Netsmart CareThreads
Netsmart CareThreads

Episode · 2 months ago

5 Key Elements Driving the Delivery of Behavioral Health Services

ABOUT THIS EPISODE

Recent history has impacted many foundational elements of the behavioral health care delivery system as we know it. To make the most of the opportunities before us, we need to understand five key elements that are driving the delivery of behavioral health services.

In this episode, I speak with Bob Sheehan, CEO at Co mmunity Mental Health Association of Michigan, about the complex factors influencing the behavioral health services delivery system today and in the future.

Join Bob and me as we discuss these five key elements:

  • Growth of managed care and risk management
  • Adequate funding
  • Integration with primary care
  • Role of public and private sector and service delivery
  • Changing community expectations
  • Bonus: Bob’s optimism and encouragement about the future of behavioral health services

This discussion was taken from our show Netsmart CareThreads. If you want to hear more episodes like this one, check us out on Apple Podcasts

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Welcome in that smart care, threads, apodcast were human services and post to cute leaders across the health carecontinuum, come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of care to the communities we serve? Let's get intothe show hello. My name is Tom Herzog and I'm your host today I serve as achief operating officer here and Netsman is my privilege to introduceour guest today. Bob Chian Bob is a chief executive officer of theCommunity Mail Health Association of Michigan. The Association representsthe state's public community health providers and centers public prepaid inpatient out plants, public health plans formed and governed by the CM, h Cs andthe providers within the CMS in the PA. I HP provider networks. Bob Is also thecurrent share of the national assensions of county behavioral healthand disabilities directors before being named Michigan's Association. So in twothousand and fifteen bob or eighteen years has the CEO of the CommunityMental Health Authority of Clinton, Eden and Ingram counties during histenure. This comprehensive mental health treatment services providerssurviver eleven thousand persons annually in its three county area Bob,was instrumental in the formation of a twenty one county prepaid impatienthealth plan that led to increase INFICI, ency and uniform larity of services,while renting a locally driven system of care. I'm really excited about ourconversation and I've had many people share with me some of the talks and presentations that Bob is givenrecently, and so you know what we really need to connect on that. Sohere's what we thought we do. The topic of our episode today is anunderstanding that focus on the delivery of beavr health services intoday's world, really focusing on by key elements impacting those effortswhere, in the time I think all of us would agree when disruption ischallenging and creating more change than I know I've ever seen in mylifetime. It's impacting many foundational elements of the BehavioralHealth Care Delivery System, as we know it and as we've all used the term we'relooking for what that new normal will be, there will be a new normal thatcomes, I don't think we're there. Yet. I think there's going to be some thingsthat we're going to learn, unlearn and relearn in that process. I think if wereally look at the ecosystem today, we're constantly evolving in allaspects clinically operationally financially politically in regulatory.We know that the influences are challenging us for what is trueobstacles and what are the opportunities before us, so we're goingto dive into the topics and, as Bob...

