:00:46,335 --> 00:00:47,615
the answer can seem different,

22
00:00:48,315 --> 00:00:50,935
but I would just say that
it's not, uh, the integration

23
00:00:50,935 --> 00:00:53,455
of virtual and physical
is no longer an option.

24
00:00:53,455 --> 00:00:56,495
It's an imperative. The
patient journey requires it.

25
00:00:57,075 --> 00:00:59,095
Uh, there are financial
incentives for a health system,

26
00:00:59,515 --> 00:01:03,095
no show rates, uh,
value-based care arrangements

27
00:01:03,095 --> 00:01:06,775
that would say you don't
want somebody to not present,

28
00:01:06,775 --> 00:01:09,855
especially for behavioral
health, where it can, um,

29
00:01:10,075 --> 00:01:12,055
it can escalate quickly
and it's hard to diagnose.

30
00:01:12,565 --> 00:01:13,695
It's not a blood pressure

31
00:01:13,795 --> 00:01:16,015
or that's something you can measure in a

32
00:01:16,015 --> 00:01:17,295
traditional biometric sense.

33
00:01:17,835 --> 00:01:19,575
So I'm hearing loud

34
00:01:19,575 --> 00:01:22,175
and clear from health system
leaders across the country

35
00:01:22,435 --> 00:01:27,415
of all, uh, service lines,
C-F-O-C-E-O, uh, oncology,

36
00:01:27,515 --> 00:01:30,375
in addition to the head of
behavioral health, that a true

37
00:01:30,985 --> 00:01:32,375
fully integrated virtual

38
00:01:32,475 --> 00:01:36,095
and physical environment,
uh, is required for success.

39
00:01:39,785 --> 00:01:41,755
- Yeah, absolutely. I completely agree.

40
00:01:41,995 --> 00:01:43,795
I love how you said it's essential

41
00:01:44,055 --> 00:01:45,435
to a patient's health journey.

42
00:01:45,855 --> 00:01:47,075
Um, and I, I agree.

43
00:01:47,155 --> 00:01:48,635
I think even those hospitals

44
00:01:48,635 --> 00:01:50,595
and health systems, I'm not
trying to do telehealth,

45
00:01:50,595 --> 00:01:51,995
definitely know that it's coming.

46
00:01:52,615 --> 00:01:54,835
Um, the next thing I wanted to ask you is

47
00:01:54,895 --> 00:01:57,315
how can leveraging virtual
behavioral healthcare

48
00:01:57,865 --> 00:02:00,595
help health systems integrate
beha behavioral health

49
00:02:01,155 --> 00:02:03,075
services across our patient journeys?

50
00:02:03,775 --> 00:02:06,355
- You know, we, we, we've
heard consistently that

51
00:02:07,405 --> 00:02:09,785
the patient request for virtual encounters

52
00:02:09,785 --> 00:02:14,585
of behavioral health has
maintained a covid level of demand.

53
00:02:15,585 --> 00:02:20,195
All other service lines
has returned roughly to the

54
00:02:21,015 --> 00:02:23,595
pre covid utilization rate of virtual.

55
00:02:24,915 --> 00:02:27,335
So we should take away that
the patient journey is best

56
00:02:27,335 --> 00:02:28,615
served by meeting the patient

57
00:02:28,615 --> 00:02:29,975
where they are in behavioral health.

58
00:02:30,395 --> 00:02:31,695
But we don't need biometrics.

59
00:02:31,695 --> 00:02:34,015
We don't need labs except in prescribing.

60
00:02:34,435 --> 00:02:38,535
And so it's a successful
encounter modality, virtual

61
00:02:39,115 --> 00:02:43,535
as is physical, and it
can effectively close time

62
00:02:43,535 --> 00:02:46,655
and distance gaps, not just in, you know,

63
00:02:46,655 --> 00:02:47,935
Texas here where I am.

64
00:02:48,005 --> 00:02:50,575
It's a huge state. Uh,
could be in New Hampshire,

65
00:02:50,575 --> 00:02:52,975
it could be in Rhode Island,
super dense Manhattan.

66
00:02:53,635 --> 00:02:54,775
And we all live our lives

67
00:02:54,995 --> 00:02:58,015
and it's hard to fit in clinical
encounters of all kinds.

68
00:02:58,395 --> 00:03:01,125
So, you know, I would
say that very clearly,

69
00:03:01,225 --> 00:03:03,525
the patient is speaking,
they're voting with their feet.

