Latest / The Mental Health Evolution / Ep 54: Building Collective Power with Nicole Sartini

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Ep 54: Building Collective Power with Nicole Sartini · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast
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Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about
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what's changing in mental health and why it
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matters.
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I'm your host, Rachel Harrison, inviting you into
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honest conversations with people from all perspectives in
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the field, clinicians, tech founders, investors, insurance companies,
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and all the folks in between.
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Let's explore what's working, what's not, and what's
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next.
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Hello, everyone.
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Today I'm so excited to bring you this
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conversation with Nicole Sartini of the Mental Health
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Insurance Reform Task Force.
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Some of the things we touched on were
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ways that advocacy is happening.
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Nicole definitely used some terminology that you may
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or may not be familiar with, but don't
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worry, we've got resources in the show notes
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and you can definitely dive in a little
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bit more.
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She has a system called the Progressive Advocacy
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Ladder, and looking at where different states are,
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what's happening in different states, and that is
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all on the website.
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So as you dive into this conversation, I
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just want to highlight the fact that what
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Nicole is working on, and all of the
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grassroots volunteers, she was very clear, this is
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not just her thing, is there really a
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way for there to be collective advocacy in
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the mental health field right now?
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So check it out.
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I'm excited for you to hear from Nicole
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herself and to see the resources she is
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providing.
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Welcome back to the Mental Health Evolution Podcast.
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I'm Rachel Harrison, and today I'm speaking with
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Nicole Sartini, a licensed clinician, group practice owner,
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and founder of Build Better Health, which is
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a nonprofit think tank that is building the
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kind of collective power that this field has
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been missing.
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Build Better Health advances two initiatives.
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The first is the Mental Health Insurance Reform
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Task Force, a provider-led coalition now active
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in all 50 states that gives clinicians a
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practical step-by-step path from documenting payer
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harm all the way to enforcement and fair
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reimbursement.
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The second is the People's Solidarity Fund Healthcare
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Cooperative, which is a pilot launching in 2027
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that is designed to reduce provider and patient
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reliance on insurance companies altogether.
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We have had a number of conversations on
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this podcast about understanding the problems going into
2:35
our field, but this episode is about some
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possible solutions, and that is really exciting.
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Before we dive in, at the end of
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today's episode, we're going to share a few
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articles and resources for anyone who wants to
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go deeper.
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We will link everything in our show notes
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and newsletter.
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Nicole, welcome to the show.
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Thank you so much for having me, and
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thank you for what you're doing to help
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put the word out on ways that we
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can help evolve our field.
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Yeah, it's awesome.
3:05
Thank you.
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So I'm curious, how did you get to
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this place of wanting to do more organization
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and advocacy for providers in our field?
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What kind of led you there?
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Well, I am a long-term provider.
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I've been in the field technically since I
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was 19 years old, but not as professional
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yet and professional therapist for a very long
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time, worked all sorts of positions, both community
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-based and eventually did private practice and started
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a group practice.
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Like you, have multiple locations, and we have
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60 providers.
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And it was just like 2024 when we
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started to really feel some shifts happening within
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the insurance industry and in our ability to
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pay our clinicians fairly.
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And we ended up seeing, because of carve
3:55
-outs and repapering of various contracts, a drop
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of about 30% of our income for
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the same exact number of sessions.
4:04
And as you can imagine, a practice that
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does its best to treat the clinicians and
4:09
providers that are there to do good work
4:11
in the community, we really prided ourselves on
4:14
having a great place for these people to
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work.
4:16
But we ended up for the first time
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after being in practice for 10 years, having
4:22
some turnover to people who ended up going
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to platforms because they didn't want to do
4:28
the insurance model that we did anymore.
4:30
And it was very loving and very sad
4:32
to lose everybody.
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We didn't think that would happen, but we
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understood that clinicians had to do what they
4:38
needed to do.
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But it started to get me concerned about
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the direction that things were moving.