...helps his members navigated within hisown community and Ashley, we as want an opportunity to learn and share whatsome of those top tub mind. Thoughts are best practices, maybe some of thosethings that were not going to do anymore as we look forward. So, let'sget started key element number one, Bob Bob you ready. I should ask you an Tom,I am Tom and against thanks for hosting this yeah. No, I'm looking forward toit, and I think this is these five things that we have outthere, I think, are the top of my topics and people are going to lookforward to this discussion today. So telema number one the growth of managedcare and risk management. So, in the past several years be abro health, ascene shift from be for service to value based payments based on theoutcomes, no question again changing by product of this emergence of managedcare and risk management. So my first question to you is: How is thisimpacting the landscape for providers and those they served? You know it's akey key question Tom, because impacts are providers across the countryfinancially and clinically. The biggest change for folks is to get used to amodel that is not volume based. You know fever services volume in the morecontexts I have with clients to be blind, whether they need it or not. Themore revenue I bring in, and sometimes the revenues. By the way the rates areso low per unit. The team to see a lot of units as it moves to more of outeither a case rate or a capitation, where it's more quality basedpopulation based with just capitation or case client based Cuisans, receivegreater flexibility that can actually make a call. What is Jan or John Need?Do they need five contexts, or can they do with one or do they need twenty andallows me to make those those adjustments? It also allows them to dothings. That aim is social determinants they may have done before. So, forexample, if I'm an outpatient, therapist and I'm getting paid for thesession, we may be talking about homelessness or job laws or divorce,but I'm dealing with the psycho therapy right in the room. If I'm paid a caserate or capitation, I can now actually call the landlord. I can drive with amouth to see the landlord to the employer, the the spouse, the familyand we're kind of the things that exaimed to mental health. So I heardfolks in the fever service world, no, not to fear risk based contract. Infact, if they understand the volume of services they do now, if they have arough sense of the cost, I think we spent too much time making peoplepanicky about you better know your cost will actually most providers know theircost. I mean I tell people, it is simply guys your budget divided by yourunits, you use that you got a good rule of thumb, so we rather making therocket science just take your clinical knowledge being the services at whatpeople need, as opposed to what the volume used to drive in revenues andadjust to a risk based environment, and I think the risk is no greater than itis in a fear or service and environment. Getting people to know that is. It iskey, I think, yeah. I think you hit on the key topic. I know in theconversations I've had it's the cost...

...and what is it going? Is it going todrastically going to impact our organization in a way that we can'tprovide those services? And I guess I'd- ask you that is. I think this is alearning time and I know I've seen willingness to adjust and adit thosethings and I'm curious. Are you seeing that as well or is it just settingstone and no one's going to move off of that? No I'm led to set it in Michigan.We provide almost a perfect laboratory in the public system. The public cms, acunnel health centers, went to capitation in ninety seven, so twentyyou know five years ago, but parallel to that, we still had a fear forservice system that they see in ages. If they are purchasers in Michigan, theseager are purchaser and and providers they're purchasing out a fever servicebasis. So we can actually study the two side by side. Those cms made theconversion in ninety seven pretty seem less like they really got it. Theyembraced it because the major driver was it gave him greater clinicalflexibility so make up a number if I'm getting a thousand dollars a month fora certain case. As a case rate, I can use that thousand dollars in all kindsof ways: ways that wouldn't be typically billab under a fever servicesystem and that's when clinicians realized that they had the ability toimprove quality of life, to improve recovery, sobriety of its substance,abuse or full functioning of ifted. Without having to worry about, do Ihave to get every wight accounted for and it has to be in some clinicalsetting. So I think that once people saw it that way, time they wereliberated and I think that's how people need to really embrace it. So I wouldurge providers actually to post their payers to move to a case Radorsubcatenary system, but I think that's a great suggestion, because I know it'sthat apprehension or fear and your encouragement is hey press in and we'rereally begin helping shape the system to work best for those we serve in yourorganization and have those conversations- and I would tell youI've seen the same thing- I've seen more collaboration on those thingsversus kind of the binary aspect that everyone was concerned about, and weall know the concerns that people have when you go to an outcomes based modeland how can we evolve and learn together on it? So I guess last followup on this is what do you see? Is the next fundamental shift on the horizonon this topic? Well, I think we're seeing more and more of states in theMedicaid side and commercial insurers are pushing risk down to theirproviders either providers it as a group or as individuals, and I thinkproviders I mean that's where we're head now it's going slow. I should tellyou on the Medicaid side: It's you know the commercial side state didn't do itduring our er late S, really two sand. There's some resistance were seen to besomewhat frank. Not only providers are used to fee for service, but payers areare too and so a lot of payers say I don't want to ship the risk. I want tohold the risk here because to be somewhat blunt, pairs then also keepthe savings right yeah, whereas I you push the risk down the provider than isincentivized to do things more...

