Hi, everyone. This is Lucas Voss with Becker's
Healthcare. Thanks so much for tuning in to
the Becker's Healthcare podcast series. It's great to
have you. I'm excited to welcome doctor Fasseltide
back to the podcast. It's great to have
him. He's a board certified psychiatrist and founder
of Psych Plus. He completed a psychiatry training
at the University of Iowa where he served
as president of the graduate medical education program
overseeing more than 800
residents and fellows. During his residency,
he began developing an EHR specifically designed for
mental health, and today, he leads Psyc plus
strategy
to scale across all 50 states through a
vertically integrated care model. His work also centers
on advancing value based care and population health
by leveraging data technology
and clinical infrastructure to improve patient outcomes, enhance
care quality,
and reduce total costs across diverse populations.
Doctor Tai, welcome back to the podcast. So
great to have you.
Good to have you as well.
Lucas,
excited to be here. Yeah. We have a
a lot to talk about again. I always
feel like we do, when we have you
on.
Unfortunately, we're still in a spot where we
have to talk about behavioral health as one
of the fastest growing cost drivers for health
plans. That's likely not going away, unfortunately, in
the near future.
Network adequacy and psychiatry
remains a major challenge.
Still,
from your perspective,
what's
still driving that gap between demand and access?
And, again, what does that scalable value based
solution look like from where you're at from
plants trying to improve outcomes while also managing
that total cost of care?
So this is
an interesting
question
and I think a fallacy in this space.
I'll give you a personal story. There was
a health plan that
we were in network with
in Texas,
and they were
also they had lives in Florida and Nevada.
And I knew the health plan president personally,
and we found out that they didn't put
us in network in Nevada and Florida.
So I was planning to go out to
Nevada where their headquartered office is anyways for
some other work. So I ended up grabbing
lunch with him and his team,
and he was very surprised. He didn't understand
why we were not allowed in network.
And so we met with the with the
VP of contracting,
and she said, well, we have so many
providers
that we didn't think we needed any more
providers. Well, anyways, obviously, I knew him, so
we got over the hump. But the more
questions I asked,
I asked them a simple question. I said,
if you guys have so many providers, then
why does the CMO keep reaching out to
me to get their patients into the to
see a psychiatrist or a therapist?
Well, the contracting people had no
idea why they're still needing to call me.
And and the problem is because what you
get in health plans is you have tons
of solo providers in this space. Right? And
the interesting thing about psychiatry is it's not
like other medical specialties.
You don't need a lot of infrastructure.
You can put a shingle
in a house, and that can be your
office. And so you have armies of therapists
and psychiatrists that are out there that are
trying to provide this care,
but they can't get to the patient. And
that's the problem. Right? And so
it's fragmented.
It's in a disarray.
It's like saying
that we don't have enough drivers to drive
Uber
prior to Uber coming out. Well, obviously, we
don't
because there's no technology connecting them. Right? And
then after Uber comes out,
you could have a guy living down the
street from your house now taking you to
the airport that you didn't even know existed.
Right? And so what the technology did for
that space was it reduced the traction between
a driver and a customer
so that
the the customer can access that driver rapidly.
Right? You're you weren't gonna go walk down
the street and knock onto a random guy's
house to take you to the airport. That
would be bizarre, but the technology fundamentally allowed
you to do so.
And I think what's
the problem in the psychiatry space and the
mental health space is, yes, we can have
more providers,
but I don't think the problem is that
we don't have enough providers. The fundamental problem,
in my opinion,
is that they're not
on
a singular or similar platforms.
They're out on their little islands, and there's
no true way for patients to actually connect
to that care,
go from one level of care to the
next level of care, even if you are
able to find a psychiatrist. Okay. You need
group therapy.
You need
exposure response therapy. Maybe you need to go
inpatient to a detox program.
There's no connection. You can't actually
the psychiatrist is gonna tell you to go
Google this stuff or maybe they're gonna refer
you to another program, but there's no actual
handoff. And so there's a lot of drop
balls. There's a lot of bad outcomes.
And a lot of it stems from
fragmented
provider base that exist in this
ecosystem.
And, really, what we are trying to change
is trying to bring them onto a singular
or similar platforms
where it really becomes like an Uber for
mental health where providers can coexist with patients
and patients can get active care, but that's
not it. When in fact the patient needs
to get referred to a different service
that the technology
and the platform can actually facilitate and own
that delivery of care and bring you to
a different provider, whichever you need at that
moment in time.
So all of these examples that you just
mentioned are are very telling because they apply,
again, from a consumer perspective to
how does all of this then we talk
about access. We talk about coordinating all of
this as you've just mentioned in your in
your examples. Right? How does all of this
then influence total cost of care at scale?
Well, I I think there's a lot of
issues with not being on a singular platform
or platforms not talking to each other. Right?
So I don't know if you're aware, but
at some point, the hospitals
the medical hospitals were required
to be on an EHR or electronic health
record system
or Medicare was gonna penalize them. And they
had some reimbursements that were tied to that.
I don't think most people are aware, but
mental health hospitals were not part of that
initiative.
