Latest / Becker's Healthcare Behavioral Health / Bernard R. Jones, Vice President, MGB Behavioral & Mental Health, Mass General Brigham; Vice President, MGB Department of Psychiatry, Massachusetts General Hospital, Brigham & Women’s Hospital, McLean Hospital, Brigham & Women’s Faulkner Hospital

Transcript

Bernard R. Jones, Vice President, MGB Behavioral & Mental Health, Mass General Brigham; Vice President, MGB Department of Psychiatry, Massachusetts General Hospital, Brigham & Women’s Hospital, McLean Hospital, Brigham & Women’s Faulkner Hospital · Becker's Healthcare Behavioral Health

• 0:00
  Welcome to Becker's Healthcare podcast. I'm Chris Sosa,
• 0:02
  your host, and I'm thrilled to be joined
• 0:04
  today by Bernie Jones. He is vice president
• 0:06
  of behavioral and mental health in the department
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  of psychiatry for Mass General Brigham.
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  Bernie, thank you for joining us today.
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  My pleasure to be here. Thank you so
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  much for having me. Fantastic. So, Bernie, for
• 0:17
  those in our audience who may not be
• 0:18
  familiar with you and the work you do,
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  could you please just simply introduce yourself, tell
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  us a little bit about your background?
• 0:24
  Sure. Glad to, Chris. So as you captured
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  it in the opening,
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  I really have two roles, complementary roles for
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  Mass General Brigham.
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  The first is as a dyad partner in
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  administering our system wide behavioral and mental health
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  clinical service. So that's the full complement of
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  all of our
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  psychiatric and psychological services across the Mass General
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  Brigham system, ranging from outpatient to inpatient and
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  everything else in between. And I also serve
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  as the chief administrator for our department of
• 0:55
  psychiatry.
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  The Mass General Brigham Department of Psychiatry includes
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  the faculties of the Brigham and Women's Hospital,
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  the Mass General Hospital, and most recently, and
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  I'll probably talk about this a little bit
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  later,
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  McLean
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  Hospital. And so in their combination,
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  I work with a wide variety of folks
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  to make sure that the behavioral and mental
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  health offerings of our system are,
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  world class and in service of the patients
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  who need them so much.
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  Makes sense. Fantastic. Thanks for laying all that
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  out for us, Bernie. So let's just get
• 1:26
  started here. So you have a lot to
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  do. Like, a lot of people in your
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  position or similar positions.
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  So what would you say are your top
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  priorities at this point in time?
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  So the number one priority is is one
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  that I'm guessing a lot of my peers
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  feel, which is just simply ensuring that world
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  class patient care happens every single day in
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  the clinical settings that we provide that care,
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  as well as advancing
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  our other missions, which for Mass General Brigham
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  include
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  education,
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  research, and then also advancing equitable care in
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  our communities.
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  But in some ways that's table stakes, really
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  important table stakes.
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  But Mass General Brigham, for your audience who
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  may be,
• 2:07
  observers of our healthcare system,
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  will acknowledge that we're a system that's rapidly
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  evolving and changing in real time. And so
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  I would say the integration
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  imperative for our system,
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  is among, if not the top priorities
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  after those sort of foundational priorities that I
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  referenced below.
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  So for the last two years, we've been
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  integrating
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  all of our academic departments,
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  specifically between Mass General and Brigham Women's Hospital.
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  And so for psychiatry,
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  we've been doing just that. And then really
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  in the last couple of months, we've added
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  the faculty of McLean Hospital into that integration
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  imperative.
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  And so I work very closely with Doctor.
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  Maurizio Fava, who's the chair of the MGB
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  Department of Psychiatry,
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  to facilitate that integration.
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  And then also with Doctor. Susan Zaleski,
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  who serves as the new president and COO
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  of McLean Hospital, as well as my dyad
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  partner at administering
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  the system wide clinical service line for behavioral
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  and mental health. And so
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  that integration
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  has pretty much every manifestation you can imagine,
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  but really major ones right now are ensuring
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  that our clinical programs are well integrated,
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  that our education programs are integrated. We're going
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  to pursue an integrated residency.
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  Right now, we have two of the top
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  five largest residences in the country between MGH,
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  McLean and Brigham, and we're gonna try and
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  combine those into a single world class residency
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  program.
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  And then there's a bunch of other things
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  that we're doing, really every single day to
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  facilitate that integration. But I would say priority
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  number one is making sure that we, make
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  the whole greater than the sum of the
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  parts,
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  through that integration process.