...officially, because here she can. Ifthey're a public body reinvest those savings into services of their privatebody, they candy, if they choose, take them out in terms of profits, and Ithink that's where I must tell you that more and more I'm find payers are moreresistant than providers. Are providers have gotten their heads around ultimatepayment methods daps, but some payers, I'm not being critical of them. Iunderstand they've under they've had this mile since the S, but changingfrom a fever service to a more riskay, capitation or case rate is a bigmindset change, but it you know you can just see it happening more yeah, thebig ship for all people involved and I think, we're going to add it and evolvethrough it, and I echo and agree everything you're saying well, let'smove on to the next topic, and and really this one is going to be aroundthe head, adequate funding and so we've seen coved nineteen relief from, butlegislation is infused billions of dollars in grant and under anotherfunding for behavior healthproviders. How do you frame this recent funding inthe context of the long time, black of funding that health brides have thatbeaver on providers have been challenged with? So the last part ofyour question is the key you're talking about thirty or forty years ofunderfunding, and I would say I would say by the way, that's true on thepublic side and the private side, all the public side Medicaid and stayGeneral Fund dollars of Fun Service to the boar. That's all he's been a skinnying down. If you made a political hierachy map right people, mentalhealth conditions are towards the bottom of that only recently as theirpolitical power begin to be exercised, and so because of that, and because tobe blunt, some people don't still don't get the fact amount. Health conditionsare real. I mean you'll hear in fact you like to see medicate by just go upfor physical health care, but you won't see that from here health care, so Ithink we're trying to beat the drum a lot of people are to say you got toclose the gap. In fact, cobis making that happen. A lot of the money that'scoming down to states and counties is our metal health dolls. One of theconcerns in the public that I should say is most of the money is relief,money or stimulus money, so it's short lived and yet the problems we'retalking about are not short lived. I understand the rest now behind it tosay. There's this acute set of anxieties and depressions happeningthroughout the country because of Ovid, but a lot of those were embeddedalready in our system. I mean anxiety and depression psychosis, substitutedisorders, family, disillusioned, academic failure, we're all we're allthere, all of which you have their roots and mal health issues. So we'redoing a lot of work to urge federal and state funders to recognize those newheaded dollars will give them. Hopefully we think a new normal, not ashort, live shot in the arm. If I could tell could talk about the private sideof it, if you don't mind, yeah absolutely- and I was going to hit onthat here coming up at please do yes. So, on the private side, there's been aunderfunding, to I mean most people who have commercial insurance, theypurchase on the exchange or they get it from their employer. Don't payattention to be here, health care...

...benefit until they need it, and thenthey realized Moses benefits cover what I called A N Z, not a through Z, a Cmeeting, hey outpatient psychotherapy or primary care providers. Givingpsychotropic me health medications or the other end in patient care. But overthe last forty years the public system has built all kinds of interventions inbetween that, from residential to drop in centers to peer supports to home,based care to implement of ports and Housing Sports. I mean the whole rangeof services, but rarely are those services covered down the private side,and so what you have is a here: a healthcare benefit that'sthinly, funded by private insurance, and that means by employers many timesthat needs to be broad and a lot of people. You know this and thecommercials hide and up in the hospital or end up, dropping out of work anddropping out of school, because those intermediate modalities, which areproven they've, been around for decades, aren't being used by the commercialside. So I would I would applaud any insurers who are willing to rethinkthat. We hear of a healthcare benefit that often comes from employers andpayers by the way you know the customer says. I think I need a pack. This actteam thing or this dropping team thing that I saw my Medicaid Dabor hap. Howcome I can't get that what I think you know you hit on and I can speak at itfrom an employer standpoint. It's number one thing that we're focused onevery year is the evolution of that and you know, I think that goodness is, asI look out, the broader community we're not having these conversations- and wejust didn't have five years ago, so the campaigns around awareness anddefeating stigma at work, but now we've kind of moved into the next magnitudeor the next challenge, and it's really two fold there on the funding piecethat you hit on that I'm worried about and one you just hit on the privateside and how do we, who are providing benefits, continue to adapt an a linethat we know provide proven treatments towards outcomes that are incrediblydesired, that are not just a medical model for physical model of care andhad that become part of the natural evolution around these things. But thenthe other one you hit on. I think the biggest thing I'm worried about thefunding is the surge is nice and it was really addressed a gap that was alreadythere before the pandemic. If were candid about it, and yes, we were ableto address some things across our communities, but when that goes away, Ihope we were ready to edit and involve because bad gaps going to be thereagain unless we've done something different, you hit the nail on the headtime. In fact, the metaphor for me is the infrastructure built right. I meanwe've ignored our bridges and roads and water systems for fifteen years, andnow we were injecting trillions of dollars into to soul van those will bespent over the next twenty years. Bellante take the same view. Mellhealth care is part of the infrastructure. I mean it really is,and we've ignored a prick for this long. We know that we thrive as families asemployees as students when we have...

