Latest / Becker’s Payer Issues Podcast / Doug Henry, Enterprise Medical Director of Behavioral Health, Highmark Health

Transcript

Doug Henry, Enterprise Medical Director of Behavioral Health, Highmark Health · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy, care, and
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  Barriers to care can lead to gaps in
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  and people forward.
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  This is Hailey Recker with the Becker's Payer
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  Podcast, and we are recording live at the
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  Becker's third annual spring payer issues roundtable.
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  Today, I am joined by doctor Doug Henry,
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  enterprise medical director of behavioral health at Highmark
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  Health.
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  Doug, thank you so much for joining us
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  today. Can you go ahead and introduce yourself
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  and tell us a little bit about your
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  background and organization?
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  Sure, Haley, and thanks for having me. Of
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  course.
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  My background is as a clinical psychologist,
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  trained and educated,
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  and
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  began,
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  my career in Southern California doing a lot
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  of work in schools. I was a public
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  high school counselor, and I worked at a
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  shelter for runaway adolescents
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  and,
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  did inpatient unit work, detox work, locked,
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  hospital based work, and,
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  then got into
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  the
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  public apparatus
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  and, spent many years working in a Medicaid
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  clinic,
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  in Southern Cal, and that was really a
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  very formative,
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  experience for me. And I say that because
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  my experience of all of my years out
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  there, we're seeing
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  many, many patients. And on a good day,
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  a psychologist sees about eight patients.
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  And,
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  again, on a good day,
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  you're able to help, you know, five or
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  six of those eight in a substantive
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  way. And as I was,
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  reading the data
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  coming in about how ill The United States
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  was becoming from a mental health perspective,
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  even though I absolutely
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  adored the psychotherapy and testing work that I
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  was doing and diagnostic work that I was
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  doing,
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  it felt like it wasn't enough, like I
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  had to make a bigger impact. And so
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  I got into administration
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  and began,
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  laying out, mental health systems
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  for cities,
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  and then for counties in California,
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  and then,
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  moved back to the East,
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  in 2007
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  and worked as clinical administrator for psychiatry for
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  University of Pittsburgh Medical Center for many years,
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  and more recently,
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  Allegheny Health Network,
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  which is a wholly owned subsidiary of Highmark
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  Health,
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  since 2017.
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  And I I just one last
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  comment about that history. I was attracted to
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  Highmark Health because of their focus on behavioral
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  health, because of their commitment
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  to making it an equal equal pillar
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  of attention and investment
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  with physical health. Well, it seems like you've
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  been in the industry for quite a while
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  now.
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  Thank you so much for letting out your
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  experience with us.
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  Now to begin our conversation, I'd like to
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  talk about balancing affordability
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  and quality first. So how is your organization
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  innovating to manage the cost of care while
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  maintaining or improving member outcomes?
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  What a great question.
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  And,
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  these,
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  are not only not mutually
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  exclusive motives. They actually go hand in hand
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  even though people often think
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  that they're at odds.
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  And one of the things that I tell
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  my team members is
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  show me a substantial
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  quality improvement, something that is a new service
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  delivery model, a new therapeutic technique,
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  a new aspect of evolving techno technology,
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  neuromodulation,
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  whatever it may be. If it really makes
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  a difference in favor of quality,
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  I will be able to create a business
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  plan that shows that it is economical and
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  it that it makes money or loses less
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  money or avoids cost.
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  So that's true in about ninety nine percent
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  of cases. There are always cases
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  like the case of orphan drugs where you
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  have a very small and, you know, maybe
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  a hundred people on planet Earth might have,
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  a rare
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  disease, and it costs millions of dollars to
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  develop the therapy for that disease. Now those
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  are instances
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  where the economics don't work,
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  but they are rare and very special. In
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  those instances, you need other forces, usually the
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  the government, to step in and support the
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  development of those medicines,
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  to so that they can have maximum
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  access.
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  But for all intents and purposes, a quality
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  advance
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  is
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  not more costly,
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  but less costly
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  in the long run. And so one example
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  of what we do, how we approach that
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  at Highmark
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  is we spent two years looking for a,
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  telepsychiatric
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  and a teletherapeutic
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  partner, for behavioral health. And we interviewed more
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  than 200 companies.
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  And so it was a a very thorough
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  process with a very,
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  detailed rubric.
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  And,
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  at the end of that process, we chose
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  Spring Health.
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  And we really chose Spring Health,
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  on the basis of, two things, their clinical
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  quality
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  and their willingness
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  to share data on a very frequent basis
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  demonstrative
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  of the progress that our members were making
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  under their care.
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  Those two things combined and and it turned
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  out
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  spring was actually one of the more expensive,
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  of the 200. If you know, to be
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  honest, I think they were the second most
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  expensive.
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  So the point that I'm trying to make
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  is that
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  our attitude in behavioral health at Highmark is
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  to go for quality because we know
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  that that is going to drive down costs.
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  The only thing that is more expensive than
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  a lack of access to behavioral health services
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  is are ineffective
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  behavioral health services. And that's that's the the
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  thing that you want to avoid.
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  You know, I'd like to go a little
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  bit deeper into that on the basis of,
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  you know, member satisfaction.
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  So what experience or engagement strategies
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  have proven effective for your organization, and how
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  are you measuring that success?
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  So, when we talk about access to behavioral
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  health services and and and most everyone knows
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  in The United States that access has been
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  an incredible problem since long before the pandemic.
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  But during the pandemic, it just became so
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  acute that everyone took notice,
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  but we really have been challenged for some
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  time.
