Latest / Becker's Healthcare Behavioral Health / Driving Whole-Person Care: Dr. Caroline Carney on Behavioral Health Innovation

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Driving Whole-Person Care: Dr. Caroline Carney on Behavioral Health Innovation · Becker's Healthcare Behavioral Health

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Welcome everyone to the Becker's Healthcare podcast series.
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I'm Moriah Muhammad, writer and moderator with Becker's
0:05
Healthcare. And I'm thrilled to have with me
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today doctor Caroline Carney, president of behavioral health
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and chief medical officer at Magellan Health. Doctor,
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welcome to the podcast. We're very excited to
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have you join us today. To get us
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started, would you mind please introducing yourself and
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telling us a bit about your background?
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First of all, thank you so much for
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hosting me today, Mariah. I
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always have great conversations on these podcasts
0:28
and was just at the Becker's meeting and
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enjoyed it thoroughly. So super excited to be
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here today.
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I am, as Mariah said, the president and
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chief medical officer of Magellan Health. And by
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background, I am an internist and a psychiatrist.
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I still practice clinical medicine through an FQHC
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and use those experiences from my past as
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being a clinician, as being a researcher,
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as working in a state Medicaid program, all
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of that to inform
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how we're looking
1:00
at
1:01
current business at Magellan and going forward.
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Wonderful. Thank you so much for giving us
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that background. So right now, what are some
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opportunities
1:10
and headwinds that you kinda have your eye
1:13
on?
1:14
I want to talk about the headwinds first
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because they're affecting the whole industry.
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And then we can talk about opportunities
1:21
based on those headwinds.
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I think the greatest headwinds are a lack
1:26
of understanding about what's going to happen with
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government supported
1:31
health care, what will happen to
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Medicaid. We have some
1:36
indications
1:37
based on funding for that yesterday and various
1:40
changes
1:41
proposed to those programs,
1:43
what will happen with the exchange population, the
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Medicare population,
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and so on, and what will happen at
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the state level,
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especially as it's related back to Medicaid programs.
1:56
I think the other
1:58
greater issue in the environment right now is
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one on parity,
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and we also have some indication
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about that yesterday.
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But it's really important to recognize
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that parity is a very important concept
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and that
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the law of the land exists as it
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exists today
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and will
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always continue to inform what we're doing.
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So I put all of those headwinds out
2:25
there because I think there are some really
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terrific opportunities.
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If we are facing funding shortages,
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just like at home, if your own budget
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was decreasing,
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you have to look at what brings most
2:39
value
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and what are we doing that's a nice
2:42
to have but isn't really changing the value
2:45
in health care, which is getting the highest
2:48
quality, the best clinical care
2:50
at the price that makes sense for both
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members,
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providers,
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and the health plan. So, you know, how
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do we drive to value in health care?
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What are those
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activities that we're doing that bring the greatest
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value?
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The second is around while we're looking at
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that,
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what's driving care right now? Is care being
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driven
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because
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there is
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a rise in suicidality
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or a rise in
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opioid
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use or
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some other
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substance?
3:28
Is there a rise in extreme weather events
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that's that, you know, that's really driving more
3:34
utilization
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because
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of the fallout
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on individuals,
3:39
and their mental health from suffering natural disasters?
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Is it the adolescent
3:44
health crisis that is driving what we're doing?
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So you have to look at what are
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those most important drivers that we need to
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address
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in health care
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and put that together with the quality value
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part of this equation
4:00
and really double down
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on the programs that people need the most
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right now.
4:06
If we look at those opportunities,
4:09
always access and availability
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of care are important.
4:14
So we're looking forward
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to ways that we can triage individuals to
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get to the right level of care,
4:20
introducing,
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the peer support model into the health plan
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world,
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recovery support navigators,
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the kinds of,
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paraprofessionals,
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if you will, that can help individuals
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on their journey to recovery.
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The second along that line is what digital
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supports
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can be used
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to enhance the care journey? What can our
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care managers use that allow them to reach
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more individuals
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more quickly or more efficiently?
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And what are the tools that help individuals
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get better that support the work that's getting
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done in therapy or support the work
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that's getting done,
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by their psychiatrist.
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So what are those kinds of things that
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can really help make the recovery journey better?
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So we focus on narrowing that down to
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those that provide the best value and the
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best outcome.
