1 00:00:00,240 --> 00:00:02,399 Hi, everyone. This is Lucas Voss with Becker's 2 00:00:02,399 --> 00:00:04,480 Healthcare. Thanks so much for tuning in to 3 00:00:04,480 --> 00:00:06,719 the Becker's Healthcare podcast series. It's great to 4 00:00:06,719 --> 00:00:09,059 have you. I'm excited to welcome doctor Fasseltide 5 00:00:09,199 --> 00:00:11,039 back to the podcast. It's great to have 6 00:00:11,039 --> 00:00:13,279 him. He's a board certified psychiatrist and founder 7 00:00:13,279 --> 00:00:16,164 of Psych Plus. He completed a psychiatry training 8 00:00:16,164 --> 00:00:18,885 at the University of Iowa where he served 9 00:00:18,885 --> 00:00:21,304 as president of the graduate medical education program 10 00:00:21,524 --> 00:00:23,704 overseeing more than 800 11 00:00:23,765 --> 00:00:26,184 residents and fellows. During his residency, 12 00:00:26,510 --> 00:00:29,390 he began developing an EHR specifically designed for 13 00:00:29,390 --> 00:00:31,310 mental health, and today, he leads Psyc plus 14 00:00:31,310 --> 00:00:31,810 strategy 15 00:00:32,270 --> 00:00:34,270 to scale across all 50 states through a 16 00:00:34,270 --> 00:00:37,070 vertically integrated care model. His work also centers 17 00:00:37,070 --> 00:00:39,549 on advancing value based care and population health 18 00:00:39,549 --> 00:00:41,170 by leveraging data technology 19 00:00:41,484 --> 00:00:44,524 and clinical infrastructure to improve patient outcomes, enhance 20 00:00:44,524 --> 00:00:45,265 care quality, 21 00:00:45,565 --> 00:00:49,505 and reduce total costs across diverse populations. 22 00:00:50,045 --> 00:00:52,365 Doctor Tai, welcome back to the podcast. So 23 00:00:52,365 --> 00:00:53,344 great to have you. 24 00:00:54,179 --> 00:00:55,719 Good to have you as well. 25 00:00:56,820 --> 00:00:57,320 Lucas, 26 00:00:58,019 --> 00:01:00,339 excited to be here. Yeah. We have a 27 00:01:00,339 --> 00:01:01,859 a lot to talk about again. I always 28 00:01:01,859 --> 00:01:03,379 feel like we do, when we have you 29 00:01:03,379 --> 00:01:03,879 on. 30 00:01:04,500 --> 00:01:06,659 Unfortunately, we're still in a spot where we 31 00:01:06,659 --> 00:01:08,655 have to talk about behavioral health as one 32 00:01:08,655 --> 00:01:10,334 of the fastest growing cost drivers for health 33 00:01:10,334 --> 00:01:13,215 plans. That's likely not going away, unfortunately, in 34 00:01:13,215 --> 00:01:14,034 the near future. 35 00:01:14,655 --> 00:01:16,194 Network adequacy and psychiatry 36 00:01:16,655 --> 00:01:18,114 remains a major challenge. 37 00:01:18,495 --> 00:01:18,995 Still, 38 00:01:19,614 --> 00:01:20,754 from your perspective, 39 00:01:21,469 --> 00:01:21,969 what's 40 00:01:22,270 --> 00:01:25,170 still driving that gap between demand and access? 41 00:01:25,310 --> 00:01:27,950 And, again, what does that scalable value based 42 00:01:27,950 --> 00:01:30,670 solution look like from where you're at from 43 00:01:30,670 --> 00:01:33,630 plants trying to improve outcomes while also managing 44 00:01:33,630 --> 00:01:35,090 that total cost of care? 45 00:01:35,984 --> 00:01:36,965 So this is 46 00:01:37,504 --> 00:01:38,325 an interesting 47 00:01:38,704 --> 00:01:39,204 question 48 00:01:39,825 --> 00:01:42,325 and I think a fallacy in this space. 49 00:01:43,905 --> 00:01:45,744 I'll give you a personal story. There was 50 00:01:45,744 --> 00:01:47,284 a health plan that 51 00:01:47,584 --> 00:01:49,204 we were in network with 52 00:01:49,584 --> 00:01:50,405 in Texas, 53 00:01:51,500 --> 00:01:52,719 and they were 54 00:01:53,579 --> 00:01:56,560 also they had lives in Florida and Nevada. 55 00:01:56,939 --> 00:01:59,439 And I knew the health plan president personally, 56 00:01:59,900 --> 00:02:02,140 and we found out that they didn't put 57 00:02:02,140 --> 00:02:04,959 us in network in Nevada and Florida. 58 00:02:05,674 --> 00:02:07,034 So I was planning to go out to 59 00:02:07,034 --> 00:02:09,835 Nevada where their headquartered office is anyways for 60 00:02:09,835 --> 00:02:11,534 some other work. So I ended up grabbing 61 00:02:11,915 --> 00:02:13,534 lunch with him and his team, 62 00:02:14,395 --> 00:02:16,814 and he was very surprised. He didn't understand 63 00:02:16,875 --> 00:02:19,615 why we were not allowed in network. 