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And so I ended up starting here in
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Kentucky with a little bit of local organizing.
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And at first, I thought what we could
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do was different than what ended up being
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achievable.
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In fact, I didn't even know that there
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were actually laws already in place that were
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supposed to be protecting us from some of
5:00
the stuff that was happening.
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And when I learned that, I started to
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gather people and we started doing these monthly
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meetings.
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We did a survey.
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And it started in Kentucky.
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We were doing these all across Kentucky.
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But more states started to learn about what
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was happening, what we were doing, and asked
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to come in and be involved.
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And within this two-year period, we've actually
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grown to have 50 states participating.
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We have 4,000 providers directly participating, and
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then more, of course, who are attached to
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them and learning about the work that we
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were doing.
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So we didn't expect it to happen.
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It was a true grassroots movement that we
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started.
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And I say we because, of course, at
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this point, it's very much a we thing,
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not a me thing.
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And that's part of what's so important to
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the mission is putting the power back into
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the hands of the people instead of just
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a select few, which is what we're seeing
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happen with these insurance companies and these platforms
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that are coming in and taking over the
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industry, it seems, or trying to.
5:56
Yeah, that's great context to be able to
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understand.
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So tell me a little bit more about
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exactly what you're doing, what's happening with both
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of your organizations, and how do they function?
6:09
Okay.
6:09
So with the Mental Health Insurance Reform Task
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Force, we have a brand new website that
6:16
has state-specific pages.
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So we have state leads in each state
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who now manage those and can help organize
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local stuff using our shared resources and our
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shared learning to help advocate for specifics within
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their state.
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And of course, we have the national gatherings
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as well, so we can learn from each
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other.
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What we did was we created a system
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to track where each state was, like a
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rung system, and one's not necessarily better than
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the other.
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A lot of states skip rungs and have
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to go, it's not always in order, but
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it does give us a little bit of
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a clue about which states are working on
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similar things.
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So if a state doesn't have any clawback
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protections or not adequate clawback protections and needs
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more, those states are on the same rung
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and can learn from and with each other.
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So we have committees where there's shared learning
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that can occur.
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So the three subcommittees that we have are
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the Education Committee, so those are people who
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are putting together materials that are going to
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go to legislators or to providers or sometimes
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to employers or to consumers or patients.
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And then we have the Innovation Committee, and
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we're thinking there through terms that are outside
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the box.
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How can we become less reliant on insurance
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in the first place?
7:31
How can we build around it and pull
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power back into the hands of...
7:35
And again, we say into the hands of
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the people, and we really mean that.
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Not just providers, we want mutually respectful systems
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that are going to honor clients' access and
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ability to gain affordable quality care.
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And so we try to think through things
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that are innovative and new, and we'll talk
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about PSF in a little bit, I'm sure,
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and that's where that kind of branched out
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of.
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And then we have the Legal and Legislative
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Committee, and there we work specifically on creating
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model legislation based on successful legislation in various
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states on the topics within that advocacy ladder
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that we created and the rung system that
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we created that helps states use things that
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we've created to advocate for that change within
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their own state legislation.
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And we also, of course, look at litigation,
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and we have about five attorneys that we
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consult with.
8:22
So if one's a paid attorney, the others
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are just advisors, and we're tracking and collecting
8:26
data so that if and when the time
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comes, we can take action that way as
8:31
well.
8:32
Wow.
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I love it.
8:32
Yeah.
8:33
We've had several attorneys on the podcast talking
8:36
about things, especially parity.
8:38
That seems to be something where there's a
8:39
lot of laws on the books already.
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And that's both at the federal and the
8:45
state level.
8:46
And like I said about in Kentucky, I
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was so surprised.
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I thought when this legislator said, yes, I'll
8:51
help you get this bill going, and I
8:54
was so excited.
8:56
But I was looking at when she sent
8:57
it to me, I was like, but this
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is already in here.
9:00
This is just...
