Darby Sullivan: I want to ask each of you to put on your respective sector hat. I know that each of you specialize in different sectors of the healthcare industry, and I'm curious what your members with the leaders that you work with would say about the vision of the behavioral healthcare system that I just outlined. So for example, Sally, what would a health plan's ideal vision of behavioral health be?

Sally Kim: If I'm allowed to include a lot, I would say financially incentivizing providers to deliver evidence-based care, getting patients the care before it becomes a crisis, and then also of course, total cost of care being managed.

Amanda Okaka: From a life sciences perspective, a lot of the life sciences leaders that we talk to on a regular basis, it seems like a lot of their data and evidence strategy is focused around clearing those regulatory hurdles. So I think for life sciences, they would like to see a world where we can design trials that fit better into an evidence space that providers can actually use, and sort of break down some of those data silos that would increase the clinical utility of the data that they do collect during trials, as well as the data that gets collected in post-market surveillance as a part of real world evidence and real world data strategy.

Sullivan: I heard something in what you said, Amanda, data that providers can actually use. So I'm curious to bring it to you, Sophia, what would that actually look like?

Sophia Duke-Mosier: Yeah, so rounding us out from the provider perspective, to make all of this work, you need the people at the organizations to be there to do the work. Every provider that we've spoken to constantly talks about the workforce shortage, which totally makes sense. You need people in place to do the work and you're constantly focused on putting out fires, but this also of course, negatively impacts patients if there aren't people at the provider organizations in place to do the work. So when we think about what the ideal system would look like, we'd really think about making sure that there are the right providers at the provider organizations to do the patient care.

So what this looks like is providers who are in the right geographic location, they have the capacity to accept new patients, they have the expertise that matches the conditions that patients need to be treated for, and they're also representative of the patient's identity or they have training and cultural awareness, because we know that providers from underrepresented backgrounds actually do better when they're being represented by the providers that they're being seen by. Then finally, of course, we need providers who can take insurance and will also stay financially afloat.

Sullivan: So what I'm hearing, a theme across each of your answers is that what an ideal behavioral healthcare system would be would a system where we have sufficient providers to actually use evidence-based care in a way that improves outcomes and reduces total cost of care. Which is not altogether super controversial, which is interesting to me, because this is a field that's typically wrapped up in a lot of cross-industry disagreement, if I can put it delicately.

Duke-Mosier: Yeah, I would agree with you, Darby. It's not really the end state that organizations are disagreeing with. We all want to see the same end state, but it's sort of more about how we get to that end state. When we throw things out like evidence-based care or raising reimbursement rates, that's really where the disagreement comes up.

Sullivan: Okay, now that's where it gets interesting. So let's start with your first example, Sophia, which is evidence-based care. How would any of you describe the challenges around defining what quality care looks like in behavioral health? So, is it that different providers disagree on quality care or is it more of a cross-industry disagreement?

Kim: I think everyone disagrees even within a stakeholder group, so no two providers are going to agree. Honestly, it makes sense, because two different patients could have different desired outcomes, and then also plans also don't agree, which just increases the administrative burden on providers.

Okaka: Yeah, I totally agree with you, Sally, especially what you said about patients desiring different outcomes. This is an area where life science has really struggles to address because when it comes to behavioral health, it's not as simple as quantitative metrics that we might see for other physical health conditions like an A1C change when it comes to diabetes.

It's really hard to define the metrics that we use in behavioral health because they are more qualitative and they look different for every patient. And so there are non-traditional metrics that we would like to consider here like quality of life, employment status, relationship health, as outcomes, but it's hard to find that alignment and collaboration between different industry stakeholders so that we can redefine the metrics that we're using to measure behavioral health outcomes.

Duke-Mosier: The other issue we're seeing, Amanda, is that all those metrics are really great and recovery will definitely look different for every patient, but what's difficult is the provider health plan relationship because recovery isn't going to fit into a perfect 12-month reimbursement cycle, but when plans are looking at, of course naturally they need the 12 months to do the reimbursement.

So it's sort of level setting between what recovery looks like and how it can be reimbursed, while also keeping in mind what the patient needs are.

Kim: There's the 12-month reimbursement cycle, but there's also just member churn and member tenure on a plan. So it's hard to justify an investment that might show up in 20 years if by that time that member has moved across the country and is now another plans member.

Sullivan: It strikes me that the issue is scalability here because on the one hand we want to provide personalized care and personalized treatment, but if everyone defines success in a different way, it's going to be really tough to figure out what works and what doesn't. And it sounds like none of your respective sectors are necessarily super thrilled with how the evidence piece in behavioral health is currently functioning, but a lot of problems in this space. I think there's tons of finger pointing on what others need to do differently.

So I'm going to ask each of you with your sector hats on to push against, what could your own sectors maybe do differently to make headway in this evidence space? Or how might your own sectors actually be contributing to the problem?

Okaka: It looks a little bit different for life sciences leaders because I think that it has more to do with breaking down, like I alluded to earlier, those data silos that can really impede the clinical utility of the data that they collect. And it also comes to enabling data sharing and interoperability between stakeholders.

So with providers on the clinical side and then also with payers on the health plan side. Life sciences leaders can do more to incorporate patient-centered metrics in their trial design and post-market surveillance, and then they can capitalize on that data by enabling cross-functional uses of it.

Duke-Mosier: I would definitely agree with Amanda on the data piece and providers struggle with that as well, being able to collect the data and providers are often a little bit shortsighted, which makes sense because they're putting out fires, but they're really focused on ED utilization and re-admissions. But I definitely think providers can do more work providing care upstream, so focusing more on preventative care and really investing in addressing the root causes of social determinants of health.

Oftentimes providers want to leave this to community organizations, to schools, to other people in their area and not take ownership over what they can do over SDOH's. So I would definitely say providers can do a lot more in that space. Of course, the partnerships with schools, community organizations, justice organizations, housing services are really, really important. But making sure that embedding SDOH related goals are in the strategic plan that providers have, which will of course have a positive impact on behavioral healthcare, and of course it'll be beneficial in the long term for providers in reducing costs of care.

Kim: One way that plans could be contributing to the problem is scoping out behavioral healthcare. Right now a lot of plans carve out behavioral health to BHOs, and this shows up in a lot of ways, but one that I saw recently that I thought was really interesting is that usually members with physical health conditions have higher NPS scores for plans because they're doing more for you.

You're actually getting care that you're paying for your insurance. So that makes sense. That shows up in care management data. That's not that surprising. What was really interesting is that this does not hold true for members with behavioral health conditions. So members with behavioral health conditions do not have higher NPS ratings.

Even though they do still have conditions, they should be getting more care. So clearly it shows that we're not giving members the same resources and support for members with behavioral health conditions as members with physical health conditions.

How different stakeholders can advance long-term, equitable change in behavioral health

Unmet behavioral health needs are pushing the healthcare system to a breaking point, and current attempts to address these issues could be making them even worse. Visit our resource page to access sector specific playbooks for building a stronger behavioral health system.