64 00:02:20,060 --> 00:02:21,659 And so we met with the with the 65 00:02:21,659 --> 00:02:23,280 VP of contracting, 66 00:02:24,539 --> 00:02:26,139 and she said, well, we have so many 67 00:02:26,139 --> 00:02:26,639 providers 68 00:02:27,739 --> 00:02:29,500 that we didn't think we needed any more 69 00:02:29,500 --> 00:02:32,299 providers. Well, anyways, obviously, I knew him, so 70 00:02:32,299 --> 00:02:33,979 we got over the hump. But the more 71 00:02:33,979 --> 00:02:35,199 questions I asked, 72 00:02:35,525 --> 00:02:37,284 I asked them a simple question. I said, 73 00:02:37,284 --> 00:02:38,885 if you guys have so many providers, then 74 00:02:38,885 --> 00:02:40,805 why does the CMO keep reaching out to 75 00:02:40,805 --> 00:02:42,405 me to get their patients into the to 76 00:02:42,405 --> 00:02:44,105 see a psychiatrist or a therapist? 77 00:02:44,405 --> 00:02:46,425 Well, the contracting people had no 78 00:02:46,805 --> 00:02:49,625 idea why they're still needing to call me. 79 00:02:50,430 --> 00:02:52,590 And and the problem is because what you 80 00:02:52,590 --> 00:02:54,430 get in health plans is you have tons 81 00:02:54,430 --> 00:02:57,469 of solo providers in this space. Right? And 82 00:02:57,469 --> 00:02:59,870 the interesting thing about psychiatry is it's not 83 00:02:59,870 --> 00:03:01,250 like other medical specialties. 84 00:03:01,870 --> 00:03:03,489 You don't need a lot of infrastructure. 85 00:03:03,789 --> 00:03:04,930 You can put a shingle 86 00:03:05,405 --> 00:03:07,405 in a house, and that can be your 87 00:03:07,405 --> 00:03:10,044 office. And so you have armies of therapists 88 00:03:10,044 --> 00:03:11,965 and psychiatrists that are out there that are 89 00:03:11,965 --> 00:03:13,425 trying to provide this care, 90 00:03:13,965 --> 00:03:16,604 but they can't get to the patient. And 91 00:03:16,604 --> 00:03:18,465 that's the problem. Right? And so 92 00:03:19,050 --> 00:03:19,949 it's fragmented. 93 00:03:20,569 --> 00:03:21,629 It's in a disarray. 94 00:03:22,409 --> 00:03:23,469 It's like saying 95 00:03:24,009 --> 00:03:26,409 that we don't have enough drivers to drive 96 00:03:26,409 --> 00:03:26,909 Uber 97 00:03:27,770 --> 00:03:30,090 prior to Uber coming out. Well, obviously, we 98 00:03:30,090 --> 00:03:30,590 don't 99 00:03:31,544 --> 00:03:33,864 because there's no technology connecting them. Right? And 100 00:03:33,864 --> 00:03:35,564 then after Uber comes out, 101 00:03:36,344 --> 00:03:37,864 you could have a guy living down the 102 00:03:37,864 --> 00:03:39,465 street from your house now taking you to 103 00:03:39,465 --> 00:03:41,864 the airport that you didn't even know existed. 104 00:03:41,864 --> 00:03:44,504 Right? And so what the technology did for 105 00:03:44,504 --> 00:03:47,219 that space was it reduced the traction between 106 00:03:48,479 --> 00:03:50,099 a driver and a customer 107 00:03:50,639 --> 00:03:51,300 so that 108 00:03:51,680 --> 00:03:54,580 the the customer can access that driver rapidly. 109 00:03:54,639 --> 00:03:56,800 Right? You're you weren't gonna go walk down 110 00:03:56,800 --> 00:03:58,960 the street and knock onto a random guy's 111 00:03:58,960 --> 00:04:00,400 house to take you to the airport. That 112 00:04:00,400 --> 00:04:03,675 would be bizarre, but the technology fundamentally allowed 113 00:04:03,675 --> 00:04:04,574 you to do so. 114 00:04:04,955 --> 00:04:06,175 And I think what's 115 00:04:06,794 --> 00:04:08,955 the problem in the psychiatry space and the 116 00:04:08,955 --> 00:04:11,354 mental health space is, yes, we can have 117 00:04:11,354 --> 00:04:12,094 more providers, 118 00:04:12,395 --> 00:04:14,074 but I don't think the problem is that 119 00:04:14,074 --> 00:04:16,990 we don't have enough providers. The fundamental problem, 120 00:04:16,990 --> 00:04:17,810 in my opinion, 121 00:04:18,670 --> 00:04:19,889 is that they're not 122 00:04:20,350 --> 00:04:20,850 on 123 00:04:21,790 --> 00:04:24,209 a singular or similar platforms. 124 00:04:25,230 --> 00:04:27,470 They're out on their little islands, and there's 125 00:04:27,470 --> 00:04:30,189 no true way for patients to actually connect 126 00:04:30,189 --> 00:04:31,089 to that care, 127 00:04:31,814 --> 00:04:33,414 go from one level of care to the 128 00:04:33,414 --> 00:04:35,175 next level of care, even if you are 129 00:04:35,175 --> 00:04:37,334 able to find a psychiatrist. Okay. You need 130 00:04:37,334 --> 00:04:38,074 group therapy. 131 00:04:38,454 --> 00:04:39,115 You need 132 00:04:39,735 --> 00:04:42,134 exposure response therapy. Maybe you need to go 133 00:04:42,134 --> 00:04:43,914 inpatient to a detox program. 134 00:04:45,120 --> 00:04:47,360 There's no connection. You can't actually 135 00:04:47,920 --> 00:04:49,600 the psychiatrist is gonna tell you to go 136 00:04:49,600 --> 00:04:52,000 Google this stuff or maybe they're gonna refer 137 00:04:52,000 --> 00:04:54,000 you to another program, but there's no actual 138 00:04:54,000 --> 00:04:56,480 handoff. And so there's a lot of drop 139 00:04:56,480 --> 00:04:58,500 balls. There's a lot of bad outcomes. 