Latest / Behavioral Health Brief / Ep. 7 | Behavioral Health In Crisis: Rethinking How Healthcare Defines And Delivers Care

Transcript

Ep. 7 | Behavioral Health In Crisis: Rethinking How Healthcare Defines And Delivers Care · Behavioral Health Brief

• 0:00
  Speaker 1: Welcome to the Behavioral Health Brief, presented by TURNED Behavioral
• 0:05
  Speaker 1: Health Services. Behavioral health is about people, people who deserve compassion, dignity,
• 0:12
  Speaker 1: and the opportunity to heal. At Turn, that belief drives
• 0:17
  Speaker 1: our mission of improving lives. This podcast brings together behavioral
• 0:23
  Speaker 1: health expertise and real stories of transformation to elevate the
• 0:28
  Speaker 1: field and inspire meaningful change. Well, welcome to the Behavioral
• 0:33
  Speaker 1: Health Brief today.
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  Speaker 2: And today I have my co host, doctor Wendy Broughton,
• 0:38
  Speaker 2: who is our chief Operating officer at TURNED Behavioral Health Services,
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  Speaker 2: and she is an individual that supports not only myself
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  Speaker 2: but our entire company on the operation side.
• 0:48
  Speaker 1: She's been my confidant for ten years that we've been
• 0:50
  Speaker 1: working together and it's been a true pleasure. Wendy, Welcome
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  Speaker 1: to the Behavioral Health Brief.
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  Speaker 3: Thank you, Jim. I'm excited to co host today and
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  Speaker 3: to jump into it with our our guest.
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  Speaker 4: Yes, doctor Bergman.
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  Speaker 1: Honored to have you here today at the Behavioral Health
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  Speaker 1: break and as a behavioral health leader with years of
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  Speaker 1: experience in mental health and substance use treatment in crisis care,
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  Speaker 1: I think that crisis care as we've experienced in.
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  Speaker 4: San Diego has really moved us forward.
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  Speaker 1: He selped shape innovative and behavioral health programs both locally
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  Speaker 1: and nationally. Doctor Bergman, welcome to the show.
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  Speaker 5: Thank you so much. It's a pleasure to be here.
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  Speaker 1: Great, great to have you. And so I'd like to
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  Speaker 1: start off with maybe just your personal journey this morning,
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  Speaker 1: and if you.
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  Speaker 4: Could share with us how you started your career.
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  Speaker 1: What led you to get into this industry of behavioral
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  Speaker 1: health and substance abuse and you've run one of the
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  Speaker 1: largest systems in the state of California.
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  Speaker 4: What inspired you to enter this field.
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  Speaker 5: I have probably a kind of unusual trajectory into behavioral
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  Speaker 5: health care and maybe in particular into work running a
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  Speaker 5: assive bureaucracy. I actually am trained as a clinical social worker,
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  Speaker 5: but also as a cultural anthropologist. I think I am
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  Speaker 5: the only cultural anthropologist to you know, to run a
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  Speaker 5: county department with fifteen hundred employees. And I did my
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  Speaker 5: doctoral training at the University of Michigan. I did field
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  Speaker 5: work ethnographic field work in the city of Detroit and
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  Speaker 5: actually was funded by NIH. Remember nih nih I used
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  Speaker 5: to fund research and stuff like that. Yeah, back in
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  Speaker 5: the day, I actually had NIH funding to spend three
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  Speaker 5: years doing ethnographic field work with young African American men
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  Speaker 5: working in the drug trade in Detroit, and so, I
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  Speaker 5: mean just incredible and really harrowing experience. Most of the
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  Speaker 5: kids with whom I was working, and you know, I
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  Speaker 5: was an ethnographer, which meant that I was sort of
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  Speaker 5: doing participant observation. I was sort of deep in the game,
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  Speaker 5: right And this was sort of towards the end of
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  Speaker 5: the last century and just over the first few years
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  Speaker 5: of the century that we're in right now. Most of
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  Speaker 5: the young people with whom I was hanging were selling heroin.
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  Speaker 5: And you know, my interest was at that point was
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  Speaker 5: really driven kind of by an interest in, you know,
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  Speaker 5: sort of economic disenfranchisement, by racial inequality, and by how
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  Speaker 5: mental illness and substitutes disorder are sort of refracted through
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  Speaker 5: really complex histories that are national, that are global, but
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  Speaker 5: that are also really importantly local, and how those impact
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  Speaker 5: people differently depending on their stations in life, their demographics,
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  Speaker 5: and the sort of very particular situations that they find
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  Speaker 5: themselves in. So my interest initially was in like kind
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  Speaker 5: of really big questions. As I sort of spent more
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  Speaker 5: time with communities of people who were you know, parts
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  Speaker 5: of illicit drug markets, but also parts of communities of
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  Speaker 5: people really afflicted by the use of substances and by
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  Speaker 5: what is so frequent concurrent mental illness. My sort of
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  Speaker 5: area of focus shifted from the ilysta economy to people
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  Speaker 5: with these diagnoses, people needing care, and I moved relatively
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  Speaker 5: quickly from being a researcher I was faculty at Oregon
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  Speaker 5: Health and Science University up in Portland, I was at UCSF,
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  Speaker 5: I was at the University of Michigan into a person
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  Speaker 5: interested in making the system of care better. And I think,
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  Speaker 5: you know, I'm imagining it. We'll have opportunities over the
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  Speaker 5: course of our time today together to talk about what
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  Speaker 5: is sort of historically been struck truly challenging with behavioral
• 5:02
  Speaker 5: health care, what sort of calls for urgent change. Right,
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  Speaker 5: these are like the pretty kind of conspicuous things, and
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  Speaker 5: it was very hard for me not to be responsive
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  Speaker 5: to those things. So I ended up kind of like, no,
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  Speaker 5: I didn't anticipate this when I was studying anthropology, I'll
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  Speaker 5: tell you, but I ended up shaping a career that
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  Speaker 5: was really about trying to kind of fix in foundational
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  Speaker 5: ways the nature of the care system for people with
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  Speaker 5: these conditions.
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  Speaker 3: You know, you know, Luke, you remind me of this,
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  Speaker 3: the fact that you got into this notion of research
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  Speaker 3: and data and what drives populous and whether it's disparities
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  Speaker 3: or generational influence, economics positioning, that kind of thing, environmental
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  Speaker 3: influences of health, right, environmental.
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  Speaker 6: Predictors of health, all of that.
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  Speaker 3: But what I love about what you just shared is
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  Speaker 3: the fact that you tied that to people. So, yes,
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  Speaker 3: there was this group, and you can refer to them
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  Speaker 3: as group, but you got to know the faces and
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  Speaker 3: the stories, I'm sure, and the families of these people,
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  Speaker 3: which really I mean, Jim and I talk about you
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  Speaker 3: a lot in terms of like you. Your reputation precedes
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  Speaker 3: you in a good way, so be proud of that.
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  Speaker 6: But the fact that I.
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  Speaker 3: Think that you know how to see people and then
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  Speaker 3: let them be seen and they feel that way with you,
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  Speaker 3: there's something very special about that I think you bring
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  Speaker 3: to your work that I don't know that everyone at
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  Speaker 3: that level you, like Jim ha said, you've been at
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  Speaker 3: that director of DBH level. I don't know that everyone
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  Speaker 3: has that benefit, but I think that that's really unique
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  Speaker 3: to your career.
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  Speaker 4: I appreciate that.
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  Speaker 5: I mean, I will say as a social scientist, the
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  Speaker 5: thing that was most compelling for me was to kind
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  Speaker 5: of take a part that story that you hear so often,
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  Speaker 5: in particular about young black folks in inner city America.
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  Speaker 5: I was working in Detroit, which has a reputation that
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  Speaker 5: also proceedes it not in a positive way in most cases,
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  Speaker 5: and people think about that community of people, young black folks,
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  Speaker 5: in a way that is in fact, very homogenizing, that
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  Speaker 5: doesn't really honor or value the distinctness of each of
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  Speaker 5: those people and frankly, the distinctness of even you know,
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  Speaker 5: specific localities.
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  Speaker 4: Right.
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  Speaker 5: The number of people who would come up to me
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  Speaker 5: and say, after becoming familiar with my work, I ended
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  Speaker 5: up writing a book about it, and you know, book
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  Speaker 5: tour and all the and all the and all the stuff.
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  Speaker 5: People would say, God, it's just you know, it's so real.
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  Speaker 5: It's like the wire. Have you seen the wire? The
• 7:34
  Speaker 5: wire is so amazing because it's so real, people would
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  Speaker 5: say to me, you know, like people with whom I
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  Speaker 5: was interacting, like, you know, at universities, and I'd say, interesting,
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  Speaker 5: how do you have even the foggiest notion about whether
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  Speaker 5: or not the wire is real. Right, So people have
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  Speaker 5: this like sense about what is authentic about like the
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  Speaker 5: inner city, based in most cases just on sort of
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  Speaker 5: mass marketed stereotypes about the inner city. The fact is,
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  Speaker 5: the or which takes place in Baltimore represents a city
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  Speaker 5: that's vastly different from Detroit, or the experience of people
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  Speaker 5: in Detroit, which is vastly different from the experience of
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  Speaker 5: people in San Diego, Los Angeles, San Francisco, et cetera,
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  Speaker 5: et cetera. It's so important that we look not just
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  Speaker 5: at the distinctness of particular people with whom we're engaged,
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  Speaker 5: but that's the distinctness of the contexts that, you know,
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  Speaker 5: in which they've sort of grown up and emerged.
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  Speaker 1: Let's go back a bit, a real quick question, but
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  Speaker 1: thank you for sharing. I learned something new again, doctor
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  Speaker 1: Berger stories. But the cultural anthropology as a young man, what.
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  Speaker 4: Was your trigger?
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  Speaker 1: Who was your mentor that led you into the field
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  Speaker 1: from cultural anthropology into behavioral health? What was that that momentum?
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  Speaker 1: Because I can hear it, yeah.
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  Speaker 5: Oh yeah, well you know this is going this is
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  Speaker 5: gonna be a weird episode.
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  Speaker 4: Jim. I love weird episodes. So let's go.
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  Speaker 5: So that probably the person who was most compelling for
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  Speaker 5: me was my dad. And I'm not going to cry
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  Speaker 5: like Tom Brady talking about my dad, but I might.
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  Speaker 5: So my dad was a philosopher, an existentialist philosopher. He
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  Speaker 5: was the child of a Lutheran minister, grew up in
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  Speaker 5: the Austrian Alps during World War Two, made it to
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  Speaker 5: the United States because he won an essay contest about democracy,
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  Speaker 5: and became a philosopher because he wanted to be something
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  Speaker 5: like his dad, but very different from his dad, so right,
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  Speaker 5: existentialist philosophy versus you know, the pastor of a Lutheran church.