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And then we also are looking at those
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populations.
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What can we do to address either the
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high cost areas to provide more support,
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and align services better to the individual's needs
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or,
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create new programs around that. So we're really
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doubling down on areas like adolescent health,
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working in the disability space and chronic pain
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space to have clinical programs for individuals,
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continuing
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our work in suicide
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prevention,
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and continuing
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our work in helping to manage
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the pharmacy experience that people have in treating
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their behavioral health conditions
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and working with providers to give
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the, you know, the advice from individuals who
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are trained in behavioral health
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psychopharmacology
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to work with providers to help them when
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they have complex patients.
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So I think despite
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the headwinds that we may be seeing from
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funding,
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it really forces us to think
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more creatively
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and in a really focused way.
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Yeah. Yeah. Absolutely. Thank you so much for
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giving us those those opportunities and headwinds.
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The the mental health aspect is something that
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I think,
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is
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a a thing that, you know, most people
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are focusing in on a lot right now,
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and I definitely hope that sector continues to
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grow.
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How are you thinking about growth and overall
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just adding value,
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to your organization
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for this year,
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or maybe for the next five years or
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so?
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I think the areas that really are great
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growth
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over the longer period of time,
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are those around integration
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of medical care alongside
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behavioral health care. And there are many different
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ways to do that kind of integration.
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They may be as
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light integrated
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as having practice agreements for
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being able to send patients,
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in terms
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of that behavioral health professional being willing and
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able to see individuals
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when they are found in primary care and
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they need help. So just like the practice
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kinds of agreements,
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they may be inserting
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an LCSW
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into
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a large primary care or specialty practice
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to be there
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on-site to work with individuals who need ongoing
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care and really part of the primary care
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team.
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They may be
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integrated
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care models like the collaborative
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care model that
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has so much evidence behind it and over
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and over again
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has shown to improve quality
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and drive savings.
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In fact, there are recent reports about the
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collaborative care model reducing the risk for suicide.
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So if there is a model that I'm
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most bullish about, it is
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more dissemination, wider dissemination of the collaborative care
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model.
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And that will force organizations
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to better understand
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that behavioral health isn't something that's settled on
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the side, but really can and should be
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integrated
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with the work that the health plan does.
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That doesn't mean it shouldn't be performed by
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an organization
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like a Magellan
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who can integrate
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people and policies and expertise into the health
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plan. It means we really have to, as
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an industry, think more holistically
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about where members present
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and meet those members where they are and
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where providers have needs and to be able
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to support those providers with those needs.
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I think the next area of integration we
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are very interested in
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is providing
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truly a combined approach for individuals with SMI,
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and physical health conditions, chronic physical health conditions.
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These folks are often those that are left
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behind in the system
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of care because
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they fall through the cracks. They may have
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too much medical complexity to only be seen
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in the behavioral health setting,
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and their behavioral health conditions,
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especially chronic psychosis,
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may make them challenging in most primary or
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specialty care settings.
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And so what are the models that we
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need to do to deliver care to those
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individuals,
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to ensure that those individuals
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are getting the care that they deserve,
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and they may be falling through the cracks
9:54
today. So that may be doing something like
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expanding behavioral health offerings
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inside
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areas like
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FQHCs
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or rural health clinics.
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So we're really interested in those. And then
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the final is really, you know, a lot
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of
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the treatment for behavioral health,
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is not measured in terms of quality today.
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And so we also are very interested in
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bringing
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measurement informed care to a much higher place
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and help practices
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implement measurement informed care, which can be foundational
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and value based care and is incredibly foundational
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in understanding the quality and outcomes of care
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individuals are getting,
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as well as looking at the pharmacy experience
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expanding that more,
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as we're already doing in some of our
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health plan partners today.
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In looking at the pharmacology
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used to treat individuals with behavioral health conditions,
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we often see patterns of it being started
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in an ER or something being started in
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a primary care office.
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And then medications being staffed upon medications
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by the time someone gets into
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the behavioral health treatment realm, they might be
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on a really big list of medications.
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And our programs really look at trying to
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get their therapy right out of the gate
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and,
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align that best medication
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with
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the individual symptoms that need that kind of
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treatment.
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We have
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we have seen over and over again when
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that's done right and individuals are supported
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in taking their medications,
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we see a decrease
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in costs,
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like the use of ER.