140 00:04:58,800 --> 00:05:00,500 And a lot of it stems from 141 00:05:00,985 --> 00:05:01,485 fragmented 142 00:05:02,024 --> 00:05:04,365 provider base that exist in this 143 00:05:04,745 --> 00:05:05,245 ecosystem. 144 00:05:06,185 --> 00:05:08,264 And, really, what we are trying to change 145 00:05:08,264 --> 00:05:10,365 is trying to bring them onto a singular 146 00:05:10,904 --> 00:05:12,285 or similar platforms 147 00:05:13,000 --> 00:05:15,079 where it really becomes like an Uber for 148 00:05:15,079 --> 00:05:18,620 mental health where providers can coexist with patients 149 00:05:19,079 --> 00:05:21,479 and patients can get active care, but that's 150 00:05:21,479 --> 00:05:24,040 not it. When in fact the patient needs 151 00:05:24,040 --> 00:05:25,899 to get referred to a different service 152 00:05:26,360 --> 00:05:27,660 that the technology 153 00:05:28,654 --> 00:05:31,875 and the platform can actually facilitate and own 154 00:05:32,574 --> 00:05:34,574 that delivery of care and bring you to 155 00:05:34,574 --> 00:05:37,134 a different provider, whichever you need at that 156 00:05:37,134 --> 00:05:38,115 moment in time. 157 00:05:38,895 --> 00:05:40,495 So all of these examples that you just 158 00:05:40,495 --> 00:05:43,139 mentioned are are very telling because they apply, 159 00:05:43,139 --> 00:05:45,160 again, from a consumer perspective to 160 00:05:45,779 --> 00:05:47,540 how does all of this then we talk 161 00:05:47,540 --> 00:05:50,100 about access. We talk about coordinating all of 162 00:05:50,100 --> 00:05:51,779 this as you've just mentioned in your in 163 00:05:51,779 --> 00:05:54,454 your examples. Right? How does all of this 164 00:05:54,454 --> 00:05:57,514 then influence total cost of care at scale? 165 00:05:58,615 --> 00:06:01,334 Well, I I think there's a lot of 166 00:06:01,334 --> 00:06:04,714 issues with not being on a singular platform 167 00:06:04,935 --> 00:06:07,414 or platforms not talking to each other. Right? 168 00:06:07,414 --> 00:06:09,500 So I don't know if you're aware, but 169 00:06:09,800 --> 00:06:11,419 at some point, the hospitals 170 00:06:12,039 --> 00:06:14,220 the medical hospitals were required 171 00:06:14,839 --> 00:06:17,800 to be on an EHR or electronic health 172 00:06:17,800 --> 00:06:18,620 record system 173 00:06:19,479 --> 00:06:22,125 or Medicare was gonna penalize them. And they 174 00:06:22,125 --> 00:06:24,785 had some reimbursements that were tied to that. 175 00:06:25,485 --> 00:06:27,904 I don't think most people are aware, but 176 00:06:27,964 --> 00:06:30,284 mental health hospitals were not part of that 177 00:06:30,284 --> 00:06:30,784 initiative. 178 00:06:31,485 --> 00:06:33,824 So even we we today 179 00:06:34,204 --> 00:06:37,240 cover over 200 plus mental health hospitals and 180 00:06:37,240 --> 00:06:37,740 facilities. 181 00:06:39,399 --> 00:06:40,779 I will tell you this. 182 00:06:41,240 --> 00:06:43,979 Majority of them are not on an electronic 183 00:06:44,120 --> 00:06:46,439 health record. Majority of them are on paper 184 00:06:46,439 --> 00:06:46,939 charts, 185 00:06:47,240 --> 00:06:49,099 and this is 2026. 186 00:06:49,319 --> 00:06:51,099 Right? I mean, to me, that is insanity. 187 00:06:51,964 --> 00:06:54,145 That is not part of the Medicare initiative 188 00:06:54,685 --> 00:06:56,944 to somehow incentivize or penalize 189 00:06:57,645 --> 00:07:00,205 health systems for moving into an electronic health 190 00:07:00,205 --> 00:07:01,904 record. And you can imagine 191 00:07:03,245 --> 00:07:05,220 there there is no capturing of that of 192 00:07:05,220 --> 00:07:07,779 that data. Right? That's not intelligent data. There's 193 00:07:07,779 --> 00:07:09,160 nothing we can do with it. 194 00:07:09,540 --> 00:07:10,759 Patients get multiple 195 00:07:11,379 --> 00:07:13,939 medications that are the same, multiple labs that 196 00:07:13,939 --> 00:07:14,680 are the same. 197 00:07:15,460 --> 00:07:18,420 There's no actual handoff at discharge with an 198 00:07:18,420 --> 00:07:19,560 outpatient provider. 199 00:07:20,185 --> 00:07:22,985 You know, outpatient provider information gets on their 200 00:07:22,985 --> 00:07:25,644 discharge summary. The patient ball gets dropped. 201 00:07:25,944 --> 00:07:28,024 When they discharge, the phone numbers are wrong. 