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  Speaker 5: I also wanted I think this is true of like
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  Speaker 5: you know, lots of young men growing up, right, they
• 9:41
  Speaker 5: want to be like their dads and also very different
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  Speaker 5: from their dad. So I was very very inspired by,
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  Speaker 5: you know, like his intellect, but probably most inspired by
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  Speaker 5: the fact that he was interested in taking rigorous intellectual
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  Speaker 5: consideration to making actual, real change in the world. So
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  Speaker 5: he was a philosopher, and all of his work was
• 10:03
  Speaker 5: on Hegel and Nietzsche and you know, people like that.
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  Speaker 5: But in fact, the stuff he cared most about was
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  Speaker 5: very real world stuff. He was famous actually for founding
• 10:18
  Speaker 5: the first Teachings during the Vietnam War. He was a
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  Speaker 5: very very active anti war kind of figure during the sixties,
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  Speaker 5: you know, in the in the US, and then became
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  Speaker 5: a labor activist because he studied like theories of labor.
• 10:34
  Speaker 5: I don't want to get too deep into any of that,
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  Speaker 5: but he studied theories of labor. Another episode, so and
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  Speaker 5: and did you know, sort of develop this body of
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  Speaker 5: work rooted in philosophy during the nineteen eighties recession when
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  Speaker 5: Michigan he was a professor at Michigan, when Michigan experienced
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  Speaker 5: incredible job loss, you know, in the in the midst
• 10:57
  Speaker 5: of that recession, or at the auto industry in particular.
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  Speaker 5: So it was a a Coca days, the Leia Coca days,
• 11:02
  Speaker 5: that's right. So it's very much about like the marriage
• 11:04
  Speaker 5: of like rigorous intellectual stuff with like we gotta use this,
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  Speaker 5: like we got smart people thinking about stuff. We've got
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  Speaker 5: to make that worthwhile. We've got to have impact, to
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  Speaker 5: use a word that I know is really important to
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  Speaker 5: sort of like turns mission. And that's kind of how
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  Speaker 5: I felt as an anthropologist, like Okay, this is like
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  Speaker 5: whatever sort of high flutin stuff, but we have to
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  Speaker 5: take it to real world circumstances. And I would say,
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  Speaker 5: you know, as somebody with clinical experience, but also as
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  Speaker 5: somebody who's an anthropologist, you'd suppose in my work as
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  Speaker 5: like behavioral health director that the clinical stuff has been
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  Speaker 5: most relevant. And that's actually not true. The stuff that's
• 11:44
  Speaker 5: been most important to my work as like a behavioralt director.
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  Speaker 5: And before that, in New York City, I was assistant
• 11:52
  Speaker 5: a VP over behavior health for the you know, the
• 11:54
  Speaker 5: nation's largest public hospital system. The stuff that was most
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  Speaker 5: inform formative of my work was anthropology. Because anthropology does
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  Speaker 5: this thing, which is that it and this is the
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  Speaker 5: most basic thing that cultural anthropology sort of asserts, which
• 12:10
  Speaker 5: is question everything, question all of the taken for granted
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  Speaker 5: ideas in the world that we inhabit. So don't just
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  Speaker 5: sort of assume that somehow it makes sense that we
• 12:24
  Speaker 5: should have a like, a behavioral health system that is
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  Speaker 5: structured in this particular way. Don't simply take for granted.
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  Speaker 5: And here I'll sort of resonate with your highlight of
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  Speaker 5: the word crisis in particular. Right, don't just take for
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  Speaker 5: granted that we should have a system that's oriented around
• 12:42
  Speaker 5: the word crisis. And I have sort of a funny
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  Speaker 5: relationship to crisis services, in particular because I am kind
• 12:49
  Speaker 5: of known for building up the you know, kind of
• 12:51
  Speaker 5: crisis continuum in San Diego. And I also whenever I
• 12:55
  Speaker 5: get a chance, and I see this as such an opportunity,
• 12:58
  Speaker 5: we'll say, we've got to actually question how it is
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  Speaker 5: that we use the word crisis, and maybe we have
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  Speaker 5: to turn away from using the word crisis to the
• 13:08
  Speaker 5: extent that we do, because it's really and I can
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  Speaker 5: talk almost endlessly about that, it's very problematic how it
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  Speaker 5: is that we take for granted that when we're talking
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  Speaker 5: about mental health, we are talking about crisis mental health.
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  Speaker 5: In the world of health care, mental health is the
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  Speaker 5: only domain where we use the word crisis. Right. There's
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  Speaker 5: emergency care, there's critical care, there's intensive care. Across the
• 13:35
  Speaker 5: physical health care spectrum. When we talk about mental health,
• 13:38
  Speaker 5: all of a sudden, we're talking about crisis. Now. Crisis
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  Speaker 5: is a very different kind of idea, right. Crisis is
• 13:44
  Speaker 5: an idea that suggests, explicitly, this is non normative. What
• 13:49
  Speaker 5: this person's going through is not normal. That's what crisis means.
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  Speaker 5: It means, you know, some sort of divergence from what
• 13:58
  Speaker 5: is normal. A lot of what we need to do
• 14:01
  Speaker 5: to sort of help structure behavioral healthcare so that makes
• 14:05
  Speaker 5: most sense for the people who most need it, those
• 14:08
  Speaker 5: particular people with those particular experiences, is we need to
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  Speaker 5: make it normal. We need to structure it in such
• 14:15
  Speaker 5: a way that it embraces the normalness of behavioral health care,
• 14:19
  Speaker 5: the normalness of episodes of psychosis even and we have
• 14:25
  Speaker 5: a long waist to go on that front. That's interesting.
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  Speaker 3: Interesting, Sorry, we're gonna We're gonna talk for each other.
• 14:30
  Speaker 6: This is what we did.
• 14:33
  Speaker 1: Go ahead, now, I'm sorry.
• 14:37
  Speaker 3: I was just gonna say it's it's just interesting because
• 14:39
  Speaker 3: sometimes there's these blanket applications and then all of a
• 14:42
  Speaker 3: sudden we get the buzzwords right, and so I will
• 14:45
  Speaker 3: I will say that one of the things that's happening
• 14:47
  Speaker 3: right now, a few of them that we hear, is
• 14:50
  Speaker 3: like this notion of trauma, and so there's this over application,
• 14:54
  Speaker 3: this really this lack of understanding what really is trauma.
• 14:59
  Speaker 3: And not to minimize anybody's experience and how they feel it,
• 15:03
  Speaker 3: that's not the point.
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  Speaker 6: But the point is.
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  Speaker 3: There's this big generalized application. So what happens is then
• 15:09
  Speaker 3: it gets diluted, the need and the care and the
• 15:11
  Speaker 3: allocation of resources, it gets diluted because there's this just
• 15:16
  Speaker 3: over you know, bearing broad application, and we see it
• 15:20
  Speaker 3: with you know, and buzzwords start circulating, and then you know,
• 15:23
  Speaker 3: you know, it's just it's an interesting thing. When you
• 15:26
  Speaker 3: were talking about that with crisis, it's very similar.
• 15:28
  Speaker 1: I can remember I was going to bring up one
• 15:30
  Speaker 1: time when I watched you presenting at the might have
• 15:35
  Speaker 1: been bared of supervisors when they were on the interim
• 15:38
  Speaker 1: remodeling your area where you were up on Overland and
• 15:42
  Speaker 1: you were bringing your plan out about the crisis kind
• 15:45
  Speaker 1: of stabilization centers. We need five of them across the county.
• 15:49
  Speaker 1: And I can remember watching that presentation and going, finally,
• 15:53
  Speaker 1: somebody's getting it. Finally, somebody's bringing something to where we'll
• 15:57
  Speaker 1: have centers for people.
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  Speaker 4: To go to you that can get that care that
• 16:02
  Speaker 4: they need.
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  Speaker 1: And I think we were all super excited with that,
• 16:05
  Speaker 1: and we're seeing a lot of it still rolling out today.
• 16:08
  Speaker 1: But that was and I'm having a better understanding of
• 16:12
  Speaker 1: where you were coming from. But then my question leads
• 16:15
  Speaker 1: me to with your experience and history coming into a
• 16:19
  Speaker 1: San Diego, you had to make a transition, because the
• 16:22
  Speaker 1: transition from everything that you had done prior to that
• 16:25
  Speaker 1: and coming in and now you're in essence running one
• 16:29
  Speaker 1: of the largest behavioral health organizations close to half a
• 16:32
  Speaker 1: billion dollars worth of budget.
• 16:34
  Speaker 4: What was that transition like for you?
• 16:36
  Speaker 1: And what because you almost had to put on your
• 16:39
  Speaker 1: clinical hat one day, then put on a business hat
• 16:41
  Speaker 1: the next, and then a board a supervisor hat, and
• 16:44
  Speaker 1: then some other politicians that probably wanted to understand your theories.
• 16:49
  Speaker 1: But I think that I'd love to hear that transition
• 16:51
  Speaker 1: that you went through.
• 16:52
  Speaker 5: Yeah, no, it's a great question. Thank you, Thank you
• 16:54
  Speaker 5: for asking that. I mean, you know, I was working
• 16:56
  Speaker 5: in New York City before coming to San Diego, and
• 16:58
  Speaker 5: I remember talking to my colleagues in New York about, like,
• 17:01
  Speaker 5: so I'm taking this job in San Diego. And I
• 17:04
  Speaker 5: think they all thought, well, San Diego, right, like you
• 17:07
  Speaker 5: be able to do that job with like half your
• 17:09
  Speaker 5: brain tied behind your head. And boy, was that not true,
• 17:15
  Speaker 5: you know, in New York City, and I was. I
• 17:18
  Speaker 5: was working there kind of, you know, prominently during the
• 17:23
  Speaker 5: Deblasio administration. So I was, you know, working as part
• 17:26
  Speaker 5: of the Deblasio administration for Bill de Blasio, a single
• 17:31
  Speaker 5: unitary executive authority. California County Land does not have such
• 17:36
  Speaker 5: a simple unitary executive authority, you know structure. There are
• 17:41
  Speaker 5: five members of a board of supervisors. As a behavior
• 17:44
  Speaker 5: health director, you have to be responsive to all five
• 17:47
  Speaker 5: of them. San Diego represents. You know, it's a really
• 17:52
  Speaker 5: interesting time politically in San Diego. Traditionally San Diego has
• 17:56
  Speaker 5: been sort of a bastion of conservative politics. The Board
• 17:58
  Speaker 5: of Supervisors been primarily conservative Republicans for years and years
• 18:02
  Speaker 5: and years. I came in and actually that's how it
• 18:05
  Speaker 5: was when I first came here, and that was a
• 18:07
  Speaker 5: switch to come from. You know, in New York City
• 18:10
  Speaker 5: at the time was like a progressive political pissing contest,
• 18:13
  Speaker 5: right it was like who can be most you know,
• 18:15
  Speaker 5: wildly progressive and you know, and now right there embracing
• 18:20
  Speaker 5: like language like socialism even there, I came here, total
• 18:23
  Speaker 5: Republican board, and I had to think, Okay, I feel
• 18:28
  Speaker 5: like a progressive. I know, I look like a progressive.