So even we we today
cover over 200 plus mental health hospitals and
facilities.
I will tell you this.
Majority of them are not on an electronic
health record. Majority of them are on paper
charts,
and this is 2026.
Right? I mean, to me, that is insanity.
That is not part of the Medicare initiative
to somehow incentivize or penalize
health systems for moving into an electronic health
record. And you can imagine
there there is no capturing of that of
that data. Right? That's not intelligent data. There's
nothing we can do with it.
Patients get multiple
medications that are the same, multiple labs that
are the same.
There's no actual handoff at discharge with an
outpatient provider.
You know, outpatient provider information gets on their
discharge summary. The patient ball gets dropped.
When they discharge, the phone numbers are wrong.
The emails are wrong. So you can't really
get hold of these patients at the outpatient
side. But there's really no owner
in delivering that care or owning that care.
Right? Every person is solving for that their
little silo,
but none of it is talking to each
other. And so the amount of redundancy and
the amount of waste that's happening in this
space
outside of even the cost of the medical
system. Right? Just the waste in mental health
is significant.
And I think
building pathways
where the care is being
facilitated from one provider to another provider, but
on
a unified platform, it reduces
a lot of redundancy,
or wastage
in this space
and perhaps improves outcomes because you now know
exactly what happened with this patient in the
hospital,
in their group session, in their residential,
a facility where they may have been admitted
in the PHP IOP program.
And and so the idea is to connect
all the dots together.
Now connecting the dots, we are connecting the
dots. Right? When we're evaluating that impact now
from an organizational perspective and a cost perspective
and a financial aspect to this, right,
What are the metrics that you're prioritizing
to actually make sure, okay, there is performance
and there is ROI across the organization from
some of these initiatives?
That's a very good question.
We track
a decent amount of data.
We also
look at metrics and how we're performing in
other value based care plans.
We're in a in a few value based
care plans. One, that's a famous one that
some of the health plans utilize, which is
when a patient discharges from the hospital,
what percentage of them are actually to show
up to an appointment
within the next seven days of hospitalization? And
it's a HEDIS measure.
And our
percentage,
for conversion is over seventy five percent.
National average for a Medicaid patient is about
twenty percent.
And so we
have three hundred percent higher chance of getting
that patient in
to be able to be seen by a
provider post discharge, which has a tremendous impact
on their rehospitalization
and then continuing in the community,
with that care. In terms of total cost
of care, we've been able to show repeatedly
about 18 to 20% deduct reduction on their
total cost of care
when they when they're following
or within our platform.
Overall, I would say the metrics
in this space are not very well defined.
There's a lack of tremendous leadership in the
mental health space in what value based care
looks like.
I I I commonly talk about mental health,
especially in the seriously mentally ill population,
is as much as a homelessness problem as
it is a medical problem.
And I think
there's not enough infrastructure
or investment in enough infrastructure
in the community to actually solve some of
these problems. And so I think if you
really want to change
how we operate, we have to be able
to invest in the right infrastructure
and not keep adding more hospital beds because
I don't think that's a solution.
Speaking of infrastructure,
and that's a very good point that you
just made. I I I wanna touch on
something that often comes up or comes up
in almost every conversation about behavioral health right
now, which is again that these gaps that
we're seeing
often manifest themselves in higher ED utilization,
right, as you just highlighted, avoidable inpatient stays,
poorly managed comorbidities,
quite frankly.
What do you think about the downstream
cost implications, again, of that delayed psychiatric care
at a population level? I know you just
touched on it, how important this is for
communities as well.
It it is pretty significant. Right? And so
when you actually look at a dollar
of mental health cost,
more than fifty percent of it is ED
visits,
which is insanity to me. Right? Like, it
it's not even inpatient or outpatient. Majority of
the cost is emergency room visits.
And what's interesting is you would think that
a lot of the hospitals like to have
ED patients because it adds revenue to their
bottom line.
And the answer is you would be surprised
no.
Emergency room visits
5% of total emergency room visits in the
country are mental health visits.
But 35%
of the bed capacity in the emergency rooms
today
is being used up by mental health patients
or psych patients or substance use patients. Right?
Which is
so
significant
in terms of the gap. Right? So an
emergency room is like a
is like a restaurant. Right? That's a fast
moving restaurant. The more tables that turn, the
more you generate.
Person sits on a table for two hours
versus thirty minutes, but you could have moved
that table around four times over instead of
keeping someone there for two hours.
Emergency rooms are not much different. Right?
When they get clogged,
most of the time, it is because a
mental health patient is
keeping the bed occupied for twelve, twenty four,
thirty six hours, and they can't move that
patient out. Right? Whether that's into another psych
hospital,
whether that's into a outpatient appointment,
nonetheless, but that care coordination
and that rapid triaging of patients and rapid
access to care is missing.
And so
medical hospitals don't necessarily like psych patients sitting
in their hospitals for two, three days. Right?
They can be disruptive,
especially if you're in a in a nicer
part of town. They may be worried about
other patients may not coming in. Right? A
lot of these patients are not
they're they have bad odors. They're not cleaning
themselves. They're not bathing.