202 00:07:28,024 --> 00:07:29,625 The emails are wrong. So you can't really 203 00:07:29,625 --> 00:07:31,404 get hold of these patients at the outpatient 204 00:07:31,464 --> 00:07:34,204 side. But there's really no owner 205 00:07:35,060 --> 00:07:38,180 in delivering that care or owning that care. 206 00:07:38,180 --> 00:07:40,740 Right? Every person is solving for that their 207 00:07:40,740 --> 00:07:41,639 little silo, 208 00:07:42,579 --> 00:07:44,259 but none of it is talking to each 209 00:07:44,259 --> 00:07:46,740 other. And so the amount of redundancy and 210 00:07:46,740 --> 00:07:48,660 the amount of waste that's happening in this 211 00:07:48,660 --> 00:07:49,160 space 212 00:07:50,214 --> 00:07:52,455 outside of even the cost of the medical 213 00:07:52,455 --> 00:07:55,175 system. Right? Just the waste in mental health 214 00:07:55,175 --> 00:07:55,915 is significant. 215 00:07:56,694 --> 00:07:57,514 And I think 216 00:07:57,975 --> 00:07:59,115 building pathways 217 00:07:59,975 --> 00:08:01,834 where the care is being 218 00:08:02,680 --> 00:08:05,639 facilitated from one provider to another provider, but 219 00:08:05,639 --> 00:08:06,139 on 220 00:08:06,519 --> 00:08:08,620 a unified platform, it reduces 221 00:08:08,920 --> 00:08:09,899 a lot of redundancy, 222 00:08:11,480 --> 00:08:12,300 or wastage 223 00:08:12,600 --> 00:08:13,500 in this space 224 00:08:14,199 --> 00:08:17,000 and perhaps improves outcomes because you now know 225 00:08:17,000 --> 00:08:18,935 exactly what happened with this patient in the 226 00:08:18,935 --> 00:08:19,435 hospital, 227 00:08:19,895 --> 00:08:22,235 in their group session, in their residential, 228 00:08:22,935 --> 00:08:24,615 a facility where they may have been admitted 229 00:08:24,615 --> 00:08:26,314 in the PHP IOP program. 230 00:08:26,855 --> 00:08:28,694 And and so the idea is to connect 231 00:08:28,694 --> 00:08:29,835 all the dots together. 232 00:08:31,019 --> 00:08:33,659 Now connecting the dots, we are connecting the 233 00:08:33,659 --> 00:08:37,120 dots. Right? When we're evaluating that impact now 234 00:08:37,259 --> 00:08:39,980 from an organizational perspective and a cost perspective 235 00:08:39,980 --> 00:08:42,159 and a financial aspect to this, right, 236 00:08:43,334 --> 00:08:45,595 What are the metrics that you're prioritizing 237 00:08:46,054 --> 00:08:48,794 to actually make sure, okay, there is performance 238 00:08:49,095 --> 00:08:51,894 and there is ROI across the organization from 239 00:08:51,894 --> 00:08:52,954 some of these initiatives? 240 00:08:54,054 --> 00:08:55,514 That's a very good question. 241 00:08:56,610 --> 00:08:57,350 We track 242 00:08:57,889 --> 00:08:59,269 a decent amount of data. 243 00:09:00,129 --> 00:09:00,870 We also 244 00:09:01,809 --> 00:09:04,210 look at metrics and how we're performing in 245 00:09:04,210 --> 00:09:06,070 other value based care plans. 246 00:09:06,850 --> 00:09:08,774 We're in a in a few value based 247 00:09:08,855 --> 00:09:10,855 care plans. One, that's a famous one that 248 00:09:10,855 --> 00:09:13,035 some of the health plans utilize, which is 249 00:09:13,254 --> 00:09:15,434 when a patient discharges from the hospital, 250 00:09:15,975 --> 00:09:18,055 what percentage of them are actually to show 251 00:09:18,055 --> 00:09:18,955 up to an appointment 252 00:09:19,495 --> 00:09:21,815 within the next seven days of hospitalization? And 253 00:09:21,815 --> 00:09:23,115 it's a HEDIS measure. 254 00:09:23,654 --> 00:09:24,475 And our 255 00:09:25,710 --> 00:09:26,210 percentage, 256 00:09:27,230 --> 00:09:29,649 for conversion is over seventy five percent. 257 00:09:30,990 --> 00:09:33,470 National average for a Medicaid patient is about 258 00:09:33,470 --> 00:09:34,289 twenty percent. 259 00:09:35,070 --> 00:09:36,129 And so we 260 00:09:36,590 --> 00:09:39,389 have three hundred percent higher chance of getting 261 00:09:39,389 --> 00:09:40,610 that patient in 262 00:09:40,964 --> 00:09:42,565 to be able to be seen by a 263 00:09:42,565 --> 00:09:45,464 provider post discharge, which has a tremendous impact 264 00:09:45,764 --> 00:09:46,745 on their rehospitalization 265 00:09:47,284 --> 00:09:49,144 and then continuing in the community, 266 00:09:50,084 --> 00:09:52,485 with that care. In terms of total cost 267 00:09:52,485 --> 00:09:54,504 of care, we've been able to show repeatedly 268 00:09:55,320 --> 00:09:58,279 about 18 to 20% deduct reduction on their 269 00:09:58,279 --> 00:09:59,580 total cost of care 270 00:09:59,960 --> 00:10:01,420 when they when they're following 271 00:10:01,799 --> 00:10:03,500 or within our platform. 