Latest / CareTalk: Healthcare. Unfiltered. / Executive Feature: Building a Better Mental Health System with Christina Mainelli of Quartet Health

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Executive Feature: Building a Better Mental Health System with Christina Mainelli of Quartet Health · CareTalk: Healthcare. Unfiltered.

• 0:00
  The behavioral health crisis is in full swing.
• 0:03
  It's well known that there's a shortage of providers, but getting a provider is just the first step.
• 0:08
  We also need to make sure that people are getting the right care for them, that quality is measured and tracked, and that patients have long term support on their care journeys.
• 0:26
  Welcome to CareTalk Executive Features, a series where we spotlight innovative companies and leaders working to advance the healthcare field.
• 0:33
  I'm your host, David Williams, President of Health Business Group.
• 0:37
  My guest today is Christina Minnelli, CEO of Quartet Health.
• 0:41
  Quartet's technology and services are designed to address the key issues in behavioral health.
• 0:46
  Christina.
• 0:47
  Welcome to Cure Talk.
• 0:49
  Thanks, David.
• 0:50
  It's great to be here.
• 0:50
  I appreciate the opportunity.
• 0:52
  You know, we're going to talk a lot about behavioral health, but, uh, we've known each other for a while.
• 0:56
  I'd like to go back even a little bit further and hear a bit about your educational background and sort of what your initial career path had been.
• 1:05
  Excellent.
• 1:06
  Um, well, I went to undergraduate in Vermont and I studied finance.
• 1:11
  I got an MBA, uh, actually with a focus on healthcare.
• 1:15
  So my graduate degree, um, was at Yale and I was in the classroom with doctors and healthcare lawyers, um, and healthcare tech leaders.
• 1:26
  And so I learned a lot about the value chain in healthcare while I was getting my MBA, which was a really interesting experience.
• 1:33
  Um, I've also spent over two decades in the healthcare industry, and I've worked across the spectrum of care from many respects.
• 1:41
  First of all, I've worked in physical health care, so sort of like on the medical side.
• 1:45
  I've worked in behavioral health care.
• 1:47
  We're going to talk a lot about that today.
• 1:49
  And I've worked in social care or in the social determinants of health.
• 1:53
  So think about things like food, transportation, housing.
• 1:57
  Since graduate school, I've held diverse leadership roles in health care.
• 2:02
  I've worked on the payer side or with health insurers.
• 2:05
  I've worked with direct providers of care in those types of groups.
• 2:09
  And I've also worked in health care tech.
• 2:11
  So I've seen quite a bit.
• 2:13
  And something that really sticks out to me is really around the complexity of patient care and also the complexities of just the health care delivery system.
• 2:24
  So it's super interconnected and super interdependent and it really needs to factor in the whole person.
• 2:33
  Um, I discovered through these experiences that my passion really lies in mental health.
• 2:38
  And it's due to the fact that, just think of the sheer number of people that struggle with mental illness and addiction today.
• 2:45
  I mean, almost everyone is touched by this, whether it's your friends.
• 2:50
  family, a loved one, or you personally, um, you may be a caregiver.
• 2:55
  It is just a real challenge that is just pervasive today.
• 2:58
  So I think that working in mental health care is a privilege.
• 3:01
  It is also an awesome responsibility.
• 3:05
  Well, Christina, I've known you for a while, as I said, across different roles that you've played.
• 3:09
  They've always been very interesting companies.
• 3:11
  I've always learned something from speaking with you about them.
• 3:14
  But I hadn't heard about Quartet, and I'm curious about how, you know, even after you decided you wanted to focus on mental health, why, why Quartet?
• 3:21
  Why was that the right place for you?
• 3:23
  Sure, well, through my many experiences, I did learn firsthand that finding mental health care for a loved one is really, really hard.
• 3:34
  And I've experienced this personally, trying to find the right provider for an individual, literally having to phone friends, family and professional connections.
