Latest / Becker's Healthcare Behavioral Health / Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health

Transcript

Caroline Carney, President of Behavioral Health and Chief Medical Officer at Magellan Health · Becker's Healthcare Behavioral Health

• 0:00
  - This is Laura Deida with the Becker's Healthcare Podcast.
• 0:03
  I'm thrilled today to be joined by Dr.
• 0:05
  Caroline Kearney, president of Behavioral Health
• 0:07
  and Chief Medical Officer at Magellan Health.
• 0:09
  Dr. Kearney, it's a pleasure
• 0:10
  to have you on the podcast today.
• 0:12
  - Thank you so much. It's terrific to be here.
• 0:16
  - Now, I know we've got a lot to talk about
• 0:17
  and there's some really exciting things happening at
• 0:19
  Magellan right now, but
• 0:21
  before we dive into our discussion,
• 0:22
  can you tell me a little bit more
• 0:23
  about yourself and your background?
• 0:26
  - Absolutely. Um, it's a long story,
• 0:28
  but I'll, I'll make it short by training.
• 0:32
  I am a board certified internal medicine doctor,
• 0:35
  a board certified psychiatrist,
• 0:37
  and I have another board in consultation, liaison,
• 0:40
  psychiatry, which is the kind of work of psychiatry,
• 0:44
  working in typically a medical setting
• 0:47
  or working with patients who might identify as medical,
• 0:50
  like someone say who has cancer or HIV aids,
• 0:54
  or even someone who has delirium from an underlying
• 0:59
  surgical, uh, procedure or infection.
• 1:02
  And I've spent the bulk
• 1:03
  of my clinical career working in that setting.
• 1:07
  I left, uh, full-time clinical care
• 1:10
  and academic medicine
• 1:12
  to pursue work full-time in administrative medicine,
• 1:16
  starting as the Chief medical officer
• 1:18
  for Indiana's Medicaid program.
• 1:21
  And I followed that with working at a regional
• 1:25
  and then national health plans before coming to Magellan.
• 1:29
  While I've been at Magellan, I was the SVP
• 1:32
  for behavioral health.
• 1:34
  I became the Chief Medical Officer
• 1:36
  for Magellan RX Management.
• 1:39
  I did that because I thought it was really important to know
• 1:43
  and understand the language that the PBM world speaks.
• 1:47
  It's, um, often set aside from the rest of healthcare,
• 1:52
  and I think it's critical we bring that together.
• 1:55
  And then a few years ago, I was asked
• 1:57
  to be chief medical officer of the company
• 2:00
  and then president of the company.
• 2:03
  So it's been a great journey at Magellan.
• 2:06
  Uh, I've loved, loved it all the while,
• 2:08
  and we have really transformed the company from being one
• 2:13
  that is utilization management heavy to one
• 2:16
  that is clinical program heavy,
• 2:19
  and that, uh, that's really a joy to be able
• 2:23
  to work with the kinds of people at Magellan
• 2:26
  and all of our partners out there who want
• 2:29
  to push forward the best kind of behavioral health programs
• 2:33
  or integrated medical behavioral programs.
• 2:38
  - Well, that's great to hear, and certainly, you know,
• 2:41
  amazing to think about all the different experiences you
• 2:44
  have now wrapped into your role at Magellan Health.
• 2:47
  What are some of the biggest issues
• 2:48
  that you're following right now in healthcare?
• 2:50
  What's top of mind for you?
• 2:53
  - What remains top of mind for me continues
• 2:56
  to be the concerns around access
• 2:59
  and availability of care to individuals who need it.
• 3:03
  We still are seeing increasing numbers of, um,
• 3:07
  people coming into care for the first time.
• 3:09
  That's a phrase known as penetration.
• 3:12
  So penetration still continues an upward climb.
• 3:16
  I think that's incredible
• 3:18
  because what it tells me is
• 3:20
  that we're seeing a reduction in stigma against mental
• 3:24
  health, that people who may not have come into care
• 3:27
  before now feel like they can come into care,
• 3:31
  that there's not a barrier of someone thinking you're weak
• 3:35
  or you know, that you shouldn't
• 3:37
  need those kinds of services.
• 3:39
  So I think it's an incredible change
• 3:42
  that we're seeing in the industry.