• 18:31
  Speaker 5: I used to run a whole bunch of harm reduction
• 18:33
  Speaker 5: programs in New York, Like this is going to be
• 18:34
  Speaker 5: a problem. So what I did sort of initially is
• 18:38
  Speaker 5: I trotted out this idea of the triple Aim, and
• 18:40
  Speaker 5: I remember talking about that a lot in the sort
• 18:43
  Speaker 5: of early presentations. And the triple aim is an idea
• 18:46
  Speaker 5: developed by the Institute for Healthcare Improvement that's really like
• 18:50
  Speaker 5: a core framing idea in how modern American healthcare works.
• 18:58
  Speaker 5: And it puts forward this idea that if you take
• 19:02
  Speaker 5: care of people addressing their particular experiences and care, if
• 19:08
  Speaker 5: you take care of a population of people, so you're
• 19:11
  Speaker 5: taking care of the individual, you're taking care of the population.
• 19:14
  Speaker 5: If you do those two things, guess what, per capita,
• 19:18
  Speaker 5: you are going to save money because if you take
• 19:22
  Speaker 5: care of people, you're going to protect them from episodes
• 19:24
  Speaker 5: of what crisis that are very expensive. And so this
• 19:29
  Speaker 5: is a way that you know, American health care, which
• 19:33
  Speaker 5: is managed healthcare, can think about the work that it
• 19:36
  Speaker 5: does so that there's an alignment of saving money, being
• 19:40
  Speaker 5: conservative with money, with also achieving better outcomes. And I
• 19:45
  Speaker 5: have to say, is it's an elegant idea, It's an
• 19:48
  Speaker 5: idea I believe in. I would say very very strongly
• 19:52
  Speaker 5: it's an ethical idea also, And in fact, i've taken
• 19:55
  Speaker 5: to talking about it in that way, thinking of what
• 19:57
  Speaker 5: my dad died two years ago now, But sorry to hear, yeah,
• 20:01
  Speaker 5: I appreciate that, but that's actually you know, the way
• 20:04
  Speaker 5: I talk now about you know, about the triple aim
• 20:07
  Speaker 5: and that kind of framework. In the context of behavioral
• 20:09
  Speaker 5: health I usually start by saying, you know, you do
• 20:12
  Speaker 5: if you work in this field, you do mission driven work.
• 20:16
  Speaker 5: And and if if what we want to do with
• 20:18
  Speaker 5: behavioral health care is make it more seamless with healthcare generally,
• 20:23
  Speaker 5: which we should talk more about, perhaps that's a thing
• 20:27
  Speaker 5: that I think it makes sense for us to be thinking.
• 20:29
  Speaker 5: If you want to make behavioral healthcare more seamless with
• 20:31
  Speaker 5: the rest of healthcare, not like you know, characterized by disparities,
• 20:36
  Speaker 5: not characterized by disconnection, not characterized by frankly lack of
• 20:41
  Speaker 5: you know, resources generally, if you want to bring those
• 20:43
  Speaker 5: things together, you probably are worried about what, you know,
• 20:48
  Speaker 5: what it will do to the you know, to how
• 20:51
  Speaker 5: you are mission driven. You are probably worried about the
• 20:54
  Speaker 5: ethical foundations of the work. Right. You know, when when
• 20:57
  Speaker 5: the CEO of United Health health Care gets shot on
• 21:01
  Speaker 5: the streets in Manhattan, three quarters of the country is clapping. Yeah,
• 21:05
  Speaker 5: that's what America thinks about managed healthcare because all they're
• 21:10
  Speaker 5: used to hearing about is denial of access, of curtailment
• 21:14
  Speaker 5: of care.
• 21:15
  Speaker 4: Right.
• 21:15
  Speaker 5: Why so the insurance companies can save money on people.
• 21:19
  Speaker 5: Often insurance companies aren't to the extent that they should
• 21:21
  Speaker 5: be driven by that triple aim. Right, take care of
• 21:24
  Speaker 5: the person, be upstream, protect them from an episode of crisis,
• 21:29
  Speaker 5: protect them from having to go to an emergency department,
• 21:31
  Speaker 5: and you're going to do fine with the money.
• 21:33
  Speaker 4: Right.
• 21:33
  Speaker 5: They don't always operate that way.
• 21:35
  Speaker 4: I don't think they think that way. I really don't think.
• 21:38
  Speaker 1: I think I think that's too high for them. That
• 21:40
  Speaker 1: might be maybe high's not the right word. And I don't.
• 21:44
  Speaker 5: Want to be conceptual. It's conception.
• 21:47
  Speaker 1: It's it's outside the realm of their thinking that that
• 21:50
  Speaker 1: can actually work. But I agree with you that the
• 21:53
  Speaker 1: day that that individual was shot in New York I
• 21:56
  Speaker 1: think it was, and then the upr or about the
• 22:01
  Speaker 1: individual being arrested, yes for being you know, in a
• 22:04
  Speaker 1: vigilante type, and that.
• 22:08
  Speaker 4: Was very eye opening.
• 22:09
  Speaker 3: Yeah, you know, but here's the you know, here's the
• 22:12
  Speaker 3: thing with that though, is, you know, on the the
• 22:14
  Speaker 3: general public. You know, looking at the general public, what
• 22:18
  Speaker 3: does it say about the general public? They're tired, they're
• 22:22
  Speaker 3: sick of having to jump through hoops for essential care.
• 22:26
  Speaker 3: They don't understand it. It seems like it's a setup,
• 22:30
  Speaker 3: like it's always about the dollar at the end of
• 22:32
  Speaker 3: the day, and you get those. Unfortunately, what hits the
• 22:36
  Speaker 3: media is the extreme cases. But we hear about these
• 22:40
  Speaker 3: stories which seem just so common sense. Give them the
• 22:43
  Speaker 3: care that they need, so you can under We don't,
• 22:46
  Speaker 3: of course non condones anything like that, but when you
• 22:50
  Speaker 3: look at something like that happens, people identify with what
• 22:55
  Speaker 3: drove the person, right, they understand that level of frustration.
• 22:58
  Speaker 6: No on condones it.
• 22:59
  Speaker 3: But again, and you got to look at that, there's
• 23:02
  Speaker 3: some responsibility in this system to reflect this, you know,
• 23:07
  Speaker 3: understanding and common sense and care.
• 23:09
  Speaker 1: Yeah, I think you hit a very valid point right
• 23:12
  Speaker 1: there about the frustration level of getting the care.
• 23:15
  Speaker 4: I think I don't know about.
• 23:17
  Speaker 1: You, but I dread the day I got to pick
• 23:19
  Speaker 1: up the phone and call the doctor because I know
• 23:20
  Speaker 1: I'm not going to get to see him for three months, right,
• 23:23
  Speaker 1: because they're too busy.
• 23:24
  Speaker 5: And so let's take this kind of I think we
• 23:27
  Speaker 5: all agree that, like, there is baseline severe frustration with
• 23:31
  Speaker 5: the nature of healthcare generally in this country. Right, And
• 23:34
  Speaker 5: I think part of the reason that you know that
• 23:36
  Speaker 5: this person Luigi I can't remember his last name, has
• 23:39
  Speaker 5: become a bit of a folk hero is that people,
• 23:42
  Speaker 5: by and large have experienced that frustration with health care.
• 23:45
  Speaker 5: I have experienced it. I was a behavior health director
• 23:48
  Speaker 5: in the County of San Diego. At my son at
• 23:50
  Speaker 5: the time was sixteen year old. He needs sixteen years old,
• 23:53
  Speaker 5: he needed mental health care, and I couldn't get him
• 23:55
  Speaker 5: access to healthcare through my employer driven health plan.
• 24:00
  Speaker 4: Wild We get calls like that all the time.
• 24:02
  Speaker 1: People will reach out when I'm out in public, Hay,
• 24:05
  Speaker 1: my son was great, straight a's Baseball All Star and
• 24:08
  Speaker 1: everything like that. Now he's kind of fallen off the track.
• 24:11
  Speaker 1: Can help, right, I can navigate him.
• 24:13
  Speaker 4: But it takes so long to get into the system.
• 24:16
  Speaker 4: Like you said, you sixteen.
• 24:17
  Speaker 1: Year old son needed healthcare, You couldn't get him into
• 24:20
  Speaker 1: the system.
• 24:20
  Speaker 5: You were leading, You couldn't get it, and I was leading.
• 24:22
  Speaker 5: I mean, and I've got other stories about like the
• 24:24
  Speaker 5: you know, needs that my family has had while i
• 24:27
  Speaker 5: was director in San Diego, and couldn't get them help either.
• 24:30
  Speaker 5: I mean, the system is built in such a way
• 24:32
  Speaker 5: that it's extremely frustrating and people would come discouraged and
• 24:36
  Speaker 5: then they cease seeking care when they need it, which
• 24:39
  Speaker 5: is really probably. So that's baseline. Now, let's look at
• 24:42
  Speaker 5: California and behavior all in specific. Right.
• 24:45
  Speaker 1: I was just getting ready to ask from your perspective,
• 24:48
  Speaker 1: what are some of the biggest healthcare challenges that we're facing.
• 24:52
  Speaker 4: His communities today?
• 24:53
  Speaker 1: Because very elegantly, and we have so many communities. I
• 24:58
  Speaker 1: think one of the things in the job that I
• 25:00
  Speaker 1: have as CEO of a behavior health services company is
• 25:06
  Speaker 1: getting out into the communities and seeing the diversity that
• 25:09
  Speaker 1: we have in our state from the central valley, from
• 25:13
  Speaker 1: the rural so the suburban to the urban and the
• 25:17
  Speaker 1: communities in between.
• 25:18
  Speaker 4: That it's tremendous the diversity.
• 25:20
  Speaker 1: And trying to understand how we take care of all
• 25:24
  Speaker 1: that diverse diversity that all needs care very interesting.