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I couldn't believe that what was on paper,
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it just didn't have the teeth to be
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enforced.
9:08
And that's kind of what we've seen with
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the...
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I mean, the MPIA, that original law was
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2008, right?
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And it's had many reiterations and changes over
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time.
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That's the federal law.
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And 2022 is when they started to do
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those reviews and they started to check and
9:25
see if it's actually being followed.
9:27
And over and over, I think there's been
9:28
about 4 cents and none of them have
9:30
shown that insurers are compliant.
9:32
Because what happens is it is cheaper to
9:35
be non-compliant and give a report that
9:38
is demonstrating non-compliance than it is to
9:41
actually be compliant because there's no consequences.
9:45
And so there are some federal laws that
9:48
are being proposed right now and that we
9:51
support.
9:52
We have a federal policy team who's following
9:53
those things closely.
9:55
And patients over profit is an example of
9:57
one of those.
9:57
But there's other things that are happening.
10:00
But as it stands right now, as you've
10:02
probably heard, the latest thing that was supposed
10:04
to add more teeth, the final rule, which
10:06
happened in 2024, was paused.
10:09
And it's so wild because we were literally...
10:11
The day that happened, we were presenting, doing
10:13
one of our provider round tables here in
10:15
Kentucky, and we had to change the slides.
10:17
But what's important for people to understand is
10:20
just because the latest thing was paused, the
10:22
latest addition to that law was paused, that
10:26
doesn't mean that everything that was there before
10:28
isn't still the law.
10:30
It actually is.
10:31
And so we really would love to see
10:34
more enforcement at the federal level because, as
10:37
you probably know, but maybe the listeners don't,
10:39
about 60%...
10:41
It's a range.
10:42
It depends on the state.
10:43
Lots of our insurance plans and coverage is
10:47
overseen by the federal government, whereas some of
10:50
it is overseen by state government.
10:52
So even when we have really big wins
10:53
like we had with Illinois, with HB1085, that
10:57
connected the reimbursement floor to the Medicare rate,
11:02
even when that happened, it's going to affect
11:04
millions of people.
11:05
It's huge.
11:06
It's such a great win.
11:07
And also, it doesn't necessarily relate to all
11:11
the insurance plans because some of those are
11:13
overseen by ERISA, which is the federal law.
11:16
I see.
11:17
Yeah.
11:17
It is a really complex system.
11:20
It is.
11:20
But I think it's important that people know
11:22
that when things are paused like that federally,
11:25
it actually is a really good time for
11:27
states to take action.
11:29
And there are several states who are quite
11:31
close to being able to pass something similar
11:34
to HB1085.
11:36
And if they do that, that has an
11:38
influence on everybody else.
11:40
That changes the scene a little bit.
11:42
And what seemed like it was impossible is
11:44
now showing to be possible.
11:46
When I first started advocacy, I was an
11:48
advocate my whole life, lots of things.
11:50
But for this particular thing, when I first
11:53
went and made an appointment with the Department
11:56
of Insurance, they acted like it was nothing
12:02
that could ever happen or would happen.
12:04
And now that Illinois has done what Illinois
12:06
has done, we can take that in and
12:08
we can use that as part of our
12:10
advocacy and we can track now better what
12:12
steps we might have to take before we
12:14
get to the spot where we can connect
12:16
it to a reimbursement floor.
12:17
In the case of Illinois, they raised the
12:19
provider's rates by about 30% for commercial
12:22
insurance.
12:23
And it really did affect a lot of
12:25
people.
12:25
And it means that people are going to
12:28
stay in network with insurance companies, which is
12:31
important.
12:31
Right.
12:32
Because if they're not networked, people who need
12:35
to use their insurance aren't able to do
12:37
it.
12:37
And the insurance companies can say that they
12:40
have network adequacy or that they offer something
12:42
on paper.
12:43
But in reality, if the clinicians aren't able
12:46
to take it because it's not sustainable, then
12:50
they actually don't really have it.
