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This is Hailey Recker with the Becker's Payer
Podcast, and we are recording live at the
Becker's third annual spring payer issues roundtable.
Today, I am joined by doctor Doug Henry,
enterprise medical director of behavioral health at Highmark
Health.
Doug, thank you so much for joining us
today. Can you go ahead and introduce yourself
and tell us a little bit about your
background and organization?
Sure, Haley, and thanks for having me. Of
course.
My background is as a clinical psychologist,
trained and educated,
and
began,
my career in Southern California doing a lot
of work in schools. I was a public
high school counselor, and I worked at a
shelter for runaway adolescents
and,
did inpatient unit work, detox work, locked,
hospital based work, and,
then got into
the
public apparatus
and, spent many years working in a Medicaid
clinic,
in Southern Cal, and that was really a
very formative,
experience for me. And I say that because
my experience of all of my years out
there, we're seeing
many, many patients. And on a good day,
a psychologist sees about eight patients.
And,
again, on a good day,
you're able to help, you know, five or
six of those eight in a substantive
way. And as I was,
reading the data
coming in about how ill The United States
was becoming from a mental health perspective,
even though I absolutely
adored the psychotherapy and testing work that I
was doing and diagnostic work that I was
doing,
it felt like it wasn't enough, like I
had to make a bigger impact. And so
I got into administration
and began,
laying out, mental health systems
for cities,
and then for counties in California,
and then,
moved back to the East,
in 2007
and worked as clinical administrator for psychiatry for
University of Pittsburgh Medical Center for many years,
and more recently,
Allegheny Health Network,
which is a wholly owned subsidiary of Highmark
Health,
since 2017.
And I I just one last
comment about that history. I was attracted to
Highmark Health because of their focus on behavioral
health, because of their commitment
to making it an equal equal pillar
of attention and investment
with physical health. Well, it seems like you've
been in the industry for quite a while
now.
Thank you so much for letting out your
experience with us.
Now to begin our conversation, I'd like to
talk about balancing affordability
and quality first. So how is your organization
innovating to manage the cost of care while
maintaining or improving member outcomes?
What a great question.
And,
these,
are not only not mutually
exclusive motives. They actually go hand in hand
even though people often think
that they're at odds.
And one of the things that I tell
my team members is
show me a substantial
quality improvement, something that is a new service
delivery model, a new therapeutic technique,
a new aspect of evolving techno technology,
neuromodulation,
whatever it may be. If it really makes
a difference in favor of quality,
I will be able to create a business
plan that shows that it is economical and
it that it makes money or loses less
money or avoids cost.
So that's true in about ninety nine percent
of cases. There are always cases
like the case of orphan drugs where you
have a very small and, you know, maybe
a hundred people on planet Earth might have,
a rare
disease, and it costs millions of dollars to
develop the therapy for that disease. Now those
are instances
where the economics don't work,
but they are rare and very special. In
those instances, you need other forces, usually the
the government, to step in and support the
development of those medicines,
to so that they can have maximum
access.
But for all intents and purposes, a quality
advance
is
not more costly,
but less costly
in the long run. And so one example
of what we do, how we approach that
at Highmark
is we spent two years looking for a,
telepsychiatric
and a teletherapeutic
partner, for behavioral health. And we interviewed more
than 200 companies.
And so it was a a very thorough
process with a very,
detailed rubric.
And,
at the end of that process, we chose
Spring Health.
And we really chose Spring Health,
on the basis of, two things, their clinical
quality
and their willingness
to share data on a very frequent basis
demonstrative
of the progress that our members were making
under their care.
Those two things combined and and it turned
out
spring was actually one of the more expensive,
of the 200. If you know, to be
honest, I think they were the second most
expensive.
So the point that I'm trying to make
is that
our attitude in behavioral health at Highmark is
to go for quality because we know
that that is going to drive down costs.
The only thing that is more expensive than
a lack of access to behavioral health services
is are ineffective
behavioral health services. And that's that's the the
thing that you want to avoid.
You know, I'd like to go a little
bit deeper into that on the basis of,
you know, member satisfaction.
So what experience or engagement strategies
have proven effective for your organization, and how
are you measuring that success?
So, when we talk about access to behavioral
health services and and and most everyone knows
in The United States that access has been
an incredible problem since long before the pandemic.
But during the pandemic, it just became so
acute that everyone took notice,
but we really have been challenged for some
time.
And,
when you look at opening access, it is
not just access. It is access
to what and for whom.
