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Closing the Behavioral Health Gap in Women's Health · Becker's Healthcare Behavioral Health

• 0:00
  - Hello, everybody. This is Erica Spicer Mason with
• 0:02
  - Becker's Healthcare. Thank you so much for tuning
• 0:05
  - in to the Becker's Healthcare podcast series today.
• 0:08
  - So I'm excited that today we're going to
• 0:10
  - talk about closing the behavioral health gap in
• 0:12
  - women's health.
• 0:14
  - And joining me for this
• 0:15
  - conversation, we have Laura Bauer, the vice president
• 0:18
  - of strategy at Iris Telehealth.
• 0:20
  - Laura, great to have you on the podcast.
• 0:22
  - How are you doing today? I'm doing well.
• 0:24
  - Thank you so much for having me. I'm
• 0:25
  - very excited.
• 0:26
  - Oh, so glad to have you here. And
• 0:28
  - before we get into the conversation, wanted to
• 0:30
  - give you the chance just to say a
• 0:31
  - little bit about yourself and your work at
• 0:33
  - IRIS telehealth.
• 0:35
  - Yeah. Absolutely. So I've been, in health care
• 0:38
  - for my entire career.
• 0:40
  - Previously, I've worked for a a number of
• 0:41
  - different health
• 0:43
  - systems. In my last role, I was over
• 0:44
  - women's and children's services for,
• 0:48
  - a health system in the San Francisco Bay
• 0:50
  - Area. So women's health, obviously, a big,
• 0:54
  - you know, passion for me as a woman,
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  - but also where I've spent a good amount
• 0:58
  - of my career.
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  - And behavioral health is sort of the other
• 1:00
  - really big passion of mine, which is why
• 1:02
  - I joined Iris, almost exactly two years ago.
• 1:06
  - We partner with health systems and community,
• 1:09
  - providers to
• 1:11
  - support and augment and deliver behavioral health, within
• 1:15
  - the their own ecosystem.
• 1:17
  - So, helping to establish really important programs for
• 1:20
  - behavioral health,
• 1:21
  - in addition to, helping supply,
• 1:24
  - both psychiatrists,
• 1:26
  - nurse practitioners, therapists as well to to deliver,
• 1:29
  - you know, really important behavioral health. So what
• 1:31
  - we've recently launched is service line specific behavioral
• 1:35
  - health solutions,
• 1:36
  - the first one being around women's health because
• 1:39
  - that's what we were really starting to hear
• 1:40
  - from our partners,
• 1:42
  - is a a really significant need to close
• 1:44
  - that gap. So
• 1:46
  - very,
• 1:47
  - timely to to have this conversation because it's
• 1:49
  - certainly, aligned with what we're hearing from a
• 1:51
  - number of our partners.
• 1:53
  - Yeah. Laura, it's so great to learn more
• 1:55
  - about you and and your work and couldn't
• 1:57
  - agree more. We're definitely across
• 1:59
  - the
• 2:01
  - industry
• 2:02
  - right now.
• 2:03
  - But it's interesting because women's health really has
• 2:05
  - traditionally been built around that reproductive and maternal
• 2:09
  - health space. So I So I'd love to
• 2:11
  - know what you see as driving that shift
• 2:14
  - toward a full lifespan model, and what does
• 2:17
  - that expanded footprint look like with the systems
• 2:19
  - that you're working with?
• 2:21
  - Yeah. And and I think what I would
• 2:23
  - start with is
• 2:25
  - and women know this,
• 2:27
  - but but I think, you know, as a
• 2:29
  - broader sort of nationwide,
• 2:31
  - we haven't been thinking about it a lot.
• 2:34
  - The iris, we just recently did a consumer
• 2:36
  - survey
• 2:37
  - surveying women about their mental health and their
• 2:40
  - needs. Seven out of ten women said that
• 2:42
  - ongoing stress and daily responsibilities
• 2:44
  - are affecting their mental health at least moderately.