70
00:03:04,025 --> 00:03:05,525
And from a health system perspective

71
00:03:05,625 --> 00:03:06,805
and a provider perspective,

72
00:03:07,805 --> 00:03:10,005
maintaining patient
continuity can be served

73
00:03:10,005 --> 00:03:12,805
by having a virtual and a
physical option available.

74
00:03:13,495 --> 00:03:16,705
Virtual can be turned on
in an instant, if you will.

75
00:03:17,165 --> 00:03:18,985
If it's present and it's been mapped

76
00:03:18,985 --> 00:03:21,945
and it's integrated, you
can move me from a physical

77
00:03:21,945 --> 00:03:23,305
encounter to a virtual encounter.

78
00:03:23,305 --> 00:03:24,705
If I just can't get across town,

79
00:03:24,785 --> 00:03:27,585
I can't get outta my meeting,
I can switch modalities

80
00:03:28,325 --> 00:03:29,985
on my phone safe.

81
00:03:30,495 --> 00:03:33,345
It's HIPAA compliant. It's
effective in behavioral health.

82
00:03:33,925 --> 00:03:38,585
So it is really, uh, as we all
think about cost in addition

83
00:03:38,585 --> 00:03:40,225
to the, the quadruple aim,

84
00:03:40,645 --> 00:03:43,665
it can also deliver a substantial
lift to the bottom line,

85
00:03:43,875 --> 00:03:46,145
which all health systems need right now.

86
00:03:46,215 --> 00:03:48,105
It's a very tough environment,
operating environment

87
00:03:48,105 --> 00:03:50,185
for health systems and for physicians.

88
00:03:51,555 --> 00:03:54,605
- Yeah. Thank you so much
for sharing, uh, that fact

89
00:03:54,605 --> 00:03:58,085
that virtual health is not
dropped after, after COVID-19.

90
00:03:58,705 --> 00:04:00,565
Uh, I think that definitely says a lot.

91
00:04:01,025 --> 00:04:02,685
Can you share some examples of

92
00:04:02,685 --> 00:04:06,085
how HO hospitals have successfully
adjusted their strategy

93
00:04:06,585 --> 00:04:07,805
to better meet the behavioral

94
00:04:07,805 --> 00:04:09,085
health needs of their community?

95
00:04:10,055 --> 00:04:12,235
- Yes. And you know, Mariah,
uh, you're in New York

96
00:04:12,235 --> 00:04:15,755
and I'm in Dallas, and
so you would clearly say

97
00:04:15,755 --> 00:04:17,435
that the patient journey
is very different.

98
00:04:17,435 --> 00:04:19,715
Therefore, Montefiore, uh, uh,

99
00:04:19,725 --> 00:04:22,355
would have a different strategy than, uh,

100
00:04:22,565 --> 00:04:25,155
Texas Health Resources, large
health system down here.

101
00:04:26,095 --> 00:04:27,275
Uh, they really don't.

102
00:04:27,695 --> 00:04:30,395
And, and the nice thing
about virtual care is

103
00:04:30,395 --> 00:04:32,755
that it can evolve with
your physical strategy.

104
00:04:33,415 --> 00:04:34,835
And so I'll give you two examples.

105
00:04:35,375 --> 00:04:37,435
Uh, the most common scenario
for a health system is

106
00:04:37,435 --> 00:04:39,355
that the referral queue
coming from primary care

107
00:04:39,895 --> 00:04:41,115
is a four to six month wait.

108
00:04:42,085 --> 00:04:43,455
It's just not acceptable for anybody.

109
00:04:43,515 --> 00:04:48,015
The health system, the payer,
the patient, their family, uh,

110
00:04:48,015 --> 00:04:50,175
there's nothing about the
quadruple aim that is served

111
00:04:50,275 --> 00:04:52,495
by a four to six month
wait for any specialty,

112
00:04:52,675 --> 00:04:55,495
but, you know, directly behavioral health.

113
00:04:56,355 --> 00:04:59,975
Uh, so the ability to reduce

114
00:05:00,595 --> 00:05:03,975
and, you know, drive the referral queue

115
00:05:03,995 --> 00:05:08,105
to an acceptable level
can easily be a six month

116
00:05:08,245 --> 00:05:10,945
to nine month project for
a virtual care strategy.

117
00:05:11,845 --> 00:05:13,785
And so once that's done, you say, great,

118
00:05:13,885 --> 00:05:17,705
now I have 3000 encounters
instead of 20 waiting.