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  A couple of follow-up questions for you there,
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  Bernie. So first of all, very simply well,
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  it's not necessarily a simple question, but
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  the just the level of change that you
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  and the health system have undergone over the
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  last two years, do you feel like it's
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  it's accelerating or is is accelerating, or is
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  that just kind of
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  not really a thing to you? Does it
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  seem like the level of change is simply
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  constant to you? Let's start there. I would
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  say it's both. You know, it would be
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  intellectually dishonest for me to say that this
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  isn't a heightened level of change.
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  The kind of integration that we're talking about,
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  I I don't wanna say it's unique because
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  I don't have perfect knowledge of what's happening
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  across the country, but it is rare and
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  uncommon to take
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  two, in this case, three
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  world class academic medical centers
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  and to try to unify them,
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  in ways that are not just simply collaboration,
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  but really creating a single unified
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  clinical program,
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  an increasingly integrated research program,
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  the integrated education program I alluded to earlier.
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  And when you think about MGH, Maclean, and
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  Brigham, you have the first, second, and one
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  of the top departments of psychiatry in the
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  country on their own. So this is taking
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  really complex,
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  really well established,
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  world class things and bringing them together.
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  And not only is that a huge amount
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  of change, but also I feel a significant
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  amount of,
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  responsibility
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  to make sure that whatever we're integrating
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  is better at the end of this than
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  the component parts that we're integrating because otherwise,
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  this would not have been the right thing
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  to do. But I'm I'm confident and I'm
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  optimistic.
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  On unrelated note, I wanna ask you. So,
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  McLean,
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  what was the process in
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  deciding, okay, this is the right move for
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  us to integrate them as well?
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  Yeah. So when the integration of our two
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  primary academic medical centers, Mass General and Brigham,
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  was announced, those of us who are working
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  in and around psychiatry
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  almost immediately asked, Well, what about McLean? You
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  know, McLean is interesting in that it's a
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  freestanding psychiatric hospital.
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  It's a world class department of psychiatry in
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  and of itself. And so we asked ourselves
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  at the time,
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  Why wouldn't we integrate them?
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  And I think the initial thinking was that
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  it was big enough to wonder about Brigham
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  and Mass General,
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  and that McLean as a freestanding hospital was
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  sufficiently different that we weren't going to include
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  that in its initial integration.
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  But I will say as Maurizio and I
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  got deeper into the integration,
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  everywhere we turned
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  lent itself to saying, well, what would this
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  mean for McLean? What would it mean if
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  we included McLean? What would it mean for
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  our patients if we were able to do
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  all of this together? And so I think,
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  like a lot of this integration journey, we
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  got smarter as we went along, and we
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  came to realize
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  what in hindsight may have been obvious, which
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  is they probably should have been in from
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  the beginning.
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  We continue to grapple with the
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  specific differences of being a freestanding hospital rather
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  than a department as part of a general
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  hospital. So we we still need to figure
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  out exactly what that will look like, but
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  mostly it was what's good for patients, what's
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  good for research, what's good for teaching,
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  and coming together,
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  won every single time when we thought about
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  those things.
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  We've looked backward a little bit. So now
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  let's move this forward, as best we can.
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  So next question is simply look at the
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  next eighteen months or so. You've described a
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  little bit about how things are going to
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  change,
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  but I'd love for you to go into
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  a little bit more detail on that. So,
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  yeah, next eighteen months, how things are gonna
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  change for you?
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  Sure. So I I think one that jumps
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  out to me is an opportunity
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  afforded by integration, which is how do we
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  look at our assets, our services, our resources
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  in increasingly
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  unified ways?
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  And one of the ones that we're gonna
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  grapple with most immediately is our myriad inpatient
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  psychiatric beds. So, I don't have the number
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  right in front of me, but it's approximately
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  five thirty five. It's north of 500 inpatient
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  psychiatric beds, which accounts for,
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  roughly
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  20%,
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  give or take, of the Commonwealth of Massachusetts
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  inpatient beds. So it's a very significant proportion
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  of the Commonwealth's
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  beds.
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  And, for very good reasons,
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  those beds
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  have worked in ways that align
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  with their institutional
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  strategies. So we had 24 beds at Mass
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  General, 24 beds at the Brigham,
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  three twelve beds at McLean.
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  But when you think about them in those
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  institutionally
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  vertical ways,
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  you lose the opportunity
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  to place patients or move patients in ways
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  that make the most sense, particularly given the
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  capacity crisis that we're feeling both as a
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  system and as a field today. And so
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  I would say over the next eighteen months,
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  we're gonna treat those more than 500 beds,
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  less so as being
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  parts of five or six different hospitals, and
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  much more, how do we make the highest
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  and best use of those 500 beds almost
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  agnostic
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  to the hospitals at which they're located. And
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  so that what that will mean is resourcing
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  them more precisely.