• 2:48
  - Forty percent said that all of the daily
• 2:51
  - mental load
• 2:53
  - is affecting them a great deal
• 2:55
  - or a lot. What does that mean? That
• 2:57
  - means that especially women who are dealing
• 3:00
  - with children
• 3:01
  - and their aging parents and their career and,
• 3:04
  - oh,
• 3:05
  - menopause is coming just to really make things
• 3:08
  - harder,
• 3:09
  - are saying,
• 3:10
  - I'm overwhelmed. It's too much.
• 3:13
  - And they're calling uncle. Like, they're not okay
• 3:16
  - with just continuing to feel like this. They
• 3:18
  - are saying,
• 3:19
  - it's too much. I have a behavioral health
• 3:21
  - burden. And they're actually saying, I want more.
• 3:24
  - And they are going to their providers and
• 3:26
  - saying, give me more. And so I think
• 3:28
  - in response to that,
• 3:30
  - health systems very wisely are starting to pay
• 3:32
  - a lot of attention to that midlife
• 3:35
  - journey.
• 3:36
  - And it's not just mental health. There's a
• 3:37
  - lot of components that happen that start with
• 3:40
  - with perimenopause into menopause, and so they're building
• 3:43
  - programs around that. Behavioral health is a key
• 3:46
  - component of that.
• 3:47
  - You're also seeing a lot of,
• 3:50
  - other sort of,
• 3:52
  - sub service lines or specific diagnoses
• 3:54
  - where we're finally talking about it. We're talking
• 3:57
  - about endometriosis
• 3:59
  - and what that means and how hard
• 4:01
  - that can be to live with. And there's
• 4:04
  - a huge correlation with, you know, severe endometriosis
• 4:07
  - and behavioral health conditions. And those women are
• 4:10
  - stepping up and saying, hey.
• 4:12
  - I need some help. You can't just treat
• 4:14
  - one component because it's still affecting how I
• 4:16
  - feel. And so it's really been being driven
• 4:18
  - by the patient or the consumer saying give
• 4:21
  - me more and
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  - we're we're listening and and I think wisely
• 4:25
  - starting to build programs to to meet those
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  - needs.
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  - Yeah. Yeah.
• 4:31
  - Appreciate the overview, Laura. And I see some
• 4:33
  - of the demand that you're speaking to. I
• 4:35
  - even see that reflected in our events at
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  - Becker's. I know just a few years ago,
• 4:40
  - we started seeing menopause come onto the agenda
• 4:42
  - and menopausal mental health. And,
• 4:45
  - and I expect that we're just going to
• 4:46
  - see those topics integrate more and more into
• 4:49
  - these leadership discussions.
• 4:51
  - But I wanna go back to kind of
• 4:52
  - this idea of,
• 4:54
  - the services that women are are demanding, rightfully
• 4:57
  - so. And yet, it it feels like resources
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  - might not be there just yet to meet
• 5:02
  - that need. So why do you think mental
• 5:03
  - health mental health keeps falling kind of outside
• 5:07
  - of traditional women's health service line planning?
• 5:10
  - Yeah. You know, it's so interesting that question
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  - because
• 5:14
  - we had this discussion internally at IRIS. And
• 5:18
  - it's really this this distinction
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  - of
• 5:21
  - what is women's behavioral health.
• 5:24
  - And so many people view it as just
• 5:26
  - like, well, it's women that have behavioral health
• 5:27
  - issues. So like why you know, women get
• 5:30
  - depressed just like men. We don't have a
• 5:31
  - men's service line. Why do we need a
• 5:33
  - women's service line? But understanding that that yes,
• 5:36
  - there are women that just, you know, happen
• 5:38
  - to be depressed.
