Leadership Insights: An Interview Series with Stacy DiStefano and Deb Adler, Featuring Martha Temple

This is an interview series moderated by Stacy DiStefano (CFHS), featuring conversations between Deb Adler (Navigator) and other innovative minds from the Behavioral Health and Substance Use Disorder (SUD) Care industry. Each piece will briefly cover what’s new, what’s still challenging and what trends we can expect to see over the next year in behavioral health and SUD treatment.

This week’s installment features Martha Temple, Former CEO Optum Behavioral Health.

STACY (TO MARTHA): You’ve had such a long and impressive career in healthcare from executive roles in managed care, to board seats on platforms such as PsychHub. From your view, what has changed the most in the last 10 years?

MARTHA: There has been a lot of change in the last 10 years in healthcare. From where I sit, the biggest changes - besides the influx of innovation, particularly in digital health and the increased use of Telehealth - has come in the recognition of the importance of behavioral health.??

In the early 2010’s everyone was focused on PCP consolidation, ACOs and groups beginning to take on full risk. While Medicare Advantage and other mechanisms continue to keep risk taking on the forefront of the conversation, more and more people are talking openly about mental health and substance use, and how it’s critical to any conversation.?

Treating the whole person is becoming more commonly part of all conversations, and the pandemic has helped to open up the conversation and hopefully lower the stigma.

STACY (TO MARTHA AND DEB): Just like in physical health, where we have a spectrum of care from well visits to emergency room care, in behavioral health and SUD treatment we have needs for everything from routine medication monitoring to inpatient detox. While linkage to some of these services can efficiently use digital or AI solutions, I would think more emergent needs require talking to a human as the appropriate front door. Would you agree with that?? What is the role of digital and AI??

MARTHA: I don’t think we will ever see the human element taken completely out of behavioral health, especially in the diagnosing and some of the treatment. However, I do believe that we will see the system become more efficient in diagnosing by using digital or AI solutions.??

I don’t think we will ever see the human element taken completely out of behavioral health, especially in the diagnosing and some of the treatment. However, I do believe that we will see the system become more efficient in diagnosing by using digital or AI solutions.

Today, many people’s first encounter with the mental health and SUD system comes during or after a crisis situation. People - doctors, families, caregivers - miss the signs that someone needs to seek help. As BH becomes a more integrated part of the overall healthcare and well being system, early identification of patients should help to get people to care sooner, with the hope it will help decrease severity. Diagnostic tools like PHQ-9 and GAD-7, which can be administered digitally successfully, are being used already to help identify people needing interventions.??

I also believe that the increased use of outpatient and intensive outpatient - both of which can be done through Telehealth with similar outcomes as in person, will help to make the system more efficient and help to catch people before they get to crisis. All of these will help the system to work more efficiently for the patients as well. I think the best uses of AI are in helping to find people early on through mining of claims data, something many digital health companies are beginning to do in the BH space.

DEB: For individuals with complex, chronic conditions, I think a human touch is still important.? I would put substance use disorder (SUD), individuals with co-occurring disorders (mental health needs plus SUD), and individuals with comorbid conditions (e.g., physical health condition plus BH need) in that category.??

While digital screening tools can help detect the need for treatment services and self-serve options might help connect some individuals with low acuity to get needed care, the healthcare system is so complex and fragmented. Most consumers just don’t have the wherewithal and tools to navigate the complexities of the healthcare system.?Even those of us with decades of healthcare experience, see this. As the “healthcare” person in the family, I’m often called upon to guide individuals and it’s difficult even for me.??

Helping individuals navigate to the right care at the right time can:

1. Improve the consumer experience
2. Improve outcomes
3. And reduce costs for the funder

For example, our SUD Navigator program shows high rates of patient engagement in settings with lower readmission rates and provides a 3-to-1 or more ROI for our customers.? There are other studies that illustrate how navigation can reduce healthcare costs such as Christina Farr’s seminal article on why navigation is the best “new thing” for digital health.

I do think digital tools, AI and ML can help inform healthcare professionals in identifying care needs. But these tech-enabled tools are insufficient when it comes to helping individuals with complex needs access and engage in services that yield the best outcomes.? We are going to continue to need human solutions and high touch support to achieve the best health outcomes.

