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 Welcome to this Week in Health It. Today we have a solution showcase for you. I'm, and I'm really excited to bring it to you. This is the intersection of behavioral health. And primary care, and it's a great solution that Common Spirit is rolling out. My name is Bill Russell, former Healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in Health.

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So, uh, yeah. Now great show. Looking forward to sharing with you o over the last couple of months, starting with the Covid series. We've done a couple of episodes on behavioral health, and I'm excited about this one because I think it just makes so much sense. First of all, it's, it's a great health system in Common Spirit Health, and it's also a, uh, great solution that Concert Health in partnership are bringing together.

We have Sp Spencer. Hutchins. Spencer, what's your, what's your title? Are you CEO co, co-founder and CEO. Yep. Co-founder and CEO. And we have Christine Ada, the Vice President of Strategic Innovation at Common Spirit joining. Welcome to the show. Welcome, Christine. Thank you. Thanks for having us. It's exciting to, to talk to you about this program today.

Yeah, I, I'm, I'm really looking forward to it. There's . There's, there's so many exciting aspects of this, but I'm just gonna, I'm gonna let you guys tell the story. Sometimes I over, I will talk over, I'll share the whole story and then say, okay, tell us more. But, but tell us, tell us about the partnership.

Tell us what you guys are doing and why it's unique and why it's exciting. I, I don't know who wants to, Christine, why don't you start and then Spencer, you can fill in some of the details. Sure. ab, absolutely. Well, so first of all, . This, this program, the genesis of it, began last year. So pre covid, we were in our markets as we usually are talking to our primary care physicians about some of the challenges that they see, what in innovations that we need to bring to market, and a trend started to emerge.

With them saying that they're seeing more and more patients in their panel with mental health issues. And it was really concerning to them. But they also expressed a lot of frustration with lack of access to, to quality behavioral health services in their markets and, and usually what happens is that there's three to four.

Behavioral health therapists in the market that the PCP knows, likes, feels confident, referring, and, and when those folks, um, are at capacity, they're, they're at a loss for, for where to send their patients and end up spending more time with those patients in a visit, managing them more closely, calling, following up.

And so they're doing this work. Today not getting paid for, for a lot of it, and just frustrated with the, the lack of ability to send their patients somewhere confidently. And so we realized that there was, there was a need to find a solution that would work for them. And, and, and they, they made one request of us as they were like, listen.

I am dealing with a very diverse patient population, so don't get fancy, you know, don't give me anything that's super complicated that the majority of of our patients really can't use. And so our team started to do research and that's when we started to, started research different models and came across the collaborative care approach in, in the thought that.

It solved two things. One is, is just the access problem. How do we get patients access to quality care more quickly? And then the second is a recognition of integrating behavioral healthcare with medical care. And that's exactly what collaborative care does. I would say that for, for a very long time,

Healthcare really separated the two. But what the research shows is that when you integrate behavioral healthcare into medic medical care, not only do you get better outcomes in, in, in terms of decreasing depression and anxiety, but you also have . Better outcomes in clinical care as well. So for all that reasons, this part, this partnership made sense.

Yeah, absolutely. And I remember at the health conference a year ago, Bernard Tyson saying we've, one of the things that we've done in healthcare, we separated the head from the rest of of the body and we just care for the rest of the body. And he was really passionate about, he was talking about mental health.

So, Spencer, talk about this. This is really integrating primary care and behavioral health services. So give us an idea of, of what Concert health does and, and what you guys brought to the partnership. . Yeah. So Concert Health is aiming to build America's largest and best behavioral health medical group.

So we're now over a hundred team members, uh, the vast majority of whom are counselors, uh, and psychiatrists that work from home. And what we do is team up with medical groups and health systems that have a passion for integrating but don't wanna figure it all out themselves. Right. Are looking for a partner, dedicated group of

Our team, often bilingual to support each of those primary care practices and really are there, uh, to provide same day and next day access. So Christine mentioned we use a model called Collaborative Care Management. I. Which might not be familiar to a lot of your listeners, although I think the logic behind it will be, uh, for those, uh, engineers or technologists, I think in many ways it's a more engineering mindset to the problem.

