Solomon Partners Presents
Solomon Partners Presents
EP 14: Behavioral Health's Defining Moment
Mental health is the last frontier of medicine. We need to seize this day and integrate, or else we'll be perpetuating this false dichotomy that it's either mental health over here, or physical health over here, as opposed to the two being inseparable.
Garen Staglin:We've got two choices. We can run away from this problem or run towards it. We chose to run towards it. And I've been doing that ever since.
Ryan Stewart:Welcome to PJ SOLOMON's healthcare tech podcast. I'm Ryan Stewart and I lead our Healthcare Technology& Tech-Enabled franchise. Today's topic is going to focus on the advancements in behavioral health. And with me today are former Congressman Patrick Kennedy, one of the leading voices and activists in the advancements of behavioral health in our country. Patrick is also a very active investor, entrepreneur and board member of very important behavioral health tech companies, including, but not limited to Quartet Health, AbleTo, which was acquired by Optum last year, Axial Healthcare in the area of opioid management and his latest venture Psych Hub. I'm also joined by Garen Staglin. Garen is a serial FinTech entrepreneur investor, legendary winemaker, and an amazing philanthropist. Garen is also on the board of Silicon Valley Bank, where he and I met about five years ago and have been collaborating ever since. Garen and Patrick also co-founded One Mind. One Mind is a not-for-profit organization focused on brain health, brain science, and the advancements of really all things behavioral health, not just here in this country, but globally. Garen, you and your wife, Shari have committed decades of your lives to the advancement of mental health. What set you on this path?
Garen Staglin:This journey for me began in 1990, when my son had a psychotic break, we were fortunate to have enough resources to actually be able to get an accurate diagnosis, get him on a system of care that allowed him to go back to Dartmouth College. It was between his first and second year. He ended up graduating on time with honors and a dual major, which caused us to say, God, we are really fortunate here. We've got two choices. We can run away from this problem or run towards it. We chose to run towards it. And have been doing that ever since We focused initially in science to understand what happened to Brandon and could we detect it and prevent it. Everybody has somebody with some form of brain health issue from autism to learning disorder, to eating disorder, to my son's schizophrenia, depression, bipolar. And now these late life illnesses. All of you have a friend, a family member, a neighbor, a workmate. So why are we not talking about why is it not a priority? And that's what Patrick and I are here to do, raise this to a national emergency. So we all get ourselves mobilized, just like we did with cancer, just like we did with heart disease. We can do this, but we can't do it alone. We need you all on this journey with us.
Ryan Stewart:Patrick, what is the state of where we stand today? Independent of progress that's been made in terms of how much behavioral health coverage care delivery is lagging, you know, physical health?
Patrick J. Kennedy:As you mentioned, Ryan mental health is seen as something outside the house of medicine. It's really original sin where we turn mental health outside the house of medicine and didn't integrate it. And you know, this happened when Congress was coming up with Medicaid and they had the decision, are we going to cover brain illnesses? And they decided to cover mental, at that time was called retardation, it's developmental disabilities. So they cover people with intellectual disabilities because they said, well, they weren't responsible for their condition, but they deliberately decided not to cover people with a mental illness and addictions and depression and anxiety, everything else, because they thought that that was a matter of personal choice. And, you know, as if someone chooses to, to live with those kinds of conditions voluntarily. And so what happened from that is we never paid for mental health. And it was really that stigma was reinforced by the fact that we didn't pay for it. It had no respect, it was never seen as real in terms of a treatable illness. So what Garen and I have been trying to do with Shari and Brandon is bring brain health together with overall health, understanding it's all interconnected. And obviously this should be so obvious, but historically both the federal government and our private insurance system has reimbursed and impose much higher treatment thresholds for gaining care on those seeking care for their brain illness as compared to other physical illnesses of their body. And I'm so grateful for Garen, not only because of his philanthropy, but Garen and Shari and their family have really gotten involved in politics from the vantage point that they understood that we need to make policy changes at the government level. And they backed me when we were passing the Mental Health Parity and Addiction Equity Act. And that law basically said, you can no longer discriminate against a mental illness in the way that you paid for it. And you had to treat it in the same way you would other chronic illnesses, and that has been kind of our model of a medical version of the Civil Rights Act, where we integrate mental health and overall health, as opposed to segregate it.