12:52
And that's when you said the word parity,
12:54
you know, we're talking about parity.
12:55
It's actually the law says that we behavioral
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health care should be accessible.
13:00
Yeah, the network adequacy should be just as
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high for behavioral health as it is for
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physical health.
13:06
But clearly, that's not the case.
13:09
Right, right.
13:10
And it is a known problem.
13:12
You know, I think about as you're talking
13:13
about this, if our listeners are thinking, okay,
13:16
so I get this a little bit, but
13:18
why should I care?
13:20
How would you answer that question?
13:22
Like, what's really the why?
13:23
What kind of differences can these things make
13:27
in people's lives, either in the industry or
13:30
just people who are seeking mental health care?
13:32
Yes.
13:33
Okay, so to answer this question, I think
13:35
it's important that we kind of broaden out
13:37
it from just the parity discussion, because of
13:40
course, it matters that providers are paid adequately.
13:43
So they'll stay in network.
13:44
And so clients can have people to see
13:46
them in network and access quality care.
13:49
But there's also the second pillar that we
13:50
organize around, which is vertical consolidation.
13:53
And that is mattering for a whole nother
13:56
set of reasons.
13:57
That is stripping, in some cases, both providers
14:01
and clients of their autonomy to choose.
14:05
So you and I are both practice owners,
14:08
we're approaching this work from the fact that
14:12
we've chosen this life work, we're invested in
14:15
our communities, we're part of these communities, we
14:16
care about what's happening, we care about our
14:18
providers, versus a platform, our venture capitalists back
14:23
platform that's coming in, because they see it
14:26
as an opportunity to make some money.
14:28
And they aren't part of the community, and
14:30
they haven't dedicated their lives to the same
14:32
kind of thing.
14:33
So there's this already starting out in that
14:34
way.
14:35
And then the terms that are negotiated for
14:38
these platforms, versus what an independent provider can
14:41
do, or what even a small business can
14:43
do, are very disproportionate.
14:46
For instance, in Florida right now, new providers
14:49
are being told that they must credential through
14:52
Headway in order to see their biggest insurer
14:55
there, which is some form of Blue Cross
14:57
Blue Shield.
14:58
And that's what has to happen.
14:59
And to us, it seems like, okay, so
15:02
in some states have any willing provider laws,
15:04
and I don't believe that Florida is one
15:06
of them.
15:06
But you know, a person who wants to
15:08
see a certain clinician should be able to
15:10
see that clinician and use their insurance if
15:13
that provider is willing to take it.
15:15
But if that provider doesn't want to go
15:16
through the middleman, or that third party entity,
15:19
that creates an issue.
15:20
And there's very good reasons that people don't
15:22
want to do that.
15:23
We've had providers at my business, Bridge Counseling
15:26
and Wellness, who have come over to us
15:28
from platforms, like I said, we've had some
15:29
who've left, and it's understandable why they did
15:32
and, you know, it's very mutually respectful.
15:34
But we've also had some people come in
15:36
from platforms and said that the data that
15:38
they had, their contact with a client after
15:41
something happened, like say a client didn't make
15:43
a session or something like that, and the
15:45
provider knows that that client is dealing with
15:49
suicidal ideation, and they are trying to make
15:52
some room and stay in contact with that
15:53
client.
15:54
In one provider's case, they completely took the
15:57
whole chart away, and the client didn't have
15:59
access to the information anymore and had to
16:01
go, not the client, but the provider, had
16:03
to go find this client, find other ways
16:06
to connect the client because the chart was
16:07
just taken away.
16:08
And so the decisions that are being made
16:10
around that, there's also concern about, you know,
16:12
data scraping that could be occurring.
16:15
The motivations are different in these terms, there's
16:17
just some risks there that we feel there
16:19
needs to be definitely more, more laws around,
16:23
and more oversight around.
16:24
And I think that's a big deal if
16:27
it squeezes private practitioners and small businesses out.