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And that's really important. It means people are
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getting the right care, and they're able to
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stay out of the ER. So those are
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all areas that are in our growth
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trajectory.
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That's wonderful. Yeah. That's wonderful. Thank you so
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much for sharing that information.
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With that and, a lot of things that
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you said previously,
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I'm sure I can kinda go into this
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answer. But I wanted to ask, is there
12:14
one risk or investment worth making this year,
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whether for your organization
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or,
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advice for another?
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Oh, sure. I think that the investments that
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are worth making
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would be investments that
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do two things. They
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help improve the efficiency
12:36
of some of the kind of clerical work
12:38
that gets done by providers and by health
12:42
plans. So,
12:43
the kind of faxing back and forth of
12:46
requests for utilization management,
12:49
even the kinds of investments to help providers
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not have to
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sit at a computer terminal and enter their
12:56
notes or check boxes along the way, but
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the use of AI tools
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perhaps to help with listening and creating those
13:05
notes and transcripts for them, any of the
13:07
kinds of investments that take the burden of
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providers delivering
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good care. I can give you a terrific
13:14
example, although it's not a device. It's the
13:17
use of an individual
13:19
in the clinic where I still work.
13:21
Often, what's happening for individuals
13:25
isn't a therapy need and it isn't a
13:27
medication need. It's really a social need. And
13:31
so we have individuals
13:34
on our team who get tasked with looking
13:36
into the community,
13:38
finding community based resources,
13:40
and connecting
13:41
those individuals
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to the right resources
13:45
that will help support and ameliorate any of
13:48
the social determinants of health that are preventing
13:50
them
13:51
from
13:52
fully getting better. It's often more than therapy
13:55
and medication. It's, again, looking at the whole
13:56
person. So I
13:56
think
13:59
person. So I think investments in those
14:02
areas
14:03
are really critical.
14:05
The risk that we're taking, we are not
14:08
really taking risks. I think we look in
14:11
a very calculated way
14:13
at where we need to do the work
14:16
to improve
14:17
the value of the care that's being delivered.
14:21
Yeah. That definitely makes sense. Thank you so
14:23
much for sharing that. And and, doctor, before
14:25
I let you go, the last question I
14:27
have for you today is where do you
14:28
see the best opportunities for growth in the
14:30
future?
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I really touched on those earlier,
14:35
in terms of all of the various integrated
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care models.
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So I'll reiterate that again. My integrated care
14:42
models are
14:43
incredibly important for a variety of reasons. They
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are the closest to a population health,
14:50
mechanism that we can do to reach the
14:53
most people and treat them early in the
14:56
in the journey that they are on with
14:58
their behavioral health needs. The second is doing
15:01
the same thing in substance use disorders, particularly,
15:06
as I look at the growing
15:09
utilization of services needed for the treatment of
15:13
substance use and alcohol use disorders.
15:16
I can tell you that
15:18
based on the increased utilization in the country
15:21
of alcohol, what we're seeing in the pandemic,
15:24
the research papers that are coming out showing
15:27
medical complications
15:28
related to alcohol use,
15:30
it is an area that we as a
15:32
country really need to be paying attention to
15:35
and providing the right supports for.
15:38
And then finally, the things that are still
15:41
out there, if we look at
15:43
an economic downturn,
15:45
which, you know, has often been talked about
15:47
recently,
15:48
what are we going to do to support
15:51
individuals
15:52
who may be losing their job,
15:55
individuals
15:56
who may have that demoralization?
15:59
We know that the risk for substance use,
16:02
depression,
16:03
anxiety,
16:04
and suicide
16:05
are markedly higher in the group of individuals
16:09
who have
16:10
lost their employment and really have no place
16:13
to turn to get new employment.
16:17
That along with something that I think we're
16:19
not talking a lot about as a society,
16:22
but gambling addiction,
16:24
is also an area where I think we
16:27
need to pay close attention
16:29
and may see opportunities
16:31
for growth and treatment programs there.
16:35
Yeah. I definitely agree. Thank you so much
16:36
for sharing all of that information for those
16:38
final thoughts. There's definitely been a very informative
16:41
discussion. So, again, I wanna thank you so
16:43
much for coming on Becca's health care, and
16:46
I look forward to connecting with you again
16:49
soon. Thank you so much, Mariah. Have a
16:51
great day. You too.