Latest / Becker’s Payer Issues Podcast / The Future of Payer-Provider Collaboration with Dr. Katherine Hobbs

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The Future of Payer-Provider Collaboration with Dr. Katherine Hobbs · Becker’s Payer Issues Podcast

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Hi, everyone. This is Lucas Voss with Becker's
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HealthCare. Thanks so much for tuning in to
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the Becker's HealthCare podcast series, Happy New Year.
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And today, we're joined by doctor Katharine Hopps,
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CEO of AuthorHealth,
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to discuss the evolving dynamics of payer provider
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collaboration
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in health care. Doctor Hobbs, thanks so much
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for being here today. It's great to have
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you.
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Great. I'm I'm excited to be here and
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appreciate this opportunity to to talk further. Yeah.
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Absolutely. We have we have a lot to
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talk about, like you've mentioned, but I wanna
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give folks an idea of of who you
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are. Could you introduce yourself and just give
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us a little bit of your background in
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health care?
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Sure.
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I'm an adult and child psychiatrist, and I've
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worked in basically every setting from inpatient to
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outpatient emergency department, built several integrated behavioral health
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and primary care programs.
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For about the last 15 years, I've worked
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in health insurance,
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And so doing core insurance functions, so behavioral
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health network,
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case management.
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But also always focused on,
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bringing high quality evidence based treatment,
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to people. So doing that through innovative care
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delivery models,
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and also by measuring quality and outcomes and
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really pushing the system to,
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to where we deliver,
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value based payment models as well.
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I joined author health about two and a
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half years ago.
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We focus on,
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treating serious mental illness, substance use disorders, and
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dementia,
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in mainly a Medicare advantage and special needs
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plans populations.
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We deliver health care services,
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and also wraparound services that are community based,
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and we participate in these value based contracts
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as well.
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And that's certainly I think that's a a
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a great pivot too because you have both
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perspectives, which is fantastic, both the insurance side
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and the provider side itself.
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And we know that payment models are very
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quickly evolving. There's new care delivery strategies coming.
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Payor provider collaboration
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is is is really key. They need to
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work together. It needs to happen it needs
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to happen together.
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To get us started here, what opportunities
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do you see for greater collaboration
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as we had into the New Year and
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certainly beyond that as well? And and how
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will this impact patient outcomes and costs?
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Yeah. So especially in in behavioral health, we
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are seeing much greater progress on quality and
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outcome measurement and also,
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transition to value based payment models. And so
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we expect for that, trend to continue.
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Core to that is the importance of of
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integration
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and and data sharing. So there are certain
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sort of information about patients,
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that only health plans have. So things like
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historical health care utilization,
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information about benefits or
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caregivers, etcetera,
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that are actionable
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and really important for a provider to be
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able to deliver high quality care,
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in the community. And so being able to
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deliver those actionable insights using data to providers
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from from from payers
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is a critical
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capability. Additionally, for providers. So,
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in order to participate in value based payment
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models, we need to be able to report
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our outcomes. And there's certain data that only
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we have access to that the payers,
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don't, and that we need to be able
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to aggregate and be able to send back.
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So things like person reported health outcome measures.
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These in these are one of
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the main ways that we measure outcomes in
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behavioral health are things like the PHQ 9
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or GAD 7. These are basically symptom rating
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scales, that we use, to collect data on
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basically the baseline
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symptom burden, but also improvement in those symptoms
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over time.
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Especially as many behavioral health providers are still
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on pen and paper, don't actually have robust
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electronic health record systems. It's really hard to
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collect
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those outcomes and report them to participate in
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value based contracting. And so that support around
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data collection and also data aggregation for your
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patient population,
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and then a scalable
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and,
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systematic way to be able to send those
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outcomes back to payers to participate in a
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value based, payment model is critical,
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in order to do this work well.
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This case, sharing is really caring.
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Correct. Well, you have to be able to
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measure the outcomes. Right? And then once you
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actually do that, you need to be able
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to report it and share that information exactly
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to show that you're actually improving health as
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you deliver care for for patients. Yeah.
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And you've touched on on a couple of
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these factors too that that play into this.
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Right? Patient population, different networks. It's very variable.
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There's
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people measure quality in different ways. That's right.
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Can you share a little bit some of
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the examples that you might have of how
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you're innovating in this space, how you're trying
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to improve this, and and what are some
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of the results that you're seeing?
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Yeah. So so there's 2 major ways that
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that we're innovating. So one,
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is addressing
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many of the barriers to delivering
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a high quality,
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behavioral health care to people. And so what
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I mean by that is, I say this
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all the time. I at at Alder Health,
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we're not inventing a new treatment for serious
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mental illness, substance use disorders. In our field,
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we have treatments that work. I can't give
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you a better treatment than than buprenorphine
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to treat opioid use disorder. Cognitive behavioral therapy
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to treat depression, anxiety, tons of evidence that
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these are effective treatments to improve health and
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keep people in the community,
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and and reduce costs.
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The problem is that these effective treatments don't
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reach people in a timely manner. And so
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what I mean by that, when when people
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need them, they're not able to access these
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services.