119
00:05:18,175 --> 00:05:20,185
Well, I can manage 3000
as a health system.

120
00:05:20,495 --> 00:05:22,785
Okay, that's great. So what
do you do with the clinicians

121
00:05:22,785 --> 00:05:25,185
that have been working on
this backlog of 15,000?

122
00:05:25,485 --> 00:05:29,535
You move them downstream, you
move them into the outpatient.

123
00:05:29,565 --> 00:05:32,935
When somebody no-shows,
you have an on-demand pod

124
00:05:33,275 --> 00:05:34,855
or seven day 30 day, you know,

125
00:05:34,885 --> 00:05:36,175
star ratings just got released.

126
00:05:37,595 --> 00:05:40,945
Every payer in the world
is feeling pain associated

127
00:05:40,945 --> 00:05:42,905
with their behavioral health achievement

128
00:05:42,905 --> 00:05:44,385
of a seven day or 30 day follow-up.

129
00:05:44,725 --> 00:05:47,225
How is that possible when
you have excess physician

130
00:05:48,025 --> 00:05:49,065
capacity and behavioral health?

131
00:05:49,735 --> 00:05:51,305
Well, you don't if you're,

132
00:05:51,305 --> 00:05:52,465
you're a hundred percent physical,

133
00:05:52,525 --> 00:05:53,785
but you could, if it were virtual,

134
00:05:54,045 --> 00:05:57,765
you can fractionally allocate
a medical group if it's part

135
00:05:57,765 --> 00:05:58,885
of your overall strategy.

136
00:05:59,265 --> 00:06:01,165
So I'm not advocating
that you outsource that,

137
00:06:01,805 --> 00:06:03,505
and I'm not advocating
that you insource it.

138
00:06:04,165 --> 00:06:07,585
I'm advocating that it has to
be part of the design of your,

139
00:06:07,735 --> 00:06:09,465
your strategy as a service line leader.

140
00:06:09,805 --> 00:06:14,735
It can deliver profitable, high
quality patient encounters.

141
00:06:15,615 --> 00:06:18,195
And so that's really,
I think the, the goal

142
00:06:18,195 --> 00:06:20,515
that we should all be focused on, uh, much

143
00:06:20,535 --> 00:06:23,515
as the stigma associated with
behavioral health has dropped,

144
00:06:23,775 --> 00:06:26,075
you know, during the covid
and post covid period of time,

145
00:06:26,615 --> 00:06:29,915
the stigma associated
with virtual is dropping.

146
00:06:30,435 --> 00:06:32,635
I mean, Iris won't be
called iris telehealth.

147
00:06:32,635 --> 00:06:34,395
There will be no telehealth
in three to four years.

148
00:06:35,045 --> 00:06:36,395
It'll just be health, right?

149
00:06:37,075 --> 00:06:38,075
'cause we're all virtually

150
00:06:38,315 --> 00:06:39,395
speaking, whether we know it or not.

151
00:06:39,935 --> 00:06:41,435
And tele is not a different thing.

152
00:06:41,775 --> 00:06:43,795
So that, that's, that's the exciting part.

153
00:06:43,915 --> 00:06:46,755
I mean, I really do have great
optimism for us as, as humans

154
00:06:47,345 --> 00:06:50,155
that we can bring care to us as opposed

155
00:06:50,155 --> 00:06:52,315
to us stopping our lives and driving

156
00:06:52,315 --> 00:06:56,495
however many miles, blocking
off our calendar, managing,

157
00:06:56,875 --> 00:06:59,825
you know, family, daycare, taking care

158
00:06:59,825 --> 00:07:03,265
of my dogs while I go get a
checkup, checkup of any kind

159
00:07:03,805 --> 00:07:07,705
and behavioral health, uh,
is the research is very clear

160
00:07:07,855 --> 00:07:12,345
that the, the quality of the
encounter virtually can match

161
00:07:13,085 --> 00:07:14,105
the physical encounter.

162
00:07:14,245 --> 00:07:16,065
So it's just really a another tool

163
00:07:16,065 --> 00:07:17,825
and toolkit for a health system.

164
00:07:19,545 --> 00:07:20,755
- Yeah, yeah, absolutely.

165
00:07:20,755 --> 00:07:22,195
Thank you so much for sharing that.

166
00:07:22,255 --> 00:07:24,315
And, uh, you are definitely right.