• 5:39
  - But there's such a significant
• 5:42
  - relationship
• 5:43
  - between, you know,
• 5:45
  - specific diagnoses that we will deal with
• 5:47
  - and behavioral health issues. I mean, obviously, we
• 5:51
  - know quite a bit about,
• 5:53
  - postpartum
• 5:53
  - depression. I always say thank you Brooke Shields
• 5:55
  - for bringing that to the forefront.
• 5:58
  - You know, that's certainly one part of why
• 6:00
  - we started talking about,
• 6:02
  - postpartum depression. Right?
• 6:04
  - But that's specific to something that women experience.
• 6:07
  - That's sort of the difference. Right? We talked
• 6:09
  - about endometriosis,
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  - etcetera. So that's, I think, the barrier. And
• 6:13
  - it it is hard in general to have
• 6:16
  - a women's service line because it's both a
• 6:18
  - demographic
• 6:19
  - and a service line. Right? And so it's
• 6:22
  - understanding
• 6:23
  - the correlation of the very specific
• 6:26
  - journey that women will go through,
• 6:28
  - and how that
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  - can
• 6:31
  - lead to behavioral health concerns.
• 6:34
  - Postpartum is what we talk about, but perimenopause
• 6:37
  - is a really big one. Pelvic floor disorders.
• 6:40
  - Right?
• 6:41
  - Huge infertility
• 6:43
  - treatment.
• 6:43
  - You know, as you talk about anything that
• 6:45
  - a woman goes through,
• 6:47
  - breast cancer,
• 6:49
  - having a double mastectomy, losing her breasts, what
• 6:51
  - if she has to have an early hysterectomy
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  - and everything that comes along with that. Those
• 6:55
  - are really big things in a woman's life
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  - that
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  - can trigger
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  - or lead to or exacerbate
• 7:02
  - a behavioral health issue.
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  - Mhmm. Yeah. It
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  - it's fascinating
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  - the range of life experiences
• 7:10
  - that you're touching on that can affect women's
• 7:13
  - mental health. And
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  - while all of them are are incredibly significant,
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  - it seems like the stakes of
• 7:21
  - those needs and service gaps are those stakes
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  - seem a bit higher when it comes to
• 7:25
  - maternal health. So I wanna talk about that
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  - a little bit.
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  - From your point of view, what does effective
• 7:31
  - behavioral health integration
• 7:32
  - look like across a women's health service line?
• 7:35
  - Right. Across the board, it's about being proactive.
• 7:39
  - Right?
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  - Moving from
• 7:42
  - screening
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  - to intervention. Doing so seamlessly,
• 7:47
  - before
• 7:49
  - we get to a really scary state.
• 7:51
  - Obviously, there's a case in the news right
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  - now,
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  - about, you know,
• 7:57
  - maybe not appropriately addressing,
• 8:00
  - behavioral health issues and postpartum
• 8:02
  - psychosis or or depression or anxiety.
• 8:05
  - But it but it's more than that. Right?
• 8:07
  - It's this idea of moving from just assessing
• 8:10
  - risk. Everybody's doing the Edinburgh right now. They're
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  - they're seeing, you know, on mom babies is,
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  - you know, how patients are doing
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  - and that's great
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  - but then what do you do with it?
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  - If they are in fact, you know, scoring
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  - a 16 quite depressed,
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  - do you have somewhere to send that patient?
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  - Are you proactively doing that? But here's the
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  - other thing. You can actually there's a real
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  - correlation. There's evidence based. There's a number of
• 8:36
  - studies that that we've looked at and we're
• 8:38
  - starting to aggregate the data with our partners
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  - of
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  - what happens in delivery and a higher likelihood
• 8:44
  - of having postpartum depression and anxiety.
• 8:48
  - If you have a severe, postpartum hemorrhage that,
• 8:51
  - you know, over a thousand cc's of blood
• 8:53
  - loss and or requiring a transfusion,
• 8:56
  - higher likelihood of postpartum depression and anxiety.
