Hi, everyone. This is Lucas Voss with Becker's
HealthCare. Thanks so much for tuning in to
the Becker's HealthCare podcast series, Happy New Year.
And today, we're joined by doctor Katharine Hopps,
CEO of AuthorHealth,
to discuss the evolving dynamics of payer provider
collaboration
in health care. Doctor Hobbs, thanks so much
for being here today. It's great to have
you.
Great. I'm I'm excited to be here and
appreciate this opportunity to to talk further. Yeah.
Absolutely. We have we have a lot to
talk about, like you've mentioned, but I wanna
give folks an idea of of who you
are. Could you introduce yourself and just give
us a little bit of your background in
health care?
Sure.
I'm an adult and child psychiatrist, and I've
worked in basically every setting from inpatient to
outpatient emergency department, built several integrated behavioral health
and primary care programs.
For about the last 15 years, I've worked
in health insurance,
And so doing core insurance functions, so behavioral
health network,
case management.
But also always focused on,
bringing high quality evidence based treatment,
to people. So doing that through innovative care
delivery models,
and also by measuring quality and outcomes and
really pushing the system to,
to where we deliver,
value based payment models as well.
I joined author health about two and a
half years ago.
We focus on,
treating serious mental illness, substance use disorders, and
dementia,
in mainly a Medicare advantage and special needs
plans populations.
We deliver health care services,
and also wraparound services that are community based,
and we participate in these value based contracts
as well.
And that's certainly I think that's a a
a great pivot too because you have both
perspectives, which is fantastic, both the insurance side
and the provider side itself.
And we know that payment models are very
quickly evolving. There's new care delivery strategies coming.
Payor provider collaboration
is is is really key. They need to
work together. It needs to happen it needs
to happen together.
To get us started here, what opportunities
do you see for greater collaboration
as we had into the New Year and
certainly beyond that as well? And and how
will this impact patient outcomes and costs?
Yeah. So especially in in behavioral health, we
are seeing much greater progress on quality and
outcome measurement and also,
transition to value based payment models. And so
we expect for that, trend to continue.
Core to that is the importance of of
integration
and and data sharing. So there are certain
sort of information about patients,
that only health plans have. So things like
historical health care utilization,
information about benefits or
caregivers, etcetera,
that are actionable
and really important for a provider to be
able to deliver high quality care,
in the community. And so being able to
deliver those actionable insights using data to providers
from from from payers
is a critical
capability. Additionally, for providers. So,
in order to participate in value based payment
models, we need to be able to report
our outcomes. And there's certain data that only
we have access to that the payers,
don't, and that we need to be able
to aggregate and be able to send back.
So things like person reported health outcome measures.
These in these are one of
the main ways that we measure outcomes in
behavioral health are things like the PHQ 9
or GAD 7. These are basically symptom rating
scales, that we use, to collect data on
basically the baseline
symptom burden, but also improvement in those symptoms
over time.
Especially as many behavioral health providers are still
on pen and paper, don't actually have robust
electronic health record systems. It's really hard to
collect
those outcomes and report them to participate in
value based contracting. And so that support around
data collection and also data aggregation for your
patient population,
and then a scalable
and,
systematic way to be able to send those
outcomes back to payers to participate in a
value based, payment model is critical,
in order to do this work well.
This case, sharing is really caring.
Correct. Well, you have to be able to
measure the outcomes. Right? And then once you
actually do that, you need to be able
to report it and share that information exactly
to show that you're actually improving health as
you deliver care for for patients. Yeah.
And you've touched on on a couple of
these factors too that that play into this.
Right? Patient population, different networks. It's very variable.
There's
people measure quality in different ways. That's right.
Can you share a little bit some of
the examples that you might have of how
you're innovating in this space, how you're trying
to improve this, and and what are some
of the results that you're seeing?
Yeah. So so there's 2 major ways that
that we're innovating. So one,
is addressing
many of the barriers to delivering
a high quality,
behavioral health care to people. And so what
I mean by that is, I say this
all the time. I at at Alder Health,
we're not inventing a new treatment for serious
mental illness, substance use disorders. In our field,
we have treatments that work. I can't give
you a better treatment than than buprenorphine
to treat opioid use disorder. Cognitive behavioral therapy
to treat depression, anxiety, tons of evidence that
these are effective treatments to improve health and
keep people in the community,
and and reduce costs.
The problem is that these effective treatments don't
reach people in a timely manner. And so
what I mean by that, when when people
need them, they're not able to access these
services.