I do think digital tools, AI and ML can help inform healthcare professionals in identifying care needs. But these tech-enabled tools are insufficient when it comes to helping individuals with complex needs access and engage in services that yield the best outcomes.? We are going to continue to need human solutions and high touch support to achieve the best health outcomes.

STACY (TO MARTHA): With so much variety available, how can health plans bring together all of their tech-enabled solutions without overwhelming the patient???

MARTHA: I think this is the current question they all face. Right now there are so many evidence based, quality solutions, but the health plans are struggling to get the patients to know about them. Educating their care engagement specialists and making it easy for them to know the appropriate solution? is important. This is more complex than it was even 5 years ago because the space has become much more specialized. Health plan jobs are getting harder the more solutions that there are. Many have hired people to help focus on this, and are working to ensure patients are being navigated to the most appropriate solution.

STACY (TO MARTHA): How are tech-enabled provider programs changing the landscape for payers? Do you see a saturation point coming where we might have too much tech and too little human engagement?

MARTHA: I think the tech enabled programs are important in helping to ease the provider shortages.? There are many patients where a tech solution can help them, and that can free the providers up to see more patients. In addition, these tools can help to make the clinicians more efficient, by taking work out of the process, leaving them more time to see patients.??

I think we will start to see some of these solutions coming together, we’ve already started to see acquisitions in the space. I’m not necessarily sure I see a time when we have too much tech, we’re still fairly nascent with that in BH.? I do think we can still automate a lot of the work that happens, but especially for the most complex and co-morbid patients, the need for human intervention will continue.

STACY (TO MARTHA AND DEB): What is the next chapter for Behavioral Health Provider Networks? What makes you optimistic about the future of BH and SUD Innovation??

MARTHA: I think the specialization in the field will help the system to work better. The most complex patients should get triaged through the networks to the appropriate providers.?

Deb and I saw this at Optum. First we had an ABA network, and then we had an MAT network, and now there are other specialists for specific conditions like eating disorders or for specific demographics or geographies. The more granular the information on the providers is, the better the match can be to a provider that will help the patient.?

This is what makes me optimistic. I see companies that are not only focused on evidence based practices, but also they’re willing to be a part of a health plan’s provider network. I see health plans talking about quality and measurement based care, two things that will drive the system to work better for everyone.

This is what makes me optimistic. I see companies that are not only focused on evidence based practices, but also they’re willing to be a part of a health plan’s provider network. I see health plans talking about quality and measurement based care, two things that will drive the system to work better for everyone. It really is an exciting time in this space.

DEB: As someone who has spent more than 20 years in the healthcare network arena, I think the time for narrow networks in behavioral health has finally arrived. I’m referring to high-performing networks centered around specific BH conditions (e.g., SUD, autism, Eating Disorder).??

While there are still workforce shortages in behavioral health that have made forward movement on this concept more difficult in BH, the time is now. I envision that health plans will take their learnings from their experience with building Centers of Excellence (COE) in physical health—currently in place for a range of complex physical conditions and interventions from transplant, to spine and joint replacement, cancer, chronic kidney disease and others–and build behavioral health COEs.?

COEs when coupled with a benefit plan design approach that incentivizes consumers to access and engage with the best providers will yield better outcomes—both in terms of consumer health outcomes and healthcare cost savings. This will require health plans to optimize their network offerings and leverage the wide array of new digital, measurement-based provider entrants to identify which providers should be included in the high-performing network.??

I would anticipate network optimization to be a core focus for payers coupled with enhancing consumer awareness with both navigational support and incentives to help strengthen health outcomes.

STACY (TO MARTHA): If you had a magic wand, what one key change would you make in our behavioral health system???

MARTHA: I know it’s slowly starting to happen - but I’d destigmatize mental health. I’d do this by integrating it more into the “rest” of the healthcare system, like other specialties are a part of everything. We should be getting annual mental health check ups, like physical health. We should not feel ashamed to take a day off from work because we mentally don’t feel up to the day - just like we don’t physically.??

We are starting to get there, but it’s going to take time and real change to make it happen. We should be funding the research into the brain more, to understand what’s going on with people, the same way we are researching cancer and other physical health conditions. Until the brain and the body are treated as one, the stigma will be there.