• 3:45
  For others that don't work in the field, this can take weeks or months to get an appointment and then you might not even be connected to the right provider or a right match.
• 3:54
  So, I joined Quartet Health over two years ago.
• 3:57
  I was aligned with the mission, improving communities by enabling the best behavioral health care for people in need.
• 4:05
  And I was also intrigued with Quartet Health's model and unique role in the space.
• 4:10
  It's all around connectivity, so it's connecting patients from physical health care to behavioral health care at the point of care.
• 4:20
  And in prior roles, David, I saw that this connectivity did not exist, and really the issues and the implications of that.
• 4:28
  For example, in post acute care, people recovering from a hospital admission often have, um, a co occurring behavioral health need.
• 4:38
  But there was almost no ability to close that gap in care, if you will, without access to behavioral health clinicians, appointments, et cetera.
• 4:48
  I also understood that Quartet Health was uniquely for this challenge.
• 4:56
  Because they have a platform that enables this.
• 4:58
  So the platform identifies patients that are in need.
• 5:02
  It matches them to the best provider based on their demographics, their preferences, um, and it really helps them to find the right care at the right time.
• 5:13
  You know, I've often remarked at how difficult it can be just to get an appointment for, appointment for someone in the healthcare system, and I often have to, uh, you know, pull some strings to get appointments for, uh, loved ones or, or friends and things that should be relatively straightforward.
• 5:27
  I find it even more the case in, uh, in mental health, because at least in physical health, usually.
• 5:32
  You want, you can find somebody who's a specialist and, you know, something very specific.
• 5:37
  And in mental health, a lot of times it's harder to find, at least I find it's difficult even to identify, you know, what's the right sub specialist or anything.
• 5:44
  And people have very general things that they, that they say, and it's just a matter of getting somebody and whether they might work, uh, or not.
• 5:51
  So it is, am I right?
• 5:52
  Is that, it seems like an extra.
• 5:54
  an extra amount of care that you have to take in finding the right mental health provider.
• 5:59
  Yeah, that, that is absolutely true.
• 6:01
  Um, and look, it's, it's due to a number of factors, which I know that we'll get into, but oftentimes it's not just about getting that appointment.
• 6:10
  It's, is that the right subspecialty?
• 6:12
  And we can talk a little bit about the definitions there, but it's also about, is that provider a good match for you?
• 6:18
  Um, it may come down to, you know, again, personal preference, ethnicity.
• 6:24
  Um, language, um, and subspecialty.
• 6:27
  Um, so this is where we can get into sort of some of the definitions around behavioral health and how that term is used.
• 6:33
  You know, one thing I do hear, and we've even used it here, uh, almost interchangeably in the call between mental health.
• 6:39
  Behavioral health, you know, substance abuse kind of comes into it, maybe that's the link and then, and then of course physical health is tied into it and sometimes very directly, um, related and I know, you know, you mentioned there's often a need of somebody who has a physical health problem.
• 6:53
  They may also have a mental health problem.
• 6:55
  I think I see also hearing from folks in primary care that a lot of people come in that maybe that that's their main issue.
• 7:02
  Is a mental health issue, but it's manifesting itself maybe as a, you know, as a stomach ache or some pain or something else that's that's going on.
• 7:09
  So how do you sort all those things out?
• 7:12
  Sure, well, let's let's talk a little bit about kind of definitions.
• 7:15
  Okay.
• 7:16
  Because that may help us to clarify 1st of all, behavioral health really is an umbrella term.
• 7:22
  Um, and within that is mental health and substance use.
• 7:26
  So, mental health, think of that as common diagnoses like depression, anxiety, mood disorders.
• 7:34
  Um, now, within mental health, um, there is a sub segment, and this is serious mental illness.
• 7:41
  Uh, we call it SMI.
• 7:43
  And these are individuals with acute mental illness that causes functional impairment in their day to day life.