272 00:10:05,080 --> 00:10:07,259 Overall, I would say the metrics 273 00:10:08,304 --> 00:10:10,884 in this space are not very well defined. 274 00:10:12,144 --> 00:10:15,105 There's a lack of tremendous leadership in the 275 00:10:15,105 --> 00:10:17,504 mental health space in what value based care 276 00:10:17,504 --> 00:10:18,325 looks like. 277 00:10:19,024 --> 00:10:21,600 I I I commonly talk about mental health, 278 00:10:21,679 --> 00:10:24,179 especially in the seriously mentally ill population, 279 00:10:24,799 --> 00:10:26,639 is as much as a homelessness problem as 280 00:10:26,639 --> 00:10:28,019 it is a medical problem. 281 00:10:29,039 --> 00:10:29,860 And I think 282 00:10:30,240 --> 00:10:31,779 there's not enough infrastructure 283 00:10:32,159 --> 00:10:34,339 or investment in enough infrastructure 284 00:10:35,154 --> 00:10:37,235 in the community to actually solve some of 285 00:10:37,235 --> 00:10:39,315 these problems. And so I think if you 286 00:10:39,315 --> 00:10:40,615 really want to change 287 00:10:41,475 --> 00:10:43,634 how we operate, we have to be able 288 00:10:43,634 --> 00:10:45,815 to invest in the right infrastructure 289 00:10:46,754 --> 00:10:49,075 and not keep adding more hospital beds because 290 00:10:49,075 --> 00:10:50,455 I don't think that's a solution. 291 00:10:51,730 --> 00:10:52,789 Speaking of infrastructure, 292 00:10:53,329 --> 00:10:54,610 and that's a very good point that you 293 00:10:54,610 --> 00:10:56,129 just made. I I I wanna touch on 294 00:10:56,129 --> 00:10:58,289 something that often comes up or comes up 295 00:10:58,289 --> 00:11:01,009 in almost every conversation about behavioral health right 296 00:11:01,009 --> 00:11:03,730 now, which is again that these gaps that 297 00:11:03,730 --> 00:11:04,470 we're seeing 298 00:11:05,134 --> 00:11:07,875 often manifest themselves in higher ED utilization, 299 00:11:08,254 --> 00:11:11,475 right, as you just highlighted, avoidable inpatient stays, 300 00:11:12,335 --> 00:11:13,794 poorly managed comorbidities, 301 00:11:14,174 --> 00:11:14,914 quite frankly. 302 00:11:15,615 --> 00:11:17,794 What do you think about the downstream 303 00:11:18,095 --> 00:11:21,730 cost implications, again, of that delayed psychiatric care 304 00:11:21,730 --> 00:11:23,730 at a population level? I know you just 305 00:11:23,730 --> 00:11:25,730 touched on it, how important this is for 306 00:11:25,730 --> 00:11:27,029 communities as well. 307 00:11:28,370 --> 00:11:31,190 It it is pretty significant. Right? And so 308 00:11:31,490 --> 00:11:33,669 when you actually look at a dollar 309 00:11:34,875 --> 00:11:36,415 of mental health cost, 310 00:11:37,514 --> 00:11:39,675 more than fifty percent of it is ED 311 00:11:39,675 --> 00:11:40,175 visits, 312 00:11:41,514 --> 00:11:43,634 which is insanity to me. Right? Like, it 313 00:11:43,675 --> 00:11:47,115 it's not even inpatient or outpatient. Majority of 314 00:11:47,115 --> 00:11:49,215 the cost is emergency room visits. 315 00:11:49,950 --> 00:11:52,269 And what's interesting is you would think that 316 00:11:52,269 --> 00:11:54,830 a lot of the hospitals like to have 317 00:11:54,830 --> 00:11:57,149 ED patients because it adds revenue to their 318 00:11:57,149 --> 00:11:57,970 bottom line. 319 00:11:58,750 --> 00:12:00,769 And the answer is you would be surprised 320 00:12:01,149 --> 00:12:01,649 no. 321 00:12:03,355 --> 00:12:04,714 Emergency room visits 322 00:12:05,914 --> 00:12:08,554 5% of total emergency room visits in the 323 00:12:08,554 --> 00:12:10,174 country are mental health visits. 324 00:12:11,434 --> 00:12:12,794 But 35% 325 00:12:12,794 --> 00:12:15,194 of the bed capacity in the emergency rooms 326 00:12:15,194 --> 00:12:15,694 today 327 00:12:16,460 --> 00:12:19,100 is being used up by mental health patients 328 00:12:19,100 --> 00:12:21,680 or psych patients or substance use patients. Right? 329 00:12:22,139 --> 00:12:22,879 Which is 330 00:12:23,820 --> 00:12:24,320 so 331 00:12:25,100 --> 00:12:25,600 significant 332 00:12:26,300 --> 00:12:28,379 in terms of the gap. Right? So an 333 00:12:28,379 --> 00:12:30,000 emergency room is like a 334 00:12:30,300 --> 00:12:32,835 is like a restaurant. Right? That's a fast 335 00:12:32,835 --> 00:12:35,634 moving restaurant. The more tables that turn, the 336 00:12:35,634 --> 00:12:36,534 more you generate. 337 00:12:36,914 --> 00:12:38,754 Person sits on a table for two hours 338 00:12:38,754 --> 00:12:40,914 versus thirty minutes, but you could have moved 339 00:12:40,914 --> 00:12:43,075 that table around four times over instead of 340 00:12:43,075 --> 00:12:44,695 keeping someone there for two hours. 