• 25:28
  Speaker 5: So go ahead, Well, okay, so let me ventilate about
• 25:31
  Speaker 5: this a little bit. Right, So this this will be
• 25:33
  Speaker 5: maybe a little bit technical, but I'll try to sound
• 25:37
  Speaker 5: that's why. Okay, we'll follow, we'll unpack it a little
• 25:41
  Speaker 5: bit and everybody like, and you know, I hope your
• 25:45
  Speaker 5: audience stays way through this because this is important. So, uh,
• 25:51
  Speaker 5: the triple aim idea, right that like, people will cost
• 25:56
  Speaker 5: less if we protect them from costing a lot by
• 26:00
  Speaker 5: protecting them from episodes of crisis. Right, that relies on
• 26:04
  Speaker 5: this idea of an incentive. Right that insurance companies as
• 26:09
  Speaker 5: the payers for all of health care that they face risk. Right,
• 26:14
  Speaker 5: risk is woven into how it is that they function financially.
• 26:18
  Speaker 5: They are paid for They are paid through what's called capitation.
• 26:23
  Speaker 5: That means they're paid an amount of money per person
• 26:26
  Speaker 5: who is enrolled in that health plan. They're paid that
• 26:29
  Speaker 5: amount of money irrespective of how well that person is
• 26:32
  Speaker 5: doing in terms of their health or their or their morbidity.
• 26:35
  Speaker 5: So the healthier they are, the better off the insurance
• 26:38
  Speaker 5: company does, right, because they're paid that amount per person
• 26:40
  Speaker 5: either way. This is in the public insurance space, So
• 26:44
  Speaker 5: they're highly incentivized to keep people well, that's the idea.
• 26:48
  Speaker 5: If they're highly incentivized financially, you can, like, you don't
• 26:52
  Speaker 5: need to talk about the ethical dimensions or you know,
• 26:55
  Speaker 5: heaven forefend the moral dimensions of how it is that
• 26:57
  Speaker 5: they might operate as you know, their business says. The
• 27:00
  Speaker 5: fact is that at a basic economic level, they're incentivized
• 27:04
  Speaker 5: to help people stay well. That's the idea California has
• 27:08
  Speaker 5: structured in the space of public insurance medical primarily, California
• 27:13
  Speaker 5: has structured care so that managed care plans in fact
• 27:18
  Speaker 5: are disincentivized from taking care of people when they are well.
• 27:24
  Speaker 5: They are disincentivized from getting resources to people farther upstreams
• 27:29
  Speaker 5: so that they don't go into episodes of crisis. And
• 27:32
  Speaker 5: why is that. That's because managed care plans in the
• 27:37
  Speaker 5: public insurance system in California are only responsible for the
• 27:42
  Speaker 5: behavioral health care of people who are designated as needing
• 27:45
  Speaker 5: mild or moderate intervention. When people are designated with a
• 27:51
  Speaker 5: serious mental illness. On the mental health side, on substance
• 27:55
  Speaker 5: use is different, weirdly, in California, anybody in substance use
• 27:59
  Speaker 5: disorders istrum disorder at this point, anybody with a sub
• 28:02
  Speaker 5: use disorder is the responsibility of the county. On the
• 28:05
  Speaker 5: mental health side though, and often the co currents of
• 28:08
  Speaker 5: sub disorder and mental health of course, like have this
• 28:10
  Speaker 5: kind of compounding impact right on the mental health side.
• 28:16
  Speaker 5: If you are sort of deemed seriously mentally ill. If
• 28:21
  Speaker 5: you go into an episode of crisis, in fact, you
• 28:24
  Speaker 5: may be a member of a managed care plan, and
• 28:27
  Speaker 5: you may have, like you know, been tracked by that
• 28:31
  Speaker 5: managed care plan, and that managed care plan may have
• 28:34
  Speaker 5: decided not to invest resources upstream to keep you well.
• 28:41
  Speaker 5: And they should suffer that decision, right, they should suffer
• 28:45
  Speaker 5: that because they are incentivized generally to be paying to
• 28:48
  Speaker 5: keep people. In California, that incentive doesn't exist because counties,
• 28:53
  Speaker 5: county behavior health departments are deemed the crisis payers. So
• 29:00
  Speaker 5: erson when a person who would otherwise be a risk
• 29:03
  Speaker 5: for a managed care plan, when they start not doing well,
• 29:07
  Speaker 5: they just get pitched over to the count I would
• 29:10
  Speaker 5: call that a perverse incentive. In fact, managed care plans
• 29:13
  Speaker 5: are incentivized not to spend money on behavioral health conditions
• 29:17
  Speaker 5: because they face no risk when a person doesn't do well.
• 29:21
  Speaker 5: Person doesn't do well, they go into an episode of
• 29:23
  Speaker 5: impatient psychiatric carea because they've been in a crisis. They
• 29:26
  Speaker 5: may have been fine before that, right, but they haven't
• 29:29
  Speaker 5: been getting the ongoing sort of normative kind of chronic
• 29:34
  Speaker 5: illness oriented care that they need for their behavioral health,
• 29:37
  Speaker 5: for their mental health and well as they haven't been
• 29:39
  Speaker 5: getting that generally because that managed care plans aren't incentivized
• 29:43
  Speaker 5: to provide it, they go into an episode of crisis
• 29:46
  Speaker 5: and the managed care plans suffer nothing for it. That
• 29:49
  Speaker 5: is a structural fact of how things happen in behavioral
• 29:53
  Speaker 5: health care in California, and until that gets fixed, it's
• 29:58
  Speaker 5: going to be a big challenge.
• 30:00
  Speaker 1: You mentioned that because the disincentive piece. I was just
• 30:03
  Speaker 1: on the San Diego Health Committee zoom call yesterday we
• 30:09
  Speaker 1: had our annual monthly meeting and a gentleman from the
• 30:12
  Speaker 1: California Hospital Association was on there was reporting out how
• 30:16
  Speaker 1: they're so they're disincentive for making money that if they
• 30:21
  Speaker 1: make too much money of their costs succeed a certain level,
• 30:25
  Speaker 1: then they're going to be put on a PIP and
• 30:26
  Speaker 1: if they don't match that pip or and the outcome
• 30:29
  Speaker 1: isn't good on that PIP, they're going to be fined
• 30:31
  Speaker 1: substantial penalties for that. So why would they take on
• 30:35
  Speaker 1: a severely mentally ill individual that is going to cost
• 30:38
  Speaker 1: them some money to take care of inside the system
• 30:41
  Speaker 1: if they're trying to keep their cost own. So when
• 30:44
  Speaker 1: you mentioned that, disincentive. That's how it came up for me.
• 30:47
  Speaker 1: I could hear it yesterday in the meeting and the
• 30:51
  Speaker 1: hospitals there, all of them are on a PIP.
• 30:53
  Speaker 4: Yeah, you know, it's just incredible.
• 30:55
  Speaker 5: And this is like, you know, this isn't sort of
• 30:59
  Speaker 5: a circumstances where we've got a workforce in you know,
• 31:03
  Speaker 5: in primary care that doesn't care about people's and behavior
• 31:07
  Speaker 5: health conditions. We do primary care physicians both you know,
• 31:12
  Speaker 5: internal medicine, people who are taking care of adults, you know,
• 31:15
  Speaker 5: pediatric generalists. They care deeply about the mental health and
• 31:20
  Speaker 5: wellness of their patients. They do care about the whole person,
• 31:23
  Speaker 5: but they sure are not incentivized to devote resources to
• 31:26
  Speaker 5: caring for the mental health of people. We've got fifteen
• 31:30
  Speaker 5: minute primary care visits as like a you know, kind
• 31:34
  Speaker 5: of normative expectation here, How are you supposed to address
• 31:37
  Speaker 5: in the midst of you know, like in the case
• 31:39
  Speaker 5: of an adult talking about hypertension, talking about other sort
• 31:42
  Speaker 5: of chronic somatic illness, talking about whatever it is that's
• 31:45
  Speaker 5: going on for a person's self. How in fifteen in
• 31:48
  Speaker 5: a fifteen minute visit, are you supposed to meaningfully address
• 31:51
  Speaker 5: anything as complex as mental health. Also, it's impossible and it's.
• 31:56
  Speaker 3: Obstructure about you're talking about to this whole normrmalizing, right,
• 32:00
  Speaker 3: We're just been having this conversation of what gets normalized.
• 32:04
  Speaker 3: So you know, people going into crisis doesn't have to happen,
• 32:09
  Speaker 3: but it's normalized. So you think about that individual, you
• 32:12
  Speaker 3: think about their family unit, and then this becomes their
• 32:16
  Speaker 3: normalized dynamic in their family.
• 32:19
  Speaker 6: And we all know this.
• 32:20
  Speaker 3: When there's mental illness, there's substance use disorder, there's anything
• 32:24
  Speaker 3: that's going on, the family is impacted. This is an
• 32:27
  Speaker 3: insular it's not just one person and we send them
• 32:30
  Speaker 3: off for care and they come home. Everyone is affected
• 32:34
  Speaker 3: by this. And so you wonder why, you know, we
• 32:37
  Speaker 3: wonder why there's big pharma. Right, So there's this, you know,
• 32:41
  Speaker 3: and I want to you know, bag on them totally,
• 32:44
  Speaker 3: but it is this generalized application of it's going to
• 32:47
  Speaker 3: throw medication at something, prescribe the medication because that's all
• 32:51
  Speaker 3: the time there is and that's.
• 32:52
  Speaker 6: What is normal right now.
• 32:54
  Speaker 3: Rather than as an example, you know, Jim is one
• 32:59
  Speaker 3: of the things I love when Jim took over, is
• 33:02
  Speaker 3: very into his health, taking care of himself and look
• 33:05
  Speaker 3: and I now look at it disgusting. Now the normal person,
• 33:10
  Speaker 3: you know, you ask, Kay, how is your weekend, and
• 33:12
  Speaker 3: they're like, it was great. I caught a movie with
• 33:14
  Speaker 3: my wife and it was you know, it was all
• 33:15
  Speaker 3: good barbecue. A little Jim comes in, He's like, yeah,
• 33:18
  Speaker 3: I pulled off eight hundred and fifty five push ups
• 33:20
  Speaker 3: and I rode seventy miles. Yeah, but so back to sorry,
• 33:27
  Speaker 3: back on Jim. So the whole point of that is, though,
• 33:30
  Speaker 3: if you look at preventative care, if you look at
• 33:33
  Speaker 3: the way you support your body, you support your mind,
• 33:35
  Speaker 3: the way that you do self care and take care
• 33:37
  Speaker 3: of yourself, you absolutely can affect how things manifest in
• 33:42
  Speaker 3: your life, whether it's stress, burnout, mental illness, et cetera.
• 33:46
  Speaker 3: You know, most people have some resources at their their hands,
• 33:52
  Speaker 3: but because we just don't take the time where there's
• 33:55
  Speaker 3: not the the alliance with that, that that self care,
• 34:00
  Speaker 3: that how is your environment?