• 7:50
  Um, think of diagnoses like bipolar disorder, schizophrenia, uh, post traumatic stress disorder, uh, major depressive disorder.
• 8:00
  So this audience also is particularly vulnerable to addiction or substance use disorder.
• 8:06
  In fact, like 40 percent of patients with an SMI diagnosis have a co occurring substance use disorder, and this really exacerbates, um, their issues and challenges.
• 8:19
  Got it.
• 8:20
  So, how do we think about how big of an issue this is?
• 8:23
  I mean, we, we talked about how, you know, everybody knows something, or maybe you're, know somebody, or maybe, you know, yourself is, uh, that's affected, but Is there a way to get a handle on how big of an issue maybe mental health is overall and then SMI within, you know, within the U.
• 8:38
  S.?
• 8:39
  Yeah, absolutely.
• 8:40
  So it's estimated, and these are recent stats, that more than one in five U.
• 8:45
  S.
• 8:45
  adults live with a mental illness.
• 8:48
  And if you add an addiction, you can imagine how that, uh, how much larger that is.
• 8:53
  Um, it is alarming to know that over half of adults with mental illness go untreated, completely untreated.
• 9:02
  Um, and the impact of mental illness on our kids is staggering.
• 9:07
  So, almost half of adolescents have had a mental health issue.
• 9:11
  And adolescent suicide is the second leading cause of death in that age group.
• 9:16
  The first leading cause of death for kids age 14 and 15.
• 9:21
  It's really, you know, a huge issue.
• 9:23
  And why does this matter?
• 9:24
  It really affects everyone.
• 9:26
  Um, it impacts productivity at work.
• 9:29
  It impacts employment rates.
• 9:30
  Individuals with SMI oftentimes are out of work.
• 9:34
  It impacts lifespan.
• 9:36
  Individuals with SMI can live an average of 15 to 17 years less than average adults.
• 9:42
  Um, there's an impact on education.
• 9:45
  Kids with mental health issues are two times more likely to drop out of high school.
• 9:49
  So there's so many impacts.
• 9:51
  There's economic, there's impacts on vitality, lost earnings, and on our communities and our families.
• 9:58
  So, one of the striking things you mentioned is the impact on lifespan, and of course when you hear about things like, you know, heart disease, diabetes, certainly that affects people at different ages, but a lot of times it's a matter of somebody who's, who's older by the time they really have that.
• 10:10
  You talk about a 14 or 15 year old, um, you know, with a suicide.
• 10:14
  And, you know, you're taking 80 years off of somebody's lifespan when you do that.
• 10:18
  So the impact of each one of these things, not just devastating within the community, but measured just in terms of, and to the family, but measured just in terms of lost years of life is just very, very striking and makes it all the more important to do something about it.
• 10:31
  What is your sense of the impact that we had from the, the pandemic?
• 10:34
  You know, there's a lot of discussion, um, about what the impact was, especially on adolescents.
• 10:40
  Yeah, I would say, so the stats I gave are kind of during or post pandemic, you know, pre pandemic, we'd say.
• 10:49
  1 and 10 adults had a mental health issue post pandemic.
• 10:53
  1 and 5, I mean, it really the numbers have doubled tripled.
• 10:59
  So it really is an issue.
• 11:01
  And while lots of sort of new entrance in the space are available now, and there has been relaxing of policy.
• 11:09
  And procedures, which has helped to provide access to care and solve a little bit on the supply side.
• 11:16
  I'd say that the demand side is going up faster than the supply side, and that's one of the big issues.
• 11:22
  Got it.
• 11:22
  So let's talk about, you know, opportunities for innovation because we can sit here and lament the problems and say, yeah, this isn't this a problem.
• 11:30
  Yeah, it sure is.
• 11:31
  Um.
• 11:33
  But what, what to do about it?
• 11:34
  Where can we innovate?
• 11:36
  Sure.