341 00:12:45,235 --> 00:12:47,495 Emergency rooms are not much different. Right? 342 00:12:47,840 --> 00:12:48,980 When they get clogged, 343 00:12:50,080 --> 00:12:52,000 most of the time, it is because a 344 00:12:52,000 --> 00:12:53,460 mental health patient is 345 00:12:53,840 --> 00:12:56,799 keeping the bed occupied for twelve, twenty four, 346 00:12:56,799 --> 00:12:59,120 thirty six hours, and they can't move that 347 00:12:59,120 --> 00:13:01,519 patient out. Right? Whether that's into another psych 348 00:13:01,519 --> 00:13:02,019 hospital, 349 00:13:02,355 --> 00:13:05,174 whether that's into a outpatient appointment, 350 00:13:05,714 --> 00:13:07,495 nonetheless, but that care coordination 351 00:13:08,115 --> 00:13:10,995 and that rapid triaging of patients and rapid 352 00:13:10,995 --> 00:13:12,534 access to care is missing. 353 00:13:12,995 --> 00:13:13,815 And so 354 00:13:14,590 --> 00:13:18,029 medical hospitals don't necessarily like psych patients sitting 355 00:13:18,029 --> 00:13:20,450 in their hospitals for two, three days. Right? 356 00:13:20,590 --> 00:13:21,649 They can be disruptive, 357 00:13:22,429 --> 00:13:24,429 especially if you're in a in a nicer 358 00:13:24,429 --> 00:13:26,029 part of town. They may be worried about 359 00:13:26,029 --> 00:13:28,269 other patients may not coming in. Right? A 360 00:13:28,269 --> 00:13:29,970 lot of these patients are not 361 00:13:31,044 --> 00:13:33,125 they're they have bad odors. They're not cleaning 362 00:13:33,125 --> 00:13:34,424 themselves. They're not bathing. 363 00:13:34,804 --> 00:13:36,884 They may be breaking furniture. They may be 364 00:13:36,884 --> 00:13:38,884 punching holes in the wall. They may be 365 00:13:38,884 --> 00:13:40,904 using a lot more staff time. And so 366 00:13:42,084 --> 00:13:43,304 a lot of our strategy 367 00:13:43,924 --> 00:13:44,745 as a community 368 00:13:45,450 --> 00:13:47,850 needs to go around figuring out how to 369 00:13:47,850 --> 00:13:48,350 divert 370 00:13:48,970 --> 00:13:51,149 mental health patients from going into the emergency 371 00:13:51,210 --> 00:13:53,769 room. Right? Could they be rediverted to psych 372 00:13:53,769 --> 00:13:56,429 hospitals? Could psych hospitals have a crisis unit 373 00:13:56,490 --> 00:13:58,634 that can function as a triage? Could they 374 00:13:58,634 --> 00:14:02,555 be rediverted to psychiatric urgent cares or rapid 375 00:14:02,555 --> 00:14:03,055 appointments? 376 00:14:03,915 --> 00:14:06,654 I think there is a tremendous potential there 377 00:14:07,754 --> 00:14:09,455 of us reducing that 378 00:14:09,835 --> 00:14:12,394 number of ED visits for psych patients by 379 00:14:12,394 --> 00:14:13,799 at least twenty to thirty 380 00:14:14,839 --> 00:14:17,000 percent, which would be a good start in 381 00:14:17,000 --> 00:14:17,820 the right direction. 382 00:14:19,000 --> 00:14:20,139 Now are those 383 00:14:20,679 --> 00:14:22,919 as you mentioned, the those factors to redirect 384 00:14:22,919 --> 00:14:25,019 folks, right, from the ED, are those 385 00:14:25,480 --> 00:14:27,980 the performance standards that you want to see 386 00:14:28,695 --> 00:14:31,815 health partners be accountable for? Right? And and 387 00:14:31,815 --> 00:14:32,934 and what are some of the other ones 388 00:14:32,934 --> 00:14:34,535 that you think are important to mitigate some 389 00:14:34,535 --> 00:14:36,235 of these risks that you just outlined? 390 00:14:36,774 --> 00:14:37,274 I 391 00:14:37,815 --> 00:14:40,375 I think that is the number one cost 392 00:14:40,375 --> 00:14:43,259 bucket today that I think somehow we need 393 00:14:43,259 --> 00:14:44,399 to build the infrastructure 394 00:14:45,340 --> 00:14:46,799 to reduce that cost. 395 00:14:47,740 --> 00:14:48,799 I don't see 396 00:14:49,980 --> 00:14:50,480 enough 397 00:14:51,340 --> 00:14:52,960 provider groups being incentivized 398 00:14:53,899 --> 00:14:56,860 in ways to engage with patients to actually 399 00:14:56,860 --> 00:14:58,414 deliver better care. Right? 400 00:14:59,595 --> 00:15:01,914 And so tons of tons of health plans 401 00:15:01,914 --> 00:15:03,855 ask us, well, what are we doing today? 