Leadership Insights: An Interview Series with Stacy DiStefano and Deb Adler, Featuring Doug Nemecek

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 Doug Nemecek, the Chief Medical Officer of Behavioral Health at Evernorth.

STACY (TO DOUG): Tell us about your current role and a few of your top objectives at Evernorth?

DOUG: I’m the Chief Medical Officer for Behavioral Health. I’m a psychiatrist, and have been taking care of people with mental health and SUD for my entire career. With Evernorth, I work to ensure that everyone has access to high-quality, evidence-based behavioral health treatment. I partner with our network team to expand our available network, and identify partners that are delivering care in innovative ways to better engage individuals and improve their overall health and wellbeing.?

At Evernorth, we’re working to simplify behavioral health by building a next-generation experience to deliver data-driven, personalized behavioral health, on-demand. By matching members to the right resources more quickly, to progress them through their care journey more effectively, improving their clinical outcomes, and allowing them to be their healthiest and most productive selves.

STACY (TO DOUG): I appreciated your recent comment in an interview with Behavioral Health Business that, “we can put [wellness platforms] Ginger or Meru Health or [eating disorder treatment app] Equip into our network,” Nemecek said during the webinar. “But when [patients] start to look for providers and see those names, … they don’t know which one is right for them.” How could payers do better in helping users navigate the wide array of resources?

DOUG: This is an important issue. It’s one thing to increase the treatment options available to people, but most people don’t know how to choose the best provider or resource when they need one. So, payers need to simplify the process, and we are in position to do so much more.?

Payers need to do more to utilize the data we have available to understand the individual’s past treatment history, and then do an assessment to best understand their current clinical needs and their expectations for care. Then, a payer can identify the right resources, providers, and tools, and quickly connect the individual to those resources and providers. Then, it’s important to follow up after the fact to ensure the match to these providers and resources was a good fit, and to determine if any additional issues have surfaced for the individual that require additional support.?

STACY (TO DEB): This seems like a job beyond what AI can tackle. I’d imagine the human element is really important here. How do you see that working best?

DEB: While Artificial Intelligence (AI) and Machine Learning (ML) are supportive technologies, I think human touch navigation is key. Having guidance at the right reachable, teachable moment can make a meaningful difference in the outcome of care. If a consumer is offered a quick connection to the right program, engagement in treatment is likely to be better—and higher engagement rates yield better outcomes.?

That’s why at Navigator we have a 24/7 resource center staffed with clinicians who are able to schedule appointments on-demand to evidence-based, in-network providers, guaranteeing a same-day, next-day appointment supported by our curated network of tech-enabled high-performing providers.??

STACY (TO DOUG & DEB): I think we can all agree that treatment options are only as good as the user’s access to them. Are you encouraged by all the new treatment providers that have emerged over the past few years, (like Groups Recover, Eleanor Health, Ria Health, etc.) or do you see the options overwhelming members looking for treatment?

DOUG: Additionally, of the 10% who seek treatment, there is a fraction of those who actually benefit from the treatment they receive. Motivation for change is a universal dynamic experienced in all facets of healthcare, and SUD is no exception to this. However, the way we engage individuals with various conditions such as diabetes, hypertension, etc. has historically been very different from how our system works to engage those with SUD.?

It’s a tall order, but I believe the first place to start is to address the institutionalized stigma that exists within our overarching healthcare service delivery system. There are a number of ways we can address this, and often will require scalable policy and workflow changes at the ground level. Payer/Provider partnerships play a crucial role in this, and through working together have the capacity for monumental shifts in how we treat those with SUD.

DEB: I think it’s very encouraging the number of new entrants of evidence-based SUD providers in the market over the past several years. More options is great, allowing the consumer choice in treatment delivery (in-person or secure telehealth) and choice in treatment approach, with more Medication-Assisted Treatment options than ever before.?

That said, more choices can make the decision-making process more difficult. Even those of us with extensive healthcare backgrounds can face many challenges in making the best selection. That’s why I think navigation support is so important and needed whether that’s for SUD treatment, general mental health needs of individuals with co-occurring and comorbid conditions. And navigation support doesn’t end with making a referral, the connection needs to be a meaningful one that can support the consumer throughout their recovery journey.? At Navigator, we recognized early on that we need to meet the consumer where they are and be an ongoing resource throughout their recovery.??

STACY (TO DOUG): I?love the inherent directional themes of names like Navigator and Evernorth. It speaks to pointing folks in the right direction for treatment when they are ready for that journey. Speaking of readiness, Doug would you agree that point in time engagement is crucial for substance abuse treatment? What would you say is the ideal time frame from “ask for help” to intake???

DOUG: When we think about engaging in substance use disorder treatment, timing is really important. We really want the moment when the individual acknowledges that they need help, and is willing to accept care. If we wait too long, their motivation may wane, and they may lose their desire to start treatment. Our goal at Evernorth is to really listen when they first “ask for help”, understand what they need and what their preferences are, and then quickly and easily assist them with getting engaged in the right treatment as quickly as possible.

STACY (TO DOUG): Does early linkage to SUD treatment improve a patient's overall health??

DOUG: Ultimately, getting an individual engaged in evidence-based, high-quality care will improve their overall health, and allow them to be more productive at home, at work, and in their community. As a payer, we also know that early engagement in quality treatment not only drives a better clinical outcome, but also makes it more affordable for everyone.?

STACY (TO DOUG): Last question for Doug, if you had a magic wand, what is one key change you would make in our behavioral health system?

DOUG: If we can eliminate the silos that exist, and better integrate behavioral health care with medical care, this would allow us to truly optimize the health for people with mental health and substance use disorders. Earlier screening and identification, more efficient referrals to high-quality providers, and coordinating care across behavioral health and medical providers will provide people with better health outcomes all around.?