• 11:36
  So, um, you know, there are a lot of opportunities to innovate in mental health.
• 11:42
  And as I said, you know, with the onset of the pandemic, we did get a lot of new entrants in the mental health space.
• 11:48
  You know, some may say too many because there's a lot of point solutions out there.
• 11:52
  But when you look at really, Sort of systemic change in particular, I would say in dealing with the seriously mentally ill, because this is where I'd say we have the biggest challenge and the biggest opportunity.
• 12:08
  So, a couple of areas to innovate, and by the way, I will share, I think some of these innovations.
• 12:15
  The behavioral health industry can borrow from the physical health industry.
• 12:18
  So we talked about kind of my journey from physical health, behavioral health, social care.
• 12:23
  I really see an opportunity to leverage things that have worked on the physical side of health care, in behavioral health care, in particular with the seriously mentally ill population.
• 12:33
  So first of all, One of the big issues, um, in behavioral health care, and in particular, very acute with the seriously mentally ill, is our fragmented delivery system.
• 12:45
  So, physical health doesn't talk to behavioral health.
• 12:48
  It is hard to get access to an appointment.
• 12:50
  Um, it is hard to get, to ensure that the patient even made it to the appointment.
• 12:54
  It's hard to get the follow up notes on the physical health side.
• 12:59
  In behavioral health, and in particular in patients with serious mental illness, It is important to treat the whole person.
• 13:07
  Um, so in order to do that, we've really got to bridge physical health, behavioral health.
• 13:12
  And also have hybrid delivery models that include bricks and mortar and virtual care.
• 13:18
  So, the opportunity to innovate here is really to leverage multidisciplinary care teams, um, virtual and, um, on the ground care delivery.
• 13:28
  And also tapping into other services that aren't traditionally paid for by the behavioral health care system.
• 13:35
  That's one area to innovate for sure.
• 13:38
  Second, it's really hard to engage patients with.
• 13:42
  moderate to severe mental health issues.
• 13:45
  Very hard to engage.
• 13:46
  Um, it requires new models of care.
• 13:49
  It's not going to be one size fits all.
• 13:50
  And by the way, people with moderate to severe mental illness, this is not just a Medicaid issue.
• 13:56
  It's not just a Medicare issue.
• 13:58
  It crosses all lines of business.
• 14:00
  Um, all walks of life so that we need new models of care, not one size fits all digital tools may work for some peers on the ground in their home may work for others.
• 14:13
  And in most cases, it's a combination.
• 14:15
  So, 2nd area to innovate is really around patient or member engagement and using all the tools that we have available to us.
• 14:25
  The third place to innovate, um, and this is a big one is really around getting aligned incentives and payment models.
• 14:32
  Um, so this is going to require models that reimburse for services outside of just behavioral health care.
• 14:39
  You yourself said, David, that many folks with physical health issues often have a behavioral health issue.
• 14:45
  That is very true.
• 14:46
  Therefore, when we think about behavioral health, in particular, those with moderate to severe mental illness, we need models of care.
• 14:54
  that reimburse for physical health, behavioral health, and for some of these additional services like peers that are typically not reimbursed.
• 15:03
  And we also need to, um, measure success against total cost of care.
• 15:09
  Because once you treat a behavioral health need, you will also see likely a benefit on the physical health side of this, of the house with reduced, um, hospital admissions with better adherence to medication.
• 15:23
  Use of lower cost, um, patient settings.
• 15:26
  So really it's important to look at total cost of care when you're looking at, in particular, the moderate to seriously mentally ill.
• 15:34
  Christina, who are the main payers?
• 15:36
  You mentioned it isn't just one line of business.
• 15:38
  You also mentioned a lot of people that have a serious mental illness, have difficulty holding down a job, perhaps, and so there's probably not as much employer based insurance there, although I suppose it could be for adolescents, but what does the landscape look like, and how does that affect the way payment is done?