402 00:15:04,154 --> 00:15:05,214 How are we changing 403 00:15:05,674 --> 00:15:06,254 the way 404 00:15:06,875 --> 00:15:09,034 we operate around these mental health patients? And 405 00:15:09,034 --> 00:15:11,115 the reality is we're not doing much because 406 00:15:11,115 --> 00:15:12,794 there is no way to actually pay for 407 00:15:12,794 --> 00:15:14,559 it. Right? So, yes, 408 00:15:15,100 --> 00:15:17,519 I could put a psychiatrist twenty four seven 409 00:15:18,059 --> 00:15:20,540 in my clinic to see them or even 410 00:15:20,540 --> 00:15:21,040 virtually, 411 00:15:22,059 --> 00:15:22,559 but 412 00:15:23,580 --> 00:15:24,720 there's no reimbursement 413 00:15:25,179 --> 00:15:26,779 for me to get a patient in or 414 00:15:26,779 --> 00:15:28,315 high reimbursement for me to get a get 415 00:15:28,315 --> 00:15:30,795 a patient in within four hours of them 416 00:15:30,795 --> 00:15:32,875 contacting us. Right? And so 417 00:15:34,075 --> 00:15:35,754 but there's a cost to it. For me 418 00:15:35,754 --> 00:15:37,754 to get be have someone available to see 419 00:15:37,754 --> 00:15:38,975 someone that rapidly, 420 00:15:39,355 --> 00:15:41,195 I would have to pay pay them some 421 00:15:41,195 --> 00:15:43,134 proprietary or urgent fee. 422 00:15:43,470 --> 00:15:44,829 There's no way for me to get paid, 423 00:15:44,829 --> 00:15:46,029 so the only way for me to run 424 00:15:46,029 --> 00:15:47,570 that program would be at a loss 425 00:15:48,589 --> 00:15:50,110 while the patient would rather just go to 426 00:15:50,110 --> 00:15:52,509 the ER and run up a $3,000 427 00:15:52,509 --> 00:15:55,490 bill. But I think there is a balance 428 00:15:55,549 --> 00:15:56,049 somewhere, 429 00:15:56,475 --> 00:15:58,174 But I think it needs to be reimagined 430 00:15:58,315 --> 00:15:59,054 and redesigned. 431 00:15:59,595 --> 00:16:01,054 I think the way we're operating, 432 00:16:01,595 --> 00:16:02,975 there's no true incentivization 433 00:16:03,355 --> 00:16:04,095 for anyone 434 00:16:04,794 --> 00:16:06,574 to actually do this correctly. 435 00:16:08,394 --> 00:16:09,694 And I will say this, 436 00:16:10,420 --> 00:16:12,980 mental health is not like the physical health 437 00:16:12,980 --> 00:16:14,660 of the world. Right? I mean, in in 438 00:16:14,660 --> 00:16:15,160 medical 439 00:16:15,620 --> 00:16:17,460 world, you have a stroke, you have a 440 00:16:17,460 --> 00:16:18,200 heart attack, 441 00:16:18,899 --> 00:16:21,080 you have a pretty short window to actually 442 00:16:21,379 --> 00:16:23,160 to actually show up to the ER 443 00:16:23,554 --> 00:16:25,475 because of the equipment they need to actually 444 00:16:25,475 --> 00:16:26,534 make sure you're alive. 445 00:16:26,914 --> 00:16:27,414 Mental 446 00:16:27,794 --> 00:16:30,294 health, you actually have some time. 447 00:16:30,754 --> 00:16:31,815 Right? When patients 448 00:16:32,355 --> 00:16:33,975 are are feeling worse, 449 00:16:34,355 --> 00:16:37,259 it's it's a slow brewing process. So if 450 00:16:37,259 --> 00:16:39,019 you can actually get them in within the 451 00:16:39,019 --> 00:16:40,700 next four to six hours to see a 452 00:16:40,700 --> 00:16:41,200 provider, 453 00:16:42,220 --> 00:16:44,320 you may actually prevent a hospitalization 454 00:16:44,779 --> 00:16:46,080 or an ER visit. 455 00:16:46,940 --> 00:16:48,779 And even if you need to hospitalize them, 456 00:16:48,779 --> 00:16:50,620 you could save them two or three days 457 00:16:50,620 --> 00:16:52,000 being stuck in the ER 458 00:16:52,514 --> 00:16:54,695 and directly send them to a psych hospital. 459 00:16:55,235 --> 00:16:57,315 But, again, not only do you have to 460 00:16:57,315 --> 00:16:59,634 incentivize the providers, the providers have to be 461 00:16:59,634 --> 00:17:02,115 part of a system that is actually connected 462 00:17:02,115 --> 00:17:03,735 to the hospitals to ensure 463 00:17:04,115 --> 00:17:06,390 that that delivery happens. Right? And it so 464 00:17:06,549 --> 00:17:08,170 boils down to the same question, 465 00:17:08,950 --> 00:17:09,769 right, incentivization 466 00:17:10,869 --> 00:17:11,609 and infrastructure 467 00:17:12,309 --> 00:17:14,650 or a platform that's actually getting 468 00:17:15,750 --> 00:17:16,970 getting incentivized 469 00:17:17,430 --> 00:17:18,170 to ensure 470 00:17:18,924 --> 00:17:21,724 that the delivery of care is happening correctly 471 00:17:21,724 --> 00:17:23,884 and no balls are dropped in that process. 472 00:17:23,884 --> 00:17:24,384 Right? 473 00:17:24,924 --> 00:17:25,664 And I think 474 00:17:26,765 --> 00:17:29,244 that vision, that mindset is just missing in 475 00:17:29,244 --> 00:17:30,224 this space today. 476 00:17:31,340 --> 00:17:34,700 Is that where organizations need to start right 477 00:17:34,700 --> 00:17:37,099 now? If you were talking to somebody and 478 00:17:37,099 --> 00:17:39,420 said, hey. We wanna improve this. We want 479 00:17:39,500 --> 00:17:41,680 we wanna redesign this process completely. 