167
00:07:24,395 --> 00:07:25,435
I definitely thought that, uh,

168
00:07:25,435 --> 00:07:26,995
the patient journey will be

169
00:07:26,995 --> 00:07:28,115
different depending on where we are.

170
00:07:28,135 --> 00:07:30,555
But you made a lot of good
points on how they are similar.

171
00:07:31,215 --> 00:07:32,235
Um, for you,

172
00:07:32,375 --> 00:07:35,115
how do you see behavioral
health fitting into the

173
00:07:35,145 --> 00:07:37,395
value-based care strategies
for health systems?

174
00:07:38,235 --> 00:07:41,525
- Yeah, virtual behavioral
health is the secret weapon

175
00:07:41,705 --> 00:07:43,885
for anybody carrying risk clearly.

176
00:07:44,065 --> 00:07:45,645
And it's, it's poorly understood.

177
00:07:45,845 --> 00:07:48,405
I mean, risk in behavioral health is hard.

178
00:07:48,475 --> 00:07:49,525
It's usually carved out.

179
00:07:50,345 --> 00:07:53,165
The software that's deployed
in a health system usually

180
00:07:53,185 --> 00:07:55,565
carves out behavioral
health for a lot of reasons.

181
00:07:55,665 --> 00:07:56,685
We, we won't go into.

182
00:07:57,345 --> 00:08:00,925
But when, when somebody says
that they're carrying risk for,

183
00:08:01,025 --> 00:08:04,845
say, me, you know, anybody
with a behavioral health, uh,

184
00:08:04,845 --> 00:08:08,835
challenge has 2.2 higher total cost

185
00:08:08,835 --> 00:08:10,555
of care than anybody who does not.

186
00:08:12,075 --> 00:08:14,735
And, and so if you think
about it in any quartile,

187
00:08:14,835 --> 00:08:17,135
the highest quartile of
total medical expense

188
00:08:17,235 --> 00:08:20,895
to the lowest quartile, half
of each of those quartiles,

189
00:08:21,665 --> 00:08:24,285
the high end of that
quartile would be people

190
00:08:24,285 --> 00:08:26,885
that have some mental health
challenge in their lives.

191
00:08:27,955 --> 00:08:30,295
And we're just starting to
understand that we're just,

192
00:08:30,295 --> 00:08:32,455
you know, we, we've, we've
started to go virtual

193
00:08:32,715 --> 00:08:34,495
for cardiology and for

194
00:08:35,015 --> 00:08:37,415
EE every other care pathway
for chronic disease.

195
00:08:38,155 --> 00:08:40,175
But the persistent unaddressed issue

196
00:08:40,175 --> 00:08:42,375
for value-based care is behavioral health.

197
00:08:42,875 --> 00:08:44,695
And you just can't meet all of us

198
00:08:44,695 --> 00:08:47,175
where we are 350 million people spread

199
00:08:47,175 --> 00:08:48,215
across the country with covid.

200
00:08:48,315 --> 00:08:50,335
We just got released
to the wild, you know,

201
00:08:50,465 --> 00:08:53,055
we're working in New
York from Idaho, right?

202
00:08:53,755 --> 00:08:58,685
So value-based care requires
a very aggressive, uh,

203
00:08:59,095 --> 00:09:01,045
innovative behavioral health strategy.

204
00:09:01,145 --> 00:09:02,365
It doesn't mean it's expensive

205
00:09:02,665 --> 00:09:04,685
or that it's heavy, it doesn't mean that,

206
00:09:04,985 --> 00:09:08,845
but virtual allows the
dexterity in a value-based care

207
00:09:08,845 --> 00:09:10,165
arrangement that every payer

208
00:09:10,585 --> 00:09:13,045
and every health system that
carries risk would want.

209
00:09:13,665 --> 00:09:16,325
You can move clinicians
in the click of a button,

210
00:09:16,505 --> 00:09:20,445
if you will, from Idaho
to Montana to Arizona.

211
00:09:21,145 --> 00:09:24,485
And so, uh, I, I am
having a, a large number

212
00:09:24,485 --> 00:09:27,325
of conversations with
people who are, you know,

213
00:09:27,805 --> 00:09:30,005
managing value-based care risk on

214
00:09:30,185 --> 00:09:31,565
how they address behavioral health.