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  And,
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  when you look at opening access, it is
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  not just access. It is access
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  to what and for whom.
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  So do you have services
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  for,
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  the single mom who has a two year
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  old just came home from visiting the pediatrician,
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  and was encouraged to get an evaluation for
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  suspected autism.
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  You know, do do you have a service
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  for that mom to get that evaluation
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  in less than six months?
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  Well, in most cases, the answer is no.
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  So you have to,
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  you have to provide the right kind of
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  access to a broad array of services
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  of the intensity that is appropriate
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  to what the member wants and to the,
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  member's clinical
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  situation.
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  So some examples,
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  of
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  actually, my favorite data point of all,
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  that I've seen over the past couple of
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  years at Highmark Health
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  is that
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  eighty percent of our members
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  who have at this point completed about a
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  140,000
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  clinical visits with Spring Health over the past
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  fourteen months,
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  but many more visits to self guided
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  meditations,
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  self guided CBT,
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  and behavioral health coaching. But a but a
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  140,
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  clinical,
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  encounters or visits
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  is
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  that eighty percent
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  of those
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  were taken by first time mental health users.
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  And what that tells me is that
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  we have lowered the friction
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  that people experience
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  when they're trying to access mental health services
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  to a degree
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  that has enabled
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  eighty percent first time users. Meaning, this is
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  a group that most of which has tried
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  for to get behavioral health appointments before
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  and has become frustrated
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  and failed.
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  But with that ratio,
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  really,
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  we're we're accomplishing our mission
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  to bring real access to behavioral health services
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  to the people that want and need it.
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  I'll give another,
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  a a quick data point
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  that, with,
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  our partner, Spring Health, we have,
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  a 65,
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  35%
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  split
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  of women to men. And and men
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  being as we are, we are a little
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  bit reluctant often to seek mental health services
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  more so than women, and that ratio is,
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  across United States is very consistently
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  three to one. So, you have 75%,
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  usually are women. And so we have 65%,
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  and that's that's nice. But once they enroll
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  in Spring Health,
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  the actual utilization
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  and consumption
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  of psychotherapy
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  and psychiatric
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  services
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  is equivalent
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  among men and women. And so really, really
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  proud about that. I'll also add that ninety
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  six percent
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  of
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  our members,
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  that are paired
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  with an initial
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  therapist by Spring Health, and they have a
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  very good pairing algorithm.
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  Six months later, they're still seeing that individual
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  therapist. So we're getting it right. The matching
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  algorithm
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  is working extremely well,
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  and patients, tend to be, satisfied to an
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  incredibly high degree,
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  with their first provider. And and I'm sure
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  we'll talk about that a little bit more
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  in other questions, but the the matching, making
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  sure that there's a right fit
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  between patient and the psychotherapist
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  and the psychiatrist is enormously important
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  and very much impacts the outcome, whether someone
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  is able to get well or not.
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  That's amazing. Thank you so much for laying
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  that out for all of us.
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  Now looking ahead to the future of the
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  payer space, what do you see
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  as the biggest opportunity for payers to lead
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  the charge in transforming care delivery and driving
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  better outcomes for all stakeholders?
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  Oh my goodness. Okay. Great question.
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  There are many opportunities in behavioral health. It's
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  a mistake to think. And I've heard executives
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  say in the past,
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  you know, we'd love to invest. There's just
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  no money in behavioral health.
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  And I know what they mean. They're you're
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  not gonna make a positive margin like,
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  medical systems often do and oncology
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  care or orthopedic care or neurological care,
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  but it's the cost avoidance.
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  It's the fact
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  that investing in mental health is one of
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  the most inexpensive
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  levers
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  that a provider system or a payer system
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  can pull to reduce
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  total cost of care. In other words, the
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  benefits
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  of mental health as opposed to mental illness
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  are manifest
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  in lower health care costs, lower disease burden
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  across the board.
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  So
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  to
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  act on that fact and that awareness,
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  What I'm really focused on are shared risk
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  models, the use of shared risk models
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  to
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  revolutionize
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  clinician behavior in favor of the patient
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  and in favor of the patient's health and
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  maintenance of health. And what this means is
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  changing
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  reactivity
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  where someone decompensates and hits the emergency department
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  in a in a difficult situation. Maybe they're
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  admitted. Maybe they're
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  arranged for ambulatory partial hospital care,
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  or or whatever it may be. But things
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  have gotten really bad to drive someone to
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  the emergency department for a psychiatric problem,
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  and we could be intervening
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  long before that and keeping people healthy
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  if the financial incentives
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  are aligned properly
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  in the patient's favor. And they have not
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  been, quite frankly. They've been in favor of
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  other interests. Sometimes they're in favor of the
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  payer. Sometimes they're in favor of the partner.
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  But they are not well aligned to the
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  interests of health, community health, and individuals.
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  And so a shared risk model really changes
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  that, and it is,
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  it gives the the sort of the power
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  and the impact
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  to really change providers' behavior very, very quickly.
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  Providers want to do the right thing to
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  keep their patients healthy. Right now, they,
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  have not
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  been allowed to, basically, because you're not generating
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  the same amount of revenue in a fee
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  for service system. So going to value based
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  care and shared risk models where
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  medical care becomes and when I say medical
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  care, I mean psychiatric care too, becomes proactive.
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  That's what where we need to go.
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  Well, doctor, thank you so much for joining
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  me today. Again, this is Haley Recker with
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  the Becker's Payer Podcast
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  recorded live at the Becker's third annual spring
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  payer issues roundtable.
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  Thank you so much. Haley, this was fun.
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  Thank you.