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Building a Stronger Behavioral Health Crisis System with Chris Santarsiero · Becker's Healthcare Behavioral Health

• 0:01
  - When the CEO of behavioral health services at
• 0:04
  - a large health system sits down with the
• 0:05
  - CEO of a small community mental health organization,
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  - the conversation sounds different than most conference panels.
• 0:12
  - Nobody's selling a framework.
• 0:13
  - They're comparing notes on what's actually failing and
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  - what's starting to work.
• 0:18
  - That's the room Becker's Fall Behavioral Health Summit
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  - is built to be. 30 plus speakers,
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  - 300 plus executive level attendees, and two days
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  - in Chicago. An agenda that goes from proving
• 0:28
  - behavioral health as value to the board, all
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  - the way to addressing the thirty day window
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  - after psychiatric discharge where readmission risk is highest.
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  - The sessions are specific
• 0:38
  - because the problems are specific. November fourth and
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  - fifth at the Hyatt Regency Chicago. Agenda and
• 0:44
  - registration at beckershospitalreview.com.
• 0:46
  - Click events in the upper right.
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  - Hello, and welcome to the Becker's Behavioral Health
• 0:52
  - Podcast.
• 0:53
  - I'm Ella Reuter, and today I'm excited to
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  - be joined by Chris Santacero,
• 0:58
  - vice president of government affairs at Connections Health
• 1:00
  - Solutions.
• 1:01
  - Chris, thank you so much for being here.
• 1:03
  - To kick us off, could you tell us
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  - a little bit more about your role at
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  - Connections Health Solutions and the work your organization
• 1:09
  - is doing to transform behavioral health crisis care
• 1:12
  - across the country?
• 1:14
  - Thank you so much for having me, Ella.
• 1:15
  - I'm really excited to be here. At Connections
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  - Health Solutions, I focus on advancing policy, market
• 1:20
  - access,
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  - and payment mechanisms that expand access to emergency
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  - behavioral health crisis care.
• 1:27
  - At Connections, we partner with counties, state governments,
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  - and payers to serve as the hub of
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  - a modern emergency crisis system,
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  - meeting individuals where they are and delivering care
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  - in the safest, least restrictive
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  - setting possible.
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  - Today, we operate in six states with crisis
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  - response centers and mobile
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  - response teams with more in development
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  - that are improving access to care, elevating quality
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  - and clinical excellence, and reducing cost across behavioral
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  - health, public safety, and criminal justice systems.
• 1:59
  - Wonderful. Thank you so much for that brief
• 2:01
  - overview.
• 2:02
  - And you've spent more than two decades working
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  - at this intersection of health care policy and
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  - care delivery.
• 2:09
  - As you look at the behavioral health landscape
• 2:11
  - today,
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  - what do you see as the most significant
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  - challenges,
• 2:16
  - communities are facing in meeting the growing demand
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  - for services?
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  - Absolutely.
• 2:21
  - Sure. In far too many communities today, when
• 2:24
  - someone is in a behavioral health crisis,
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  - the default option is the emergency departments or
• 2:29
  - even jail. And neither of those settings is
• 2:31
  - designed to deliver the kind of specialized care
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  - that our friends,
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  - family, and community members need.
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  - Delivering behavior health care in emergency departments or
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  - jails leads to high costs, poor outcomes,
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  - while adding significant strain to our systems that
• 2:46
  - are already overwhelmed.
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  - When you see that gap in higher acuity
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  - situations when someone presents with suicidal ideation,
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  - acute agitation,
• 2:56
  - or substance use intoxication,
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  - appropriate care is critical.
• 3:00
  - Without the right level of support in place,
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  - those individuals often cycle right back through emergency
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  - departments, hospitals, and then ultimately the criminal justice
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  - system.
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  - That's exactly the problem we're trying to solve
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  - at connections.
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  - Our model is designed to complete the emergency
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  - response continuum
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  - by bringing intensive medical, nursing,
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  - and peer focused capabilities
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  - directly into the behavioral health crisis setting.
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  - This allows us to properly treat high acuity
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  - patients in a way that's both clinically appropriate
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  - and far less restrictive.