16:31
And we only have the option of working
16:33
with these bigger platforms.
16:35
And most of those MSOs that you're talking
16:37
about are actually owned by insurance companies.
16:42
Oh, exactly.
16:43
So you're hitting a really important point.
16:46
Not only, at the same time that we're
16:48
dropping, our rates are being dropped.
16:50
Like I said, I used the example at
16:52
our practice, we just had it happen again
16:54
in Kentucky with the MCOs, across the board,
16:57
they're just paying at 80%.
16:59
Oh, I'm sorry, it's not across the board,
17:00
it's at Passport Malina in this case.
17:02
But regardless, they dropped it to 80%
17:04
of the fee schedule for everybody, instead of
17:06
100% of the Medicaid fee set schedule,
17:08
right?
17:09
So even the MCOs are owned by these
17:12
Fortune 500, and sometimes even Fortune 5 companies,
17:16
these CEOs of these companies are making in
17:19
the millions.
17:19
Actually the salary that a CEO is making
17:23
in a year, they made $60,000 a
17:26
day, which is more than what the average
17:28
clinician makes in a year.
17:30
So in our mind, there's no job that
17:33
is that far in disparity, that the pay
17:36
should be that different, right?
17:37
And honestly, I can't remember what the original
17:39
question was, sorry about that.
17:40
That's okay, no, no, no, you definitely answered
17:42
it.
17:42
And we're diving into some great things here.
17:44
And we do short conversations on purpose to
17:48
hold people's attention.
17:49
So we are also almost out of time.
17:51
I would love to know from you, what
17:54
is an important takeaway for anyone who cares
17:58
about mental health, how it's delivered, and what's
18:02
happening right now?
18:03
What do you see as some takeaways for
18:06
people?
18:06
I would say that it's very important that
18:09
we remember that we're not going to be
18:10
able to compete with the financial resources that
18:14
these big companies have.
18:16
Some of them spend $3 million a month
18:18
on advertising, for instance, and we're not going
18:19
to be able to compete with that sort
18:21
of financial security.
18:23
But what we can do is we can
18:26
really truly learn together how to harness the
18:29
power of the people, how to start seeing
18:31
ourselves as a collective that is stronger together,
18:34
and to use the power that we all
18:37
have, especially as clinicians, the power of the
18:39
heart, allowing our decisions to move from that
18:42
space and to be willing to be strong
18:44
in the heart.
18:45
And to remember that it doesn't always mean,
18:47
you know, our field is 84% women,
18:49
for instance, it doesn't mean that we may
18:51
be, it feels really good to give, it's
18:52
a lot harder at times to stand firm
18:54
and strong in your love.
18:55
But that's a form of love too, because
18:57
it's not just a problem in healthcare.
19:00
Few more and more people, they call it
19:02
the K economy, right?
19:03
So the disparity is getting larger and larger,
19:08
and something has to be done about it.
19:09
Because if we continue at that pace, you
19:12
know, unfortunately, money is what makes decisions.
19:14
And you can buy your ability to make
19:17
decisions in some cases.
19:18
So what is the way that we can
19:19
challenge that?
19:20
We can learn how to truly work together
19:22
as a collective and advocate and make some
19:25
noise and take action together, which is part
19:28
of the reason why we encourage people to
19:30
join the Mental Health Insurance Reform Task Force,
19:32
specifically, if you're a provider, because we're taking
19:35
collective action on very specific things.
19:38
And we actually have made impact in a
19:41
few situations, just the recent Adnan Alma stuff,
19:44
and we were able to get 2200 signatures
19:47
in the Harry Ritter thing that it's provider
19:50
voices who made a difference on them reversing
19:54
two of the three changes that they were
19:56
going to make.
19:56
I know you just said takeaway.
19:58
So let me get briefer again.
19:59
I also think it's important to remember that
20:02
everybody has to make the decision that's best
20:04
for themselves.
