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Solving Behavioral Health’s Access Problem at Scale · Becker's Healthcare Behavioral Health

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  Hi, everyone. This is Brian Zimmerman with Becker's
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  Healthcare. Thank you so much for tuning into
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  the Becker's Healthcare podcast.
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  Today, we're going to talk about solving behavioral
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  health access problem at scale.
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  Joining me for today's discussion is Sandeep Archarya,
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  CEO and founder at Oktiv.
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  Sandeep, thank you so much for being here.
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  Thanks for having me.
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  Excellent. And and and to get started here,
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  can can you sort of introduce yourself more
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  fully and and sort of walk us through,
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  I guess, what you saw broken in the
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  behavioral health system
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  and how that founding vision has helped shape
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  the work you're doing today,
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  the growth at Octave and everything everything else
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  you've been up to. Can you give us
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  some background there? First off, thanks for having
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  me, Brian. I founded Octave Health eight years
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  ago, but I've been working in the health
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  care industry for about fifteen years.
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  First as an investor, then as an executive
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  at the primary care group, one medical.
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  And as a result, I've gotten to see
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  the mental health system, not just for myself
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  and loved ones, but also professionally, just to
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  think about how the system works.
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  Our mission at Octave has been simple. We're
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  trying to use better health mental health matching
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  to improve mental health outcomes.
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  We started off with care delivery, but we
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  realized quickly that you can't improve outcomes unless
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  you start solving infrastructure problems and not just
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  improve the network.
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  What we've learned is
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  that as an industry, I think we've done
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  a good job of destigmatizing care. Stigma at
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  this point is overrated as a barrier to
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  accessing good high quality mental health care.
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  What we've realized is that people don't access
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  care. They can't access care, not because they
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  don't want to access care,
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  but they are failed by a system that
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  sometimes guides them in an outdated,
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  and unclear fashion like the yellow pages. We've
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  modernized care. There's a lot of places people
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  can go to find care,
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  but we haven't modernized the process of actually
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  stepping into that care.
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  Today,
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  the front door to mental health is often
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  just a static directory. Nearly forty percent of
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  people begin their mental health journey inside their
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  health plan directory. That's where they start.
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  And and what they're presented with is often,
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  a series of lists of names that are
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  outdated and hard to follow through on. So
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  if the system can't guide people to care
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  properly, it doesn't matter how strong the network,
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  how many providers there are. It becomes very
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  challenging for people to find care.
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  Yeah. I wanna dig in on that and
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  sort of the the stigma
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  component as well because I I've seen a
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  change just in my time as sort of
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  a a health care journalist just
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  how much more attention is being paid to
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  behavioral health, at least in conversations.
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  But then there are still so many barriers
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  to your point, Sandeep,
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  about sort of just dated processes and infrastructure.
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  Clearly,
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  a big challenge with that that 40% of
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  people you mentioned beginning their search for mental
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  health care and inside those directories with it,
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  anyone who's looked at those things can get
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  confused by them, even somebody who's close to
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  health care. Right? I I guess my question
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  for you, what does that failed first interaction
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  cost patients?
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  And why is this such a hard problem
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  to solve when, to your point, like, stigma
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  isn't as big of a barrier as it
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  once was, but still,
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  with the we can't seem to get rid
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  of these challenges, these these barriers to access,
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  Sandeep.
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  Yeah. I mean, one of the one of
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  the terms you hear when people talk about
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  barriers to access is what folks call ghost
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  networks. And that's the idea that no matter
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  what,
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  you tried to do, with your insurance plan,
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  it's often hard to find a provider.
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  And ghost networks have been on the attention,
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  of state and federal lawmakers,
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  but this doesn't necessarily have to be the
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  case. There's actually a number of providers who
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  accept insurance. But the problem is when people
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  access their directories, their directories weren't meant to
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  be real time appointment systems. They're built for
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  compliance.
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  So the plans that are, operating with these
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  so called ghost networks,
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  often have available providers. It's just they don't
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  have a means for the patients to find
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  them. So for instance,
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  if there's a thousand providers in a network
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  directory
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  and the first a 100 are not available,
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  which often can be the case,
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  patients might easily give up.
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  And so when they reach those dead ends,
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  it can frustrate patients. I saw a good
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  friend of mine who didn't access care, couldn't
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  find the right therapist for him when he
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  was going through a difficult and traumatic situation.
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  And he didn't delay care for a month.
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  He delayed care for seven years.
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  And he was navigating a substance use problem.
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  And as a diabetic, it was very, very
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  challenging for his health.
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  And so it was really difficult to watch
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  the human toll it took on him. But
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  also, as someone who works in the health
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  care system,
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  the impact when he was able to access
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  care was much higher care than it would
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  have been had we handled it early.