Ryan Stewart:We've made a lot of progress, but from a parity perspective, it's still a rounding error, right? Against other chronic conditions?
Patrick J. Kennedy:We've had a historic opportunity with the new administration and many of the people that are taking positions within CMS and within the broader Biden administration to really turn the corner with the move towards value based payment models and alternative payment models are going to be the future for us because as opposed to the parity law, which says you have to pay the same, provide the same across inpatient, outpatient, and network out-of-network and so forth. This will really say to the capitalist system,"where is the value" for reducing your total cost of care? And it will be recognized by all the payers, including the federal government, which is the biggest payer of all that. If you invest in depression, anxiety, alcoholism, addiction, mental illnesses, like schizophrenia, you invest at them early. Like we would cancer. You will see the biggest value-add of any area of medicine because as you know, Ryan, having managed a lot of these companies in the medical space, we've squeezed all of the savings in many respects, out of various aspects of the medical system. The one area which remains untouched is the mental health and addiction treatment system. And so, if you want to reduce diabetes, people can't be alcoholics at the same time. You want to reduce heart disease, you've got to address depression and so forth and so on. So finally, the innovation that's taken place in cancer and other areas of medicine, we hope to steer towards mental health and addiction. And that will happen if we move to this risk-based contracting, which I see as a potential real game changer in terms of the private marketplace investing in mental health and addiction.
Ryan Stewart:We had Bruce Broussard from Humana on a couple of weeks ago, and Bruce talks a lot about managing the whole person. Where are we as an industry of looking at this from the whole person and not putting this bright line between behavioral conditions and physical medical conditions, because they are so late?
Garen Staglin:We're trying to champion the term"neuro- diversity," Ryan, as a element of all companies' D&I strategy, because just as you must pay attention to racial, gender and sexual orientation, you also must pay attention to neuro-diversity for a variety of perspectives. One, because just the capacity and the availability of talented workers is being challenged now in this environment. And there are incredible skills with people with neuro-diversity and substantially enhance your own workforce. So we're working on ESG criteria for reporting and we're putting a taskforce together in that regard. I would say from the point of view of employers, we're seeing a real movement towards this. COVID-19 has really put the highlight, if there's anything good about this pandemic it's the understanding that the real second wave is the second wave of anxiety, depression, and post-traumatic stress and suicidality, which COVID along with racial tension and political divisiveness and economic uncertainty have brought to America's and the world's workforce population. So we are seeing 40, 50% increases in these conditions in people who already have them and people who never had them before now have them. So as an employer, you have no choice but to address this and you need to address it because what's going to happen if you don't, I have just been on the phone with a CEO of a major global employer, he just had two suicides in his company. And that is the too late part of wake-up that you don't want to have as an organization. So we can talk about capacity, which Patrick can. And I know you're well aware of the tremendous growth in tele-psychiatric services and the use of digital health tools. And we can dive into that, but we have real issues about capacity, accessibility. And, but in the end, you've got it right. Affordability, if you don't, if you don't pay for it, now you pay for it later because you're going to die. Your employees are going to die 20 years earlier from heart disease, diabetes, or cancer, if they have serious mental illness. And that costs way more than treating these illnesses now.
Ryan Stewart:You know what we're seeing in healthcare today from my vantage point, and clearly you guys have a front row seat and are driving this with, with One Mind at Work, the employer, the self-insured employer has really stepped up in the last five or so years and is telling that payer that good enough is no longer good enough, right? They are carving so much away from the health plan. Things like front- end healthcare advocacy and navigation, otherwise traditionally known as customer service. Employers are saying, you, no longer can call my employee. We're going to outsource that to companies like Accolade and Quantum that have this kinder, gentler, more agile way to communicate with our populations, with our, with our employees. In terms of diabetes, we had the, the, the scale of Livango that got bought by Teladoc managing diabetic populations in a fundamentally different way that we're really focused on delivering consumer delight on the front end and highly defensible outcomes on the backend. We're seeing this with the adoption of virtual care and in particular virtual care in behavioral health where 70 or so percent of any behavioral health matter could be handled virtually. How much have you seen this call to action, where these employers are raising their hand and saying, I can't rely on the government. I can't rely on the third-party administrator. I can't rely on the EAP guy anymore. I got to take matters in my own hands, and I've got to stand up and do what's right for my employees to drive real change.