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  - What keeps me energized in this work is
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  - seeing what happens when communities finally have that
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  - missing piece in place. We're starting to see
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  - better outcomes, lower costs,
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  - and most importantly, people getting a real chance
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  - at recovery
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  - and long term well-being.
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  - At its core, the connections model really changes
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  - how the behavior health and legal systems interact.
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  - We just opened a new center in Prince
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  - William County, Virginia
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  - that is already
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  - elevating system wide pressures,
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  - easing persistent bottlenecks across the county,
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  - and significantly reducing the demand on Virginia's
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  - psychiatric hospitals.
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  - In just the first six months,
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  - we've enjoyed significant community impact.
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  - Since opening, we've saved over 5,433
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  - law enforcement hours,
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  - avoided 1,580
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  - emergency department days, and also avoided nine thousand
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  - four hundred and eighty nine psychiatric inpatient bed
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  - days.
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  - These measures prove the connections model creates a
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  - true diversionary pathway and gives people access to
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  - immediate
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  - targeted care when they need it most, and
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  - that's incredibly meaningful work.
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  - Yes. Thank you so much. I think it's
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  - so incredible to note that measurable impact like
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  - you mentioned. Thank you so much for bringing
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  - that data.
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  - You helped contribute to SAMHSA's national guidelines for
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  - behavioral health coordinated system of crisis care.
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  - How has the national conversation around behavioral health
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  - crisis response
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  - evolved in recent years from your perspective,
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  - and where do you believe the greatest opportunities
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  - for improvement still exist?
• 5:07
  - That's a great question, and, honestly, it's why
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  - SAMHSA's new guidelines are so important. As we've
• 5:12
  - scaled our model to new states and communities,
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  - many leaders throughout the country told us we
• 5:17
  - want the no wrong door model for mental
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  - health and substance abuse treatment.
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  - However, it became clear very quickly that most
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  - didn't understand what that meant in practice or
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  - policy.
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  - My work on SAMHSA's updated national guidelines for
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  - crisis care focused on acknowledging that fact and
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  - clarifying the many different safe
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  - safe places for help that exist throughout the
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  - country today.
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  - There's been a lot of inconsistency
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  - in how we define behavioral health crisis services.
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  - When you look at emergency crisis and crisis
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  - residential care, the terminology and expectations can vary
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  - widely depending on the state, county, and especially
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  - the payers.
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  - That variability creates a real confusion
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  - about what the services actually include, how they
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  - should be delivered, and what should be covered.
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  - It's also made it harder for states, tribal
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  - communities,
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  - local systems,
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  - and public and private insurers to align around
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  - clearer standards.
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  - So the updated guidelines and model definition have
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  - brought clarity and consistency
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  - to the system.
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  - We need alignment on a shared understanding of
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  - what these services are along with recommended minimum
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  - expectations for how they should be delivered to
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  - help improve quality, standardized services,
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  - and ultimately support broader payer coverage.
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  - At its core, this effort is about access,
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  - ensuring that people in any setting can get
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  - timely, high quality crisis support when they need
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  - it.
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  - And when we talk about behavioral health crisis
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  - services, we're really
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  - talking about rapid, responsive, and intensive supports
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  - designed to stabilize someone in the moment
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  - or prevent a crisis from escalating
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  - so that they can continue functioning in their
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  - daily life, whether that's at home, school, work,
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  - or in the community.
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  - That consistency
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  - combined with clearer standards is what really helps
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  - transform crisis care into a continuum
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  - that supports the physical health system to work
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  - better for everyone.
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  - Yes. And love the note about keep keeping
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  - people within the community. I think super important,
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  - especially when we're thinking about
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  - quality of life and quality of services that
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  - are happening there.
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  - And I wanna touch on more insurance
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  - as
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  - we discuss this. Throughout your career, you've worked
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  - extensively on Medicare,
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  - Medicaid, and value based care initiatives.
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  - How do you see reimbursement
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  - and policy influencing organizations'
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  - ability to expand access to behavioral health services
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  - and improve patient outcomes?
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  - Comprehensive reimbursement is one of the most important
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  - factors in shaping access right now. One of
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  - the biggest challenges we face is that Medicare
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  - still provides limited coverage for community based crisis
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  - stabilization
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  - services.
