Speaker 0: Hello, everyone. This is Jacob Emerson with the Becker's Behavioral Health Podcast. Thrilled today to be joined by doctor Matthew Hereford, who's the president and CEO of Community Care Behavioral Health Organization and the vice president of behavioral services at UPMC Health Plan, and doctor Michael Lynch, who's the senior medical director of quality and substance use disorder services at UPMC Health Plan. Doctor Hartford, doctor Lynch, thank you so much for taking the time to be with me on the podcast today.

Speaker 1: Great to be with you, Jacob. Yeah. Thank you for having us.

Speaker 0: Absolutely. And before we dive into everything we wanna talk with you both about, can you each tell us a little bit more about yourselves and what it is that you each do today at UPMC? Michael, do you wanna start us off?

Speaker 2: Sure. Happy to. So as you said, I'm a senior medical director for quality and substance use disorder services at UPMC Health Plan. Also, triple board certified in emergency medicine, medical toxicology, and addiction medicine, and practice at multiple hospitals in at UPMC, primarily in Pittsburgh, but we do offer telehealth addiction and toxicology services to all UPMC hospitals throughout Pennsylvania. Also founded and directed a telemedicine bridge clinic, to fill in gaps, with people with substance use disorder, particularly opioid use disorder, maybe experiencing in their care, to ensure that we don't lose them and we can help connect them back to, long term local treatment.

So work in the emergency department, as well as inpatient toxicology services where we manage overdoses, withdrawal, addiction, and a variety of other, poisonings, envenomations, etcetera.

Speaker 0: Thanks, Michael. How about you, Matt?

Speaker 1: Yeah. Again, happy to be with you. My name is Matt Hereford. I'm a board certified psychiatrist, and I am the VP of behavioral health at UPMC insurance services where I provide executive clinical whole strategic oversight across our array of insurance products. UPMC insures over 4,000,000 people nationwide, across Medicare, Medicaid, commercial insurance.

We work closely with Friends at Work partners and employee assistance programs nationally. In addition, I'm also the President and CEO of Community Care Behavioral Health, one of UPMC's Medicaid insurance plans. We cover just over 1,000,000 Pennsylvanians, and cover their Medicaid behavioral health benefits, working with 43 of Pennsylvania's 67 counties.

Speaker 0: Wonderful. Well, Matt, Michael, we really appreciate you both taking the time out of your schedules to talk with us today. Matt, I wanna talk with you first about, some recent news from UPMC Health Plan. You opened a new neighborhood center in Erie, Pennsylvania this past summer, with food, job navigation support that's being provided to that community. So So talk to us a little bit about this.

Explain for our listeners who aren't familiar with what these centers are. What are these services gonna look like on the ground, and, ultimately, what are you hoping to achieve in the long term?

Speaker 1: Well, we're really thrilled, about opening this neighborhood center in the Lower East Side Of Erie. We have opened a neighborhood center in Pittsburgh that has been up and running now for a few years. And this center in Erie is really modeled after that very successful program. And for us, it's really just another piece in a kind of ongoing mosaic of support for the Erie and Northwestern PA community. As you mentioned, this goes well beyond kind of support for traditional health needs and supports folks, whether they're members of our health plan or not, members of the community around, all sorts of health related social needs, like food security, job searching activities, and just navigating health and human services systems in general.

And so while we have a physical location, they are great building where there's meeting spaces and opportunities and places for private consultation, there's so much more going on because of the over 50 partnerships we have with various community based organizations across Erie and Northwestern PA. So whether folks come in looking again for a job, we can help navigate that through our UPMC Pathways to Work Programme, whether they're seeking employment with us at UPMC or elsewhere in the community, or if they're looking for, access to affordable, low cost or free healthy nutritious food, we have a fantastic partnership with the Second Harvest food pantry and created this Second Harvest marketplace where folks can make an appointment and come in and have access to, healthy and fresh produce, meats, dairy items, as well as shelf stable foods, all with the idea that, you know, food really is medicine. And there's so much more, lots of opportunities for individualized understanding of what people and their families might need. And this community center provides a front door, to this community so we can better support them.

Speaker 0: Well, it's great to hear that another community in the state has access to these types of services, Matt. And Michael, anything that you would add on this topic?