...strong metal health, and so we need tomake sure that the in Astruc or there well Bob. I just got I've been on aMental House Task Force Committee here locally in our community, because therewas a desire to rethink how we as a community. If we have, the notion is tohave a healthy and thriving community. It doesn't just happen through fancycampaign slogans. There's got to be intentional Audi in there, both in theservices that are offered how we offer him, how we connect even down, goingdown to co responders and how we engage in when there is a time of crisis. Soon the positive I'm seeing it happen, your connection to the infrastructurepiece, I think, there's a bigger conversation that we have to have as asociety, and that is how are we going to fund these things if we want theoutcomes around healthy and thriving communities, which is obvious exactlyright? Exactly let's move on to, I think you- and I could talk a long timeabout that when someone move on to the next one, which is around integrationwith primary care so and we hit on a little bit around modalities, areexpanding opportunities for providers are expanding or they're being asked toexpand. So another key element impacting the delivery of our behaviorhealth care services. Is that focus on whole person, care, integrated, caraway,there's a lot of different words or bus words that we use around that, butessentially addressing a person's mental health, subtance abuses, shoesor potential Septanti issues also throw out social determinants of health within the mix and physical health needs. Now you and I have grown up in amedical model, physical model, these others are there now. So I got to knowwhat are your views on the initation with primary care? What works, whatdoesn't work and what needs improvement? Great Question: It's really fundamentalto our involving health care systems. I always start with the premise of wehave to define integration from the client or patient's perspective. First,really, because it's he or she is saying if my care was integrated, itwould look like x now turns on it's very different for people, but here'swhat it does it me. This is where we have a debate going across the country.It doesn't mean there's a single payer, meaning, and I could hear people saythat if my insurance company was paying for physical and Behar man would it beintegrated, and I ask most people who have commercial and courage. Is thatwhat you see in your own world really? Are you finding your behavior healthcare provider is talking to your primary care provider or your primarycare? Gad Jung specialist? No, and yet you have a single paper. So the reasonI say that is it's on the ground as a term we use on the ground where thepagiant or client is served and some of the models that work really well again.This is driven by the client or patient colocation miles work great now. Somepeople think collocation is not sufficient. However, if my therapist isdown the hall for my Primary Care Dock, my chance of walking down the hall upona referral is a lot greater yeah. If my doctor says hear the phone number. Infact, I don't know if you've seen some of the data the take up rate. If myprimary care dock says, you see depressed to me, Bob here's a phonenumber when you call the utpatel clinic the Tickut Rad, for that is almost zero.I mean most people, they lose the thing...