215
00:09:31,945 --> 00:09:34,765
And I really do think
that we'll look back over

216
00:09:35,625 --> 00:09:39,085
the next two years, you know, in 2030,

217
00:09:39,965 --> 00:09:42,965
I believe the stat is that, uh, 70% of all

218
00:09:42,965 --> 00:09:44,125
of us will be in some form

219
00:09:44,125 --> 00:09:46,365
of a VA value-based care
arrangement, you know,

220
00:09:46,365 --> 00:09:50,125
per CMS 70%, huge number.

221
00:09:50,745 --> 00:09:52,405
And virtual has to be part of that.

222
00:09:52,405 --> 00:09:53,965
Otherwise, the economics will never work.

223
00:09:54,185 --> 00:09:55,765
And it is in other modalities,

224
00:09:55,815 --> 00:09:57,125
we're catching up in behavioral health.

225
00:09:58,755 --> 00:09:59,805
- Yeah. Yeah, absolutely.

226
00:09:59,805 --> 00:10:01,485
Thank you so much for
sharing that statistic.

227
00:10:01,505 --> 00:10:04,005
And Andy, before I let you
go, the last thing I wanted

228
00:10:04,005 --> 00:10:07,285
to ask you is, what role do
you think virtual care plays

229
00:10:07,945 --> 00:10:09,725
in the future of behavioral healthcare?

230
00:10:10,985 --> 00:10:13,475
- Yeah, it, you know,
we're learning so much.

231
00:10:13,575 --> 00:10:15,675
You know, you have psychedelics, uh,

232
00:10:15,675 --> 00:10:17,195
you have neuroscience catching up

233
00:10:17,195 --> 00:10:18,355
and starting to participate.

234
00:10:18,375 --> 00:10:20,315
We have AI starting to listen to my voice.

235
00:10:20,975 --> 00:10:23,355
And, you know, none of these
are gonna solve the problem.

236
00:10:23,825 --> 00:10:24,835
None of these are gonna in

237
00:10:24,835 --> 00:10:26,435
individually gonna solve the problem.

238
00:10:27,215 --> 00:10:29,875
But just as research in
behavioral health has been low,

239
00:10:29,875 --> 00:10:32,595
innovation in behavioral health
has been low historically.

240
00:10:33,295 --> 00:10:36,755
And with, uh, a lot of
the reimbursement, um,

241
00:10:37,135 --> 00:10:38,755
levers being pulled by CMS

242
00:10:39,985 --> 00:10:43,085
and the economics we just
discussed around value-based care,

243
00:10:43,625 --> 00:10:46,605
uh, I think that we're gonna
see virtual care become,

244
00:10:47,185 --> 00:10:50,615
you know, kind of the
bedrock of behavioral health.

245
00:10:51,505 --> 00:10:54,365
And it's the one thing that
you can commonly count on,

246
00:10:55,295 --> 00:10:58,715
as opposed to, I'm on
vacation, I'm in New York,

247
00:10:58,775 --> 00:11:00,315
I'm business, I'm in Japan.

248
00:11:00,955 --> 00:11:01,955
I travel all over the world,

249
00:11:02,755 --> 00:11:05,295
and I can always rely on, on

250
00:11:06,135 --> 00:11:08,095
a virtual, uh, experience.

251
00:11:09,765 --> 00:11:13,185
So I, I just feel like, you
know, we're seeing the beginning

252
00:11:13,245 --> 00:11:15,065
of integration, we're talking about it,

253
00:11:16,285 --> 00:11:19,625
and, um, you know, I'm,
I'm just excited to be

254
00:11:20,135 --> 00:11:22,385
somewhere in the periphery, uh,

255
00:11:22,745 --> 00:11:24,345
involved in this evolution
for our industry.

256
00:11:24,975 --> 00:11:25,975
Yeah,

257
00:11:27,355 --> 00:11:28,355
- Absolutely.

258
00:11:28,355 --> 00:11:29,475
Andy, thank you so much for joining me

259
00:11:29,475 --> 00:11:30,675
today for this discussion.

260
00:11:31,025 --> 00:11:32,955
It's been an absolute
pleasure speaking with you.

261
00:11:32,975 --> 00:11:35,795
And I'd also like to thank
our sponsor, Iris Telehealth.

262
00:11:36,175 --> 00:11:37,915
You can tune into more podcasts

263
00:11:37,915 --> 00:11:39,715
and virtual events from
Becker's Healthcare

264
00:11:40,135 --> 00:11:41,595
by visiting becker's hospital

265
00:11:41,595 --> 00:11:43,395
review.com. Thank you again, Andy.

266
00:11:43,805 --> 00:11:44,635
- Thank you, Mariah.