• 34:01
  Speaker 6: What are you doing?
• 34:03
  Speaker 3: It's it's it's quick, and it's it's in and out.
• 34:06
  Speaker 3: It's like you were just saying, there's fifteen minutes in,
• 34:08
  Speaker 3: here's your prescription.
• 34:09
  Speaker 6: How you do and how's the meds? Oh they're not working.
• 34:11
  Speaker 3: Let's prescribe this med try this instead. There's a place
• 34:14
  Speaker 3: for medication, so don't hear I'm not saying that there's not.
• 34:16
  Speaker 3: But what I am saying is there's a plethora of
• 34:19
  Speaker 3: other things that we can be doing in the spirit
• 34:21
  Speaker 3: of preventative care and preventive medicine.
• 34:24
  Speaker 5: Yeah, I mean, and it's I think, you know, become
• 34:26
  Speaker 5: not uncommon knowledge that people with behavioral health conditions are
• 34:30
  Speaker 5: five times more likely than those without to visit an
• 34:33
  Speaker 5: emergency department, five times more likely. We have expectation state
• 34:37
  Speaker 5: that's right. We know that the you know, alcohol use
• 34:41
  Speaker 5: in particular is a terrible exacervent to you know, to
• 34:45
  Speaker 5: cancer treatment, for example. Right, But we don't think about
• 34:50
  Speaker 5: these things in the same space clinically, right, And we've
• 34:54
  Speaker 5: built structures that keep behavioral health care segregated from the
• 34:59
  Speaker 5: rest of health care. And that I think it's a
• 35:01
  Speaker 5: little dramatic in California, the way that we've got all
• 35:03
  Speaker 5: these perverse incentives set up. I do think those of
• 35:06
  Speaker 5: us sort of you know, active in the policy space,
• 35:08
  Speaker 5: are interested in kind of what the direction things may
• 35:12
  Speaker 5: go in with a new administration. There's perennial talk in
• 35:17
  Speaker 5: California about shifting to what would be a carve in.
• 35:21
  Speaker 5: Right now, we've got a carve out or be your
• 35:22
  Speaker 5: health dollars or carved out of the rest of healthcare.
• 35:25
  Speaker 5: Maybe that would be helpful, you know. I'll mention that
• 35:29
  Speaker 5: when I was working in New York City, I helped
• 35:32
  Speaker 5: write what's called an eleven fifteen waiver, which is a
• 35:35
  Speaker 5: mechanism from CMS to change Medicaid structure. And so we did.
• 35:40
  Speaker 5: We went from a full carve out in New York
• 35:43
  Speaker 5: to a full carve in. I would say ten years
• 35:47
  Speaker 5: on the tree is still a little bit out about
• 35:49
  Speaker 5: the long term impacts because healthcare is real complicated. But
• 35:53
  Speaker 5: boy did it feel good, Like it really it felt
• 35:56
  Speaker 5: And it wasn't just you know, for people working in
• 35:59
  Speaker 5: hospital settings or other clinical settings that that felt good
• 36:02
  Speaker 5: to like be be incentivized to think about the whole person.
• 36:07
  Speaker 5: It was it felt good to people in care people
• 36:10
  Speaker 5: you can get.
• 36:11
  Speaker 3: Behind something that makes sense, you really, you can hear
• 36:14
  Speaker 3: your passion and it makes a lot of sense. And
• 36:16
  Speaker 3: so why wouldn't we want to get some momentum with
• 36:19
  Speaker 3: something like that.
• 36:20
  Speaker 6: It just it's very.
• 36:21
  Speaker 3: Hard when you see this fractured system, and we were
• 36:24
  Speaker 3: just saying at a former podcast that we were doing that.
• 36:28
  Speaker 3: You know, our clients people in general, they don't experience
• 36:33
  Speaker 3: their illnesses, their needs, They don't experience them categorically. You know,
• 36:39
  Speaker 3: they don't start and move progressively in terms of what's
• 36:42
  Speaker 3: approved and what system and move on down the line.
• 36:45
  Speaker 3: That's what becomes very frustrating because it is not there's
• 36:48
  Speaker 3: not that common sense behind it. If you could have
• 36:51
  Speaker 3: that common sense and I love this whole I was
• 36:53
  Speaker 3: imagining like this lake approach.
• 36:55
  Speaker 6: You have the lake, you know, it's this big resource.
• 36:58
  Speaker 5: Yeah, I mean, you know, the phrase that's used is
• 37:01
  Speaker 5: a little more modest than a lake. It's a pool.
• 37:03
  Speaker 5: But it should be. The idea is it's definitely that
• 37:10
  Speaker 5: there should be one fluid pot of resources that you know,
• 37:14
  Speaker 5: we have latitude as people, you know, kind of caring
• 37:17
  Speaker 5: for the whole person to distribute as we need to.
• 37:20
  Speaker 5: One thing I would say though, right that I think
• 37:23
  Speaker 5: is an additional challenge with the current state is that
• 37:25
  Speaker 5: people have learned, people have learned through interactions with mainstream
• 37:30
  Speaker 5: healthcare to think about their behavioral health as distinct and
• 37:34
  Speaker 5: usually to think about it with a sense of shame. Right,
• 37:37
  Speaker 5: So where you know I think just kind of intuitively,
• 37:41
  Speaker 5: people think about themselves as like, you know, a whole
• 37:44
  Speaker 5: kind of cohesive entity. There isn't any institutional thing that
• 37:49
  Speaker 5: has done more to teach people to segregate themselves than
• 37:53
  Speaker 5: mainstream American health care. And I would say it is
• 37:56
  Speaker 5: an incumbent upon mainstream American health care to re educate
• 38:01
  Speaker 5: the public in care about how important it is to
• 38:05
  Speaker 5: think about their entire person. But that's not going to happen.
• 38:08
  Speaker 5: I'll just just to say healthcare does what you pay
• 38:11
  Speaker 5: it to do. That's not going to happen until the
• 38:13
  Speaker 5: structure that flows the money, the structure that flows that
• 38:17
  Speaker 5: fluid resource, whether it's a lake or a pool, or
• 38:19
  Speaker 5: a see or an ocean, until that structure changes. I
• 38:23
  Speaker 5: remember one of the sort of signal moments of learning
• 38:26
  Speaker 5: for me when I was working in New York. I
• 38:30
  Speaker 5: was sort of working in the Central Behavioral Health Office
• 38:33
  Speaker 5: for the New York City Public Hospital System, which is
• 38:36
  Speaker 5: massive eleven acute care hospitals and fqs and all these things,
• 38:40
  Speaker 5: including places like Bellevue. And I had a problem, which
• 38:45
  Speaker 5: was that I didn't have enough people enrolled in substitutes
• 38:48
  Speaker 5: disorder treatment to support the system and frankly also to
• 38:52
  Speaker 5: support the money that we needed to draw down from
• 38:54
  Speaker 5: the block grant from New York State. And I was
• 38:56
  Speaker 5: getting all this pressure from New York State, You've got
• 38:58
  Speaker 5: to enroll more peace people in your substance use disorder
• 39:01
  Speaker 5: treatment programs. And I took a look at I was like, oh,
• 39:03
  Speaker 5: we have four thousand people in subs used treatment in
• 39:06
  Speaker 5: this hospital. Like that's not so bad. We've got four
• 39:09
  Speaker 5: thousand people. And then it occurred to me, I wonder
• 39:12
  Speaker 5: how many people, how many unique people this massive system
• 39:17
  Speaker 5: is diagnosing with a substance use disorder every year, right,
• 39:20
  Speaker 5: because the people we have in subsist use disorder treatment
• 39:22
  Speaker 5: are people whom we've recruited into substance use care, usually
• 39:26
  Speaker 5: by going to health faars by, you know, by flying
• 39:31
  Speaker 5: right by doing the things that most community based programs
• 39:35
  Speaker 5: would do. But we're a massive, mainstream healthcare system, and
• 39:39
  Speaker 5: no one had ever looked, no one had ever counted
• 39:43
  Speaker 5: in that system, no one had ever bothered to count
• 39:46
  Speaker 5: how many unique patients per year were diagnosed with substance
• 39:49
  Speaker 5: use disorder. So we had four thousand in specialty care.
• 39:53
  Speaker 5: The data that I uncovered showed that per year, consistently,
• 39:56
  Speaker 5: we were diagnosing one hundred thousand unique people with subten's
• 40:00
  Speaker 5: use disorder really every one hundred thousand, which meant that
• 40:04
  Speaker 5: we were seeing in specialty care in response to a
• 40:07
  Speaker 5: very serious diagnosis, a diagnosis that you know is going
• 40:13
  Speaker 5: to be foundational to a panoply of additional health concerns.
• 40:17
  Speaker 5: We were managing to get those folks from that moment
• 40:20
  Speaker 5: of diagnosis into specialty care four percent of the time.
• 40:24
  Speaker 5: I showed it to the CMO, who was pissed and excited,
• 40:28
  Speaker 5: and we radically changed everything in that system kind of
• 40:32
  Speaker 5: from that moment.
• 40:33
  Speaker 1: For me, interesting, So I wanted to back up just
• 40:36
  Speaker 1: a minute because when I heard you speak about the
• 40:40
  Speaker 1: system as it exists today, I think about advocacy. When
• 40:44
  Speaker 1: I think about that, how much is being advocated up
• 40:47
  Speaker 1: in Sacramento right now or really being talked about at
• 40:51
  Speaker 1: the subcommittee levels of the Assembly and or Senate California.
• 40:56
  Speaker 1: Is that really being discussed up there or is it
• 40:59
  Speaker 1: still not being discussed?
• 41:02
  Speaker 5: Man, That's a really great question. And this is another
• 41:06
  Speaker 5: case where California presents particular challenges, like actually around change
• 41:11
  Speaker 5: that people think of California as always, you know, Miles
• 41:14
  Speaker 5: ahead of the rest of the country with respect to like,
• 41:17
  Speaker 5: you know, innovative ideas. California, though in the behavioral health space,
• 41:22
  Speaker 5: is saddled with a state authority that's the Department of
• 41:26
  Speaker 5: Healthcare Services DHCS. I will not say anything negative about
• 41:32
  Speaker 5: or will I DHCS is not Let's just say it's
• 41:36
  Speaker 5: not the most nimble organization.
• 41:38
  Speaker 4: Yes, it is not, right, it is not.