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  So the Brigham Faulkner, which is a community
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  hospital associated with the Brigham and MGH,
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  as well as Salem,
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  have varying levels of med psych capacity.
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  But they also do a fair amount of
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  community level care. What we're going to do
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  is to say, well, what if we really
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  double down on the med site capacity of
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  one or two or all of those units?
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  What would it mean for our ability to
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  care for those complex patients? But also, what
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  would it mean if we were then diverting
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  some of the patients that otherwise would go
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  to those units to more community level settings
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  of care. And so that's a very long
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  winded way of saying, we're gonna look at
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  a bunch of different things that we used
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  to look at separately and start looking them,
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  more in combination and together.
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  I'm glad you've got Maritzo and other people
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  on your team to help you so you're
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  not doing this all by yourself,
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  very simply for it. No. Thank you for
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  explaining all that. I'm sure that our audience
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  will will love and learn a lot from
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  the process that you're describing.
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  You seem very excited about that, which you
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  definitely should be even though it's a lot
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  of work. You you describe it as an
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  opportunity, which I think is a terrific way
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  to look at it. What else are you
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  excited about right now? And it can be
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  with related related to the integration that you
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  discussed or just, in health care and in
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  general.
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  So one thing that I'm excited about, and,
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  maybe in a little bit, we can talk
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  about some of the challenges that we're facing
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  as well. But I I I do generally
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  like to look at the glass as half
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  full.
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  I think we've made a huge amount of
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  progress as a country and as a society
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  in how we talk about mental illness.
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  And the reduced stigma that,
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  face
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  patients,
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  families, and our communities as they grapple with
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  mental illness.
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  And, you know, I think over the last
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  year or so, we've seen some threats to
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  that. I think we've seen some indications that,
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  that commitment
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  to mental health, is a little bit more
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  at risk. But, I I look a little
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  bit more optimistically that I've seen folks redouble
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  their commitment to this and what it means
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  for our communities if we do this right.
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  And so what excites me is engaging with
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  our employee population,
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  our patient population, our elected officials, our agency
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  and regulatory leaders to really double down on
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  the imperative
• 11:15
  around behavioral and mental health. The crisis
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  that existed before the pandemic was certainly revealed
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  and exacerbated during the pandemic, but is not
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  going anywhere anytime soon. And so I'm enthusiastic
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  about the opportunity
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  to work on sort of addressing those challenges
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  and improving the health and well-being,
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  of our communities both near and far.
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  I would say another thing that makes me
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  very excited is how rapidly our field is
• 11:42
  advancing.
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  So for many folks, probably less so the
• 11:45
  ones listening to this podcast, but their image
• 11:48
  of psychiatric care and behavioral and mental health
• 11:51
  care involves a long couch and people talking,
• 11:54
  you know, psychotherapy.
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  We do a lot of that in the
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  system, but we also do a lot of
• 11:59
  cutting edge procedural and otherwise interventions
• 12:03
  that are really at the vanguard, not only
• 12:04
  of our field, but of science. So I
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  think about TMS. I think about ketamine and
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  esketamine. I think about our research work in
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  psychedelics.
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  And all of this
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  significantly,
• 12:16
  portrays promise for how we might move the
• 12:18
  field forward and how we might deal with
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  some of the most insidious features
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  of mental health crises, which is those persistent
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  treatment
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  Excellent. Thank you for that, Bernie. So you
• 12:43
  did open the door
• 12:44
  to the challenges that you're facing. Right? And,
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  you know, I'm not gonna dismiss that in
• 12:49
  the slightest. I would love for you to
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  lay out exactly what you're thinking as far
• 12:53
  as the challenges with with related to what
• 12:55
  you're excited about or in general. So
• 12:58
  So, maybe I'll talk about two kinds of
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  related challenges.
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  The first, which we've felt for a long
• 13:05
  time now,
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  and I would say it's accelerated,
• 13:09
  over time is the the financial backdrop
• 13:12
  of how we deliver health care.
• 13:14
  And I don't wanna be overly pessimistic, particularly
• 13:17
  since I claimed to be optimistic earlier,
• 13:19
  but I really do worry about the fundamental
• 13:22
  underpinnings of health care finance today. You know,
• 13:25
  everyone is struggling.
• 13:27
  Patients are struggling to find and pay for
• 13:29
  care.
• 13:30
  Provider organizations, hospitals, and health systems are struggling
• 13:33
  financially.