...or they forget about it or that anxiety.They felt was relieved a little bit by having a phone number. They don'tfollow up on or they're embarrassed by it. If I could just walk down the hallof my Primary Care Provider and get it on to the guys, a primary care, I'm notworried about about stigma, yeah truly other way to Co. Locating primary careproviders in Mahel settings that are meant for pure people with seriousmetal, health condition so ver, for example, wives kits a friend Ye.Actually, my health home is my mal help, provider, yeah or or Vibe Down Syndrome.My health home is that provider. I might want my primary care providerthere, so I can see them there. I don't want to have to go to a primary caresite. No, I shouldn't that's not true for everyone for some people indegrades and just means, please share clinical records. So that's anothermodel that we use a lot so yeah. I don't really watch in the same buildingeffect, my primary care provider. I want to be able to change that one ormy meal health one and I don't want to have to lose that that link. So pleaselink your clinical records. The third one we see a lot is high utilize. It sothere's some people in our community who use a lot of me. Healthcare, a lotof physical health care ambulance, runs gers and find with a model calledcomplex care management. If some adult comes alongside me and says, Hey Bob, Isee you going to the r a lot what's going on. You know. The old story issometimes the prison says. Well, I'm lonely or I'm cold or I could use ameal, but those are the social determines, could be sailed very easilywithout expensive, er run or the person might say. I keep losing my medications,and so we realize I kind of make sure I get to your metal health meds every day,I'm going to drop him off for every week or every month, yeah. So it's thatkind of when I say immigration, it's what the client or patient needsspecifically and those three miles, the ones we see most often co, location, em,R E, H, r link and or how utilizers, and even how utilizers are driven byDeta right pea need to know. Where are the high number of encounters and thecosting counters happen? Well, I mean I've seen all models now and we on nowmy vocational role. I serve allmodels and I think you had youknow the one that I've seen work so well is the more we can make thatimmediate connection the better and for the Ki for the conation and the careproviders. That contecta relevance is critical and it can't be. How do I goget this other information and the more we can quite candidly untether peoplefrom technology and really use technology to empower them so that,whether you're a working on physical health, you havethat contextual relevance around the social determent or the behavioralhealth, or on the opposite that if you're a burly focused on placement ona vocational role or addressing homelessness that you have that othercontext to be able to. So I think the goodness is those things are happeningnow. You're, seeing everyone get innovative around the models. Yes, inyour point around for your seeing that partnership or collaboration, I thinkyou don't always have to solve it within your own organization. You cango work with someone and just editing a...

...ball from there and biggest challenge.I get asked you know hey, what are your thoughts or what do you see in thecommunity? You serve, I say start with something and ere. It won't be perfect.There's going to be some things that work really well and there's going tobe some things. You know what we know and what not to do now and I think itwill evolve in a big way. So in time. I'm glad you said that, because it's isinteresting thing when this movement started about fifteen years ago. Therewas this insistence on perfection right unless you're using the high end Samsonmodel, you aren't doing it, and so people stayed away from it this I Ican't afford it or I can't find a partner. I agree with you at least cosyup to it. In fact, it's pretty organic right once it starts the relationships,get better, I'm going to go something else that you said. I know this ismaybe longer than we had hoped, but it is. You is perfect, it's good! It'sgood, your points, a good one, and then you don't have to invent it. Forexample, I'm a big believer invest in breed, so if I'm a really goodproviders, kids or friend a recovery services, I don't have to open my ownbehavior primary care clinic. There's one down the street or there's an facedown the street. I can party with them and they say I don't need not open aservice, that's really great et treating people but CAZAN. I canactually party with Bob who's that therapist, so I'm seeing more of thosewoven together what we used to call greated funding, it's braided comicalwork, you brad that clinical work and then the client the pace is getting thebest of both specialties. Well, I then may be a follow up discussion. We needto have, because I think people are interested in those models, but there'snot necessarily a play book on how to go, make them work and there's also some lessons learnsthat we shared, and I think, when you're, each trying to be each other.Those models almost never work, but if you appreciate the each the what youbring to the table- and you can complement man, some amazing things canhappen. It's stunning, in fact, because then you're also both keeping up onyour own fields latest. You know, and that doesn't happen when someone triesto be a ominibus. I just seen that they become really good at one thing andthey're using something. That's fifty years old in the other and then ourclients and patiences are better than that. I A hundred percent, agree. Well,I'm gonna, I'm going to come back to. You talked about private and public, soour next topic is to roll up public and private sector in the service delivery.You know, you've been a leader and an advocate for public cal services inMichigan and nation wide. What are your thoughts if you can expand a littlemore on this and regards how public and providers can work together to achievethe best energy? You touch on a little bit of it. A couple questions before,but this is such I hear a concern out there. You know and you're seeinginvestment coming from the investment firms and and the people who've beenserving this in a non profit were. What does that mean to me and where doesthat? Go let's hit on this one, because I love for you to share your thoughtson you know. My belief is less fear and how can we play offense together inthis area? Better, we agree completely, so I have sort of a territory map in myhead. If you don't mind- and I mean a geographic one- I mean a public privatresponsibility, one on the private Si.