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  - So if that happens,
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  - let's be a bit more proactive
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  - about
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  - not just doing the Edinburgh on mom baby,
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  - but let's follow-up in two weeks. Send it
• 9:09
  - to her MyChart. She can do it on
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  - her phone at 4AM while she's breastfeeding.
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  - And if it turns out that, you know,
• 9:15
  - she's depressed,
• 9:17
  - then let's make it an easy button to
• 9:18
  - get her to talk to somebody about that.
• 9:20
  - Right? There are a number of different things
• 9:22
  - that can happen within the journey that we
• 9:24
  - can be much more proactive about. And you're
• 9:27
  - you're starting to see a lot of some
• 9:28
  - payer signals as well that are getting this
• 9:32
  - idea. Right?
• 9:34
  - You know, investors are really wanting to fund
• 9:37
  - platforms that are supporting sort of longitudinal relationships,
• 9:42
  - for that exact reason, right, of, you know,
• 9:44
  - it's not just that one component
• 9:47
  - of
• 9:48
  - right before discharge after you have the baby.
• 9:50
  - But
• 9:51
  - remember, it can be twelve months after birth
• 9:54
  - that postpartum depression or anxiety hits.
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  - Mhmm. So what are we doing once they're
• 9:59
  - clear from their OB at six weeks
• 10:02
  - until twelve months later. Right?
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  - And so I think, you know, five years
• 10:06
  - from now, the question won't be whether or
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  - not
• 10:08
  - behavioral health belongs
• 10:10
  - in women's health. The question is gonna be,
• 10:13
  - can a women's health program or service line
• 10:16
  - really be considered comprehensive
• 10:18
  - if it doesn't have behavioral health integrated?
• 10:22
  - And so proactive. Proactive, proactive, proactive.
• 10:25
  - Yeah.
• 10:27
  - Yeah. You make some really great points, Laura.
• 10:29
  - And
• 10:30
  - I think I I wanna take this a
• 10:32
  - little bit further because it seems, you know,
• 10:34
  - without that proactive approach,
• 10:36
  - the clinical risks and possibilities are are clear.
• 10:40
  - Right? You've outlined those, you know, what can
• 10:42
  - escalate
• 10:43
  - in the perinatal period.
• 10:46
  - But for for behavioral health services and women's
• 10:49
  - health, really getting that integrated from a business
• 10:51
  - perspective,
• 10:52
  - what do the growth and
• 10:54
  - the margin side of the story look like
• 10:57
  - when when we have that true embedded
• 11:00
  - service line? Are there any metrics that you're
• 11:02
  - seeing resonate with CFOs and service line leaders
• 11:05
  - that you talk to?
• 11:06
  - Yeah. Yeah. I mean, I think
• 11:08
  - let's start with why do we focus on
• 11:12
  - maternal care? Why do we
• 11:14
  - wanna put all of our sort of marketing
• 11:16
  - spend on
• 11:18
  - women?
• 11:20
  - Because they're the decision makers
• 11:22
  - of the family. Right? We all know all
• 11:25
  - of this.
• 11:26
  - So if we're being proactive and we're engaging
• 11:29
  - these women and we're saying, hey.
• 11:32
  - I think maybe you're not okay, and that's
• 11:34
  - okay. I
• 11:35
  - please.
• 11:36
  - We wanna help you. We wanna support you
• 11:38
  - and your family.
• 11:40
  - Boy, there's a lot to be said about
• 11:43
  - gaining
• 11:45
  - trust
• 11:46
  - with that patient, but more importantly,
• 11:49
  - they're gonna be very, very loyal. Right? And
• 11:51
  - if we wanna gain that woman because she's
• 11:53
  - a healthcare decision maker, well, gee, let's do
• 11:56
  - a lot to help gain her loyalty. Right?
• 11:58
  - So engaging patients in this way and being
• 12:00
  - really proactive and helping them feel seen because
• 12:03
  - that's sort of what this, you know, customer
• 12:05
  - survey that we did said is that women
• 12:07
  - aren't feeling seen, we're feeling overwhelmed. Right?