• 3:44
  The challenge is, is that we haven't grown enough providers
• 3:48
  to meet the demand.
• 3:50
  And so as we were heading into the Nader
• 3:54
  of not having enough behavioral health providers in the
• 3:57
  country, that was expected to be at a low point in 2025,
• 4:02
  that difference is even greater now, given all of the people
• 4:07
  who are raising their hand, um, saying that they need help.
• 4:10
  So that's really top of mind issue for me
• 4:13
  and how we creatively solve that.
• 4:16
  The second issue is quality of care.
• 4:19
  So we can throw a lot of people at delivering care,
• 4:24
  but will the care be number one,
• 4:25
  the right care that they need?
• 4:27
  And number two, will it deliver the right kind of outcome?
• 4:32
  One of the things that I've seen during the course
• 4:35
  of the pandemic and following the pandemic is a lot
• 4:40
  of entrance into the market of services
• 4:43
  that are either high cost or high tech,
• 4:47
  but not necessarily services that are leading to
• 4:52
  improved outcomes where people stay out of the hospital
• 4:56
  and stay out of the emergency room
• 4:59
  and get normal courses of treatment for therapy instead of
• 5:04
  months to years long courses of therapy.
• 5:08
  And so quality of care is really top
• 5:11
  of mind as well.
• 5:15
  - That's fascinating to hear and
• 5:16
  and certainly appreciate, you know, those points
• 5:19
  that you made in terms of access to health, making sure
• 5:22
  that people continue, continue
• 5:24
  to access mental health care in,
• 5:25
  in breaking down the barriers of the stigma as well
• 5:28
  as having those providers available and in place.
• 5:31
  And, um, then too,
• 5:32
  I I really appreciate you talking the quality of care
• 5:35
  and being able to look at, um,
• 5:37
  what you know will really improve outcomes
• 5:39
  and be beneficial for communities.
• 5:41
  I can imagine it's not a one size fits all, um, situation,
• 5:44
  but really being able to, uh, under better understand that,
• 5:48
  um, can make a really big difference in the future.
• 5:52
  - I really think so. And I think what what we see is
• 5:56
  if an individual is wealthy enough, they can
• 6:00
  pay cash today to see
• 6:04
  what might be the best therapists.
• 6:06
  If you know, and I'm using best in air quotes,
• 6:08
  but those who refuse
• 6:09
  to participate in the public mental health system
• 6:12
  or in the insured me mental health system.
• 6:16
  Um, and so
• 6:18
  what happens is we then have lower level licenses left
• 6:23
  to see individuals say in the public mental health system.
• 6:27
  And to me, that's not equality for all that, that means
• 6:31
  that the system is really catering in different parts of it
• 6:36
  to different levels of income
• 6:38
  or individuals
• 6:39
  who may be suffering from diff different
• 6:43
  social determinants of health.
• 6:45
  So I would really love to see a system where we were able to
• 6:49
  align the presentation that the presenting needs that
• 6:54
  that individual had with the right level of care
• 6:58
  and the right type of care, whether that was therapy,
• 7:03
  whether that was coaching, whether that was a digital tool
• 7:07
  all the way to, um, inpatient need
• 7:12
  or residential need.
• 7:13
  Um, I think that when there's so much direct to consumer
• 7:20
  advertising, what we see is a shift toward higher levels
• 7:24
  of care that may not be necessary.
• 7:27
  And in behavioral health, there's always been the dynamic
• 7:31
  that, um, community-based tenure,
• 7:34
  meaning living in the community, living in your home
• 7:38
  is the goal that you don't want
• 7:40
  to keep people institutionalized
• 7:42
  and in hospitals for longer than they need to be.
• 7:46
  And so getting that balance right is really critical,
• 7:51
  especially at a time when there are entrants into the market
• 7:55
  who want nothing more than to make money from high levels
• 7:58
  of care, from delivering higher levels of care.
• 8:02
  So it's a really important balance.
• 8:04
  We need more providers,
• 8:06
  we need those entrants into the market,
• 8:08
  but I think as a country, we need to align around
• 8:12
  what those services are, what they should look like,
• 8:15
  and how we get people to the right level of care.