Speaker 2: I think Matt covered it really, really well, the the variety and diversity of services. And I think just really emphasizing the point that health and well-being don't only need to be addressed in the doctor's office, in the hospital, or from the payer headquarters. We really I think this just reflects UPMC's commitment to being a part of the communities, where our patients and our members are and our desire to be parts of those communities, be available, be present and partner, not just on traditional medical needs, but on all the other factors that contribute to health, but also to both physical and mental well-being, understanding that all of that is part of our mission. So I think the neighborhood centers really are just a demonstration of that commitment of being physically in the community and not sort of just waiting for people to come to us, but going out to find ways, to help anyone, in these areas to access incredible resources and really cool programs to help with education and not just helping people right now, but really teaching them to fish through training and job acquisition. So, really, really proud of the work that the health plan has done and our partners who oversee those programs.

Speaker 0: Yeah. No. It's really great to hear all about this. And I hear you loud and clear that, a lot of needs can be met outside the four walls of a hospital. But, Michael, if we are sticking to some new recent developments this year, within UPMC Hospitals, We're seeing that you've added behavioral inpatient capacity this year at different facilities, more intensive outpatient programs, behavioral health pods in emergency departments.

So how are you all thinking right now about balancing your investments across inpatient, outpatient, and community based recovery supports? What are some lessons learned this year that the other behavioral health leaders listening in can really take away from, where UPMC is leading?

Speaker 2: I think it's just so important to break down the walls and the barriers. You know, too long physical health and behavioral health, have kind of worked in silos, and a lot of that has been structural, not necessarily by desire. And I think most in both worlds recognize the integration or the need for integration of services that each influences the other. You can't treat behavioral health without managing physical health and vice versa. And so to try to treat them in separate places and treat them separately, you're going to be bound for worse outcomes.

So I think that's really at the foundation. And beyond sort of integrating that care and trying to partner with physical health and behavioral health providers and payers and resources, I think another driving force for us is continuity.

Speaker 0: We really want to think

Speaker 2: about those connections of care. We really want to think about those connections of care. I think for too long, we have looked at the structure of healthcare and looked at nodes, stopping points, whether it be the hospital or ED or the outpatient office or the therapist's office or social services provider and those kinds of things. Instead of thinking them as we should, as sort of a web or a net that's connected, where each one should kind of have an easy and obvious pathway to the other and back and forth, both through communication for us, but also navigation for the patients. You know, because for most just laypeople, navigating the system is incredibly challenging.

It's confusing. It's complicated. Who needs what? Where do you need to be? What paperwork needs to be signed?

All of those kinds of things are all opportunities to lose somebody to the care that we know they need. And the better we can connect those things, and start the process in one place, and then hand it off to the next place, all with the patient at the center of that journey. And so it's you know, the pathway is easy for them. Those are all things that are going to help us get people the care that they need and long term, hopefully prevent them from needing those more acute or urgent care kinds of services that we see at the hospital. So while a lot of the investment occurs at the hospital, the fundamental goal is actually to reduce the need of hospital and emergency care because we've connected people to those community, both healthcare, behavioral health, and social service resources that they need.

So, I think still a lot of work to do. It's a complicated space. But, you know, the first step in doing it is to do it, is to prioritize it and make sure that we demonstrate through our actions and through our behaviors that that is what we think is important. And so I think that's really fundamental and at the heart of that work.

Speaker 0: Absolutely. No. It's a great call to action for everyone listening in. And, Matt, I would extend the same question to you in terms of for our leaders, hearing from from you both right now. And when you're thinking about some of the investments I mentioned that the system has made in this space over the last year or so, what would you say in terms of lessons learned?

Speaker 1: Well, Mike absolutely nailed the answer, I think, and and and right to the heart of the matter, which is not only you have to think about this in terms of a continuum of care, but actually think about it as a web of support or a safety net. And, that net is only as strong as its weakest portion. And so the when we think about the investments and what lessons learned that we can take away from working in particularly high needs communities, it's to constantly remind ourselves of that fact. And so to think about a concrete example here, if I'm somebody with a serious mental illness, I know that I can go into UPMC's, Western Psychiatric Hospital and get world class inpatient care for my schizophrenia or bipolar disorder or or other diagnoses. But if I'm discharged to a community where I don't have access to, you know, food or I have to make a decision between spending money on transportation to get to my follow-up appointment or my medicines or my food, then those choices put people in impossible situations.

And so when we think about these investments, we have to take the blinders off and recognize that we cannot look at this in silos, and that the partnerships that are so important and pivotal in people's daily lives, round out and complete that safety net of support. And that's why things like the neighborhood center in Erie are these partnerships, with food pantries, transportation providers, legal aid, and other community based organizations are so essential because everything falls apart when people don't have that full safety net and the set of supports available to them. And so the important thing is that we don't stop our investments at the four walls of our hospitals, our clinics, or our emergency departments. And we recognize that the vast majority of time that our members and our patients are spending are outside of our campuses. They're in their homes, they're in their churches, at their workplaces, in their communities.