• 15:58
  Yeah, I mean, I would say the payers, it's very similar.
• 16:02
  Um, to the rest of healthcare in that you have your government payers, you have health insurers, um, risk bearing provider groups for sure, and in mental health, often the patient has a pretty heavy responsibility, um, which I think is, um, unusual in the healthcare system.
• 16:21
  Very high patient responsibility that can lead back to some of the reimbursement issues and lack of access issues.
• 16:29
  Got it.
• 16:29
  I know in the, in the olden days, back maybe 20 years ago or so, there was a major divide between behavioral health and physical health in terms of payer rules and a lot more restrictions on that.
• 16:42
  And there was more of an emphasis lately on parity, uh, so that you, it wasn't treated differently by an insurer if it was physical health versus mental health.
• 16:51
  Have those worked out in reality or is there still a sort of distinction that you see and it's harder as you're mentioning, for example, the patient burden, financial burden might be higher.
• 17:00
  I would say that, um, mental health parity was a very important step taken around 10 years ago.
• 17:07
  I don't think it has been implemented to the degree that it needs to be on having parity and level of benefits and access and network.
• 17:15
  Um, quite frankly, if it has worked and if it was fully implemented, I don't think the issues would be as pervasive as they are today.
• 17:24
  Got it.
• 17:24
  So value based care is something that's been talked about for some time, uh, and it's being applied now.
• 17:30
  Um, also it sounds like, to some extent, from what you're saying, in the behavioral health space.
• 17:34
  Does value based care, these models, work well for serious mental illness, or do we have to find a different paradigm?
• 17:40
  Value based care...
• 17:42
  I think is really the only way to treat the seriously mentally ill and have, you know, a functioning reimbursement model that rewards the right types of behaviors and outcomes.
• 17:53
  Um, what I can tell you is that fee for service definitely does not work.
• 17:57
  Um, this population requires a lot of services.
• 18:01
  The services are costly and the services aren't only on the behavioral health side of the house.
• 18:06
  It often requires treating.
• 18:08
  Physical health conditions, as well as providing other services, like I mentioned, things like peers on the ground again, only covered by Medicaid, not by other lines of business.
• 18:18
  So it's very important to treat the whole person.
• 18:22
  Um, and in order to do that, we also need to prioritize.
• 18:28
  Outcomes and ensure that the outcomes are being measured against total cost of care that is not common in a fee for service model.
• 18:36
  So, as we move to value based care, we can look at whole person care, treating the whole person, and then we can measure the success.
• 18:45
  And how it has improved outcomes and how it has also reduced cost overall through a value based reimbursement model.
• 18:53
  So I understand total cost of care can be measured.
• 18:57
  Um, it's not that straightforward, but it still can be done.
• 19:00
  What about in terms of these, you know, quality and outcomes, how easy is that to measure?
• 19:06
  In mental health compared with physical health.
• 19:10
  So that is, um, that is 1 of the challenges in mental health.
• 19:14
  You know, we talk about access and supply common challenge.
• 19:19
  I've mentioned the fragmented delivery system.
• 19:21
  I'd say 1 biggest challenges is quality.
• 19:24
  Um, you know, this is an area in the field that we continue to talk about.
• 19:30
  Coming to some agreement or alignment around quality measures in mental health care.
• 19:35
  In fact, there's not even commonly, you know, agreed upon evidence based treatment in mental health care.
• 19:42
  What we use to identify and assess severity of illness.
• 19:46
  are some assessments like the PH29 you might have heard of, um, the GAD 7.
• 19:52
  Um, you know, these are assessments, um, in many cases that were developed by Big Pharma.
• 19:57
  Um, so while we use them, um, there still is a very big need to identify standard agreed upon quality measures.
• 20:07
  For behavioral health care.
• 20:08
  Now, some innovative companies quartet does this in their care delivery group use a method called measurement based care.
