Hi, everyone. This is Lucas Voss with Becker's HealthCare. Thanks so much for tuning in to the Becker's HealthCare podcast series, Happy New Year. And today, we're joined by doctor Katharine Hopps, CEO of AuthorHealth, to discuss the evolving dynamics of payer provider collaboration in health care. Doctor Hobbs, thanks so much for being here today. It's great to have you. Great. I'm I'm excited to be here and appreciate this opportunity to to talk further. Yeah.
Absolutely. We have we have a lot to talk about, like you've mentioned, but I wanna give folks an idea of of who you are. Could you introduce yourself and just give us a little bit of your background in health care? Sure. I'm an adult and child psychiatrist, and I've worked in basically every setting from inpatient to outpatient emergency department, built several integrated behavioral health and primary care programs.
For about the last 15 years, I've worked in health insurance, And so doing core insurance functions, so behavioral health network, case management. But also always focused on, bringing high quality evidence based treatment, to people. So doing that through innovative care delivery models, and also by measuring quality and outcomes and really pushing the system to, to where we deliver, value based payment models as well. I joined author health about two and a half years ago.
We focus on, treating serious mental illness, substance use disorders, and dementia, in mainly a Medicare advantage and special needs plans populations. We deliver health care services, and also wraparound services that are community based, and we participate in these value based contracts as well. And that's certainly I think that's a a a great pivot too because you have both perspectives, which is fantastic, both the insurance side and the provider side itself.
And we know that payment models are very quickly evolving. There's new care delivery strategies coming. Payor provider collaboration is is is really key. They need to work together. It needs to happen it needs to happen together. To get us started here, what opportunities do you see for greater collaboration as we had into the New Year and certainly beyond that as well? And and how will this impact patient outcomes and costs?
Yeah. So especially in in behavioral health, we are seeing much greater progress on quality and outcome measurement and also, transition to value based payment models. And so we expect for that, trend to continue. Core to that is the importance of of integration and and data sharing. So there are certain sort of information about patients,
that only health plans have. So things like historical health care utilization, information about benefits or caregivers, etcetera, that are actionable and really important for a provider to be able to deliver high quality care, in the community. And so being able to deliver those actionable insights using data to providers from from from payers is a critical capability. Additionally, for providers. So, in order to participate in value based payment models, we need to be able to report
our outcomes. And there's certain data that only we have access to that the payers, don't, and that we need to be able to aggregate and be able to send back. So things like person reported health outcome measures. These in these are one of the main ways that we measure outcomes in behavioral health are things like the PHQ 9 or GAD 7. These are basically symptom rating scales, that we use, to collect data on basically the baseline symptom burden, but also improvement in those symptoms over time.
Especially as many behavioral health providers are still on pen and paper, don't actually have robust electronic health record systems. It's really hard to collect those outcomes and report them to participate in
value based contracting. And so that support around data collection and also data aggregation for your patient population, and then a scalable and, systematic way to be able to send those outcomes back to payers to participate in a value based, payment model is critical, in order to do this work well. This case, sharing is really caring. Correct. Well, you have to be able to
measure the outcomes. Right? And then once you actually do that, you need to be able to report it and share that information exactly to show that you're actually improving health as you deliver care for for patients. Yeah. And you've touched on on a couple of these factors too that that play into this. Right? Patient population, different networks. It's very variable. There's people measure quality in different ways. That's right.
Can you share a little bit some of the examples that you might have of how you're innovating in this space, how you're trying to improve this, and and what are some of the results that you're seeing? Yeah. So so there's 2 major ways that that we're innovating. So one, is addressing many of the barriers to delivering a high quality, behavioral health care to people. And so what I mean by that is, I say this all the time. I at at Alder Health, we're not inventing a new treatment for serious
mental illness, substance use disorders. In our field, we have treatments that work. I can't give you a better treatment than than buprenorphine to treat opioid use disorder. Cognitive behavioral therapy to treat depression, anxiety, tons of evidence that these are effective treatments to improve health and keep people in the community, and and reduce costs. The problem is that these effective treatments don't
reach people in a timely manner. And so what I mean by that, when when people need them, they're not able to access these services. Many people wait months, even years to actually access, evidence based care. And it's also not delivered in a convenient manner. So good example is, in person therapy. A lot of times that's only offered during working hours. Well, that doesn't work for an hourly worker. Right? A person
receiving sort of hourly wages. Right? They'd have to get off work every week, go to a therapist. And and it's not possible to to do that. And so using technology, using innovative ways that we've developed our care team, addressing social social issues, so things like transportation, housing, etcetera.