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  So I think between the fines for noncompliance,
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  the the pressure from employers, the desire to
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  get a greater control of spend, plans are
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  more and more taking a big bigger role
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  in helping get folks into care.
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  I appreciate you sharing that that that that
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  personal story, Sandeep, because
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  it's it's so
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  it's so it's such
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  a struggle when you think about the implications
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  for for mental health. Like, this is this
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  implications across health care. Right? Like, across someone's
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  entire health, these two things aren't separate. Correct,
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  Sandeep?
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  Absolutely. I mean, for this particular friend, you
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  know, as a type one diabetic,
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  you could really harp on his a one
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  c's, but if you don't understand the trauma
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  some of the trauma traumatic experiences he's dealing
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  with, you really can't help.
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  And I saw that with a close friend,
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  and and we see it across the system.
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  There's so much that goes on between patients,
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  in their behavioral health journey that ties into
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  how they handle their own medical care.
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  For sure. And so your your approach to
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  fixing this was to build technology that that
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  integrates
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  across health plans, EHRs, provider groups simultaneously.
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  Can you explain how and it's wise match,
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  correct, why that works and and why a
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  platform approach is really critical to solving this
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  challenge? You can't solve it by
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  perhaps putting one thing on one health plan,
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  one thing on one EHR, like, you need
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  this sort of integrated data. Right? First, we
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  have to acknowledge why this problem has been
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  hard to to solve.
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  There is not one technology system that people
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  access. Every single payer has a different system.
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  Every single provider has a different scheduling system.
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  And so there's this tragedy of the commons.
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  Everyone needs a common set of scheduling rails,
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  but no individual can provide it. So think,
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  if your local Blue wants you to conform
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  to a single scheduling system, that might be
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  burdensome to you if you have to do
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  a different one for every single payer. And
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  for the payers, if they wanna try to
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  get the providers in their network to to
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  list common available appointments, it's very, very challenging
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  to have individual providers have different systems. And
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  so what we did was we got multiple
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  platforms together. We said, look. We've gotta solve
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  this problem by coming together. And what we
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  did was we brought real time availability for
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  multiple systems
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  into one shared system that we could then
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  distribute to payers
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  across the country. And so the impact is
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  real. What used to be Yellow Pages, a
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  Yellow Page like experience of calling providers one
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  by one and getting frustrated when they're not
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  available is an OpenTable like experience. And for
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  for those of you that are not familiar,
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  OpenTable is a restaurant booking system that you
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  can use to book an appointment at your
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  favorite restaurant. In a similar fashion, you can
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  log in to your plan directory
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  and not see all thousand providers,
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  but instead see the 50 or a 100
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  that are relevant for your given condition. And
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  so instead of reaching a dead end for
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  patients, WiseMatch lets you book an in network
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  provider
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  and,
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  and one that suits your needs instantly.
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  It wouldn't have been possible, frankly, without partnership
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  across the board, and this is an example
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  of why infrastructure matters. And I and I
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  tend to geek out about infrastructure. Can I
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  share with you a metaphor that I think
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  brings it home for me? Please do. Please
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  do.
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  So
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  American railroads
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  in the eighteen hundreds used to have different
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  sized tracks, believe it or not. You know,
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  you go to the American South, one state
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  had a different sized track than another. Did
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  you know that, Brian? I did I I
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  did not, but I am, picturing some logistical
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  nightmares now. Exactly. You used to have to
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  unload a train
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  from one track and then load all the
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  cargo on the next train until 1886
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  when folks got fed up and they said,
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  we gotta have the same size rails.
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  And that day,
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  productivity as, in the country must have skyrocketed
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  because it suddenly became
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  possible
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  to,
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  send
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  freight across the country. And in the same
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  way, having a similar set of scheduling rails
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  that work across systems can add a lot
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  of value to accessing care. And not only
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  that, allow
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  insurance companies to get a a stronger relationship
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  with providers and pro providers, frankly, to deal
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  with less friction in in making sure that
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  their their caseloads are full, that they're able
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  to see the kind of patient mix that
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  is appropriate for them.
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  And so this is an example of how
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  infrastructure can be very insidious. It can be
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  ignored,
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  but often really powerful when you address it.
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  I had never heard that, Sandeep, and I
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  I will confess that I am stealing that
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  in some capacity.
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  Appreciate appreciate that. And and, you know, if
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  we can do it with railroad tracks and
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  freight, we ought to be able to do
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  it with health data too. And and you
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  built WiseMatch
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  as an open platform as you were discussing,
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  bringing all those partners and including some partners
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  that would, you know, traditionally be considered competitors.