What I would say where the privatesector is has an obligation. Also really good is in the commercialinsurance market either exchange or when the the employers paying it.Secondly, there's a lot of great private providers, and so I think thosetwo things are really good and the private providers by the way complainthe private market and the public one. So just keep that in mind. If you don'tmind, the Prie forebodes complain, both the private payers can play, and Iwould prefer it when I look across the country where they work best is in thecommercial market, where the public side place is in the public payer forthe Medicaid benefit or what I call the public patient. You know people withoutany insurance with Medicaid, and this doesn't always go well, but I've seenin states where they've, given that payer roll to a private sector firm. Itlooks a lot like a commercial benefit and in the commercial benefit peopleforget. An insurance model is right. I want to make sure I can withhold enoughmoney from service delivery to pay a profit. Well, that's not what ithappens in the public pair world, the public payer world I on send all themoney out only keeping enough to have enough reserves to cover risk. There'sno profit to be taken out. In fact, the salaries, even the public sector payers,are far less than the private sector, so their admirate is lower and I thinkthat's true in the the what I call the organizer, and so all the providers onthe ground don't have to be public providers. I can, as I said, sorr bestpartnerships are public providers and private ones partnering up, but there'san organizer role in every community. What a check call is station atorganizer role, that says, if you're, a medicated rolly or if you're a personin poverty without health insurance, you should be able to rely on a publicutility like body who organizes that care, whether it's a private sectorprovider pool or a public one, and that's a rule that can't be played bythe privates. Well, because they're they don't have the same legalobligations or moral ones, I'm not faulting them there. They have a marketdriven one and that's appropriate, but it's not appropriate talking the mostvulnerable and the most for some of our porest members in our community. Theyneed to be served by that public factor who dis no dog in the fight of relatedto profit. They have a dog in the fight, lades equality and coverage. So so Ithink that that's how it can play and some of the best parters ips, some weretrying to build across a country bring a private sector. Health InsuranceCompany, who understands physical health management really well to it,with the be hero, health care, firm and a form, a joint venture where theyshare in the savings and the risk. But what the behavior health care sidebrings the table is this, but you mentioned this social determinant focusthis whole person focus and what the hell plan and is primary care networkbrings. The table is, has physical health work and I think those are theones that were going to be seeing more and more doing your map isn't fair to say,there's enough room for both entities to exist and while there's somesimilarities in the missions, there are some differences within the missionsthat I think you know and he'll be some overlap. I don't think there's anyquestion about that. I cut, I think there they'll be an evolution thatcomes from that and I'm on me transparent. One of the things I knowmy non non non profit friends are...