Garen Staglin:I think that's very real and it's very active. And many of our employer members of which we have over 90 now, representing almost 8 million employees across the globe, are in that very same mode. The separation between in and out of network is almost gone because if y ou try to deal with only in network capacity, you know, em ployees a re go ing t o w ait six months to g et a treatment- that's not accessible and not worthy. In some sense, th ey're p ainting the providers of these services as, as bad guys. I don't, just like Bruce, I don't view them as a bad guy. We have me mbers t hat include United, Sutter, Kaiser, Hackensack Meridian th at a r e s truggling with this issue of capacity. And I think they're welcoming this change and payer le d a ction and derivatives. And so are the health plan provider designers like Aon, Mercer and others, this is a very important discussion. And I think if all of us pay a little more now, we will all pay a lot less later, by this issue of dealing with capacity prevention, early intervention services and the reduction of stigma, because you're raising this point, Ryan. EAPs don't work just because you have them. People have to use them and you have to encourage them to go after and eliminate the potential for discrimination, which people feel. And the last person that most employees want to go talk to is HR about their mental health condition. That's where we are right now.
Ryan Stewart:Patrick, we're seeing the plans. Centene's investments in Quartet. Humana's making big investments here. They all recognize that they're still in the early innings, but in terms of the institutions, the payers, the self-insured employers that are pioneers here, that want to drive change, what are you seeing? And what do you think is needed to really affect long-term lasting change?
Patrick J. Kennedy:Well, the great news here is that it's becoming very transparent to point that the economics of presenteeism are profound. Given the fact depression is the leading source of disability worldwide and never before were payers, the third-party administrators really factoring in the value of spending more to make sure that their patients were engaged with mental health services, because they didn't bear the fiduciary responsibility of the productivity of the workplace. That's a part of this equation where the economic incentives were not aligned because if they were also not only trying to reduce the total cost of care on the medical side, but also increase productivity on the worker side, they wouldn't be investing more in mental health than not. The transparency of these economics are, are now being recognized. And as a result, this is not an issue of passion, you know, born a personal experiences. It isn't the case with Garen and myself and others. It's born out of expediency and efficiency and economic value. And that's a good thing for us, frankly, because we haven't been able to move the needle on the advocacy side the way we would like. But we think that now that we have these Fortune 500 companies that are joining One Mind at Work, or they're part of this global movement, that we're going to get the attention on a bipartisan basis, that we were never able to get in, in the old course of advocating. So I see this as a really positive changecfor those, with these illnesses that they're now going to become front and center in the issues that are before the Congress and the president and future administration.
Ryan Stewart:And to that end, how much is the Fortune 100, Fortune 500, these big institutions pushing public policy in Washington on behalf of their associates?
Garen Staglin:We don't see a consortium yet, but if I'd come back to my comment to you about making neuro- diversity an ESG reporting element, if we can get that accomplished and agree on the narrative by which companies will report, I think that's going to create the kind of movement because when stakeholders now demand that this be a part of your corporate citizenship, then I think we're going to see the action necessary. But as another point, I was just telling you that Patrick and I belong to a huddle, which is a loose affiliation of the leading advocacy organizations in the country. And we've actually put a seven pillar plan together, directed primarily at policy makers in both the state, local and national level. And we've got a five-year journey in front of us here to influence public policy, to make what all of the things that Patrick just described a priority for legislators. Keep in mind, it's not politically expedient to spend a lot of money on this because the benefit accrues to your political successor, not to you in your term of office. We have to change that metric because this pandemic has made it very clear that we can no longer tolerate that kind of short-term thinking. This is a long-term issue that must be addressed.
Ryan Stewart:Patrick, you and I spoke about this golden moment as we're dealing with tackling the COVID challenges on a day-to-day basis. Would you talk a bit about that and what you see as the opportunity, and can you mitigate COVID and manage COVID while you attend to the behavioral health dynamics or do we need to do this sort of sequentially versus concurrently?