These are all of the barriers that that people experience to be able to engage in high value care that our company is is is working to address, so that we can actually get these these evidence based treatments to people in a convenient and a in a scalable manner. The other thing that we're doing is is changing payment. So I've also said many times that fee for service payment breaks behavioral healthcare really breaks all of healthcare, but certainly behavioral
healthcare. And the reason for that is that some of the most impactful things we do are are are not based on a billable visit with a clinician. So all those things that we do in between those clinic visits. So addressing again health related social needs, calling the patient to check on, you know, side effects of a medication, working with caregivers, doing care coordination with other
providers. A lot of those types of interventions are not funded in fee for service and therefore are hard to scale. And so one of the major ways that we're working with payers and insurance companies is to move towards more of a population based approach. And so we, we work with payers to identify a patient population with serious mental illness, substance use disorder in the geographies where we're live. We receive prospective payments to manage the health and the social needs
of this patient population. And then we go at up and downside risk and have to report on quality to show that we're actually helping this patient population get better, and that we're managing the costs through the clinical treatment and the social services that our that our company provides. And that is a very different I I know that this is, sort of, old hat, and the rest of health care is very new,
in behavioral health. And and and I'm so grateful to payers, providers that are really coming together and thinking on how how we build these models and how we actually deploy them and and and deliver them at scale. Because I really think that's a key piece to transforming overall, health care for people with behavioral health conditions.
Yeah. And that in conjunction, as you mentioned, sort of with that holistic look at care and being able to integrate everything into each other so that there's a a picture that is created that encompasses everything, not just pieces here and there that that are important. And and I think especially for for value based models and and value based care, this is incredibly important. And and one of the things that you've you've noted at at our payer issues roundtable and almost quoting you exactly
here. Right? Untapped potential in value based payment models. That's really what you're seeing. You're seeing untapped potential there, and the importance of, as you've said, fully integrating mental health services like you've talked about. How can organizations successfully transition to value based models and and really meet these standards, these aims that that, would make a difference potentially, and what strategies would you highlight there? Yeah. So number 1 is is integrating payment.
And so what I mean by that is currently today and and over the last several decades, in general, payment and management of physical health services is done separately from behavioral health services. So a lot of times the behavioral health payment and management is carved out to a separate organization that manages it, you know, apart from physical
health. What we know is that people with behavioral health conditions and especially people with more severe and complex illness, almost all of them have co occurring physical health, chronic medical conditions. So things like diabetes, cardiovascular disease, COPD. And when you separate out the payment and the management of their behavioral health conditions separate from their physical health, it leads to misaligned
incentives. And it also leads to substantial lack of coordination in the in the care that that's being provided. And so number 1 is to stop creating that division and figure out how to integrate. And to be clear, behavioral health card companies absolutely can integrate payment. And so we did that at Blue Cross, North Carolina, where I worked before at United and Optum.
So even at places where you have carve outs, you can still work with providers to, pay them, from sort of like a single source for their for for delivery of integrated behavioral health and and physical health services. And also hold them accountable for, integrated quality measures. So hold behavioral health providers accountable for diabetes management, and other medical conditions. And similarly, hold PCPs and hospital systems accountable for screening and treatment
of depression. That's totally appropriate for them to be doing. And then similarly hold each group accountable for total, costs and and MLR. And so examples where we've done that really well was this was more when I was on the payer side. We work we had robust ACO contracts where, we made sure that the ACO that that the behavioral health payment was also included in the delegated risk to these ACOs.
And then additionally, like I said, we put in, behavioral health quality measures to incentivize them to address things like depression. So screen for depression, treat treat depression, and then also held them accountable for the for the total cost of care, including the behavioral health spend as well. Similarly, author and other providers like us, we we partner really closely with primary care groups. Many providers like us also deliver what we call reverse integration.