480 00:17:42,380 --> 00:17:44,460 Is that factor that you've just highlighted the 481 00:17:44,460 --> 00:17:46,720 one that you want them to start at? 482 00:17:46,964 --> 00:17:48,884 And, again, what can they do? What are 483 00:17:48,884 --> 00:17:50,825 those partnerships that organizations 484 00:17:51,204 --> 00:17:52,884 can strive for, can look for to be 485 00:17:52,884 --> 00:17:55,065 able to say, okay. We've redesigned this process. 486 00:17:55,285 --> 00:17:56,505 We are improving here. 487 00:17:57,125 --> 00:17:58,424 I think the best 488 00:17:58,724 --> 00:18:01,204 thing that payers can do is find ways 489 00:18:01,204 --> 00:18:01,944 to incentivize 490 00:18:03,009 --> 00:18:03,509 organizations 491 00:18:03,890 --> 00:18:06,470 that have the ability and the infrastructure 492 00:18:06,769 --> 00:18:08,789 to actually deliver that care. 493 00:18:09,490 --> 00:18:11,809 And I think the other thing that I 494 00:18:11,809 --> 00:18:14,529 would caution against, which is very typical in 495 00:18:14,529 --> 00:18:15,269 this space, 496 00:18:15,704 --> 00:18:17,625 is a lot of neat solutions. And a 497 00:18:17,625 --> 00:18:20,444 lot of niche solutions don't actually provide 498 00:18:21,384 --> 00:18:24,904 vertically integrated care work, which reduces wastage. Right? 499 00:18:24,904 --> 00:18:27,144 So you may have a platform that only 500 00:18:27,144 --> 00:18:28,349 provides and not that 501 00:18:28,829 --> 00:18:31,230 we we don't need those platform platforms, but 502 00:18:31,230 --> 00:18:33,390 you have a platform that only provides substance 503 00:18:33,390 --> 00:18:35,710 use care. Well, in my fifteen years of 504 00:18:35,710 --> 00:18:37,009 practicing as a psychiatrist, 505 00:18:37,549 --> 00:18:39,630 I have yet to see patients that only 506 00:18:39,630 --> 00:18:40,369 have strictly 507 00:18:40,750 --> 00:18:42,429 substance use issues and no amount of health 508 00:18:42,429 --> 00:18:43,875 issues that they need to treat. 509 00:18:44,355 --> 00:18:46,055 Right? Or you may have a platform 510 00:18:46,595 --> 00:18:48,375 that's only treating anxiety 511 00:18:48,994 --> 00:18:49,494 while 512 00:18:49,954 --> 00:18:52,375 anxiety is very comorbid with depression, 513 00:18:53,154 --> 00:18:55,414 right, and other mental health issues. And so 514 00:18:56,434 --> 00:18:57,414 you you need platforms 515 00:18:58,450 --> 00:19:01,410 that are able to treat the vastness and 516 00:19:01,410 --> 00:19:03,570 are also connected. Right? So you're you have 517 00:19:03,570 --> 00:19:04,070 platforms 518 00:19:04,690 --> 00:19:08,529 that focus mostly on hospitals or mostly focus 519 00:19:08,529 --> 00:19:11,590 on clinics or mostly focus on schools. 520 00:19:12,375 --> 00:19:14,775 Well, it that's all well and good, but 521 00:19:14,775 --> 00:19:17,115 what happens when you have someone at school 522 00:19:17,255 --> 00:19:19,515 or someone at an employer campus 523 00:19:19,894 --> 00:19:21,815 that actually needs a higher level of care? 524 00:19:21,815 --> 00:19:23,595 Where are you sending them to the ER? 525 00:19:23,654 --> 00:19:25,835 Well, that doesn't help either. Right? And so 526 00:19:25,974 --> 00:19:26,474 so, 527 00:19:27,279 --> 00:19:29,440 you know, I think the only solution and 528 00:19:29,440 --> 00:19:31,279 maybe I'm biased about this, right, because that 529 00:19:31,279 --> 00:19:32,740 is how I built my company. 530 00:19:33,039 --> 00:19:35,359 But the only true solution would have to 531 00:19:35,359 --> 00:19:38,420 be diverse in how it treats the pathology, 532 00:19:39,119 --> 00:19:41,539 and it has to be vertically integrated 533 00:19:41,914 --> 00:19:44,154 where it can actually treat multiple levels of 534 00:19:44,154 --> 00:19:44,654 care 535 00:19:44,954 --> 00:19:46,894 so that the patient doesn't get lost 536 00:19:47,434 --> 00:19:48,734 in in that forest. 537 00:19:49,674 --> 00:19:51,595 Unfortunately, there's no easy button here. 538 00:19:51,994 --> 00:19:54,315 Never has been in this space, and it's 539 00:19:54,315 --> 00:19:56,410 going to take some time. Doctor Tai, again, 540 00:19:56,410 --> 00:19:57,769 thank you so much for your time and 541 00:19:57,769 --> 00:19:59,789 insights today. It's, great to have you again. 542 00:19:59,930 --> 00:20:02,410 Appreciate it. Thank you, Lucas. We also want 543 00:20:02,410 --> 00:20:04,250 to thank our podcast on Recycling Plus. You 544 00:20:04,250 --> 00:20:06,009 can tune in to more podcasts from Becker's 545 00:20:06,009 --> 00:20:10,480 Healthcare visiting our podcast page at @beckershospitalreview.com.