Patrick J. Kennedy:There's kind of an inherent bias that we're not aware of where we look at mental health as something as other, as opposed to, as part of. And one of the things that all of us as advocates are really interested in doing is ensuring that patients coming in, for example, for their vaccinations, understand that COVID is not just a physical manifestation of an illness. It's also being manifested in mental health comorbidities and to tackle COVID is to tackle not only the respiratory and heart attacks, but to tackle the overdoses, the self-medication, depression, anxiety, and suicide ideation that comes from the impact of COVID. And that both need to be addressed concurrently. There is a profound appreciation for the fact that we don't have scale. We barely scratch the surface in the available treatment for those with addiction, less than 10% of people who have addiction avail themselves and how to access to services. It's just striking when you think about the prevalence of addiction in our society, and over half of those with mental illness do not avail themselves to these services. So we have a lot of that is driven by the historic discrimination and payment and so forth to this field of medicine. And so we have to make up the capacity as Garen said, and that is a challenge. We have obviously levers with tele-health as has been mentioned, but I really see this as an opportunity to really focus on solving the problem. America in World War 2, fought a war on both sides of the world at the same time. It seems to me, if we can do all these great things in our history we should be able to tackle getting vaccinations out at the same time. We're tackling the fact that people ought to be thinking about their mental health, because the long tail of COVID is going to be the repercussions of the mental health aspects of isolation, financial insecurity, anxiety, depression, and, social isolation that's come from this. So we h ad better start dealing with that now, not as I think is in the current vein; dealing with it right after we're done so to speak with vaccinating e veryone. Because when that happens, the challenge is going to be that much greater because we'd lose over 150,000 people a year to suicide and overdose. So that's basically writing off roughly that number between now and we get around to dealing with mental health. And what we should be doing is trying to come up with these innovative solutions. And the good news is that all of the private sector is invested in helping the government figure this out because of the need as Garen pointed out from our business community and our medical community and our payer community to all get about doing this, it's the unfinished business. It's the last frontier of medicine that we haven't put together. And this should be the turning point for us. We need to seize this day and integrate or else we'll, we'll be perpetuating this false dichotomy that its either mental health over here, or physical health over here, as opposed to the t wo b eing inseparable.
Ryan Stewart:On the diagnostics, we're shipping test kits to the home. We're doing virtual care visits to get prescriptions delivered to the home, but on the behavioral health front, to what Patrick is saying here, Garren, what are some of the leading One Mind at Work employers thinking in terms of just specific to COVID to where we stand right now to get their associates the resources they need to stop the overdoses, to stop the suicides, to not be too late on that care intervention? What are some of the things you're hearing?
Garen Staglin:It starts with the top. So doing one-on-one fireside chats with myself and the CEOs of these companies, that's, we're seeing a lot of that. I'm about to do one with Liberty Mutual. I just did with David[Long] there. I just did one with Brian Moynihan at Bank of America, Tim[Armour] at the Capital Group, we're seeing more and more CEOs get in front of their employees saying,"it's ok not to be ok." Everybody has somebody and come forward. And because we've got great resources, if you don't know about them, find out about them. Secondly, I think there's a clear examination of plans for parity that Patrick discussed and trying to align that wherever possible. It's also the going beyond- what are the factors that are increasing this stress? The data that we're seeing is that women are much more impacted by this in terms of anxiety and depression, because in most cases in the workforce, they're not only doing their job, but they're also the chief medical officer at home, as well as the one who's worrying about the kids going back to school. And so paying for daycare services, reimbursing for nursery school, or other ways for people to maintain their children's education while this is going on, we're seeing forward-thinking employers doing that. Of course, there's a huge experiment also going on in digital tools, not only the apps, in which we, One Mine Cyber Guide, actually rate for an independent service. We did this with the Northeast Business Group on Health, then use this whole wonderful benefit of neuro-plasticity, but we now have this whole other industry, which from your point of view is achieving these incredible valuations on further funding. I believe... just had a huge uptick in valuation, Mindstrong and several others. You're seeing this whole tele-health, tele-psychiatric services gain significant momentum to build the policy into the system. So I did get to top to bottom review. It needs to start at the top training frontline supervisors. We're seeing a lot of that on how to ask the question of,"are you okay?" And knowing what to do about it. And then the employment of ambassadors. Here's this place where people will come and want to go to. And so a whole movement of training your workforce to have ambassadors within the centers. Accenture is one of our leading companies, they have over a thousand ambassadors, against their 500,000 person workforce that are there for that very reason, able to then go and talk to, and they feel more comfortable dealing with a peer than dealing with HR.