So the beginning is to start with recognizing that probably 50 to 60% of people with depression, anxiety don't tell you they have it either 'cause they don't realize it or . Or they're embarrassed about it or they're just hesitant to bring it up. But we've known for years that there's a series of pretty easy screening tools.

Really just quick surveys that you can give people. . At least on an annual basis or around any major health event, like a new diagnosis or a hospitalization. And it picks up a lot more not to diagnose people, but to screen them for higher risk, right? So it should be flagged for their primary care physician.

So one thing we're doing is working with Common Spirit to do that. How do you implement and scale that? So really everybody's being asked and you pick up that 50, 60% of the people that maybe never were going to get, were gonna be, uh, missed by care. And then you provide a warm handoff. So now when a patient shows up in the in Bakersfield clinics with.

They're able to say, let's say I'm the patient. Instead of saying, Hey, Spencer, you have depression. Here's an antidepressant. You should think about seeing a therapist. You know, you could say, Hey, Spencer, looks like you're struggling with your nerves, with your sleep, with your mood. I've, uh, I see that a lot of people, and I, what I love is for a member of my team, Danny, to call you today or tomorrow.

And what Danny does with a lot of my patients is checks in, in between our visits, and what she does is, is gives you the same tool we gave you this morning so we can really quantify how you're doing. Just check in on how things are going. If this medication I'm giving you is working. And she's got some coping techniques that she teaches.

A lot of my patients. They find helpful. So some people will recognize that as, oh, Danny is a therapist that's in-house. Others will just say, no, she's part of my team. You don't need to make that, you don't need to have that same division of this is something different. It's just part of a comprehensive primary care experience.

But Danny would be one of our licensed, uh, mental health providers and she'd do just do that. Patient would experience us as a phone call or video visit, whichever they like, and often touching base two to five times over the course of that, um, each month. And what we do is every month we give them that same assessment tool.

Uh, in depression, it's con one commonly used as a PHQ nine, or there's different ones for anxiety, suicide risk, bipolar. In each of those cases, whenever possible, really measuring whether or not I'm getting better as a patient and then doing brief psychotherapy interventions, each of our, Dans, each of our care managers then have a, a weekly check-in with one of our psychiatrists using that data registry to talk through those patients that aren't getting better.

So let's say, again, using myself as an example. Let's say I, uh, am doing great with my morning meditation, but I stopped taking my antidepressant 'cause I have erectile dysfunction. I. Eight weeks later, my PHQ nine is dropped from 18 to 12. That's great. That's an improvement. Lower, better on that score, but that's still pretty symptomatic.

That'd be a classic person that'd say, Hey, I'm feeling better, so I'm gonna not bring it up. Or I'm embarrassed about the side effect I have, so I'm never gonna talk to my doctor about it again. by having that collaborative care team around, by having Danny with me, she'll know that bring it up to the psychiatrist, doesn't need a an hour long visit.

In that case, they'd say, let's drop a quick note to the primary care physician. Remind her that congratulate Spencer on the meditation he's doing, think about changing it to a different SSRI. That's less likely to create that side effect. 'cause it looks like we're gonna need both the therapy intervention and a medication to make Spencer asymptomatic.

So my primary care physician looks like a hero. She knows what's happening in my life. I. And she has an actionable recommendation that she can act on. And Danny's really making sure that I don't slip through the cracks and that patient's being managed, and in my case, I'm being managed until we really declare success, which is when I'm asymptomatic, right?

When I'm over it, when my depression's in remission and I can move on. So that's what we've been doing. We've been doing it for, for four years now, across 40 medical groups and health systems, and incredibly excited to be kicking off. In, in Bakersfield with Common Spirit and, and obviously taking the relationship, hopefully to many other locations around the state and around the country.

So I'm gonna, I'm gonna come back to some really pragmatic questions, but I wanna start in Bakersfield and Christine, give us an idea of what you're looking for out of the pilot and, and, and what you're learning and what you hope to learn. Yeah, a absolutely. We were, we were fortunate to receive a grant from the state of California.

