- This is the Becker's Healthcare Podcast, created
by the team of Becker's Healthcare,
a multimedia company devoted to the people
who power us healthcare.
Four new 15 minute episodes are released daily containing
industry news analysis and thought leadership.
From powerful healthcare decision makers Support our show
by leaving it a five star rating and review on Apple Podcast
or other platforms you use.
It's a chance to tell us what you like about the show
and act on your feedback.
Thanks for listening. Now here's the episode.
- Welcome everyone,
to the Becker's Healthcare podcast series.
I'm Mariah Mohammed, writer
and moderator with Becker's Healthcare,
and I'm absolutely thrilled to have
with me today Dr. Stanley Williams, director
of Integrative Health at the Hair Center
for Mental Health Houston.
Dr. Williams, it's very nice
to have you on the podcast today.
To get us started, would you mind please introducing
yourself and telling us a bit about your background?
- Yes. Um, I'm very excited to be here, um, on, on this call
with you, Mariah, Dr. Stanley Williams.
I have a PhD in psychology, a master's in counseling,
a bachelor's in healthcare management.
I worked in, um, different places like Georgia.
I worked with the Carter Center,
with the Georgia Association Primary Health Centers.
I was facilitating, uh, integrated health
with the FKC partners with mental health centers.
Um, I've worked in mental health, both private and public
and also private practice.
Also teach and, um, you know, see myself sort of
as a thought leader in senior management
and developing integrated systems of care.
- Perfect. Thank you so much for giving us that background.
So to jump right into our conversation today,
you hear a lot about value-based care when it comes
to hospitals, but can you provide an overview for us
as it relates to community-based behavioral health?
- Yeah, a that's, that's a really good question, Ryan.
So when you think about, um, you know, uh,
community mental health, uh,
community behavioral health services, um, a lot of, a lot
of those facilities operate, um, from a fee for service, uh,
kind of a traditional payment model
where the providers are reimbursed
for each individual served, uh, they deliver,
uh, to a patient.
And so, uh, under that construct, um, the, uh,
provider received payment based on the, uh, quantity
of services rendered, um, not necessarily based on quality
or outcomes achieved.
And even though a lot of like, um, state organizations
or semi-state organizations, um, uh, we, we have a contract
with the, uh, state of Texas
and, uh, we have some additional outcomes.
But for the most part, traditional models really just, um,
are based on that fee for service model.
Um, associated quantity of services.
Now, uh, compare that to value based, um, care.
Uh, it's a payment model that focuses more on achieving, um,
better outcomes for the patient.
And so, you know, you're looking at different types
of measures, uh, to try to get certain points.
A lot of times the value-based care is connected
with a managed care company in terms of a partner,
and, um, you're really focused on, um, uh, quality of care.
- Wonderful. Thank you so much for giving us that insight.
Um, the discussion mentions the, the challenges in, uh,
transitioning from a fee for service model to value, uh,
value-based model.
Can you elaborate on these challenges
and how healthcare organizations
can address them effectively?
- Yes. Um, so when you, when you think about, um,
transitioning to, um, from a fee for service
to a value-based model, there's some real, um, you know,
serious challenges I think, um,
within traditional mental health centers.
When you think about, um, do you have a, you know,
change in management capacity?
And that's a whole methodology of
how do you move an organization, um, from doing one type
of service and, um, transforming them to a different type
of way of delivering services, as I explained earlier,
from fees, uh, fee for service versus value-based care.
And, um, and that creates some real challenges.
Uh, for instance, like, um, you know,
in traditional models, um, they may not look at claims data
or population health, um, kind of management
where you look at populations.
And a lot of that has to do with another challenge
of not having access to, uh, data.
Um, oftentimes the data is really related to, um, you know,
people served the diagnosis and so forth.
It may not get into, um, data such as claims data,
which a lot of mental health centers may not have access to.
And that's where managed care companies come in
where they can help support that to be able
to provide claims data and a partnership, um,
because that's actionable data.
So if a person, uh, was not, um, taking their medications,
you'll know through the claims data
if they didn't get a refill.
That's a good example for that.
And so there's some other challenges associated with it is
where traditional mental health centers have maybe looked at
just pathology or,
or, um, diagnosis in terms of mental illness,
and they may not look at a whole care approach, uh, to begin
to look at, um, non-medical drivers
or social determinants of health, um, that actually impact,
uh, overall wellness.
- Got it. Got it. Thank you so much for explaining that.
Um, switching over a little bit, the partnership
between the Harris Center
and Optum is highlighted as a very successful example
of collaboration revolutionizing behavioral healthcare, um,
which is absolutely amazing.
What specific strategies
or tools have contributed
to the success of this partnership?
- I think a big part of that is understanding our why and,
and we actually worked with, uh,
Optum on understanding the why.
And, uh, for example, the National Association
of State Mental Health Program directors has some, some
fascinating data out that talks about that people
with s severe
or serious mental illness died 25 years earlier than
the general population.
Um, and two thirds of that premature deaths are due
to preventable, treatable medical conditions
that are underserved
or undertreated by this population, uh, related to, uh,
cardiovascular or infectious diseases.
Diseases. A number
of this population have real challenges also
with like high blood pressure, VMI and so forth.
And so sitting down with, um, with Optum, we were able
to kinda look at some of that data.
Uh, for instance, folks with, um, like arthritis or asthma.