So primary care services delivered from a behavioral health home. Very similarly, you know, insurance companies can pay those behavioral health providers for both the physical and the behavioral health services, and then hold them accountable for the physical health quality measures and the
total cost of care. But it really, though, starts with integrating the payment and the management with which then flows downstream to how providers are incentivized to deliver that care and and really, treat patients holistically and and and and improve, population health, across the full spectrum of physical and behavioral health care. Certainly, the integration that you've mentioned is is is a big piece to this, like you said. You you've mentioned accountability
quite a bit in this. Right? And and and I feel like to be accountable, you have to have something to go back on. You have to have data. You have to have information that you can use. You have to have some sort of system that that gives you an idea, okay, where is
my accountability at? And and one of the things that you've talked about, previously at our page, Shus Ron Teo, which I think is is very important, is the and and our conversation today is the challenge that a lot of these folks, like you said, pen and paper. Right? Yeah. EHR capabilities just aren't there. There is a system, but it might not be great. Right? It just makes it hard. It makes it incredibly hard to collect data, measure outcomes, what's
the quality, where's the accountability. Right? Can you touch a little bit on how you support these providers in in creating that efficiency and being able to say, okay. We can help you, especially from from a from from a data collection perspective and and also from a systems perspective. Sure. Yeah. And and the fact is, you know, many behavioral providers were were left out of meaningful use support and the high-tech act.
And so we need to find a way to go back and increase that support for behavioral health providers to move from pen and paper, more analog approaches to to data informed and tech tech enabled approaches. And we'll see that transition very similarly to how we saw the transition over the last several decades with that support in the rest of health care At different payers where I've worked, we have delivered, like, direct support for that kind for
for technology. So we've, you know, worked with different technology companies that are, measuring and reporting outcomes. We provided funding, to support providers to actually, move to EHRs and other electronic support. It's critical. It's a, it's a, it's a core foundational capability that's required to participate in value based
arrangements. And so if we really want to move the behavioral health system to a value based approach, we have to figure out how to support providers to make that transition, to use more technology. Yeah. It has been a must for for many, many years, and it certainly will remain a must in 2025 and beyond, I think. Looking ahead to to this year certainly and then and then beyond as well, what are some of the most significant changes in in how payers and providers
work together? What are you seeing, ahead here for the future? And and how should systems how should leaders prepare now, today? Yeah. You know, one thing that's been delightful, over the last 1 to 2 years at various conferences and also as as our company is working with with insurance companies, there's an acceptance that we have to measure quality. We have to report quality. And there's, there's real progress being made on delivering and
participating in in value based payment models. We did not see that even 2 3 years ago. So there's been major progress made made in that way. So and I expect that to continue. The other is technology. So we had a huge and rapid and important transition to telehealth and tech enabled services during covet that was necessary. And while we've had, you know, some movement back to in person services, we are still, you know, light years beyond, where we were pre COVID in terms of the integration of
technology, and I expect that to continue. It's it's made a substantial difference in terms of access to care, really overcoming a lot of the barriers that I talked about earlier in terms of convenience for people. It's overcoming transportation issues, things like that, so that we can actually deliver this high quality evidence based care with fidelity. That's the other really important with fidelity to the to the
evidence based model. Through technology, we're able to get those services to people, in a more sustainable and efficient manner. And addressing one of the most important issues in health care across the country, I think, for the future. I believe that what not only within health care, but also for our society. And you see it Yes. It's through everything, through employment, through education,
in our in our justice system. You know, behavioral health has has major impacts on all aspects of our society. And so we have to figure out a way to pull these pieces together and also overcome, you know, limited workforce and and and figure out how to deliver these services at scale so that so that people can actually engage in them and and and reach a quality of life and a function that's meaningful for them. Absolutely. Doctor Hobbs, this was a delightful conversation.
Thanks so much for taking the time today. Great great insights. Thank you. Yeah. Great to talk with you, and thank you so much for the opportunity to speak together. Absolute absolutely. And we also want to thank our podcast sponsor, Author Health, and you can tune in to more podcasts from Becker's Health Care by visiting our podcast page at beckershospitalreview.com.