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  I wonder how you think about that in
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  terms of what does that level of collaboration
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  suggest about where behavioral health infrastructure really needs
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  to go and how it's going to get
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  there. You know? No one's gonna be able
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  to do this alone,
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  but but curious to hear you elaborate on
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  that. Well, first off, I mean, to me,
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  it it was a litmus test. I think
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  I'm fortunate in to work in an industry,
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  in the behavioral health industry, where
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  to a person, it just feels like the
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  leaders that we have in our industry are
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  very mission oriented. They don't just wanna build
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  big and successful companies. They wanna make a
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  difference.
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  And I think the proof of that is
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  that when a direct competitor approached many of
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  them and said, hey. Can we work together?
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  Folks were excited, and there was there was
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  very little resistance, and there was a shared
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  desire to see a problem be solved. I
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  think that's the difference.
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  Folks just wanna see a problem be solved.
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  And there was a recognition that no single
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  organization can fix access alone and that we've
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  gotta work together.
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  And so,
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  we're fortunate. The the partners that we're working
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  with collectively represent tens and into the hundreds
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  of thousands of providers, and that's how you
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  get real coverage.
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  So,
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  I think that that lead needs to continue.
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  That momentum needs to continue. In order for
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  us to solve,
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  problems about how we improve value and get
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  better outcomes, which payers are increasingly demanding
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  as they see and they notice
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  more and more spend going to behavioral health
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  care,
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  we think the best way that can operate
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  is not by everyone trying to outcompete themselves
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  with point solutions, but by coming together into
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  a cohesive ecosystem
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  that makes it easier for payers to navigate,
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  patients to navigate, providers to navigate.
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  And I think we've got a great start
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  with what we've done so far with WiseMatch.
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  Yeah. And there seems to also be, like,
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  a true
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  desire and and push towards accountability here in
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  terms of people fixing this access challenge from
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  both the regulation side of things and employer
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  side of things and, of course, patients want
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  it too. And, you know, when you get
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  go back to talking about
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  how difficult the experience can be for patients,
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  that doesn't just prevent a patient from seeking
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  care that day. It can erode trust in
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  the general health care system.
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  So I guess, how do you see the
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  next few years playing out? And what role
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  do platforms like WiseMatch
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  play in sort of rebuilding that trust
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  in behavioral health access and driving that accountability?
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  Yeah. And when you talk about accountability, there's
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  accountability to different folks. Two two that I
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  wanna highlight that we haven't talked about a
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  ton. One is employers who've been demanding that
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  behavioral health networks more and more have,
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  solutions or ability to support their members. But
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  the second is regulators. I I I briefly
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  touched on this, but there have been multimillion
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  dollar fines to payers across the country being
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  handed out by different states. Most recently, Emblem
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  in New York was fined over $2,000,000
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  by, state attorney general Leticia James.
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  And and there is an ongoing desire for
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  state and federal governments to keep track of
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  whether, networks are adequate or whether they are,
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  as they term them, ghost networks.
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  And so that accountability is challenging
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  when you don't have tools for measurement. Right?
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  So one of the things you hear is
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  that they're being measured on some staffer is
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  calling down these these lists and seeing who's
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  available
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  as as one example.
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  Another one is you hear about proxies. Right?
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  How many providers in a given ZIP code?
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  But what I think is so interesting is
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  with the availability,
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  the ability of data
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  to actually track how many appointments are available,
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  we go from guessing to delivering. Right? And
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  so I've heard payers say, hey. We've got
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  a great network, but we're gonna fail this
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  adequacy measure not because we don't have adequate
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  networks but because the measure is broken. Well,
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  here's an opportunity
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  to both allow payers to demonstrate compliance
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  and allow regulators to be effective at holding
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  folks accountable and employers to see the value
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  they're getting from it. And that's why I've
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  I've seen excitement from the the few state
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  and federal regulators that we've been able to
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  speak to is part of this process. We've
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  spoken with state, offices. We've spoken with senators
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  and senators' offices, and they're all very excited
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  about what they feel is a practical solution.
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  And I think the key
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  is that by doing this, by offering this
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  solution, there's an opportunity to regain trust.
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  What happens when a patient can't access care
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  is they lose trust, that their plan can
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  support them in a time of need. And
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  I think that's an important thing to be
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  able to rebuild to something like this. Yep.
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  And it comes back to, you know, the
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  the the personal story you shared too.
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  If if that person was able to get
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  care when he when he needed, you know,
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  maybe the the higher acuity care he had
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  to seek later on wouldn't be an issue.
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  Yeah. Absolutely.
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  Sandeep, it's been a pleasure speaking with you
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  today. Thank you so much for coming on
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  the podcast.
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  Thank you for having me.
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  We also wanna thank our podcast sponsor, Octave.
• 13:50
  You can tune in to more podcasts from
• 13:51
  Becker's Healthcare by visiting our podcast page at
• 13:54
  beckershospitalreview.com.