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Many people wait months, even years to actually
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access, evidence based care.
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And it's also not delivered in a convenient
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manner. So good example is,
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in person therapy. A lot of times that's
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only offered during working hours. Well, that doesn't
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work for an hourly worker. Right? A person
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receiving sort of hourly wages. Right? They'd have
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to get off work every week, go to
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a therapist.
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And and it's not possible to to do
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that. And so
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using technology,
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using innovative ways that we've developed our care
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team,
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addressing social social issues, so things like transportation,
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housing, etcetera.
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These are all of the barriers that that
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people experience to be able to engage in
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high value care
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that our company is is is working to
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address,
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so that we can actually get these these
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evidence based treatments to people in a convenient
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and a in a scalable manner.
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The other thing that we're doing is is
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changing payment. So I've also said many times
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that fee for service payment breaks behavioral healthcare
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really breaks all of healthcare, but certainly behavioral
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healthcare. And the reason for that is that
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some of the most impactful things we do
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are are are not
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based on a billable visit with a clinician.
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So all those things that we do in
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between those clinic visits. So
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addressing again health related social needs, calling the
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patient to check on, you know, side effects
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of a medication,
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working with caregivers, doing care coordination with other
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providers. A lot of those types of interventions
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are not funded in fee for service and
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therefore are hard to scale.
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And so one of the major ways that
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we're working with payers and insurance companies
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is to move towards more of a population
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based approach. And so we, we work with
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payers to identify
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a patient population with serious mental illness, substance
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use disorder in the geographies where we're live.
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We receive
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prospective payments to manage
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the health and the social needs
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of this patient population. And then we go
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at up and downside risk
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and have to report on quality
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to show that we're actually helping this patient
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population get better, and that we're managing the
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costs through the clinical treatment and the social
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services that our that our company provides. And
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that is a very different I I know
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that this is, sort of,
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old hat, and the rest of health care
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is very new,
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in behavioral health. And and
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and I'm so grateful to
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payers,
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providers
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that are really coming together and thinking
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on how how we build these models and
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how we actually deploy them and and and
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deliver them at scale. Because I really think
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that's a key piece to transforming overall,
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health care for people with behavioral health conditions.
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Yeah. And that in conjunction, as you mentioned,
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sort of with that holistic look at care
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and being able to integrate everything into each
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other so that there's a a picture that
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is created that encompasses
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everything, not just pieces here and there that
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that are important. And and I think especially
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for for value based models and and value
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based care, this
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is incredibly important. And and one of the
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things that you've you've noted at at our
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payer issues roundtable and almost quoting you exactly
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here. Right? Untapped potential
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in value based payment models. That's really what
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you're seeing. You're seeing untapped potential there,
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and the importance of, as you've said, fully
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integrating mental health services like you've talked about.
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How can organizations
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successfully transition to value based models and and
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really meet these standards, these aims that that,
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would make a difference potentially,
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and what strategies would you highlight there?
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Yeah. So number 1 is is integrating payment.
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And so what I mean by that is
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currently today and and over the last several
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decades,
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in general,
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payment and management of physical health services is
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done separately from behavioral health services. So a
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lot of times the behavioral health payment and
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management is carved out to a separate organization
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that manages it, you know, apart from physical
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health. What we know is that people with
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behavioral health conditions and especially people with more
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severe and complex illness, almost all of them
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have co occurring physical health,
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chronic medical conditions. So things like diabetes, cardiovascular
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disease, COPD.
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And when you separate out the payment and
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the management of their behavioral health conditions separate
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from their physical health, it leads to misaligned
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incentives. And it also
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leads to substantial
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lack of coordination
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in the in the care that that's being
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provided.
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And so number 1 is to
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stop creating that division and figure out how
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to integrate. And to be clear, behavioral health
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card companies
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absolutely
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can integrate payment. And so we did that
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at Blue Cross, North Carolina, where I worked
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before at United and Optum.
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So even at places where you have carve
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outs, you can still work with providers to,
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pay them,
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from sort of like a single source for
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their for for delivery of integrated behavioral health
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and and physical health services. And also hold
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them accountable for,
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integrated quality measures. So hold behavioral health providers
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accountable for diabetes management,
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and other medical conditions. And similarly, hold PCPs
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and hospital systems accountable for screening and treatment
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of depression. That's totally appropriate for them to
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be doing. And then similarly hold each group
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accountable for total,
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costs
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and and MLR.
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And so examples where we've done that really
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well was this was more when I was
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on the payer side.
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We work we had robust
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ACO contracts where,
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we made sure that the ACO that that
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the behavioral health payment was also included in
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the delegated risk to these ACOs.
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And then additionally, like I said, we put
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in,
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behavioral health quality measures to incentivize them to
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address things like depression. So screen for depression,
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treat treat depression, and then also held them
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accountable for the for the total cost of
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care, including the behavioral health spend as well.
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Similarly, author and other providers like us,
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we we partner really closely with primary care
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groups. Many providers like us also deliver what
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we call reverse integration.