• 41:40
  Speaker 5: It's like a bit rigid or crusty. You could even
• 41:44
  Speaker 5: say it's not strong. That's like the most important thing
• 41:47
  Speaker 5: to note about DHCS is that, relative to the legislature,
• 41:51
  Speaker 5: DHDS is not a strong state authority. It doesn't have
• 41:54
  Speaker 5: what we would call bulletin authority to actually make very
• 41:57
  Speaker 5: many significant changes. Significant change in California has to go
• 42:01
  Speaker 5: through the legislature. It has to because the legislature decided
• 42:05
  Speaker 5: that it needs to. What does that mean. That means
• 42:08
  Speaker 5: that every single little thing regulatorily that we need to
• 42:12
  Speaker 5: have happen in order for improvements across the system to
• 42:16
  Speaker 5: become realized, has to go through a legislative process that
• 42:18
  Speaker 5: is subject to lobbying. So now let's look look at
• 42:23
  Speaker 5: the industry. Which aspects of the industry have the strongest
• 42:26
  Speaker 5: lobbying presence, the ones that would stand to lose if
• 42:30
  Speaker 5: we got rid of perverse incentives. For example, right manage care,
• 42:35
  Speaker 5: manage care very powerful kind of you know, lobbying presence.
• 42:38
  Speaker 5: It doesn't want things to change. Most recent legislation in
• 42:41
  Speaker 5: California Behavior Health Services Act, through Prop one, for example,
• 42:46
  Speaker 5: notes that managed care plans need to be held more accountable,
• 42:50
  Speaker 5: but doesn't actually put in place mechanisms to hold them
• 42:54
  Speaker 5: to account. Right, So this is going to be an
• 42:56
  Speaker 5: ongoing challenge. There is right now, and it's getting some
• 43:01
  Speaker 5: I think people are paying attention to this. There is
• 43:02
  Speaker 5: right now a commission that was put together by the
• 43:04
  Speaker 5: California Healthcare Foundation, a wonderful organization that I do think
• 43:09
  Speaker 5: the state is blessed to have a body called the
• 43:14
  Speaker 5: Future of Medical Commission. It is, you know, kind of
• 43:19
  Speaker 5: in the process of convening and includes like a lot
• 43:23
  Speaker 5: of real smart folks from a you know, a kind
• 43:26
  Speaker 5: of a wide array of pieces and parts of the
• 43:28
  Speaker 5: behavioral health landscape, so including people who lived experience, people
• 43:32
  Speaker 5: on the community side, mainstream healthcare side, policymakers, et cetera,
• 43:37
  Speaker 5: to try to sort of envision what should things really
• 43:41
  Speaker 5: look like because we know there are these structural problems
• 43:44
  Speaker 5: that are going to be the things that will you know,
• 43:46
  Speaker 5: inhibit access to care. How do we address those?
• 43:49
  Speaker 1: Yeah? Those are really interesting questions. And I think that
• 43:52
  Speaker 1: brings us to a point this morning where we can
• 43:55
  Speaker 1: take a break right now, and I think I'd like
• 43:57
  Speaker 1: to talk about when we come back from our break
• 44:00
  Speaker 1: is some of the things as CBOs in San Diego,
• 44:03
  Speaker 1: what can we really do to make the shift From
• 44:07
  Speaker 1: an advocacy standpoint. I'm spending a week in Sacramento or
• 44:11
  Speaker 1: maybe more in the middle of August and at a
• 44:13
  Speaker 1: run in with all of our elected officials up there,
• 44:16
  Speaker 1: what's the message that I should really be carrying to
• 44:19
  Speaker 1: them about the system? Right there's one thing to take
• 44:22
  Speaker 1: a message about our organization.
• 44:25
  Speaker 4: Most of them know our organization.
• 44:27
  Speaker 1: But how can I elevate that conversation in Sacramento about
• 44:31
  Speaker 1: the system and the system of care. And I think
• 44:33
  Speaker 1: one of the other things is there's so many different
• 44:36
  Speaker 1: avenues right now, so many different organizations that are advocating
• 44:40
  Speaker 1: for this and advocating for that and overseeing how our
• 44:44
  Speaker 1: industry is working. That maybe we come back to some
• 44:47
  Speaker 1: of that and beautiful our second.
• 44:48
  Speaker 4: Part of our conversation this morning.
• 44:50
  Speaker 1: So with that and our audience will be right back.
• 44:53
  Speaker 7: Improving lives every day and in every way for Californians.
• 44:58
  Speaker 7: This is the mission of TURN Behavioral Health Services. By
• 45:02
  Speaker 7: focusing on wellness, recovery and resilience, TURN is helping create
• 45:06
  Speaker 7: lasting change, especially for our military community. If your active
• 45:11
  Speaker 7: duty of veteran reservists, regardless of military status or part
• 45:16
  Speaker 7: of a military family in San Diego.
• 45:19
  Speaker 5: Support is here.
• 45:21
  Speaker 7: Courage to Call is a free confidential helpline staffed by
• 45:25
  Speaker 7: veterans who understand military life. From eight am to eight pm.
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• 45:32
  Speaker 7: ready to listen, guide and help. On the very first
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  Speaker 7: in every way.
• 46:01
  Speaker 1: Well, welcome back, and now we're going to enter our
• 46:04
  Speaker 1: section of the Behavioral health brief called the brief, And
• 46:07
  Speaker 1: Luke I asked you a question about advocate today.
• 46:09
  Speaker 4: What can we.
• 46:10
  Speaker 1: Do as CBOs as CEOs and really help advocate for
• 46:15
  Speaker 1: some of the things that you talked about this morning.
• 46:17
  Speaker 4: Go yeah, yeah.
• 46:18
  Speaker 5: So largely what we've kind of described over the course
• 46:23
  Speaker 5: of our conversation has been this rift in healthcare, right
• 46:27
  Speaker 5: and in particular in behavioral healthcare, a rift between kind
• 46:31
  Speaker 5: of mild moderate care and serious mental illness care. In
• 46:35
  Speaker 5: the state of California, CBOs are positioned critically to actually
• 46:41
  Speaker 5: be able to traverse that gap. A lot of organizations
• 46:45
  Speaker 5: would have a lot of difficulty traversing that crap that
• 46:48
  Speaker 5: gap CBOs that and I would actually say the turn
• 46:52
  Speaker 5: is kind of ideally sized as a CBO to do
• 46:55
  Speaker 5: this work, because you know, it can be better done
• 46:58
  Speaker 5: by I think a more nimble organ to one with
• 47:01
  Speaker 5: a substantial footprint, but still one that's able to sort
• 47:04
  Speaker 5: of move nimbly. And it really is about innovative partnership
• 47:10
  Speaker 5: with entities like federally qualified health Centers, right, so entities
• 47:14
  Speaker 5: that the true cares, the true cares of the world,
• 47:17
  Speaker 5: or the family health centers or the santrasedros. I don't
• 47:20
  Speaker 5: want to get into the politics of fq's in San Diego, right,
• 47:22
  Speaker 5: because there is one. But I would say like CBOs
• 47:26
  Speaker 5: that have been devoted more to doing county paid serious
• 47:30
  Speaker 5: mental illness work have opportunities now and there is a
• 47:35
  Speaker 5: sort of you know, there's a threat to some recent
• 47:37
  Speaker 5: federal policy that we may talk about, they have opportunities
• 47:40
  Speaker 5: to develop partnerships with fqs that can I think, do
• 47:45
  Speaker 5: a lot to bridge this gap. In ways that the
• 47:48
  Speaker 5: governing entities, counties, managed care plans, the state, et cetera,
• 47:54
  Speaker 5: are not yet willing to do right, they are incentivized
• 47:57
  Speaker 5: to perpetuate those gaps. CBOs like turn can actually bridge
• 48:02
  Speaker 5: that by creating partnerships, by working across payers, right, so
• 48:07
  Speaker 5: working with mcps that pay for mild moderate care right
• 48:11
  Speaker 5: like CBOs can work with those payers and at the
• 48:13
  Speaker 5: same time work with county payers and create continua of
• 48:18
  Speaker 5: care that bridge that gap so that people don't feel that,
• 48:22
  Speaker 5: you know, when they go into crisis, all of a sudden,
• 48:24
  Speaker 5: they're having this wildly disjointed experience, right of like having
• 48:29
  Speaker 5: one set of providers and one set of contacts and
• 48:31
  Speaker 5: then all of a sudden a different set of providers
• 48:33
  Speaker 5: in a different and a different like authority, making decisions
• 48:36
  Speaker 5: about how much care they get and stuff like that. Right,
• 48:39
  Speaker 5: CBOs can actually make a lot of that feel much
• 48:42
  Speaker 5: more seamless to the people who need care. So that's
• 48:47
  Speaker 5: one thing I would say, right is making it clear
• 48:50
  Speaker 5: to people up in Sacramento that right now, we've got
• 48:53
  Speaker 5: a system that's defined by these very problematic silos and divisions.
• 48:57
  Speaker 5: And guess what kind of entity is best suited to
• 49:00
  Speaker 5: help alleviate that. It's the I would say, medium sized
• 49:04
  Speaker 5: CBO in the state of California. The other thing that
• 49:07
  Speaker 5: I think CBOs are really well positioned to do, and
• 49:11
  Speaker 5: that I think it's important that more and more folks
• 49:14
  Speaker 5: up in Sacramento understand, is to actually teach county behavioral
• 49:19
  Speaker 5: health payers the business of behavioral health. Counties have been
• 49:24
  Speaker 5: long standing in the business of behavioral health. And I'll
• 49:26
  Speaker 5: just sort of say, you mentioned that when I came
• 49:28
  Speaker 5: into the job in San Diego, I had half a
• 49:30
  Speaker 5: billion dollar budget. I'll just note when I left, I
• 49:32
  Speaker 5: had one and a half billion dollar budget in that department.
• 49:34
  Speaker 5: It's a massive amount of money, a massive amount of resources.
• 49:38
  Speaker 5: But we weren't built as a department like a managed
• 49:42
  Speaker 5: care entity. We weren't built as a business. We were
• 49:44
  Speaker 5: built as a local governmental thing that was saddled with
• 49:46
  Speaker 5: all the EIGHTHR problems and all the stuff that like
• 49:50
  Speaker 5: local government gets business right with all that well trying,
• 49:54
  Speaker 5: I mean it was sort of like trying to run
• 49:55
  Speaker 5: a business in the context of parks and rec you know.