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  - What that means in practice is that crisis
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  - care for almost 200,000,000
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  - Americans is largely being subsidized
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  - by safety net funding, Medicaid, federal block grants,
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  - and state and local dollars.
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  - When federal programs don't establish clear reimbursement pathway,
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  - commercial insurances are hesitant to follow. I'm gonna
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  - resend it. When federal programs don't establish clear
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  - reimbursement pathway,
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  - commercial insurers are hesitant to follow.
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  - This results in fragmented funding that slows innovation
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  - and limits access.
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  - That's why efforts in congress like the Care
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  - for Behavioral Health Act is so important. It
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  - would create a Medicare demonstration pilot for crisis
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  - stabilization
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  - services
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  - and develop more consistent definitions
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  - around crisis stabilization
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  - centers, which is really needed. The bipartisan legislation
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  - would also help establish a sustainable model for
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  - scaling behavior health care nationally
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  - and will address existing gaps in reimbursement.
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  - At the end of the day, a behavior
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  - health crisis is a health emergency.
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  - It can be life threatening, and it should
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  - be treated and reimbursed the same way we
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  - treat
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  - many other health emergencies.
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  - The absence of Medicare reimbursement makes it difficult
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  - to fully fund medically led, interdisciplinary,
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  - recovery based care that high acuity crisis centers
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  - can provide.
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  - Ultimately,
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  - if we treat behavioral health crisis as like
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  - health emergencies
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  - from a reimbursement standpoint,
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  - we'll see better outcomes for individuals,
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  - communities,
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  - and reduced costs across the care continuum.
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  - Yes. I mean, especially, I think, looking at,
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  - again,
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  - cost and quality of care,
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  - super important and the downstream effects of,
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  - patients being able to get care earlier and
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  - also being reimbursed and having those services be
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  - sustainable as well from the health system perspective
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  - and organization perspective.
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  - So thank you so much for that. And
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  - as we know, behavioral health is increasingly requiring
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  - collaboration between
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  - health care providers, community organizations,
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  - government agencies,
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  - and payers.
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  - What are some of the most effective strategies
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  - you've seen for bringing these stakeholders together to
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  - create a more coordinated
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  - system of care?
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  - Sure.
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  - In government affairs where there's an unmet need,
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  - there's always a way. First, let's acknowledge that
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  - the network of stakeholders
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  - engaged in behavioral health is both extensive and
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  - diverse.
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  - It spans governors, their health secretaries and commissioners,
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  - state legislators,
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  - payers, county commissioners,
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  - law enforcement leaders, prison wardens, district attorneys, and
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  - increasingly,
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  - education officials.
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  - It also encompasses
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  - health system CEOs,
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  - mental health and substance use providers, and a
• 10:49
  - wide range of social service organizations
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  - and housing authorities.
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  - The sheer breadth of this coalition
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  - emphasizes the necessity of a coordinated campaign
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  - to address existing gaps in behavioral health care.
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  - The key is getting everyone focused on the
• 11:04
  - North Star of establishing the no wrong door
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  - model of treatment.
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  - This is this will ensure these life saving
• 11:11
  - services remain available to everyone
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  - regardless of insurance status or time of day.
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  - Most communities know that the current way of
• 11:19
  - caring for people in mental health and substance
• 11:21
  - abuse is not humane or effective.
• 11:24
  - Our approach at Connections
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  - realizes better health outcomes,
• 11:29
  - significantly lower average length of stay, and reduces
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  - the reliance on hospital emergency departments,
• 11:35
  - long term inpatient psychiatric care, and jail.
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  - When stakeholders see both better outcomes for individuals
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  - and their communities
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  - and system efficiencies,
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  - alignment becomes much, much easier.
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  - 100%. Thank you so much. And to really
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  - finish off this conversation,
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  - I'd love to hear from you. What trends
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  - in behavioral health are you watching most closely,
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  - and what gives you optimism about where the
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  - field is headed over the next several years?
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  - In many ways, the 988
• 12:06
  - lifeline has been a catalyst for innovation and
• 12:08
  - behavioral health care public policy.