To, to implement integrated behavioral healthcare in Bakersfield and in Inland Empire. So that's where we're starting first. And, and for folks who, who aren't familiar with Central Valley, California, it, it is a, it's a very diverse population. It's, it's isolated in the middle between Southern California and the Bay Area.

And there's, there's a little of what we call like a little of everything. We have . We have folks who, a lot of agricultural workers, we have a huge rural population, and when we think about the diversity in that population, it's, it's pretty enormous. And so what we're looking to do is to implement this program with our primary care providers.

And, and really demonstrate that we could prove out the results in this, in this real world setting that we've seen in the research. And so we'd, we'd expect to see three, three major pieces, which is, one, a reduction in mild to moderate depression and anxiety. 90 days out to a reduction in clinical or an improvement in clinical outcomes.

And so that would mean for chronic care patients, improvements in a one c, a reduction, um, in ED and in patient visits and in all of that contributing to a reduction in, in cost of care. And we also wanna demonstrate that these results. Could be meaningful to the Medicaid population, which, which is, has always been, you know, a challenge in terms of meeting their behavioral health needs.

And so I think this is a, we have a pretty aggressive goal ahead of us, but, but we're really excited and excited by. Not only the collaboration from our PCPs, but also in working with the payers in that market as well. I think all of us recognize that we need more tools to serve populations with their behavioral health needs, and, and so the, the ability to really track the data and and learn together, I think is, is gonna be great.

So I'm, I'm gonna come back to you and talk about the physicians and how they're responding to it. How they, how they're looking at it. I'm also gonna go in the direction of. We, our, our listeners are primarily healthcare providers and whatnot, and right now they're sitting back going, okay, this is an interesting pilot.

And, and you're not kidding when you say bakersfield's, diverse , right? It's, it is rural, it is industrial, it is people commuting into LA making half a million dollars a year. It's, it's everything in everything in between. So it's. It, it really is a microcosm of, uh, a lot of different populations. But, you know, uh, some people might be asking about the financials.

What, what are the codes? How does this get funded? How does it get paid for? Which one of you wants to, wants to take that and talk about that? I'll take a Oh yeah, go ahead. I'll take a little overview crack, and then I'll pass it on to Spencer. Given all the robust research about collaborative care. About two years ago, Medicare released collaborative care codes, and these are CPT codes, and then many payers, major payers followed suit.

And so that, that was a, I think, a wonderful win for for healthcare because it's a recognition. That this type of model in integrating care with primary care, that, that it is, it produces results. And I think some, some Medicaid payers reimburse it. Some, some do not. Currently in the state of California, it's, it's, it's not.

For those that really want to geek out, it's 9, 9 4, 9 2, 9, 9 4, 9 3, and 9, 9 4, 9 4. It's a monthly case rate, uh, that covers this. But to do it, you have to prove you've assembled this three person team, primary care, behavioral care manager, and site consultant. You're using a registry to track outcomes, and you're doing treat to target, meaning you're, you're

Testing and learning based on whether or not you're generating results and changing the approach in psychotherapy and the approach in medication, and really, frankly, faster than we expected. The commercial health plans followed essentially every major national plan and almost all the regional blues have covered this, added this to their fee schedule.

The evidence is so robust and everybody recognizes they need better access and better quality on the behavioral health side, and Medicaid has covered it now in 18 states. Across all sorts of different markets. Arizona, Washington, New York, uh, Massachusetts, lots of places. Red and blue, left and right. Uh, coastal and inland.

California in some ways has been a little bit of a laggard, frankly. They're talking a lot about this, but they haven't added it to the fee schedule. One thing that's inspired us from the beginning of the conversations with Common Spirit and Christine, is they said, listen, we're not gonna solve this in an easy place.

We're gonna go to a place where the need is the greatest, and we're gonna solve it for the communities that matter, matter most about us. And I remember when they said, we really wanna bring this to the Inland Empire. Said, well, it's not . Medicaid in California is not paying for it yet, so that's gonna be complicated.