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So primary care services delivered from a behavioral
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health home. Very similarly,
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you know, insurance companies can pay those behavioral
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health providers for both the physical and the
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behavioral health services, and then hold them accountable
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for the physical health quality measures and the
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total cost of care. But it really, though,
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starts with integrating the payment and the management
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with which then flows downstream
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to how providers are incentivized to deliver that
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care and and really,
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treat patients holistically and and and and improve,
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population health, across the full spectrum of physical
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and behavioral health care.
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Certainly, the integration that you've mentioned is is
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is a big piece to this, like you
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said. You you've mentioned accountability
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quite a bit in this. Right? And and
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and I feel like to be accountable,
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you have to have something to go back
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on. You have to have data. You have
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to have information that you can use. You
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have to have some sort of system that
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that gives you an idea, okay, where is
12:33
my accountability at? And and one of the
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things that you've talked about, previously at our
12:38
page, Shus Ron Teo, which I think is
12:39
is very important, is the and and our
12:42
conversation today is the challenge that a lot
12:44
of these folks, like you said, pen and
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paper. Right? Yeah. EHR capabilities just aren't there.
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There is a system, but it might not
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be great. Right?
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It just makes it hard. It makes it
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incredibly hard to collect data, measure outcomes, what's
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the quality, where's the accountability. Right? Can you
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touch a little bit on how you support
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these providers in in creating that efficiency and
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being able to say, okay. We can help
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you, especially from from a from from a
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data collection perspective and and also from a
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systems perspective.
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Sure. Yeah. And and the fact is, you
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know, many behavioral providers were were left out
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of meaningful use support and the high-tech act.
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And so
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we
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need to find a way to go back
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and increase that support for behavioral health providers
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to move from
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pen and paper, more analog approaches to to
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data informed and tech tech enabled approaches.
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And we'll see that transition very similarly to
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how we saw the transition over the last
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several decades with that support in the rest
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of health care
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At different payers where I've worked, we have
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delivered, like, direct support for that kind for
13:53
for technology. So we've,
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you know, worked with different technology companies that
13:58
are, measuring and reporting outcomes. We provided funding,
14:01
to support providers to actually, move to
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EHRs and other electronic support. It's critical. It's
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a, it's a, it's a core foundational
14:11
capability that's required to participate in value based
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arrangements. And so if we really want to
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move the behavioral health system to a value
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based approach, we have to figure out how
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to support providers to make that transition,
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to use more technology.
14:24
Yeah. It has been a must for for
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many, many years, and it certainly will remain
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a must in 2025
14:30
and beyond, I think.
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Looking ahead to to this year certainly and
14:34
then and then beyond as well, what are
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some of the most significant changes in in
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how payers and providers
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work together? What are you seeing, ahead here
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for the future? And and how should
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systems how should leaders
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prepare now, today? Yeah. You know, one thing
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that's been delightful,
14:53
over the last 1 to 2 years at
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various conferences and also as as our company
14:58
is working with with insurance companies,
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there's an acceptance that we have to measure
15:02
quality. We have to report quality.
15:05
And there's,
15:07
there's real progress being made on delivering and
15:10
participating in in value based payment models. We
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did not see that even 2 3 years
15:15
ago. So there's been major progress made made
15:17
in that way. So and I expect that
15:19
to continue.
15:20
The other is technology. So we had a
15:22
huge and rapid and important transition to telehealth
15:26
and tech enabled
15:27
services during covet that was necessary.
15:31
And while we've had, you know, some movement
15:34
back to in person services, we are still,
15:36
you know, light years beyond, where we were
15:39
pre COVID in terms of the integration of
15:41
technology, and I expect that to continue. It's
15:44
it's made a substantial difference in terms of
15:46
access to care, really overcoming a lot of
15:48
the barriers that I talked about earlier in
15:50
terms of convenience for people. It's overcoming transportation
15:54
issues, things like that, so that we can
15:56
actually deliver this high quality
15:58
evidence based care with fidelity. That's the other
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really important with fidelity to the to the
16:02
evidence based model. Through technology, we're able to
16:05
get those services to people,
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in a more sustainable and efficient manner.
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And addressing one of the most important issues
16:12
in health care across the country, I think,
16:15
for the future. I believe that what not
16:17
only within health care, but also for our
16:19
society. And you see it Yes. It's through
16:20
everything, through employment, through
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education,
16:24
in our in our justice system. You know,
16:26
behavioral health has has major impacts on all
16:29
aspects of our society.
16:31
And so we have to figure out a
16:33
way to pull these pieces together
16:35
and also overcome, you know, limited workforce and
16:38
and and figure out how to deliver these
16:40
services at scale so that so that people
16:42
can actually engage in them and and and
16:44
reach a quality of life and a function
16:45
that's meaningful for them.
16:47
Absolutely. Doctor Hobbs, this was a delightful conversation.
16:49
Thanks so much for taking the time today.
16:51
Great great insights. Thank you.
16:53
Yeah. Great to talk with you, and thank
16:54
you so much for the opportunity to speak
16:56
together. Absolute absolutely. And we also want to
16:59
thank our podcast sponsor, Author Health, and you
17:01
can tune in to more podcasts from Becker's
17:03
Health Care by visiting our podcast page at
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beckershospitalreview.com.