• 13:35
  And this is largely
• 13:37
  both a macroeconomics
• 13:39
  problem. So our expense base, particularly over the
• 13:42
  hyperinflationary
• 13:43
  period that was the last couple of years,
• 13:45
  was growing anywhere from 5% to 20%, depending
• 13:48
  on the category. And our reimbursement
• 13:51
  was close to flat on a blended basis.
• 13:53
  And, we didn't really talk about my background
• 13:56
  earlier, but I'm an, English major, from undergraduate,
• 13:59
  but I don't need to be a math
• 14:01
  major to know that the mismatch of expense
• 14:04
  growth versus revenue growth is simply unsustainable,
• 14:08
  for health
• 14:09
  care. And then when you drill down to
• 14:11
  behavioral mental health and psychiatry,
• 14:13
  it gets even worse. We are a chronically
• 14:16
  under reimbursed discipline,
• 14:18
  yet the demand for our services
• 14:20
  is growing wildly
• 14:31
  vested interest in that. But also generally in
• 14:34
  healthcare. You know, I think we've come to
• 14:36
  a place as a society where we value
• 14:39
  the very best of what American healthcare can
• 14:41
  deliver us, but we're struggling with the concept
• 14:44
  of paying for that.
• 14:46
  And that really brings us to a fork
• 14:48
  in the road between, you know, our fee
• 14:50
  for service, sort of traditional health care environment,
• 14:53
  and a value based health care environment. I
• 14:55
  think there's promise in both, but we're we're
• 14:58
  in some ways trying to have our cake
• 15:00
  and eat it too. We want world class
• 15:02
  on demand health care, but for bargain basement
• 15:05
  prices.
• 15:07
  And I don't think that fully reconciles.
• 15:09
  And so, one of the challenges that I
• 15:11
  think we face is
• 15:13
  the immediate term economic situation that we find
• 15:16
  ourselves in, the challenging one, but also the
• 15:18
  broader misalignment
• 15:20
  between what our patient community in the broadest
• 15:23
  sense wants from its healthcare, but also what
• 15:25
  it and the payers are willing to pay,
• 15:28
  for that healthcare.
• 15:30
  And I would be remiss in leading a
• 15:32
  department of, or helping to lead a department
• 15:34
  of psychiatry at an academic medical center to
• 15:36
  not reflect on the significant challenges
• 15:39
  that our community has faced
• 15:41
  in recent sort of political times,
• 15:44
  specifically
• 15:45
  those items relating to,
• 15:47
  diversity, equity, and inclusion,
• 15:50
  as well as,
• 15:51
  impacts on research funding. You know, we're obviously
• 15:54
  keen to,
• 15:56
  work with,
• 15:57
  our partners at all levels to make sure
• 15:59
  that, you know, we're in compliance with the
• 16:01
  law
• 16:01
  and that we're, doing right by the imperatives
• 16:04
  that exist in front of us. But we
• 16:06
  are also a proud institution with a long
• 16:08
  held commitment to both health equity as well
• 16:11
  as,
• 16:12
  our opportunity to contribute to new knowledge and
• 16:16
  innovation, across the country.
• 16:18
  And,
• 16:19
  both of those things are a dynamic
• 16:22
  landscape under our feet that we are trying
• 16:24
  to adapt to, while also make sure that
• 16:27
  the underlying principles
• 16:28
  and key commitments associated with them are maintained.
• 16:32
  You know, I think in fiscal year twenty
• 16:34
  five, we will be at or around $250,000,000
• 16:38
  of, research expenditures as an academic department.
• 16:41
  And each of those research initiatives
• 16:45
  has a connection to improved patient care, improved
• 16:48
  outcomes, more innovative,
• 16:49
  delivery of care. And I really worry, along
• 16:53
  with the rest of our field, that if
• 16:54
  we see disinvestment
• 16:56
  in those areas,
• 16:57
  the long term consequences of that are gonna
• 16:59
  be significant
• 17:00
  and felt by individuals,
• 17:02
  in terms of their health, and well-being. And
• 17:04
  so, those are two semi related challenges,
• 17:08
  money and the headwinds,
• 17:10
  that we're facing in a in a new
• 17:11
  administration.
• 17:13
  Dynamic landscape under our feet is an excellent
• 17:15
  way to put that. I think that that's
• 17:18
  gonna go a long way. That image is
• 17:21
  definitely gonna resonate for sure.
• 17:23
  Bernie,
• 17:24
  lastly, I simply wanna ask, and you've you've
• 17:27
  covered so much ground, which I very much
• 17:29
  appreciate.