So do you have services
for,
the single mom who has a two year
old just came home from visiting the pediatrician,
and was encouraged to get an evaluation for
suspected autism.
You know, do do you have a service
for that mom to get that evaluation
in less than six months?
Well, in most cases, the answer is no.
So you have to,
you have to provide the right kind of
access to a broad array of services
of the intensity that is appropriate
to what the member wants and to the,
member's clinical
situation.
So some examples,
of
actually, my favorite data point of all,
that I've seen over the past couple of
years at Highmark Health
is that
eighty percent of our members
who have at this point completed about a
140,000
clinical visits with Spring Health over the past
fourteen months,
but many more visits to self guided
meditations,
self guided CBT,
and behavioral health coaching. But a but a
140,
clinical,
encounters or visits
is
that eighty percent
of those
were taken by first time mental health users.
And what that tells me is that
we have lowered the friction
that people experience
when they're trying to access mental health services
to a degree
that has enabled
eighty percent first time users. Meaning, this is
a group that most of which has tried
for to get behavioral health appointments before
and has become frustrated
and failed.
But with that ratio,
really,
we're we're accomplishing our mission
to bring real access to behavioral health services
to the people that want and need it.
I'll give another,
a a quick data point
that, with,
our partner, Spring Health, we have,
a 65,
35%
split
of women to men. And and men
being as we are, we are a little
bit reluctant often to seek mental health services
more so than women, and that ratio is,
across United States is very consistently
three to one. So, you have 75%,
usually are women. And so we have 65%,
and that's that's nice. But once they enroll
in Spring Health,
the actual utilization
and consumption
of psychotherapy
and psychiatric
services
is equivalent
among men and women. And so really, really
proud about that. I'll also add that ninety
six percent
of
our members,
that are paired
with an initial
therapist by Spring Health, and they have a
very good pairing algorithm.
Six months later, they're still seeing that individual
therapist. So we're getting it right. The matching
algorithm
is working extremely well,
and patients, tend to be, satisfied to an
incredibly high degree,
with their first provider. And and I'm sure
we'll talk about that a little bit more
in other questions, but the the matching, making
sure that there's a right fit
between patient and the psychotherapist
and the psychiatrist is enormously important
and very much impacts the outcome, whether someone
is able to get well or not.
That's amazing. Thank you so much for laying
that out for all of us.
Now looking ahead to the future of the
payer space, what do you see
as the biggest opportunity for payers to lead
the charge in transforming care delivery and driving
better outcomes for all stakeholders?
Oh my goodness. Okay. Great question.
There are many opportunities in behavioral health. It's
a mistake to think. And I've heard executives
say in the past,
you know, we'd love to invest. There's just
no money in behavioral health.
And I know what they mean. They're you're
not gonna make a positive margin like,
medical systems often do and oncology
care or orthopedic care or neurological care,
but it's the cost avoidance.
It's the fact
that investing in mental health is one of
the most inexpensive
levers
that a provider system or a payer system
can pull to reduce
total cost of care. In other words, the
benefits
of mental health as opposed to mental illness
are manifest
in lower health care costs, lower disease burden
across the board.
So
to
act on that fact and that awareness,
What I'm really focused on are shared risk
models, the use of shared risk models
to
revolutionize
clinician behavior in favor of the patient
and in favor of the patient's health and
maintenance of health. And what this means is
changing
reactivity
where someone decompensates and hits the emergency department
in a in a difficult situation. Maybe they're
admitted. Maybe they're
arranged for ambulatory partial hospital care,
or or whatever it may be. But things
have gotten really bad to drive someone to
the emergency department for a psychiatric problem,
and we could be intervening
long before that and keeping people healthy
if the financial incentives
are aligned properly
in the patient's favor. And they have not
been, quite frankly. They've been in favor of
other interests. Sometimes they're in favor of the
payer. Sometimes they're in favor of the partner.
But they are not well aligned to the
interests of health, community health, and individuals.
And so a shared risk model really changes
that, and it is,
it gives the the sort of the power
and the impact
to really change providers' behavior very, very quickly.
Providers want to do the right thing to
keep their patients healthy. Right now, they,
have not
been allowed to, basically, because you're not generating
the same amount of revenue in a fee
for service system. So going to value based
care and shared risk models where
medical care becomes and when I say medical
care, I mean psychiatric care too, becomes proactive.
That's what where we need to go.
Well, doctor, thank you so much for joining
me today. Again, this is Haley Recker with
the Becker's Payer Podcast
recorded live at the Becker's third annual spring
payer issues roundtable.
Thank you so much. Haley, this was fun.
Thank you.