There's a lot of managed care out there. So on the commercial and Medicare side, it's a little bit more complex and they just put their foot down and said, this is the right thing for the market and we're gonna use our resources, our brand, our people to, to bring everyone to the table. And as you imagine, it's a little bit easier to go hand in with, along with Christine, we're gonna go talk to the the plans and other stuff and say, listen, this is the right thing to do.

Let's figure it out and a little bit, if we can figure it out clinically and if we can figure it out financially there, there's nowhere in California we won't be able to do this and there's nowhere in other common Spirit markets. That's been inspiring and, and it's been exciting to do that 'cause we know to be useful at the, at the point of care for that primary care provider.

It needs to work for everybody. Those, those physicians, they're doing so much. They're seeing 35 people a day. They know 3, 4, 5 of them every day are gonna have depression, anxiety. If we can find a way to support all of them, it's a life changer for them clinically and operationally. Oh, I have this person that, they're my partner.

I, anytime I identify these problems, I know someone's gonna be reaching out to the patient, checking in, documenting, so that I can see the record giving me useful recommendations. If you're just, if you take a plan centric view and you say, well, for my Cigna patients I got this for my Aetna ACO patients, I can do that.

You know it, that doesn't work, right? It doesn't work in the day of the life of the doctor. And I think that's, that's something we've been passionate about. We're so excited for Christine's leadership and on the ground to say, we're gonna make this work at point of care, which means we have to make it work, cross panel for them, quite all payer.

And that's where it unlocks the behavior change that drives the clinical outcomes that we all wanna see. Spencer, I'm gonna go to Christine here, but I'm gonna come back to you on a, a question around the technology and how I integrated into the rest of the tools that I have for, mm-Hmm. , sort of an integrated digital experience.

Christine, let's talk about the physician and the physician experience. Is, is concert health sort of white boxed in the background? Does it appear as like, just part of the Common Spirit team? How does and how, how do the physicians. How do you get the physicians on board? Or are they just naturally on board because it's the right thing to do?

Yeah. Well, so I'm a, I'm an innovation person and so I'm, I'm usually doing the big sell on , a variety of innovations. And I, I have to tell you that, that that is not the case with this. This is a, a situation where PCPs acutely feel. The results of the lack of access to behavioral health in the market. And so when we were presenting this to the PCPs, they got it immediately.

They, they appreciated just how much evidence was, was baked into the model. They put their hand up and said, when are you coming to my clinic? And it, I think it's for all the reasons that, that Spencer talked about, this is a, a model where . They are staying at the center of the care that they can follow their patient's progress.

The therapist is, is documenting directly into the EMR and, and then the physician is able to do any med rec that they can. And so for them, this is helping them with their schedule. This is a way to. To easily do a warm handoff to the therapist and feel confident that they know where their patient's going.

And so for, for all those reasons, I think this is a program where we feel that there's, there's PCPs putting their hand up and saying, okay, what about me? Let me, let me get, you know, into the queue. And, and I think really speaks to the, to the need that we feel not only in Bakersfield, but I'd say in a majority of our markets.

That makes sense. Spencer, this week in health, it, so we gotta talk about the technology aspects of it. I realize phone is some of it and Christine sold some of your thunder. So you're documenting directly into the EHR. That's pretty exciting. Yeah. You have a digital tool. Can I integrate it into, into the other tools that I have?

Give us, give us an idea of some of the lay of the land on the technology side. Yeah. Our, our view has always been that . We need to be more than an app, right? We need to build this organization as the medical group itself because the magic is the people, the protocol empowered by the right technology. And when we canvased independent practices and large health systems, it wasn't, they were saying, Hey, the only problem we have in behavioral health integration is I need a new SaaS.

Platform that I can license. It said, no, we need to figure out how to find these people, how to train them, um, how to get paid for this service, how to do the work, right? So we said, okay, we need to be that full service solution, not just that. Now, that said, we're proud of the technology we've been able to build and we're really focused on is anything that makes the life easier for the patient.