20:05
We are certainly not judging anybody about what
20:07
they need to do to survive, and you
20:09
are always going to be the expert on
20:10
yourself.
20:11
And if you have capacity to contribute your
20:14
time, your energy, or your voice to this
20:17
movement, it is needed and it is wanted.
20:20
And we're trying to create something different than
20:22
what we have seen in typical models.
20:24
We're creating a circle of care where it's
20:26
less based on hierarchy and more based on
20:28
shared using our gifts in our own unique
20:30
ways and making a web together to help
20:33
hold not only our profession, but also the
20:36
clients that we really do want to serve
20:37
and give care within that web and be
20:40
stronger together.
20:41
And they invited to a meeting.
20:42
We meet the second Wednesday of every month
20:44
at 11am Eastern time or 8am Pacific time
20:48
as a full national group.
20:49
But then we have several other groups that
20:51
meet as well.
20:52
And we would really love you all to
20:53
come and join us.
20:55
That's awesome.
20:55
Nicole, I know that there are so many
20:58
things that we could have talked about in
21:00
addition to this, but I think your main
21:02
message definitely got out there for all of
21:04
our listeners.
21:05
If you want to dive in more, all
21:07
of the ways to connect and to get
21:09
involved will be in our show notes for
21:11
you.
21:11
So please reach out and do that.
21:14
And Nicole, I just appreciate how much you're
21:16
doing and what you're building.
21:18
And thank you for helping us gather as
21:21
a collective because advocating for wellness, for ourselves,
21:26
for our clients, for this industry is really
21:28
important.
21:29
And honestly, what this podcast is all about.
21:32
So thank you.
21:33
Well, thank you so much, Rachel, for what
21:35
you're doing as well.
21:36
And it's an honor to be here with
21:37
you.
21:37
Thank you.
21:38
You bet.
21:39
Before we wrap up, I want to share
21:41
a few resources for listeners who want to
21:43
dig in deeper into what we've been discussing
21:46
today.
21:47
These will all be linked in our show
21:48
notes and newsletter.
21:50
The first article from Mercer is called Trump
21:53
Administration Puts Its Stamp on Mental Health Parity.
21:57
This piece gives a clear overview of where
22:00
MHPAEA enforcement stands right now, the Department of
22:05
Labor's 2025 report to Congress, the pausing of
22:09
the 2024 final rule, and what that means
22:13
for providers going forward.
22:15
The next article from Sequoia is called What
22:18
Plan Sponsors Need to Know?
22:21
2025 Mental Health Parity Report to Congress.
22:24
And this was released in May 2026.
22:27
This breaks down what the federal government's own
22:30
enforcement data shows, including the finding that none
22:34
of the comparative analyses submitted by health plans
22:37
were adequate on the first submission.
22:40
If you want to understand why Nicole's work
22:42
exists, this is a great place to start.
22:46
Article 3, Capstone Partners Behavioral Health Care Service
22:51
Market Update.
22:52
And this is from March 2026.
22:55
Behavioral health deal activity rose nearly 50%
22:59
year over year in 2025.
23:02
For practice owners trying to understand the consolidation
23:05
forces reshaping the field, this one is also
23:09
worth the read.
23:10
And lastly, article entitled Mental Health Insurance Reform
23:15
Task Force Progressive Advocacy Ladder and National Strategy.
23:20
This is Nicole's own published framework for how
23:23
providers can move from documenting payer harm to
23:26
meaningful enforcement and fair reimbursement, a direct action
23:30
resource for anyone who wants to get more
23:34
involved.
23:34
I want to thank you for joining us
23:36
today.
23:37
And we will be back next week with
23:40
more on the Mental Health Evolution podcast.
23:44
See you soon.
23:45
Thanks for listening to the Mental Health Evolution
23:48
podcast.
23:49
Join the conversation.
23:51
Find us on socials, send us your thoughts
23:53
and tell us what you're seeing in your
23:55
corner of the mental health world.
23:57
Until next time, stay curious and keep evolving.