• 49:58
  Speaker 5: And I used to say that actually all we're parks
• 50:01
  Speaker 5: and reck here. We got a way well right, it
• 50:04
  Speaker 5: went over just like I wanted, just to be a
• 50:07
  Speaker 5: little bit irritating to you. And so counties right now
• 50:11
  Speaker 5: aren't positions where they have to function more like businesses,
• 50:15
  Speaker 5: and they find themselves like woefully under equipped to do
• 50:20
  Speaker 5: that kind of work. CBOs again like turn that have
• 50:24
  Speaker 5: business acumen, that are interested in sort of new thinking
• 50:28
  Speaker 5: about how to create value structured payments. For example, we
• 50:32
  Speaker 5: talk about value based payments that we're value based contract
• 50:35
  Speaker 5: valuy based contracting, or performance based contracting. There's a lot
• 50:38
  Speaker 5: of sort of you know, terms terms of art. In
• 50:40
  Speaker 5: most cases where counties are doing that, they ain't really
• 50:43
  Speaker 5: doing it, you know, or they're doing it in such
• 50:46
  Speaker 5: a way that it's not really sort of like driven
• 50:48
  Speaker 5: by sophisticated ideas about what value is. And I think
• 50:53
  Speaker 5: CBOs can help teach them how to do that. It's
• 50:55
  Speaker 5: important I think that folks up in Sacramento realize ones
• 51:00
  Speaker 5: aren't all of a sudden just because DHCS told them
• 51:02
  Speaker 5: to function in this way. In fact, they're not all
• 51:04
  Speaker 5: of a sudden able to do that. And if they're
• 51:07
  Speaker 5: having to manage counties are if counties are having to
• 51:09
  Speaker 5: manage networks of providers that are just like you know,
• 51:14
  Speaker 5: I can't see, can't hear right, can't taste anything to
• 51:18
  Speaker 5: do with value, the counties are never going to learn it.
• 51:22
  Speaker 1: So it's interesting that you mentioned that because now in
• 51:25
  Speaker 1: San Diego they're separating off from HHSA, they are and
• 51:29
  Speaker 1: not to I mean, that's a whole other episode we could.
• 51:31
  Speaker 5: That was my idea.
• 51:32
  Speaker 1: JA Yeah, but I think I think the I'm not
• 51:37
  Speaker 1: sure they know where they're headed with this because it's
• 51:42
  Speaker 1: the staying with HSA, right, Nor do we really know
• 51:46
  Speaker 1: what's going We've got a pretty good idea what's going
• 51:49
  Speaker 1: to the behavioral health. But again they're separating a business
• 51:53
  Speaker 1: organization which is now going to become two separate.
• 51:55
  Speaker 4: Business organizations, which is going to take its own challenge.
• 51:59
  Speaker 4: And so for us at CBOs out there it's.
• 52:03
  Speaker 1: A little hard to navigate when you know, we don't
• 52:06
  Speaker 1: get all the information maybe at the right time. But
• 52:08
  Speaker 1: that's a that's kind of a different discussion we can
• 52:11
  Speaker 1: hit in.
• 52:11
  Speaker 4: But I like the idea.
• 52:13
  Speaker 1: I just don't understand how it's fully going to get implemented.
• 52:16
  Speaker 4: But I like the idea.
• 52:17
  Speaker 1: I think, well, what you say about how we have
• 52:20
  Speaker 1: the ability to cross over right now, because we're the
• 52:23
  Speaker 1: thinkers out there, we're the boots on the ground.
• 52:25
  Speaker 4: We know what it takes.
• 52:26
  Speaker 5: You've got the business acumen, and you've also you aren't
• 52:29
  Speaker 5: you aren't governed in such a way that you have
• 52:31
  Speaker 5: to just work with counties, right you actually like you
• 52:35
  Speaker 5: have the latitude.
• 52:38
  Speaker 6: Well leverage that I think that's what you're saying is
• 52:40
  Speaker 6: like leverage.
• 52:40
  Speaker 3: It don't just look at it as a workaround opportunity,
• 52:43
  Speaker 3: but leverage systemic change exactly. And so we we do
• 52:48
  Speaker 3: try to mix, you know, sort of the portfolio not
• 52:51
  Speaker 3: just by services but by payers as well, because you
• 52:54
  Speaker 3: really don't have a choice but to be successful that way.
• 52:57
  Speaker 3: That's right, And I think I think it's interesting what
• 53:00
  Speaker 3: Jim had asked you in terms of you know, advocating
• 53:03
  Speaker 3: and so when Jim is in front of the people
• 53:06
  Speaker 3: that can make a difference, and we explain, you know,
• 53:09
  Speaker 3: at the thunder level.
• 53:11
  Speaker 6: We've prepared white papers.
• 53:13
  Speaker 3: And we've done you know, ROI analysis and explained how
• 53:17
  Speaker 3: this could make sense. What really moves the needle in
• 53:23
  Speaker 3: your estimation, what really makes that difference.
• 53:27
  Speaker 5: In terms of getting resources to CBOs to help them
• 53:30
  Speaker 5: do that kind of work. Is that what you're asking. Well,
• 53:34
  Speaker 5: in my experience, what moves the needle is a very
• 53:36
  Speaker 5: concrete story, right, Like, it's got to be specific, it's
• 53:40
  Speaker 5: got to be human. I think we open the conversation
• 53:42
  Speaker 5: by sort of referencing the importance of sort of the
• 53:44
  Speaker 5: human face of all of this work. So bring that in.
• 53:49
  Speaker 5: But I wouldn't shy away from talking about very concrete,
• 53:53
  Speaker 5: very specific business practices that you want to innovate. Now,
• 53:56
  Speaker 5: the way that California works generally is by supporting little
• 54:01
  Speaker 5: pilot e things. And I say that in a way
• 54:04
  Speaker 5: that sounds detegrading, which you know I don't mean to be,
• 54:06
  Speaker 5: because frankly, like little pilot e things can quickly because
• 54:09
  Speaker 5: big pilot e things. And that's also how I would
• 54:12
  Speaker 5: recommend things get framed to actors in Sacramento. Right, Like,
• 54:16
  Speaker 5: you are in a position to like be innovating value
• 54:20
  Speaker 5: structures in payment by innovating methods to bridge the gap
• 54:25
  Speaker 5: between people in care with mental illness in federally qualified
• 54:29
  Speaker 5: health centers to people in care for mental illness or
• 54:32
  Speaker 5: behavior health conditions in specialty care organizations. Right, you want
• 54:35
  Speaker 5: to create pilot structures to do that to show the
• 54:39
  Speaker 5: world how it works, and that will would be very
• 54:43
  Speaker 5: compelling for political actors.
• 54:44
  Speaker 4: Very good. That's really great information. With the guard to that.
• 54:48
  Speaker 1: Now we're at one of my favorite parts of the show,
• 54:50
  Speaker 1: and that's community questions.
• 54:53
  Speaker 3: Okay, I think I'm in charge of this one, Jim,
• 54:55
  Speaker 3: Im will let you pick the first one. Hand it
• 54:57
  Speaker 3: over all, right, Luke ready.
• 55:00
  Speaker 5: I'm so ready.
• 55:01
  Speaker 6: Okay, here we go.
• 55:02
  Speaker 3: This is from Sophia from Chula Vista, and she asks,
• 55:06
  Speaker 3: many people find it difficult to understand how major public
• 55:11
  Speaker 3: budget decisions and funding cuts are made. Can you explain
• 55:15
  Speaker 3: how that process typically works?
• 55:17
  Speaker 6: Any insight?
• 55:18
  Speaker 5: My goodness, that's a big question.
• 55:20
  Speaker 1: So where to go?
• 55:21
  Speaker 4: So where to go?
• 55:24
  Speaker 5: So you know, where I have most experience in California
• 55:28
  Speaker 5: around that question is at the level of county local government, right, Uh?
• 55:33
  Speaker 5: And and it is. I mean, I think the thing
• 55:36
  Speaker 5: that I want would want listeners to carry away is
• 55:38
  Speaker 5: that it's it's very complex and it's not just that,
• 55:44
  Speaker 5: you know, I mean what what the public will often
• 55:46
  Speaker 5: see is like maybe a decrease in the total budget,
• 55:50
  Speaker 5: and they'll say, why did the behavioral health director decide
• 55:53
  Speaker 5: to decrease like his or her total budget? And that
• 55:56
  Speaker 5: is very seldom the case that that's what has happened.
• 55:59
  Speaker 5: There's so so many different things, considerations, people, politics that
• 56:05
  Speaker 5: end up, you know, determining ultimately how a budget gets
• 56:08
  Speaker 5: put together. In California, behavioral health budgets are made up
• 56:12
  Speaker 5: of a bunch of different sources of revenue. There's a
• 56:15
  Speaker 5: revenue source called realignment that's sales tax. So sales tax
• 56:20
  Speaker 5: is dependent upon you know, how much stuff people are
• 56:24
  Speaker 5: buying across the state. So there may be a budget
• 56:27
  Speaker 5: cut that you see at the county level and you
• 56:29
  Speaker 5: think somebody decided to cut the budget to that it
• 56:31
  Speaker 5: could have in fact to do with sales tax revenue.
• 56:34
  Speaker 5: At the state level, there's another sort of funding called
• 56:37
  Speaker 5: Behavioral Health Services Act money. That's money that is colloquially
• 56:41
  Speaker 5: referred to as the millionaire's tax. It's revenue that the
• 56:44
  Speaker 5: state makes from taxing any individual or entity that makes
• 56:49
  Speaker 5: a million dollars or more one percent, and all of
• 56:52
  Speaker 5: that funding, all of that one percent of everybody or
• 56:55
  Speaker 5: a thing that makes a million bucks or more goes
• 56:57
  Speaker 5: to mental health care. That source of revenue, also at
• 57:00
  Speaker 5: the local level, ticks up and ticks down, and depending on.
• 57:04
  Speaker 1: The change, really substantially dramatically and two years.
• 57:09
  Speaker 5: Also important for Sophia and others who would have that
• 57:11
  Speaker 5: interest to keep in mind that the state just made
• 57:14
  Speaker 5: this enormous policy shift. It was a voter driven thing,
• 57:19
  Speaker 5: I would say, so it's not a thing that you can,
• 57:21
  Speaker 5: you know, necessarily easily blame state actors for though I
• 57:25
  Speaker 5: would just note it was Proposition one, voter driven twenty
• 57:30
  Speaker 5: thousand votes. Yeah, was the difference, you know, between approval
• 57:35
  Speaker 5: and rejection. It was approved by twenty thousand votes across
• 57:38
  Speaker 5: the state of California. It means that there's some substantial
• 57:42
  Speaker 5: budget cuts coming right now at the county level. Not
• 57:46
  Speaker 5: a decision made at the county level at all. That's
• 57:48
  Speaker 5: a decision made by voters across the state of California
• 57:51
  Speaker 5: and then implemented by the state.
• 57:52
  Speaker 6: Gohe Yeah, I was going to say.
• 57:54
  Speaker 3: I think sometimes we hear people equate budget cuts in
• 57:58
  Speaker 3: certain line or what we would consider line items or populations,
• 58:03
  Speaker 3: you know, and it doesn't correlate with a lack of
• 58:07
  Speaker 3: care or a lack of you know, consideration for that population.