• 20:16
  And what that says is that each of your clinicians is using certain standards for each patient and measuring the progression of that patient, ensuring that they are getting better after the care plan is executed against.
• 20:31
  So that is that is a very good.
• 20:33
  That's a that's a best practice in the space.
• 20:35
  but it's not widely used.
• 20:37
  So, I guess in response to your question, quality measures are not standardly agreed to.
• 20:42
  They're desperately needed.
• 20:43
  But when we move to value based care, what we can look at is that the total cost of care has gone down and that patients are getting better.
• 20:52
  Now, that reduction in care is often due to a reduction in high cost services.
• 20:58
  So, moving to a lower cost of care setting, a reduction in hospital admissions, And we should see an increase in behavioral health utilization and other services for an overall reduction in total cost of care.
• 21:12
  I think this, Christina, has to do with what we were talking about, let's say, before there was mental health parity 10 years ago or so, they just focused very specifically on what's the spending on mental health.
• 21:22
  And what you're suggesting is that if someone's being properly treated, that cost is actually going to go up.
• 21:28
  That's going to help the total cost to decline if I've understood correctly, that is correct.
• 21:34
  Let's talk about quartet health itself.
• 21:36
  Um, that 1 question, I guess my 1st question is, is the name or their quartet?
• 21:40
  Are there 4 parts of it?
• 21:41
  I'm thinking about like, uh, string quartet or something like that.
• 21:44
  Is it, uh.
• 21:45
  Just a nice name or is there some meaning to the four parts of it?
• 21:48
  There are four parts.
• 21:50
  There is a patient, there's a physical health provider, a behavioral health provider, and there is, um, the payer.
• 21:57
  And they're all involved in making sure that we get the patient the care that they need.
• 22:02
  Well, that sounds, that sounds good.
• 22:03
  It's not like, you know, they had the triple aim and then they had to include it to make to the quadruple aim because they forgot.
• 22:08
  They forgot about how the.
• 22:09
  The physicians were feeling about things the first time they're like, yeah, and the physicians are supposed to feel good about it too.
• 22:14
  Not just the patient for them to survive.
• 22:15
  It sounds like you got the, it wasn't called trio health.
• 22:18
  It was the quartet.
• 22:19
  We are not trio.
• 22:20
  There is quartet.
• 22:21
  That's good.
• 22:22
  So is there a kind of a well articulated vision and mission for the company?
• 22:26
  Clearly I understand the space you generally work in, but how, how do you think about, you know, your leadership and, and defining that vision and mission?
• 22:34
  Sure, um, well, really just to clarify, you know, what we do just to be sure that's clear.
• 22:39
  Um, so 1st of all, um, quartet is a tech platform and we are a direct provider of patient care.
• 22:47
  Um, our on our platform, we have over 20, 000 providers and we service up to 21Million members.
• 22:55
  So this helps us to improve access.
• 22:57
  So remember that connectivity play.
• 22:59
  And do that with scale from a care delivery perspective.
• 23:03
  We have over 300 clinicians and we saw over half a million patients last year alone.
• 23:10
  So what do we do?
• 23:11
  We connect patients to care from physical to behavioral health care through our technology and referral platform.
• 23:17
  We match them to the best mental health providers.
• 23:20
  So this is really where that matching process is important, whether that's in person or virtual.
• 23:27
  And we provide care.
• 23:28
  So we deliver behavioral health care services directly to patients.
• 23:33
  They could have mild, moderate, or be seriously mentally ill.
• 23:38
  For patients that are seriously mentally ill, we are building a behavioral health home.
• 23:43
  So we are offering whole person care treatment.
• 23:46
  in a value based care model, and our vision is to be the nation's leading outcomes based behavioral health home.
• 23:56
  Now, how do you think about this idea of being a platform and a provider?
• 24:01
  Because those don't automatically go together.
• 24:03
  There are some players that do that, but if I look throughout healthcare, it's more likely you are a provider.