They may be breaking furniture. They may be
punching holes in the wall. They may be
using a lot more staff time. And so
a lot of our strategy
as a community
needs to go around figuring out how to
divert
mental health patients from going into the emergency
room. Right? Could they be rediverted to psych
hospitals? Could psych hospitals have a crisis unit
that can function as a triage? Could they
be rediverted to psychiatric urgent cares or rapid
appointments?
I think there is a tremendous potential there
of us reducing that
number of ED visits for psych patients by
at least twenty to thirty
percent, which would be a good start in
the right direction.
Now are those
as you mentioned, the those factors to redirect
folks, right, from the ED, are those
the performance standards that you want to see
health partners be accountable for? Right? And and
and what are some of the other ones
that you think are important to mitigate some
of these risks that you just outlined?
I
I think that is the number one cost
bucket today that I think somehow we need
to build the infrastructure
to reduce that cost.
I don't see
enough
provider groups being incentivized
in ways to engage with patients to actually
deliver better care. Right?
And so tons of tons of health plans
ask us, well, what are we doing today?
How are we changing
the way
we operate around these mental health patients? And
the reality is we're not doing much because
there is no way to actually pay for
it. Right? So, yes,
I could put a psychiatrist twenty four seven
in my clinic to see them or even
virtually,
but
there's no reimbursement
for me to get a patient in or
high reimbursement for me to get a get
a patient in within four hours of them
contacting us. Right? And so
but there's a cost to it. For me
to get be have someone available to see
someone that rapidly,
I would have to pay pay them some
proprietary or urgent fee.
There's no way for me to get paid,
so the only way for me to run
that program would be at a loss
while the patient would rather just go to
the ER and run up a $3,000
bill. But I think there is a balance
somewhere,
But I think it needs to be reimagined
and redesigned.
I think the way we're operating,
there's no true incentivization
for anyone
to actually do this correctly.
And I will say this,
mental health is not like the physical health
of the world. Right? I mean, in in
medical
world, you have a stroke, you have a
heart attack,
you have a pretty short window to actually
to actually show up to the ER
because of the equipment they need to actually
make sure you're alive.
Mental
health, you actually have some time.
Right? When patients
are are feeling worse,
it's it's a slow brewing process. So if
you can actually get them in within the
next four to six hours to see a
provider,
you may actually prevent a hospitalization
or an ER visit.
And even if you need to hospitalize them,
you could save them two or three days
being stuck in the ER
and directly send them to a psych hospital.
But, again, not only do you have to
incentivize the providers, the providers have to be
part of a system that is actually connected
to the hospitals to ensure
that that delivery happens. Right? And it so
boils down to the same question,
right, incentivization
and infrastructure
or a platform that's actually getting
getting incentivized
to ensure
that the delivery of care is happening correctly
and no balls are dropped in that process.
Right?
And I think
that vision, that mindset is just missing in
this space today.
Is that where organizations need to start right
now? If you were talking to somebody and
said, hey. We wanna improve this. We want
we wanna redesign this process completely.
Is that factor that you've just highlighted the
one that you want them to start at?
And, again, what can they do? What are
those partnerships that organizations
can strive for, can look for to be
able to say, okay. We've redesigned this process.
We are improving here.
I think the best
thing that payers can do is find ways
to incentivize
organizations
that have the ability and the infrastructure
to actually deliver that care.
And I think the other thing that I
would caution against, which is very typical in
this space,
is a lot of neat solutions. And a
lot of niche solutions don't actually provide
vertically integrated care work, which reduces wastage. Right?
So you may have a platform that only
provides and not that
we we don't need those platform platforms, but
you have a platform that only provides substance
use care. Well, in my fifteen years of
practicing as a psychiatrist,
I have yet to see patients that only
have strictly
substance use issues and no amount of health
issues that they need to treat.
Right? Or you may have a platform
that's only treating anxiety
while
anxiety is very comorbid with depression,
right, and other mental health issues. And so
you you need platforms
that are able to treat the vastness and
are also connected. Right? So you're you have
platforms
that focus mostly on hospitals or mostly focus
on clinics or mostly focus on schools.
Well, it that's all well and good, but
what happens when you have someone at school
or someone at an employer campus
that actually needs a higher level of care?
Where are you sending them to the ER?
Well, that doesn't help either. Right? And so
so,
you know, I think the only solution and
maybe I'm biased about this, right, because that
is how I built my company.
But the only true solution would have to
be diverse in how it treats the pathology,
and it has to be vertically integrated
where it can actually treat multiple levels of
care
so that the patient doesn't get lost
in in that forest.
Unfortunately, there's no easy button here.
Never has been in this space, and it's
going to take some time. Doctor Tai, again,
thank you so much for your time and
insights today. It's, great to have you again.
Appreciate it. Thank you, Lucas. We also want
to thank our podcast on Recycling Plus. You
can tune in to more podcasts from Becker's
Healthcare visiting our podcast page at @beckershospitalreview.com.