• 12:09
  - If we say no, I see you and
• 12:11
  - I'm here for you and it's okay to
• 12:13
  - feel like that,
• 12:14
  - the lifetime
• 12:15
  - patient value
• 12:17
  - that we're gonna
• 12:18
  - get and the retention of patients is is
• 12:21
  - huge. Right? Behavioral health is a retention strategy
• 12:24
  - that's gonna lead to future primary care,
• 12:27
  - specialty care, ancillary,
• 12:29
  - procedural revenue for the health system.
• 12:32
  - Monetizing
• 12:33
  - existing patient relationships
• 12:35
  - rather than paying to acquire new patients. Right?
• 12:38
  - I mean, how much are you spending trying
• 12:40
  - to shift market share?
• 12:42
  - Move the dollars to go ahead and work
• 12:44
  - on retaining
• 12:45
  - patients. And oh, by the way, like, you
• 12:47
  - feel good about it because it's the right
• 12:48
  - thing to do.
• 12:50
  - I mean, so it's it's really about the
• 12:53
  - behavioral health increases that value, expanding touch points,
• 12:57
  - the referrals. There's a lot of downstream revenue
• 12:59
  - that's gonna come with it.
• 13:01
  - And the margin story is about that increased
• 13:03
  - reimbursable services while
• 13:06
  - doing the right thing, reducing leakage,
• 13:08
  - supporting
• 13:10
  - the overall ecosystem
• 13:11
  - by
• 13:13
  - getting loyalty from the patients that we're
• 13:16
  - targeting with all of our marketing spend.
• 13:18
  - Yeah. Sounds like a win win win scenario.
• 13:22
  - Right. Right. Right. Yeah. I mean, and there's
• 13:24
  - certainly a a component as well of sort
• 13:26
  - of, you know, downstream impact in terms
• 13:30
  - of readmissions and everything else. There's also the,
• 13:33
  - you know, do a good job, keep patients
• 13:35
  - out of the NICU, which is
• 13:38
  - less resonating with the CFOs. But I mean,
• 13:41
  - there's there's a number of ways to spin
• 13:43
  - it, but I think the the easiest one
• 13:44
  - to wrap everybody's head around because it is
• 13:47
  - intuitive is
• 13:48
  - make women feel seen, gain their loyalty. There's
• 13:51
  - a lot of downstream impact.
• 13:53
  - Yeah. Yeah. It's a great message, Laura. Thank
• 13:55
  - you. And, you know, you've given so much
• 13:58
  - practical guidance and and thought leadership already, but
• 14:00
  - I just wanna end our conversation with just
• 14:03
  - one final piece of practical advice to leave
• 14:05
  - folks with.
• 14:06
  - You know, for that leader who is seeing
• 14:08
  - this gap that we're talking about in women's
• 14:11
  - health service lines and behavioral health offerings,
• 14:14
  - say they're aware of that, but and they're
• 14:15
  - working within their existing structures to try and
• 14:18
  - address it. Where do you think they should
• 14:20
  - start?
• 14:21
  - And and what does meaningful progress look like,
• 14:23
  - you know, a year or so out?
• 14:26
  - Yeah. I mean, I think
• 14:27
  - start with what you have. Right?
• 14:29
  - What can you build on? Where are the
• 14:31
  - existing tools or infrastructure?
• 14:33
  - You're already doing the Edinburgh. That's great. Is
• 14:36
  - there a way to build in a system
• 14:37
  - trigger for those with a positive screen on
• 14:40
  - mom, baby
• 14:41
  - that it's an easy referral button to get
• 14:43
  - them connected with resources?