• 24:09
  Or platform, but not both.
• 24:11
  So how, why do those go together for Quartet?
• 24:14
  Oh, they go together because the platform allows us to connect and match.
• 24:21
  And that really is a core issue in the system.
• 24:24
  You know, it, it essentially helps to solve.
• 24:27
  That access problem, it helps to solve the fragmentation problem.
• 24:31
  By delivering care, we can get at quality.
• 24:35
  And we can also tackle some of the toughest problems in behavioral health care, which quite frankly many are not tackling, and that's the seriously mentally ill.
• 24:43
  Most of these new entrants are tackling the mild and the worried well.
• 24:48
  Um, so there are, there's a plentiful of solutions out there, but the SMI space is really some white space in behavioral health care, and we're super, super excited to go after it.
• 24:59
  What does it look like when you succeed?
• 25:01
  You know, what does success look like from the perspective of a patient, their family, the overall system?
• 25:07
  I think some of the things are straightforward, but I'm, I'm interested in, you know, what, what should it feel like?
• 25:12
  What should it look like?
• 25:13
  You know, as you succeed.
• 25:15
  Yeah, what it should really look like is that we get people back to life and work with serious mental illness.
• 25:25
  Um, and from an outcomes perspective, we're reducing total cost of care.
• 25:31
  Um, we are leveraging quality measures, um, that are agreed upon and we're improving outcomes.
• 25:37
  Um, so really that is what we're headed toward and that is our North Star.
• 25:43
  It sounds like you have, you know, many providers and treating many patients and supporting even, even more than that.
• 25:49
  Can you just maybe describe where you are seeing success?
• 25:52
  Like what, where would be a good measure or a particular segment or, you know, a way to make it a little bit more real at the, at the individual or smaller, uh, cohort level?
• 26:01
  Yeah.
• 26:02
  Yeah, I think, you know, there's a few, there's a few areas.
• 26:05
  So first of all, one of the biggest issues as we know is sort of access to care.
• 26:11
  So when we use our platform and connect patients to care from physical health to behavioral health care, we are seeing patients get connected to care in their appointment in 14 days or less.
• 26:22
  And if someone has an acute situation or condition, we can offer a same day appointment.
• 26:27
  Um, So, really, we think that's pretty strong in this space, and that is a broad based number for us nationally.
• 26:34
  When we deliver care through our medical group, as I mentioned, we practice measurement based care, so we can measure the progression of an individual's, um, care plan and disease.
• 26:45
  We see an average seven point reduction in the PHQ 9, so that's used to diagnose and monitor the severity of depression.
• 26:54
  So, patients are getting better.
• 26:57
  And we're providing.
• 26:58
  value based care that works.
• 27:00
  Um, where we connect patients to care, we see a 10 percent decrease in total cost of care.
• 27:06
  And when we're tackling the SMI population, we see upwards of 30 percent reduction in total cost of care.
• 27:13
  So really these numbers give me strong conviction in our strategy and also our team.
• 27:18
  Um, it is very hard to measure an ROI in mental health and we're doing it.
• 27:23
  What kind of reaction do you get, uh, in presenting to health plans?
• 27:26
  And maybe how has that changed over the last two plus years that you've, that you've been there?
• 27:30
  Have you seen a shift in, in attitude?
• 27:33
  Yeah, I think, um, we have seen a shift.
• 27:36
  Um, you know, with the platform and connecting patients to care, that still is a very real and present issue.
• 27:44
  What we are seeing more recently is that, Um, health plans really don't have a solution to treat the seriously mentally ill population.
• 27:52
  They are largely unmanaged, completely unmanaged.
• 27:57
  So the opportunity is huge to make an impact and there is not a clear solution out there.
• 28:03
  Um, sadly, I think, you know, many physical health providers, um, are reticent to treat the seriously mentally ill.