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  - And what we're seeing now is the next
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  - phase, building a truly comprehensive connective crisis continuum
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  - that can support people not just in the
• 12:18
  - moment, but throughout their recovery.
• 12:21
  - July marks the four year anniversary of ninety
• 12:23
  - eight, and it is normalizing health help seeking
• 12:27
  - behavior and addressing stigma by making support more
• 12:30
  - visible and accessible.
• 12:32
  - The launch of the three digit number fundamentally
• 12:35
  - shifted how states and communities think about crisis
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  - response.
• 12:39
  - Almost immediately created an urgency momentum for policymakers
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  - to build out a more complete coordinated system
• 12:45
  - across the country at all levels of government.
• 12:48
  - This simple, easy to remember number, just like
• 12:51
  - 911988
• 12:53
  - sends a very clear message. Mental health issues
• 12:56
  - are real health issues.
• 12:58
  - That alone helps reframe help seeking as something
• 13:01
  - proactive and appropriate
• 13:03
  - rather than something people only do as a
• 13:05
  - last resort. That's a major shift.
• 13:07
  - People can call, text, or chat so they
• 13:09
  - can choose what feels most comfortable.
• 13:12
  - And the support itself is provided at no
• 13:14
  - cost to individuals,
• 13:15
  - is confidential,
• 13:17
  - and judgment free, which really addresses some of
• 13:19
  - the biggest fears people have, especially our youth.
• 13:23
  - In its first eighteen months, our new center
• 13:26
  - mobile crisis services
• 13:28
  - in partnership with Dolphin, Cumberland, and Perry Counties
• 13:30
  - in Pennsylvania
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  - have driven a more than 20% reduction in
• 13:34
  - civil commitment petitions in those counties.
• 13:37
  - This demonstrates that these services work as a
• 13:39
  - preventive tool and relieves pressure across entire systems.
• 13:44
  - Well, thank you so much, Chris. This has
• 13:46
  - been such a fascinating discussion
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  - about the future of behavioral health crisis care
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  - and policy changes needed. Before we wrap up,
• 13:53
  - is there anything else that you'd like to
• 13:55
  - share with our listeners?
• 13:57
  - Absolutely. I would just like to emphasize that
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  - behavioral health crisis care is one of the
• 14:01
  - highest impact investments we can make today.
• 14:04
  - Health care affordability and particularly the growth in
• 14:07
  - health care spendings is at the center of
• 14:09
  - almost every conversation
• 14:10
  - by policymakers right now. What we're seeing is
• 14:13
  - a recognition that affordability isn't just about insurance
• 14:16
  - coverage anymore.
• 14:17
  - It's about what people actually pay and whether
• 14:20
  - they can realistically
• 14:21
  - access care when they need it. On the
• 14:23
  - policy side, there's a focus on transparency,
• 14:26
  - value based care, and expanding access points, things
• 14:30
  - like telehealth,
• 14:31
  - community based services, and surely crisis response systems.
• 14:35
  - At the end of the day, affordability
• 14:37
  - is about making sure the system works for
• 14:39
  - people so that cost isn't the thing that
• 14:42
  - stands between someone and the care they need.
• 14:44
  - And that's where a lot of policy energy
• 14:46
  - and innovation is being directed right now.
• 14:49
  - When we get this right, we're improving the
• 14:51
  - performance of the entire system from hospitals
• 14:54
  - to law enforcement to community providers in criminal
• 14:56
  - justice.
• 14:57
  - And perhaps most importantly,
• 14:59
  - we're helping people at the most vulnerable moment
• 15:02
  - have a real chance at recovery,
• 15:04
  - getting back to their lives with the support
• 15:06
  - needed for long term well-being.
• 15:07
  - Thank you for having me here today, Ella.
• 15:10
  - Of course. Thank you so much for joining
• 15:11
  - us, Chris, and thank you so much for
• 15:13
  - all the important work that you're doing at
• 15:14
  - Connections,
• 15:16
  - and joining us on the Becker's Behavioral Health
• 15:18
  - Podcast. Thank you to our listeners as well
• 15:20
  - for tuning in, and we'll be back soon
• 15:22
  - with more conversations exploring the innovations,
• 15:25
  - policies, and leaders shaping the future of behavioral
• 15:27
  - health.