Health care management firm says more beds not enough

NJ Spotlight News | August 8, 2017 | Health Care
Continuum Health vice chair explains the key to reforming behavioral health care is looking at the system holistically.

Gov. Chris Christie’s made tackling New Jersey’s drug addiction crisis one of the top priorities for his administration, putting mental health and access to behavioral health services in the spotlight. But not everyone agrees the state is using all the right tactics to get there. Don McDaniel, the vice chair of Continuum Health joins Senior Correspondent David Cruz for more on that.

Cruz: The first question is what is Continuum Health Care?

McDaniel: Continuum Health Care is a health services company that works with physicians that are really motivated to try to change the system. So, the feeling is that health care has been not in a great place. It’s a marginal product, marginal outcomes and there are a lot of physicians that are motivated to really change the system and do better for patients. I think the other piece of this is that there has been this population of consumers that we haven’t really talked about, we talked about patients and sick care, but we don’t talk a lot about consumers. So, we try to work with physicians to build community-based system connections.

Cruz: Consumers that haven’t yet had interactions?

McDaniel: Both patients and consumers to build community-based systems candidly to try to drive better value, convenience, lower costs, better quality, better outcomes.

Cruz: So you’re a service provider and a consultant, is that right?

McDaniel: Yes, definitely we consult with providers but we help them execute strategies to be more effective and work with other stakeholders.

Cruz: So, you wrote an op-ed recently right after the governor released his plan to expand access to beds for those with substance abuse and other mental health disorders. You said more beds is not enough, why not?

McDaniel: Well, I think part of the problem is the system is really choppy, and let me just step back a second. The history of the system, the overall health care system since the sixties has been a system where the payment model has really driven how services are delivered. I tell people all of the time, the payment system has really been the regulator services, and one of the outcomes of that is that there has been a complete┬ábifurcation of psychiatric care from what we call somatic care, physical care. So, when we step back a second and say, well how would another industry, a more competitive industry attack this problem. The first thing we identify is that probably only about 10 percent of composite attributes of health status are a physical care delivery, right? So, we start to think about behavioral health almost like primary care, holistically in a different model. So, we are now 50 years later, we are now 50 years after the great society. We have Medicaid providers who have polarized behaviors, there’s a stigma attached to it, they have outsourced it to the third parties and I think it’s time to really time to think about reintegrating behavioral health. There has been an underpayment in our piecemeal payment system to behavioral health providers or mental health providers. And so consequentially what you get in a supply and demand market is you get less supplies, so there is less access. So, the beds piece of this is part of the treatment, part of the sickness protocol, but that’s not nearly as important as access. To really drive access, we believe we need to integrate the payment system and we need to understand that underlying most conditions in America, most physical conditions or many of those conditions, is some underlying some psychiatric problem. It’s a co-morbidity as the professionals call this in most patients that have some chronic disease, and we don’t think about it that way, we compartmentalize it.

Cruz: It’s your sense that we need to start looking at all of these other things as part of, or at least influenced by, mental health disorders.

McDaniel: To use a finance industry term, we need to think about behavioral health, or mental health or psychiatric issues as a leading indicator and not a trailing indicator. It’s really symptomatic of or driving some other symptomatically. So the whole notion is let’s get out in front of this. The thing I like about that is run-of-the-mill consumers often times have some underlying pathology. We have anxiety, we have this, that and the other thing and we don’t treat those things holistically.

Cruz: You said that providers need payment reform. What’s wrong with how they’re being compensated now?

McDaniel: The payment system has been for a long time a fee-for-service, predominately a fee-for-service payment system, which means that you get what you incent so the fees are created around certain procedures and if the policymaker decides that procedure should be paid more, then well guess what? You’re going to get more of that service.

Cruz: How do you fix that?

McDaniel: Well, you bundle the payments, you globalize the payments, you allow provider organizations to think holistically about how they might deploy. So it’s sort of like saying to a provider who has a business, hey, we are going to pay you a certain way which dictates how you operate your business. What I’d rather to see is to have a global payment to the provider organization and let you figure out how you want to treat this underlying problem with the incentives in place to lower the cost.

Cruz: So, what is the sense in the industry now? We, at least for now, appear to have repeal and replace off the debate table as it were. Does it provide more or less of an opportunity for holistic reform.

McDaniel: You know, I think repeal and replace is a little bit of a red herring because I think the train around the value movement, the train has left the station. Purchasers are sick and tired of spending a lot of money and getting a little. The juice isn’t worth the squeeze. Whether that’s a third party, an employer or a union, whether that’s the government which is in the middle of this, consumers are increasingly involved in these payment issues because of high deductibles and cost shifting and so on and so forth. And, so the reality is people are very frustrated with the current system. So, regardless of what happens in D.C., some might say despite what happens, hopefully that’s gridlock but the reality is the market is starting, I believe, to reform, to drive these changes in health care.

Cruz: So, you think the market will do what lawmakers are unwilling?

McDaniel: Yes. As a guy who taught health economics at John Hopkins for over 20 years, I always would get these textbooks for my students and the textbook would say we tried market principles in health care and they failed — and the argument is a false argument. So, the whole notion that markets can really change things, I think, is very powerful. The other thing is we need to start treating consumers with the respect that they deserve. As I tell people in the 80 percent of our economic lives that are not tied to the health care industry, we take a lot of stuff for granted that are all obstacles in health care. We go to Best Buy, we buy something, if it doesn’t plug and play and work we are furious, we walk back in, they give us a refund. We go to the doctors office, he says get there at 9:45, he shows up at 10:15, he’s arrogant, he doesn’t solve our problem, he refers us to somebody else, we are further inconvenienced. The system is completely backwards. So coming back to the behavioral health issue, it seems to me there can be systemic ways that innovators can really drive behavioral health issues discovery treatment as part of this overall milieu. And one of the things that we are doing right now, is we’re using technology-enabled tools to drive patient engagement. It seems to me that patients that have underlying, and this is anecdotal by the way, I’m not an expert, have underlying behavioral issues, want to be engaged. They might want to be engaged differently. They might want to text, or they might want to watch videos, they might want to correspond with a group that looks and feels like them. So we are starting to think behavioral is really an overlay for this holistic health concept.

Cruz: Alright, Don McDaniel thank you very much for coming in.

McDaniel: Thank you for having me.