Many people wait months, even years to actually
access, evidence based care.
And it's also not delivered in a convenient
manner. So good example is,
in person therapy. A lot of times that's
only offered during working hours. Well, that doesn't
work for an hourly worker. Right? A person
receiving sort of hourly wages. Right? They'd have
to get off work every week, go to
a therapist.
And and it's not possible to to do
that. And so
using technology,
using innovative ways that we've developed our care
team,
addressing social social issues, so things like transportation,
housing, etcetera.
These are all of the barriers that that
people experience to be able to engage in
high value care
that our company is is is working to
address,
so that we can actually get these these
evidence based treatments to people in a convenient
and a in a scalable manner.
The other thing that we're doing is is
changing payment. So I've also said many times
that fee for service payment breaks behavioral healthcare
really breaks all of healthcare, but certainly behavioral
healthcare. And the reason for that is that
some of the most impactful things we do
are are are not
based on a billable visit with a clinician.
So all those things that we do in
between those clinic visits. So
addressing again health related social needs, calling the
patient to check on, you know, side effects
of a medication,
working with caregivers, doing care coordination with other
providers. A lot of those types of interventions
are not funded in fee for service and
therefore are hard to scale.
And so one of the major ways that
we're working with payers and insurance companies
is to move towards more of a population
based approach. And so we, we work with
payers to identify
a patient population with serious mental illness, substance
use disorder in the geographies where we're live.
We receive
prospective payments to manage
the health and the social needs
of this patient population. And then we go
at up and downside risk
and have to report on quality
to show that we're actually helping this patient
population get better, and that we're managing the
costs through the clinical treatment and the social
services that our that our company provides. And
that is a very different I I know
that this is, sort of,
old hat, and the rest of health care
is very new,
in behavioral health. And and
and I'm so grateful to
payers,
providers
that are really coming together and thinking
on how how we build these models and
how we actually deploy them and and and
deliver them at scale. Because I really think
that's a key piece to transforming overall,
health care for people with behavioral health conditions.
Yeah. And that in conjunction, as you mentioned,
sort of with that holistic look at care
and being able to integrate everything into each
other so that there's a a picture that
is created that encompasses
everything, not just pieces here and there that
that are important. And and I think especially
for for value based models and and value
based care, this
is incredibly important. And and one of the
things that you've you've noted at at our
payer issues roundtable and almost quoting you exactly
here. Right? Untapped potential
in value based payment models. That's really what
you're seeing. You're seeing untapped potential there,
and the importance of, as you've said, fully
integrating mental health services like you've talked about.
How can organizations
successfully transition to value based models and and
really meet these standards, these aims that that,
would make a difference potentially,
and what strategies would you highlight there?
Yeah. So number 1 is is integrating payment.
And so what I mean by that is
currently today and and over the last several
decades,
in general,
payment and management of physical health services is
done separately from behavioral health services. So a
lot of times the behavioral health payment and
management is carved out to a separate organization
that manages it, you know, apart from physical
health. What we know is that people with
behavioral health conditions and especially people with more
severe and complex illness, almost all of them
have co occurring physical health,
chronic medical conditions. So things like diabetes, cardiovascular
disease, COPD.
And when you separate out the payment and
the management of their behavioral health conditions separate
from their physical health, it leads to misaligned
incentives. And it also
leads to substantial
lack of coordination
in the in the care that that's being
provided.
And so number 1 is to
stop creating that division and figure out how
to integrate. And to be clear, behavioral health
card companies
absolutely
can integrate payment. And so we did that
at Blue Cross, North Carolina, where I worked
before at United and Optum.
So even at places where you have carve
outs, you can still work with providers to,
pay them,
from sort of like a single source for
their for for delivery of integrated behavioral health
and and physical health services. And also hold
them accountable for,
integrated quality measures. So hold behavioral health providers
accountable for diabetes management,
and other medical conditions. And similarly, hold PCPs
and hospital systems accountable for screening and treatment
of depression. That's totally appropriate for them to
be doing. And then similarly hold each group
accountable for total,
costs
and and MLR.
And so examples where we've done that really
well was this was more when I was
on the payer side.
We work we had robust
ACO contracts where,
we made sure that the ACO that that
the behavioral health payment was also included in
the delegated risk to these ACOs.
And then additionally, like I said, we put
in,
behavioral health quality measures to incentivize them to
address things like depression. So screen for depression,
treat treat depression, and then also held them
accountable for the for the total cost of
care, including the behavioral health spend as well.