And that's where we need to be partnering and supporting. So that that has been a major focus of UPMC for some years, and I think it will only increase relevance and importance in the years ahead.

Speaker 0: Certainly. And so these these services, they're they're so important to continue to invest in, and it sounds like UPMC is really committed there, looking forward. In terms of where both of you sit, you know, you're really leading efforts at the intersection of emergency care, toxicology, behavioral managed care as as an insurer. So what do you both think right now are some of the most scalable strategies for continuing to, see more investment in across the populations that you serve? Matt, do you wanna go start us off there?

Speaker 1: Yeah. Happy to. You know, I think it comes down to, in in my mind, a single word, and that's network. And that's in both senses or multiple senses of that word. We have just talked about the importance of having a network of partnerships out in the community to help close those practical, logistical gaps for individuals like, you know, trans getting to care, transportation, child care, mobility, etcetera.

But, you know, there's also an opportunity through, tele and digital networks and growing out the offerings that we can do virtually to help people also close those gaps to, access to care, whether, again, that's because they have personal mobility issues or because they simply, they're a single parent and they can't take the, the risk of, having their child not in a safe place while they go take care of their own health. The ability for us to use virtual Intelli options, has greatly expanded our ability to meet people where they are. And so when we think about what what can we truly scale and in some environments, we're gonna have to continue to do more, with with less, then we have to look to these scalable solutions. And so in my mind, it really does come down to, leveraging technology and leveraging partnerships with those community based organizations, other providers, payers, policymakers, human service organizations to think about where, can we help support their efforts, where can they support ours, all with this idea of keeping the person at the center of what we do.

Speaker 0: And and, Michael, let you weigh in on what you think are the most scalable strategies right now in this space, but also how you're thinking about measuring the business impact and and the clinical impact, in ways that resonates with your other payer partners, with your state partners. How are you thinking about that?

Speaker 2: Absolutely. And and it the measurement is so critical. It it's can be challenging, but it's necessary. And I fully I think you can maybe not surprise that Matt and I frequently agree with each other. But I absolutely agree.

I think from a scalable perspective, you know, digital and that can mean things like EHR integration, information, kind of communication, and being at at our fingertips so we can get more rapid, integration of community based information, whether it be drug availability, what's happening, you know, local pressures, things like that that can be integrated, the digital space in the EHR so that, you know, we spend less time, looking for information, but just having it there and coming to us, I think that's going to be really important, even to the degree of artificial intelligence being able to take over not a lot of the care duties, but some of the tasks, the administrative burdens, I think, you know, that allow us to spend more time with people. So people are taking care of people and the things that are tasks can get handled in the background. I think those are all opportunities. And from a telehealth perspective, and I will, use that as an example to answer your question regarding measurement. In my own personal experience, you know, running a telehealth bridge clinic, we've seen, continuous growth.

We operate throughout all of Pennsylvania. We've managed more than 16,000 encounters across 66 of the 67 counties in Pennsylvania. And, you know, so that's rural, that's urban, that's suburban. And I think really that supply demand mismatch, you know, is really scalable, not just in behavioral health and substance use, but in medicine in general, where maybe you have a concentration of certain types of providers in one area, but not so many in another area, but there are people there who need those services. How do we make those connections, whether through econsulting or professional consultations, direct telemedicine?

I think there's all sorts of, possibilities there to scale and meet those needs. With capacity that exists in the system, it just doesn't always exist where the needs are. And so I think that is, really an exciting opportunity. But to your point, we need to make sure that when we're doing that, we don't just do it because we think it's a good idea, but that we're able to show that not only is it feasible and is the quality of care sufficient, and appropriate to meet people's needs, but is it making sense, from a business perspective? Because in the end, to support those, particularly to get those things started and expanded and scaled, it takes some degree of upfront investment, to stand it up.

And so part of what we've done through our telemedicine bridge clinic is we have done that with not only UPMC health plan data analytics, we've worked with the, with the Pennsylvania Department of Human Services and Medicaid Review Committee to do analyses where we look at what the utilization is, what are the quality outcomes we care about? So are people getting on medication? Are they following up with outpatient treatment providers? Are we reducing the amount of unplanned care utilization and total cost of care and those types of things? Are we engaging them in other preventive treatments, that we want to see?