• 8:19
  I'll give an example. If I use up all
• 8:22
  of the therapy spots with l LCSW
• 8:27
  and psychologists with people who could get better
• 8:32
  with coaching or could get better
• 8:34
  with short-term problem focused therapy,
• 8:38
  then there won't be any spots left for persons with moderate
• 8:41
  to severe mental illness who really need
• 8:44
  those levels of care.
• 8:46
  And so it's, it's that tension between getting
• 8:50
  the right level of care for people when they need it.
• 8:54
  And right now, if there's no availability,
• 8:57
  it's a real challenge to do that.
• 9:01
  - That's such a great point,
• 9:02
  and certainly, you know, a, a huge issue I can imagine
• 9:05
  for a lot of different communities
• 9:07
  and something that nationally I,
• 9:09
  I know that we're grappling with.
• 9:11
  Now, in looking ahead,
• 9:13
  what are you most excited about and what makes you nervous?
• 9:17
  - Um, I actually am most excited about
• 9:20
  promulgating the collaborative care model.
• 9:23
  It's a model that we are rolling out, uh,
• 9:26
  to organizations at Magellan.
• 9:29
  It's one of those best practice clinical models.
• 9:32
  Uh, collaborative care has an evidence base of 80 plus
• 9:37
  clinical trials showing, uh, higher quality
• 9:40
  and better cost savings for individuals
• 9:44
  if their care is measurement informed
• 9:47
  and started in the primary care setting as opposed
• 9:50
  to waiting for individuals who become so ill
• 9:54
  that they end up landing in an emergency department
• 9:57
  or in a hospital.
• 10:00
  So collaborative care is a terrific model
• 10:03
  that involves the triad of the primary care
• 10:07
  or the medical provider, uh, care manager
• 10:11
  who is fully dedicated to that group of patients coming
• 10:15
  through primary care
• 10:17
  and a psychiatrist who sits in the background helping
• 10:20
  to quarterback how the patients are treated
• 10:24
  based on the information gathered from the care manager
• 10:28
  and subsequent scores on standardized scales
• 10:32
  that will help guide and direct what we do next.
• 10:37
  So for instance, if I have someone who comes in
• 10:40
  and they score that they have mild depression
• 10:45
  and um, they do need services,
• 10:48
  the psychiatrist would recommend,
• 10:50
  let's start them on short-term therapy.
• 10:53
  First, let's give this a try. It's mild depression.
• 10:56
  They, they don't need a medication, let's do this first.
• 11:00
  And then if I assess them four weeks later
• 11:03
  or six weeks later after a course of treatment
• 11:06
  and they're getting worse, the case would go back
• 11:09
  to the psychiatrist who would say, okay,
• 11:11
  now therapy isn't working.
• 11:13
  The person's gone to therapy. They've tried therapy.
• 11:16
  Their symptoms are worsening.
• 11:18
  Now is maybe the time we need medication.
• 11:21
  In a normal course of settings, a person would go off
• 11:26
  to therapy and then be lost.
• 11:28
  They would come back to their primary care provider
• 11:31
  at some point in time.
• 11:33
  Um, they wouldn't necessarily be screened again to know
• 11:38
  how they were doing if they were better, the same or worse.
• 11:41
  And so collaborative care starts on a population level
• 11:45
  of assessing all the individuals in that practice
• 11:49
  and identifying
• 11:50
  and focusing on helping getting those who need care,
• 11:54
  the right level of care,
• 11:56
  and changing that care more rapidly over time, depending on
• 12:01
  how they are scoring on the outcomes
• 12:05
  that are important to them.
• 12:07
  Often measured by scales
• 12:09
  or measured by the kinds of things that they want
• 12:11
  to achieve, focused on their own goals
• 12:15
  and their own, their own outcomes.
• 12:18
  So it's a really terrific model.
• 12:20
  It works in primary care settings.
• 12:22
  It works in other medical settings.
• 12:24
  Um, and it's one that I, I really believe in.
• 12:29
  I think the second thing that we're going
• 12:32
  to see in the field is a move toward trying
• 12:37
  to do triage to get individuals
• 12:39
  who could benefit from coaching
• 12:42
  or short-term therapy, short-term problem focused therapy,
• 12:45
  those kind of tools so that individuals who do need
• 12:50
  that longer term higher level therapy
• 12:53
  and medication management have availability of providers
• 12:56
  to deliver those services.