• 28:11
  They're complex as we've discussed.
• 28:14
  Um, they are, you know, costly and time consuming to treat and it's not always clear what the best pathway to help is.
• 28:21
  So when we come forward with our platform and then also a care delivery model that focuses on the moderate to SMI population, we're seeing a lot of, um, positive response and openness to the conversation.
• 28:35
  So they've been a lot of patients, you know, treated lessons learned over the past few years.
• 28:41
  And I'm wondering, where do you see things heading in the future?
• 28:43
  Is it sort of, you know, getting bigger?
• 28:46
  In terms of what you're doing now, because the need is still very large, even though you, you know, maybe the leading player getting close to it, where, where are things headed with Quartet Health?
• 28:56
  You know, we are really incredibly focused on, um, continuing to deliver value based care and to become the nation's leading behavioral health home.
• 29:07
  And that's a big task, um, to implement a value based care model with, um, a high acuity population.
• 29:16
  Requires a lot of intention and depth.
• 29:20
  And focus in certain geographies.
• 29:22
  And that's where we're putting our intention and focus as a team.
• 29:26
  And we've got an amazing team working on this.
• 29:28
  Amazing group of clinicians and healthcare leaders all focused on solving this one big problem.
• 29:35
  What are the things, I mean, it's obviously a lot to be excited about if you're able to carry that off.
• 29:39
  What, what worries you or what keeps you up at night?
• 29:43
  I would say, David, um, there is a huge opportunity here for the industry and probably more importantly for communities and patients, but a lot of this is depending on our clinical workforce.
• 29:57
  Um, so remember, we talked about the lack of supply, um, or even sort of the lack of getting the match of the right provider for the right patient.
• 30:06
  That worries me a lot, the behavioral health clinical workforce, um, and ensuring that that continues to grow and in the right specialty areas and in the right geographies.
• 30:17
  I'm also worried about the physical health side of the house.
• 30:20
  I worry that these clinicians might feel ill prepared to support their patients at the point of care, while there are solutions out there.
• 30:28
  So I would say sort of the clinical workforce is really an industry wide issue.
• 30:33
  I do think there are solutions out there.
• 30:35
  We can absolutely address this, but it is a big worry of mine.
• 30:40
  Last question is going to be about artificial intelligence, uh, and in particular, we talk about, you know, you're not just going to be able to train enough, you know, mental health workers that is going to satisfy the shortage.
• 30:51
  And there's sort of an attempting approach to say, well, you know, AI can, can address it.
• 30:56
  And in fact, some of the earliest forms of, you know, primitive AI were in maybe the mental health, uh, space, you know, asking questions back and forth and sort of simulating a psychiatrist.
• 31:05
  What is the role for.
• 31:07
  AI, uh, in your field, uh, today and, you know, what would you expect?
• 31:11
  I think, um, there are opportunities.
• 31:16
  I think, for starters, there's more opportunity probably on the mild side of the acuity spectrum to kind of, um, have text based chatting and to sort of, um, be able to identify the level of acuity or high, how, uh, how acute a situation is with a patient.
• 31:36
  So it's kind of like almost that initial intake to try to assess where is this patient on the acuity level?
• 31:42
  How serious is this issue?
• 31:45
  Um, I do think that can translate into the more moderate and severe cases, but I'd say it would probably, for now, stop there.
• 31:53
  Um, because these patients are so complex, because their needs are so diverse, um, at this point in time.
• 32:00
  I probably wouldn't see it going beyond that initial intake and gauging acuity level of a patient.
• 32:07
  Well, that's it for yet another episode of our CareTalk Executive Features.
• 32:12
  My guest today has been Christina Minnelli.
• 32:14
  She's CEO of Quartet Health and Quartet's technology and services have been helping those with serious mental illness to be able to thrive and prosper in the world.
• 32:24
  Christina, thank you for joining me today on CareTalk.
• 32:27
  Thank you, David.