• 17:30
  But I wanna see if there's anything else
• 17:31
  in health care that you think deserves a
• 17:34
  brighter spotlight. Certainly, there's a lot that you
• 17:36
  mentioned the headwinds. You mentioned the
• 17:39
  administration that everyone in health care is dealing
• 17:41
  with as well. But is there anything else
• 17:42
  out there that you think, you know what?
• 17:44
  People should be talking about this as well?
• 17:47
  So I think we,
• 17:49
  don't spend enough time talking about
• 17:52
  experience.
• 17:53
  And, I'll expand on that definition because I'm
• 17:56
  gonna think about it in two ways. One
• 17:58
  is patient experience, and then the other is
• 18:01
  provider
• 18:02
  or employee experience.
• 18:04
  And we've long felt in our system that
• 18:06
  if those two things are optimized,
• 18:09
  then we're doing our jobs,
• 18:12
  and we're going to be successful.
• 18:14
  The patient experience
• 18:15
  comes pretty naturally to health systems like ours.
• 18:18
  We're very patient centric organizations.
• 18:21
  But oftentimes when we think about it, we
• 18:23
  think about it in fairly
• 18:25
  sort of simplistic, cut and dry manners, which
• 18:28
  is like, do we have the number of
• 18:29
  available visits for our patients?
• 18:31
  Do we have the staff in the clinics
• 18:33
  to make sure that we're able to get
• 18:35
  the throughput of the patients?
• 18:37
  But every meeting that,
• 18:39
  I start,
• 18:40
  large scale staff meetings, I read two patient
• 18:43
  letters,
• 18:44
  one that's positive about their experience
• 18:47
  with our services, and another one that's more
• 18:50
  constructive and critical about our services.
• 18:52
  And I think we can often lose ourselves
• 18:54
  in abstraction
• 18:55
  of this data or this dashboard is saying
• 18:57
  that we're doing a good job. In some
• 18:59
  ways, the most important measures are what are
• 19:02
  our patient outcomes and what are our patients
• 19:04
  saying about their experience here? And so I
• 19:06
  really hope that we will continue to invest
• 19:08
  and redouble our emphasis
• 19:10
  on the sort of true patient experience
• 19:13
  of getting care in settings like ours.
• 19:15
  But I also would be remiss in helping
• 19:17
  lead a workforce
• 19:18
  that in our department is north of 2,000
• 19:21
  people, that
• 19:22
  the ability to provide that great patient experience
• 19:25
  requires our employees to feel really good about
• 19:27
  the place that they go to work and
• 19:29
  how they deliver their,
• 19:31
  services every single day. And,
• 19:33
  we just finished an employee experience survey here
• 19:36
  at Mass General Brigham, and we saw a
• 19:38
  lot of promise in the results, but also
• 19:40
  a large call for action,
• 19:42
  to improve the experience of our employees and
• 19:45
  for them to better understand where we're headed
• 19:47
  and why we're headed there. And so as
• 19:49
  a personal commitment of mine, I'm gonna really
• 19:51
  try to better translate the vision that exists
• 19:54
  in my head and the heads of my
• 19:55
  colleagues into the front lines
• 19:57
  and make people feel very excited,
• 20:00
  about the work that they do every day.
• 20:02
  You know, I think I go back to
• 20:03
  and I'll conclude here, and I think it
• 20:05
  was
• 20:06
  JFK visited Cape Canaveral or somewhere like that
• 20:09
  and asked a janitor,
• 20:11
  what that person did there, and they responded
• 20:13
  they were helping to put someone on the
• 20:14
  moon. We're not quite so grand as that,
• 20:17
  but I do want all of the folks
• 20:19
  in our department
• 20:20
  to clearly understand that we're here to take
• 20:22
  care of patients, we're here to advance research,
• 20:24
  we're here to help educate the next generation
• 20:27
  and really transform the field. And,
• 20:29
  there's a lot more that I and we,
• 20:31
  can do on that front
• 20:33
  to make a greater impact ultimately
• 20:35
  in service of our patients.
• 20:37
  Well said, Bernie. And I would add that
• 20:39
  simply that helping
• 20:41
  people stay healthy is quite grand and quite
• 20:44
  worthwhile,
• 20:45
  but I know that you're saying that as
• 20:46
  well. Thank you so much again, Bernie, for
• 20:49
  being on the podcast today. We're gonna love
• 20:52
  sharing all your insights with our audience as
• 20:54
  soon as possible, and I I very much
• 20:56
  look forward to next time we cross paths.
• 20:58
  Great. Thank you, Chris. Really appreciate the opportunity.