• 14:45
  - Do you already have outpatient behavioral health
• 14:49
  - within your health system and can you
• 14:51
  - establish
• 14:52
  - a, you know, a clean referral from OB
• 14:56
  - and pediatrics because often, you know, they're the
• 14:58
  - ones who see it from your o nine,
• 15:01
  - from all of those sort of women's sub
• 15:02
  - service lines to easily refer women in with
• 15:06
  - a positive screen,
• 15:07
  - leveraging that existing
• 15:09
  - behavioral health resource that you already have within
• 15:11
  - your health system.
• 15:13
  - Go to the gemba, so to speak. Right?
• 15:15
  - Ask your patients. Ask the providers.
• 15:18
  - But don't forget the front line. Right? What
• 15:20
  - are your lactation consultants
• 15:22
  - seeing? Could they be the ones that are
• 15:24
  - referring some of these moms? The nurses, the
• 15:26
  - pelvic floor PTs. Right?
• 15:29
  - And actually ask the real resources because they're
• 15:32
  - gonna know
• 15:33
  - what they're seeing with patients and then they're
• 15:35
  - gonna tell you. Maybe they're gonna be best
• 15:38
  - referral resource.
• 15:40
  - Who knows?
• 15:41
  - But certainly evaluate
• 15:42
  - how you can augment any of those existing
• 15:45
  - resources with experienced and trained providers.
• 15:48
  - All of our, you know, therapists that that
• 15:51
  - see women are trained specifically in
• 15:54
  - the women's health journey and how that impacts
• 15:57
  - their behavioral health. Right? You know, it it's
• 16:00
  - important that a therapist understands what
• 16:04
  - all of your perimenopause
• 16:06
  - journey looks like
• 16:07
  - as she's talking to you about
• 16:10
  - your mental health. Just saying you should get
• 16:12
  - more sleep is not maybe the best thing
• 16:14
  - to say to them going through perimenopause. He
• 16:16
  - would love to be sleeping and unfortunately is
• 16:18
  - wide awake at 3AM.
• 16:21
  - And so how can
• 16:23
  - you augment that with, you know, say a
• 16:24
  - partner like Iris or train up some of
• 16:26
  - your own therapists?
• 16:28
  - So I think
• 16:30
  - what meaningful progress
• 16:32
  - means is
• 16:34
  - contingent upon what you already have. But, ultimately,
• 16:38
  - if you
• 16:39
  - are better identifying women and better treating
• 16:43
  - women and their behavioral health needs,
• 16:46
  - that's meaningful progress.
• 16:47
  - So maybe it's just something that you've got
• 16:49
  - to establish an assessment protocol.
• 16:51
  - Maybe it's that you wanna train your existing
• 16:53
  - providers.
• 16:54
  - Maybe you just need to
• 16:56
  - wait for Epic or your EMR to build
• 16:59
  - out that, you know, easy button
• 17:02
  - of positive screens that are sort of automatically
• 17:04
  - sent to care.
• 17:06
  - I think it depends on on what baseline
• 17:08
  - is.
• 17:09
  - Yeah. Yeah. Well, Laura, it it's been so
• 17:12
  - fantastic talking to you today. I feel like
• 17:14
  - we we almost need a part two.
• 17:16
  - But I I just truly appreciate the insights
• 17:19
  - and the practical next steps that you've left
• 17:21
  - our listeners with there at the end.
• 17:23
  - But also wanna thank you for shedding light
• 17:25
  - on an important issue today. So thank you
• 17:27
  - again for making the time.
• 17:29
  - Yeah. Absolutely. Thank you so much for having
• 17:30
  - me. Always always happy to talk about it
• 17:32
  - because it is. It's important.
• 17:34
  - Yeah. Fantastic. And the passion certainly comes through.
• 17:37
  - So thank you again, Laura,
• 17:38
  - and thank you so much to the Iris
• 17:40
  - Telehealth team for making today's episode possible.
• 17:43
  - So listeners, be sure to tune in to
• 17:45
  - more podcasts from Becker's by visiting our podcast
• 17:47
  - page at beckershospitalreview.com.