And so those are some of the analyses we've actually done and published, and we have been able to show that. And just to take that one step further, I've been able to use those analyses and those data to go back to payers and other stakeholders to demonstrate and say, this is what we're doing. This is what the potential value is. And actually get additional buy in, of resources and investment to continue and increase that work. And so I think that's always going to have to be the way that it works.

I think of it as like a ratchet, you know, where you start to do something and then you need to scale it, so you have to show some outcomes. You do that. You get some more investment. You scale it further. You get, a more robust set of outcomes and so on and so forth.

And that's what we really need to do to ensure that we're not implementing lots of digital or application based or telehealth programs that aren't good quality, but are offering the services people need where they need them, and the outcomes are what we want them to be from a quality and a cost efficiency perspective. And so that is really important. It is hard work and there is cost itself in the evaluation. But I think in the long run, it becomes well worth it.

Speaker 0: Yeah. No, it seems like such a fine balance between making those investments that you both mentioned, growing those physical and and virtual networks, but then also bringing it back to the sustainable business piece and and meeting those measures you've set internally and with your external partners. Gentlemen, before we go, I I do wanna mention, of course, I I'm sure most of our listeners are aware that September is National Recovery Month, which really observes, the gains that individuals like you all over the country have made in terms of, making progress in mental health and substance use recovery efforts. So, as as your final, thoughts or final piece of advice you wanna offer to the audience, can you each take a minute within the context of a national recovery month and and share for us, anything else we might have missed today? Matt, you wanna start us off?

Speaker 1: Sure. Well, obviously, at UPMC, we're all about recovery twelve months out of the year. But the fact that as a nation, we take September to shine a special light on on recovery, whether that's from substance use disorders, or other mental health conditions, I do think it has tremendous value to raise people's awareness around the importance of recovery and behavioral health, generally speaking, as well as reducing the stigma associated with these conditions and seeking help for them. So I wanna thank Becker's for trying helping to shine a light on recovery month, this year. And it's so important, I think.

We've coming out of the COVID pandemic, we have certainly seen a dramatic increase in the demand for behavioral health services. I do think a lot of that has to do with the kind of education and public awareness that increased during COVID and it's a positive sign that people are more willing to ask questions about and check-in with themselves and loved ones about their health and overall wellness, including behavioral health. So as we go into, you know, National Recovery Month, certainly UPMC is going to continue to provide support and offerings. We've got trainings, for example, that are available, free and open to the public, whether you're a UPMC provider member or not. You can, for example, go to Community Care Behavioral Health's website, ccbh.com, and there's information on, seven training sessions throughout the month of September, all about substance use disorder recovery, and how to support individuals on that journey.

I know that Doctor. Lynch has been doing trainings in this area as well around empowering providers on substance use disorders. It's just one of the ways at UPMC that we wanna continue to support, the provider community. And as, mister Rogers said, it's helping the helpers.

Speaker 0: And great. Last message and sentence for me there, Matt. I really love that. Michael, anything else you'd like to add?

Speaker 2: Yeah. I just wanna echo the appreciation for the discussion and shining a light. You know, a major barrier and challenge, in this space is stigma, you know, both real and perceived, conscious and unconscious. I think it it limits the the work that could otherwise be done because people are concerned about how others are gonna feel about them when they seek help. When people seek help, they sometimes encounter negative, you know, circumstances.

And so the more we can talk about it and just recognize, that these issues are out there, they're common, they're a disease, they're not a moral failing or a choice and those kinds of things, you know, it seems like an obvious thing to say, but I think it bears repeating, because we the more we focus on it and then think about what are the real solutions, what are the available therapies that work, what is the evidence, just like we would if we were talking about diabetes or hypertension or coronary artery disease. I think that really just helps to put it in the framework, of other, you know, kind of processes and, and procedures that we use in, health care all the time. And finally, with that, I think the other part, and I like to emphasize this particularly during recovery month, because recovery month is really about the hope and the promise that recovery is there, recovery is possible. It doesn't just happen. It has to be worked at, but it is absolutely possible.

And another quote that I love as well from Joel Barker, we're thinking about hope and vision and looking at what our plans are is vision without action. Is merely a dream. Action without vision just passes the time, but vision with action can change the world. And I think that's what we need to do is have our mission, have our vision, focused on recovery, on saving lives. And if we act and work on that, then we can change the world, and that's our goal every day.

Speaker 0: Wonderful. Well, doctor Lynch, doctor Hereford, I wanna thank you both for taking the time to sit down with us and for sharing about the work that's going on under both of your leadership at UPMC. We really appreciate it. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckers hospital review dot com.