Ryan Stewart:On the innovation front I think you're dead on there, Garen. You know, one of the things that Patrick and I were chatting about the other day, and you as well is, advances that we've seen in artificial intelligence with facial recognition and voice recognition, and that we don't need a psychiatrist for every encounter, right? We can scale at mass and you know, Patrick, maybe you spend a moment. I know we're running up on time here to the explosion we think we're going to see in paramedical resources where we can use the machine to identify who's at risk and not, and get them into some care. With that, I want to close with just any final comments, Patrick, you could take this and we'll come back to you Garen. On the topic of leadership, I had Bruce Broussard on, you know, just couple of weeks ago and I asked him, what does leadership mean to you in this brave new world we're in. Patrick just quickly, any last comments on the, you know, as we were talking about the A.I. Driven need for paramedical resources, and your thoughts on leadership?
Patrick J. Kennedy:What we have found, as Garen mentioned, we're in the CEO huddle, is that because of COVID we were forced to go on these Hollywood Squares of zoom meetings to have meetings, but in fact, they facilitated a cross-section of advocates, not having the excuse to say that they couldn't fit it in their schedule. That because of COVID we all had to virtually connect and we got a critical mass of people at the same time to join weekly meetings, to discuss strategy, which has, I think really advanced the movement so much further than it could have been done prior to COVID because of the fact that everybody was thinking in the silos that were enabled silos because of the physical distance that everyone has and busy schedules. With Zooms, there's really no excuse for that. So we came up with a unified vision. What a great, powerful thing. If you look at all the other big issues, you know, whether it's labor, there's AFL CIO, why? Because all the trades and service and construction trades all realized they had to work together for common cause. Chamber of Commerce. It's not breaking down business. It's unifying all the business around commonly held principles. League of Conservation voters. It's not air, water land, sea, it's all of the above. We have to come up with a much more comprehensive vision in order to be more effective. We never were before. I think because of COVID there's leadership kind of indirectly by default, that we're forced together. I think that's going to end up being a good thing for us, and we're going to see great things to come. And I hope people who are listening, join our One Mind at Work and, and get plugged into what we're doing. It's a movement and we need people to sign up. It's a kind of a campaign. It's not a Democrat or Republican campaign because this affects all of us equally. It's a big campaign to get these issues more front and center in our nation's consciousness.
Ryan Stewart:Thank you for those comments, Patrick. Garen, final thoughts on your end?
Garen Staglin:If he talked about leadership, I think the new model is a model of empathy, not autocratic. You have two ears and one mouth for a reason, you need t o b e a ble to listen more and talk less. I'd say the third thing is, you know, when we talk about returning to normal, the new normal is n ot n ow not g oing t o look like the old one, right? At least 30, 40, 50% of our patients in the workforce will probably never go back to the office fulltime. So we're g oing t o need a hybrid model here and not one size is g oing t o fit all as it relates to the behavioral health needs of people. So you need a portfolio approach and please get an approach. And Patrick said a t One Mind a t Work, i t w ould, the beauty of it is a network we're sharing where we're practicing, we're avoiding tuition fees and we're learning together. And w e have a long way to go. That's the best way to get there.
Ryan Stewart:You know, what bounces me out of bed every morning is these types of conversations and collaborating with friends who are so steeped in these topics. The other thing is that the convergence of services and technology. Long gone are the days that we just talk about technology with route wrappings services around it. And the advancements we're seeing are being tracked on a monthly, quarterly basis versus over a two, three, four year period. So things are moving really, really fast. Obviously One Mind at Work is scaling at a dramatic pace and helping those that are in significant need. So friends, thank you so much for joining us today. And we will pick up this conversation in-person, socially-distanced in Cape Cod on September 21. So until then, well, we hope to be talking before then, but thank you. Thank you both. It's been a very, very special conversation. Thank you for listening to our healthcare technology podcast, our monthly podcast series with leading visionaries across the healthcare industry. For more information on PJ SOLOMON, please visit us at pjsolomon.com.