Similarly, author and other providers like us,
we we partner really closely with primary care
groups. Many providers like us also deliver what
we call reverse integration.
So primary care services delivered from a behavioral
health home. Very similarly,
you know, insurance companies can pay those behavioral
health providers for both the physical and the
behavioral health services, and then hold them accountable
for the physical health quality measures and the
total cost of care. But it really, though,
starts with integrating the payment and the management
with which then flows downstream
to how providers are incentivized to deliver that
care and and really,
treat patients holistically and and and and improve,
population health, across the full spectrum of physical
and behavioral health care.
Certainly, the integration that you've mentioned is is
is a big piece to this, like you
said. You you've mentioned accountability
quite a bit in this. Right? And and
and I feel like to be accountable,
you have to have something to go back
on. You have to have data. You have
to have information that you can use. You
have to have some sort of system that
that gives you an idea, okay, where is
my accountability at? And and one of the
things that you've talked about, previously at our
page, Shus Ron Teo, which I think is
is very important, is the and and our
conversation today is the challenge that a lot
of these folks, like you said, pen and
paper. Right? Yeah. EHR capabilities just aren't there.
There is a system, but it might not
be great. Right?
It just makes it hard. It makes it
incredibly hard to collect data, measure outcomes, what's
the quality, where's the accountability. Right? Can you
touch a little bit on how you support
these providers in in creating that efficiency and
being able to say, okay. We can help
you, especially from from a from from a
data collection perspective and and also from a
systems perspective.
Sure. Yeah. And and the fact is, you
know, many behavioral providers were were left out
of meaningful use support and the high-tech act.
And so
we
need to find a way to go back
and increase that support for behavioral health providers
to move from
pen and paper, more analog approaches to to
data informed and tech tech enabled approaches.
And we'll see that transition very similarly to
how we saw the transition over the last
several decades with that support in the rest
of health care
At different payers where I've worked, we have
delivered, like, direct support for that kind for
for technology. So we've,
you know, worked with different technology companies that
are, measuring and reporting outcomes. We provided funding,
to support providers to actually, move to
EHRs and other electronic support. It's critical. It's
a, it's a, it's a core foundational
capability that's required to participate in value based
arrangements. And so if we really want to
move the behavioral health system to a value
based approach, we have to figure out how
to support providers to make that transition,
to use more technology.
Yeah. It has been a must for for
many, many years, and it certainly will remain
a must in 2025
and beyond, I think.
Looking ahead to to this year certainly and
then and then beyond as well, what are
some of the most significant changes in in
how payers and providers
work together? What are you seeing, ahead here
for the future? And and how should
systems how should leaders
prepare now, today? Yeah. You know, one thing
that's been delightful,
over the last 1 to 2 years at
various conferences and also as as our company
is working with with insurance companies,
there's an acceptance that we have to measure
quality. We have to report quality.
And there's,
there's real progress being made on delivering and
participating in in value based payment models. We
did not see that even 2 3 years
ago. So there's been major progress made made
in that way. So and I expect that
to continue.
The other is technology. So we had a
huge and rapid and important transition to telehealth
and tech enabled
services during covet that was necessary.
And while we've had, you know, some movement
back to in person services, we are still,
you know, light years beyond, where we were
pre COVID in terms of the integration of
technology, and I expect that to continue. It's
it's made a substantial difference in terms of
access to care, really overcoming a lot of
the barriers that I talked about earlier in
terms of convenience for people. It's overcoming transportation
issues, things like that, so that we can
actually deliver this high quality
evidence based care with fidelity. That's the other
really important with fidelity to the to the
evidence based model. Through technology, we're able to
get those services to people,
in a more sustainable and efficient manner.
And addressing one of the most important issues
in health care across the country, I think,
for the future. I believe that what not
only within health care, but also for our
society. And you see it Yes. It's through
everything, through employment, through
education,
in our in our justice system. You know,
behavioral health has has major impacts on all
aspects of our society.
And so we have to figure out a
way to pull these pieces together
and also overcome, you know, limited workforce and
and and figure out how to deliver these
services at scale so that so that people
can actually engage in them and and and
reach a quality of life and a function
that's meaningful for them.
Absolutely. Doctor Hobbs, this was a delightful conversation.
Thanks so much for taking the time today.
Great great insights. Thank you.
Yeah. Great to talk with you, and thank
you so much for the opportunity to speak
together. Absolute absolutely. And we also want to
thank our podcast sponsor, Author Health, and you
can tune in to more podcasts from Becker's
Health Care by visiting our podcast page at
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