• 58:11
  Speaker 6: And sometimes we hear that correlation, and so we want to.
• 58:14
  Speaker 3: Just leave Sophia and listeners understanding that there's a lot
• 58:17
  Speaker 3: of care and there's a lot of heart at our
• 58:20
  Speaker 3: county and other folks who have to make those really
• 58:22
  Speaker 3: tough decisions.
• 58:23
  Speaker 6: And by no means does it mean anyone.
• 58:25
  Speaker 3: Cares less about a certain population if that particular budget
• 58:27
  Speaker 3: had been because we hear that a lot.
• 58:29
  Speaker 4: Oh, they don't care about this population, right.
• 58:31
  Speaker 5: Oh, I may have heard that a bit when I
• 58:33
  Speaker 5: was the behavioral the record. I can I just harp
• 58:35
  Speaker 5: on this for just one yes, but with respect to
• 58:38
  Speaker 5: kids in particular, that was an issue that got taken
• 58:41
  Speaker 5: to me often was the budget seems to be going
• 58:44
  Speaker 5: down for our littles, you know, our most vulnerable, Like
• 58:47
  Speaker 5: on whose heartstring? Does that not tug?
• 58:50
  Speaker 1: Right?
• 58:51
  Speaker 5: Part of the dynamic there is that in county, behavioral
• 58:55
  Speaker 5: health funding has shifted from the sources of revenue. I
• 58:59
  Speaker 5: was just describing. It's like tax revenue driven, you know,
• 59:03
  Speaker 5: kind of designated allocated funding to fee for service funding. Now,
• 59:09
  Speaker 5: fee for service funding pays for as much services are provided.
• 59:13
  Speaker 5: And so that's another important thing for listeners to be
• 59:15
  Speaker 5: aware of. When you're scrutinizing a budget that only is
• 59:19
  Speaker 5: referencing tax revenue and isn't referencing revenue driven by fees
• 59:24
  Speaker 5: that are part of the medical system, you're not actually
• 59:27
  Speaker 5: seeing the devotion of funding that's going.
• 59:29
  Speaker 1: To different public Yeah, you hear out there in the
• 59:31
  Speaker 1: public on that. Just to add in, they don't put
• 59:34
  Speaker 1: any money towards children, it's all towards adult and older.
• 59:37
  Speaker 1: But it's actually the revenue stream that is out there.
• 59:40
  Speaker 4: To be able to feed that's services that we need.
• 59:43
  Speaker 4: That's right, that's great.
• 59:44
  Speaker 1: Let's go to number two.
• 59:46
  Speaker 3: Let's jump in here we go. Kevin from Sacramento wants
• 59:49
  Speaker 3: to know how can employers create a workplace culture that
• 59:54
  Speaker 3: supports mental wellness.
• 59:56
  Speaker 5: Gosh, what a beautiful, great question, Such a great question.
• 59:59
  Speaker 5: I mean, you know, it has become kind of facile
• 1:00:03
  Speaker 5: for people in positions of institutional leadership to talk about
• 1:00:06
  Speaker 5: the importance of mental health and behea of health. And
• 1:00:08
  Speaker 5: there's a lot of sort of virtue signaling frankly around
• 1:00:12
  Speaker 5: that without real investments in you know, in change that
• 1:00:17
  Speaker 5: is consequential. I mean, I would just say things that
• 1:00:19
  Speaker 5: are really important are establishing an institutional cultural expectation that
• 1:00:24
  Speaker 5: people actually unplug. And that means you, Jim, that means
• 1:00:27
  Speaker 5: you Wendy. Yeah, that means that you genuinely like leadership
• 1:00:31
  Speaker 5: has to model that you have got to take time
• 1:00:34
  Speaker 5: away and you've got to genuinely support you have amazing
• 1:00:37
  Speaker 5: people who work for you, they also need to really
• 1:00:40
  Speaker 5: really unplug that. I would say that's a very basic consideration.
• 1:00:45
  Speaker 5: There's a lot of talk right now about the kind
• 1:00:47
  Speaker 5: of mental health ramifications of on site as opposed to remote,
• 1:00:51
  Speaker 5: as opposed to hybrid. You know, like that conversation is
• 1:00:57
  Speaker 5: happening simultaneously with conversations about caring more about mental health
• 1:01:02
  Speaker 5: kind of impacts of work environments. There's a lot of data.
• 1:01:06
  Speaker 5: I would say leaders of institutions need to be held
• 1:01:10
  Speaker 5: to account to what those data are.
• 1:01:12
  Speaker 4: That's really interesting point.
• 1:01:13
  Speaker 1: We really try to push a wellness plan. In fact,
• 1:01:16
  Speaker 1: we got a nereat provider this year on our medical
• 1:01:19
  Speaker 1: side and then dedicated almost one hundred thousand dollars to
• 1:01:22
  Speaker 1: wellness for the employees. That's to our discretion to use
• 1:01:26
  Speaker 1: to help motivate people to take care of themselves first,
• 1:01:31
  Speaker 1: because they're taking care of so many clients, different levels
• 1:01:34
  Speaker 1: of stuff that the clients are experiencing so well. In
• 1:01:39
  Speaker 1: Just to close out, Luke, I want to thank you
• 1:01:42
  Speaker 1: for being here today. This has been a very educational
• 1:01:45
  Speaker 1: session for myself. And before we close, is there anything
• 1:01:49
  Speaker 1: that you'd like to leave our listeners with today?
• 1:01:53
  Speaker 5: I hope that that I mean, I imagine that you
• 1:01:56
  Speaker 5: know that your audience is you know, it's folks interest
• 1:02:00
  Speaker 5: in this topic. I would just say what we want
• 1:02:05
  Speaker 5: to cultivate among everybody in our communities, people who you know,
• 1:02:09
  Speaker 5: have behavioral health concerns themselves for family members, and this,
• 1:02:13
  Speaker 5: by the way, makes up almost all the people in
• 1:02:16
  Speaker 5: our community. Yes, it does. That they should understand that
• 1:02:19
  Speaker 5: things actually need to change pretty dramatically, and that none
• 1:02:25
  Speaker 5: of the change that needs to happen will happen without
• 1:02:28
  Speaker 5: their participation in making it happen. People shouldn't just sort of,
• 1:02:32
  Speaker 5: you know, bemoan the fact that we have a care
• 1:02:35
  Speaker 5: system that is less responsive than they want it to be.
• 1:02:38
  Speaker 5: They can play a significant role, and you're making.
• 1:02:41
  Speaker 6: Their voice matters, their voice counts. They need to speak up.
• 1:02:44
  Speaker 5: An advocate absolutely well said thank you Wendy, and Wendy
• 1:02:47
  Speaker 5: as my co host today, what do you have to
• 1:02:48
  Speaker 5: add today's session?
• 1:02:50
  Speaker 4: And as we go into close.
• 1:02:51
  Speaker 6: Out, I mean, just you know, thank you, Luke. I'm
• 1:02:54
  Speaker 6: so happy that.
• 1:02:55
  Speaker 3: You were able to be here on you you're a
• 1:02:58
  Speaker 3: think tank and at the same time you're so approachable
• 1:03:02
  Speaker 3: and it's very apparent to us that you have a
• 1:03:05
  Speaker 3: lot of passion in your heart for this work. You
• 1:03:07
  Speaker 3: care very deeply, and to have those two things married
• 1:03:11
  Speaker 3: in one person, it's fantastic.
• 1:03:13
  Speaker 6: We're lucky to have you here today.
• 1:03:15
  Speaker 4: Thank you so much, Thank you very much.
• 1:03:17
  Speaker 5: Thanks appreciate it.
• 1:03:18
  Speaker 1: This will close out our episode for today. But what
• 1:03:22
  Speaker 1: an amazing episode with doctor Luke Bergman. Wendy, do you
• 1:03:25
  Speaker 1: have anything as my co host to add today? With
• 1:03:27
  Speaker 1: regards to doctor Bergman.
• 1:03:28
  Speaker 3: I mean, I just think he's amazing and it is
• 1:03:30
  Speaker 3: a lot of rich information and I'm sure our viewers
• 1:03:33
  Speaker 3: took a lot out of it as well. I mean,
• 1:03:35
  Speaker 3: he's just an amazing addition to what we have in
• 1:03:39
  Speaker 3: terms of resources in San Diego.
• 1:03:40
  Speaker 6: He's amazing.
• 1:03:41
  Speaker 1: Yeah, I'd like to end the show today with a
• 1:03:44
  Speaker 1: moment about gratitude. And I'm grateful today that we actually
• 1:03:47
  Speaker 1: had doctor Luke Bergman on our show. I think this
• 1:03:50
  Speaker 1: has been amazing and it's been really an educational opportunity
• 1:03:54
  Speaker 1: for myself. I'd like to extend gratitude to the behavioral
• 1:03:57
  Speaker 1: health professionals, peer support, special social workers, community organizations, including
• 1:04:03
  Speaker 1: our own turn employees who show up every day and
• 1:04:07
  Speaker 1: support all of our communities. Wendy, would you like to
• 1:04:10
  Speaker 1: share your moment of gratitude.
• 1:04:13
  Speaker 6: Yeah, I mean I agree with you. I think there's
• 1:04:16
  Speaker 6: so much out there.
• 1:04:17
  Speaker 3: I love that people who just leave it on the table,
• 1:04:21
  Speaker 3: like Luke, like our staff, like you just mentioned, people
• 1:04:24
  Speaker 3: that have the passion and their hearts to make a difference.
• 1:04:26
  Speaker 6: And we know that it doesn't go without sacrifice.
• 1:04:29
  Speaker 3: I mean, Luke was here squeezing us in between demands
• 1:04:32
  Speaker 3: and his schedule and time with his family, and you know,
• 1:04:35
  Speaker 3: this is the way that we move the needle, This
• 1:04:37
  Speaker 3: is the way that we make change, which is what
• 1:04:39
  Speaker 3: we you know, we set out to do. So I
• 1:04:41
  Speaker 3: just I think everyone who has it in their heart
• 1:04:44
  Speaker 3: and the passion and to make a difference.
• 1:04:46
  Speaker 6: It's just what we're about.
• 1:04:48
  Speaker 1: And then to just close out today to our listeners,
• 1:04:51
  Speaker 1: thank you for spending time with us today. Please like, share,
• 1:04:55
  Speaker 1: and subscribe. I'm Jim Callahan alongside doctor Wendy Broke. This
• 1:05:00
  Speaker 1: has been the behavior of health brief.
• 1:05:02
  Speaker 6: Thank you.
• 1:05:04
  Speaker 1: This has been the behavior of health brief where insight
• 1:05:07
  Speaker 1: meets impact.
• 1:05:15
  Speaker 5: H