And, and most importantly, and second, most importantly, the primary care physician and our team, our care managers, and our psychiatric consultants. And so as Christine started, that started at the beginning, we always said, we wanna treat all patients no matter their technological literacy. So from the beginning we said, this is a model that can be done incredibly effectively over the phone, and that'll always be an option, right?

And so that is, but if a patient, uh, has a preference to do or wants to do video visits, they can do that. It's a, it's a secure link texted or sent to them. Boom. Uh, a video connection with their therapist. They can do that every visit or just the first couple to get to know them. Right. And that, that can be really powerful too.

The, the face-to-face can be great. Sometimes actually the phone can be a great way to access someone from a technology limitation, or they're, they're, we're calling them on their lunch break or on their commute home, or maybe . They're so agoraphobic or so depressed that they don't want it. They don't feel like they can be up for a video session and, and get dressed and get, but they will take a call and start talking to us and that can be a great entree from the primary care physician perspective.

Our view was, I. There needs to be a single source of truth, right? The, the first time that we make a recommendation based on a med list or broaden list that's seven months old, is the last time they read of one of our recommendations. And so that is we really need to work with, with the medical groups of health systems, say we need to have the ability to access the medical record and document directly there.

Now what we're doing more and more as we scale is also doing backend integration, right? Which says, okay, let's make sure we're not re-keying medical record numbers. Patient names, other things, PHQ nines, being able to pass them back and forth increasingly, digitally. But I think really always having that direct interface connectivity to the EMR will be important too, because a lot of people use that phrase, oh, I'm integrated with an EHR.

You say, well, what does that mean? It says, well, there's AP. There's APDF somewhere buried in someplace. The physician doesn't even know where to look. So yes, it could survive an audit. Yes, the information is, is there, but it's not part of their day-to-Day operations. Right? And our view is our team needs to be an extension of theirs and they need to see our messages come through, just like we were a nurse or a, or another physician on their team.

Uh, so they can really interact with us and those sorts of things. And so, you know, we've really built our technology infrastructure around that, around how to enable that, how to make sure we can bill for it as well in these new time-based codes. And then be as light touch from the primary care perspective as possible and just make it look like it's, it's automagically populating.

Even if at times that means our team's doing double data entry or something like that. Yep. Absolutely. It's, I, I, I'm really glad to do this show. I love doing this show 'cause we know there's such a huge need. This is such an elegant solution and partnership. I, I, I continue to, to be impressed with the things that Common Spirit's rolling out and really exciting to hopefully hear more about this in the coming year.

I'd like to hear how the pilot goes, and I'm looking forward to reading the, the press release as you expand this into other markets. I know I'm, I know I'm putting my expectations out there, but that's, that's my hope we're excited about, about it too. And one of the things that, that we. We're, we're almost like piloting within a pilot, and I think it's worth mentioning to folks who are thinking about behavioral health is that we're, we're using this as a way to learn about how social needs are surfaced when you're having behavioral health conversations.

So when, when you are talking to your therapist, you may disclose that you have anxiety because you cannot pay. For your utility bill that you are food insecure and what do we do when we hear about those things? And so we're out, we're working out workflows to be able to surface those social needs and get them to our, our care coordinators who can make those referrals into the community.

And so, um, starting to really connect a variety of programs we have so that we're overall just treating the patient holistically. They're, they're, they're going to surface medical care issues, behavioral health issues, social needs issues. How do we start to really connect those pipes so that those aren't separate issues?

It's, it's manifesting altogether in, in, in the patient, and we're looking to address those needs. So I'm, I'm really excited about that aspect as well. Yeah, that's the foundation of Catholic healthcare right there. Mind, body, and soul. It's the whole person. And hey, I, I want to thank you guys for, uh, taking the time to come on the show.

And again, it's just, I, I appreciate the things you guys are doing. I'm looking forward to. To hearing from you next year on how this progresses. Thanks so much. Thanks for, thanks for having us on. That's all for this week. Don't forget, sign up for clip notes, participate in the uh, referral program. Special thanks to our channel sponsors, VMware Starbridge Advisors, Galen Healthcare.

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