Um, you know, when you look at their annual cost of care,
um, if you add a mental health condition, it, um,
multiplies, um, sometimes triples
in terms of the cost of care.
Um, sometimes the mental health centers may
not even look at that.
And so in our conversations with Optum, we also
recognize that is is a, um, a patient experience challenge.
You know, when you think about having to go to the hospital,
um, where you don't have to go to the hospital, if you sort
of do these kind of upstream models
and looking at social determinants.
So talking with, um, Optum,
they kinda shared with us this model
that actually came from the Affordable Care Act.
Um, it talks about, uh, behavioral health homes.
And so that's kind of the model that we developed with them
of a behavioral health model, um,
through a kind of a health home.
And within the health home we look at
these different measures.
Some of those measures include what we call,
um, HEDIS measures.
Those are healthcare effectiveness data, uh,
and information sets.
And so you look at things like seven day
and 30 day follow up at the hospital, um,
all cause readmissions.
Uh, it means that you do a up upstream kind
of diabetes screening, uh, on people with schizophrenia
and all those kind of things helps us
to improve the overall wellness with the individual.
And, um, so that's been very important for us to, to be able
to have access to data through, uh, through Optum's, uh,
portal that gives us that claims data to see
where people are at in their overall care.
And then we dispatch our care navigators, which we had
to train differently, uh, to be able
to have some actionable data, um,
and actually look at care Pathways
to actually improve that data.
- Got it. Got it. Thank you so much for explaining that.
And you know, you emphasized the importance
of addressing social, um, determinants
of health and value-based care.
Can you share examples of
how this approach has positively impacted
patient outcomes and behavioral health?
- Yeah, so social determinants of health
and in Texas we call 'em non-medical drivers.
Um, there was some research that came out that said that,
um, these factors actually, um, you know,
impact overall wellness
and is one of the main reasons for, uh,
poor health status for folks.
And, and when you think about these drivers of poor health,
these are kind
of everyday kinda lived experiences that we have.
Like for instance, do we have transportation
to go from point A to point B?
Well, you know, folks, um, with poor, um, access
to care, uh, means that they don't meet with their provider,
uh, either primary care or behavioral health.
Um, that means they don't get their medication refills.
That means that their conditions get poor.
Um, also a big area when you look at, um, these determinants
has to do like with food insecurity.
So we found out a lot of our clients, um, don't have access
to, um, high quality food, you know, um,
vegetables and so forth.
And some actually live in food deserts, you know,
where there's only convenience stores that have, um,
you know, food that would has high as sodium
or sugar content in it.
And folks will gain weight, uh, from that.
Well, when you think about taking a psychiatric medication,
um, sometimes those psychotropic medications
actually increase your weight.
Um, you add on top of that sodium
and you know, foods with high sugar content, um,
and then you're gonna actually gain either more weight, um,
or it's gonna affect things like your blood pressure
and, uh, your overall BMI.
And so these types of things that actually have impacted,
um, you know, folks with mental health conditions, it's one
of the reasons why they die earlier than a than
a general population.
And so for us, we wanna be able
to look at a whole care approach,
not just a specialty care approach
of just looking at the diagnosis
or deal with the pathology of mental illness.
- Thank you so much for giving us that insight.
And Doctor, before I let you go, the last thing I wanted
to ask you is looking ahead,
what do you believe are the key steps
and considerations for healthcare providers
and organizations really looking
to fully embrace an integrated health approach
to value-based care, um, in the behavioral health sector?
- Yes, Mariah,
that's a a really good question about looking ahead.
I I believe that, um, yes, to know your why, I,
I think you have to take a step back and as an organization
and look at, do we want to do just specialty care, uh,
knowing that, uh, our population with severe, uh,
mental illness died 25 years, um,
earlier than the general population
because of untreated health conditions,
or you wanna do kind of this whole care approach.
And so that's your why.
And then looking at some of the data
that I had mentioned earlier, um, what it means also is
that you have the capacity for change management.
Are you able to work with your team and identify champions
and create care pathways, um, that are associated with those
ADIs measures and being able to look at, um, the client
satisfaction in terms of are they improving their condition?
Um, do they feel like it's a better situation for them?
Um, in addition to retaining, um, retraining the, um,
the care coordinators, um, you have to have kind of the,
that methodology of looking at data
and being able to make, um, decisions,
clinical decisions based on data, um, associated with,
um, what you're able to get through a,
a portal like we were able to get from, uh, from Optum
to be able to look at are they actually improving?
And then when you identify some of those risks, uh,
are you able to dispatch your team, uh, to begin
to look at things related to health coaching, begin
to address those gaps in social determinants
and lowering those non-medical drivers.
Um, are you able to do kind of
that integrated care management approach, um,
and incorporating a whole care approach to individuals.
- Thank you so much, doctor, for your final thoughts
and for your time today.
This has definitely been an amazing
and informative, informative discussion.
So again, I wanna thank you so much
for coming on Beckers Healthcare
and I look forward to connecting with you again soon.
- Thank you so much. Thank you for having me.
- Yes, absolutely. - It's so important
for leaders at the top of organizations to keep learning,
stay sharp, grow their networks
to help our audience better do this in a more simplified,
personalized, and meaningful way.
Becker's Healthcare has launched my BHC,
it's your trusted Becker's healthcare experience
and more with content, connections, events
and learning opportunities.
Join the community free of charge at
www.my.beckerhospitalreview.com and we'll see you there.