• 12:58
  So I hope that that's the shift we see.
• 13:00
  We're really promoting that at Magellan.
• 13:03
  And I, I think it's really terrific On the way far out,
• 13:08
  I'm really curious to see where we're going to land in areas
• 13:13
  of personalized medicine for behavioral health, whether
• 13:17
  that is in using, uh, functional MRI
• 13:21
  or genetic testing, uh, a variety of sorts for
• 13:27
  diagnosing or at least helping to diagnose
• 13:31
  and follow up treatment of illness.
• 13:34
  Those kinds of things are known as biomarkers typically.
• 13:38
  And there is a lot of research being done in this field.
• 13:42
  There's been a lot done
• 13:43
  for years without finding any certain biomarkers,
• 13:47
  but I think we're getting closer as a, as a field every day
• 13:52
  to figuring out what's the biology behind this
• 13:56
  that we could use to help better diagnose what someone may
• 14:01
  or may not have so we can then better tailor treatments
• 14:05
  to those individuals.
• 14:07
  So I think that still is a ways out there,
• 14:10
  but, um, something really exciting
• 14:12
  and something we need to keep our eyes on.
• 14:16
  - Absolutely. That's great to hear.
• 14:17
  And certainly, you know, love the idea of being able to, um,
• 14:21
  just really have that more, um, comprehensive care in,
• 14:25
  in being able to, um, you know, have that triage in,
• 14:29
  in beneficial collaborative processes between the
• 14:33
  clinical care models and different specialists and,
• 14:35
  and having it in the right setting.
• 14:36
  Thank you so much for explaining that to us.
• 14:39
  Um, and, and then too, you know, when you look ahead,
• 14:42
  where do you see as being important
• 14:44
  for the most effective healthcare leaders
• 14:46
  to succeed in the next two to three years or so?
• 14:50
  - I think it's the same traits
• 14:51
  that the most effective have had, um, over the years at,
• 14:55
  at least in, in my opinion.
• 14:58
  I think the first is you have to listen.
• 15:00
  You have to listen to what's happening coming out of
• 15:04
  Congress and the federal, you know,
• 15:05
  the federal government in terms of funding,
• 15:07
  whether it's congress or agencies.
• 15:10
  You have to listen to what your frontline workers are
• 15:12
  telling you about what they're seeing.
• 15:15
  You have to listen if you have the ability to, to
• 15:18
  what it's like to set in, uh,
• 15:21
  to go into the healthcare system to see what people struggle
• 15:24
  with when they go to try to get care.
• 15:28
  And it sometimes is just ludicrous.
• 15:31
  Um, you have to listen
• 15:33
  and there are all kinds of points that tell, you know,
• 15:36
  should tell a leader where to look so
• 15:39
  that when they are making decisions,
• 15:41
  when they are creating new programs,
• 15:43
  when they are writing new policy, they understand
• 15:47
  what the milieu is that this is all happening in
• 15:51
  and what, what the need is.
• 15:52
  So I think that's number one.
• 15:55
  And um, number two, you have to be flexible
• 15:59
  because things are rapidly changing in this industry.
• 16:04
  And if you would've asked anyone two years ago,
• 16:08
  everything was going to be app driven
• 16:11
  and, uh, tech driven going forward.
• 16:14
  And I think what we're seeing now is, um,
• 16:18
  rebound away from a lot of that
• 16:20
  and, um, getting back to the basics
• 16:25
  of we need human delivered care complimented
• 16:29
  by not driven by technology.
• 16:32
  And that's really, you know, a huge, a huge rebound from
• 16:36
  where we were, say two years ago.
• 16:38
  So I think that ability to be flexible, that ability to
• 16:43
  not go with the flow if the data are telling you otherwise,
• 16:47
  and really be flexible with how you are creating programs
• 16:51
  that are the best for the members
• 16:53
  or the patients that you're serving.
• 16:57
  - I love that. Dr. Kearney, thank you so much
• 16:59
  for joining us on the podcast today.
• 17:00
  This has been such a fascinating discussion
• 17:03
  and I look forward to connecting with you again soon.
• 17:06
  - Thank you so much. It's been terrific to be here.
• 17:09
  I love the Becker's meetings
• 17:11
  and love to be part of your podcast.
• 17:15
  So thank you so much.