...worried about is great they'll. Takethe things that work really well and they'll leave us with the things theydon't continuing to squeeze and burden ess. How would you answer that? Becausethat's probably the number one thing that a year from people roly and sothere's a metaphor for it, and I'm not sure everyone wants to hear this. Butthe metaphor is a one time: You had a single thing called the postal serviceright, the post office, and it was your only package and liter carrier it inCarrie to everybody. People who you know and it was like eight or not ornine cents was always below the xo cost. I'm not sure that was appropriate bythe way. But then you had fedex and ups come in and say we can actually takethat market. Of course, what they're taking is the most lucrative markets?They don't serve every little burro and and Berg across the country. That'sleft to the the postal service, and you have people say the postal servicesgoing broke yeah because you creamed right, you chariot and that's and thatworks, and I have no problem that the partnership would have worked and couldwork. If we as a public, then said well, what would it take then, to fund thatSafety Net Public Postal Service? Let's find it right, so it may be the and itmight have be all stamp driven by the way I may pay the postage I'll make upa number of a buck and a half to send a package, but it turns out the beds orpaying the other buck and a half because it costs three bucks and thereason I say that is that isn't mismanagement by the posal service,that's all the good clients or customers and market had taken away bythe private sector. So I have nothing wrong with that. If we admit that tosay we don't mind that that's a good partnership. However, then we as publicneed to fund the Sagi Net Bro and the postal service terms is the same safein that that I think the public mouth health system serves and in ours itmight be crisis services or, as you said, mobile teams going out with thepolice. Those are all public goods the public expects. So let's fund thembecause those aren't lucrative. You know no one will get into that theprivate market, but he probably good that people expect well in your seatinginto my next question in the last one here- and thishas been great and you've got my mind- spending on a bunch of different sometopics. I would love to get into, and you know I agree with you, and that isyou know in the way I say it is we're funding those things whether we want tobe candid about it or not, they're, just not always in the most optimal way,whether it's in an optimal outcome in regard to how we may engage in a crisisin a community or around the efficiency. So I believe you know that we got tohave that conversation. That's a society that the safety night isessential to our quality of life, to the opportunity, accessibility,affordability, and we need to be very pragmatic around those things and helppeople who have raised their hand and stepped into these roles that are veryessential to our lives and give them the resources, tools and funding. To dothe amazing things and that's really the same way on the last one that Ihave here, which is changing community expectations. So we know that theengagement you and I've just talked...

...about in mental health and supinesissues continues to increase, and I think that's through a lot of theefforts for seeing that happened. You know. Mental Health for State is a goodexample that wasn't even a word many years ago, and now it's a phrase thatpeople understand that how we connect and helpful person in need is differentthan person in a physical crisis. This isdriving the expectations and the opportunities for expanded services atyou just talked about such as mental programs, not just in the traditionalsetting, but also in schools in creative programs law enforcement inour justice system. So I would ask you: How does this impact your members andother providers around the country? You know, I think that you and I talkedabout some of the threats and discouragements in our system, but thisis one of hope. I think more and more people expect to get access to mounthealth care. In fact, they're more and more expecting to talk about it, I meanI've been stone in the last twenty years. People wouldn't have mentioneddepression or anti depressants ever right in a session or if they werejoking about it right now, people talk about it because it's real and I'vebeen impressed that how often people talk about depression and anxiety andsums you disorders at and recovery, as if we're talking about getting overphysical health health condition. So I think it's really encouraging. I thinkbecause of that, though, they're expecting us to perform wit, they wantthe system, then to could you help help me recover. You know, and it's a littlebit different than physical health care people kind of forget them withphysical health care. You can often get a shot or get a bone set right, andeven if even if you're, not a compliant patient and that's not true foreverything, but if you're a non compliant patient, your code will goaway if you just take the medicine but with no health care. You have to alsodo something almost beyond that. So if I'm taking medication forantidepressant, they might also say you know, be good if you exercise by or ifyou hung out with friends or if you got a religious life or if you ate betteror slept better, so I have to sort of take on a whole porson orientation tomyself. I think people are getting that they're saying I m willing to do that.So I think that's key. You mentioned a couple other expectations and that'swhy I've seen the really the huge grove in what Er called treatment courtsright, sobs his course metal health course MESSIC, bion courts. People aresaying we should just be locking people up, because almost always we remindpeople that person's life gets a whole lot worse and by the way, sometimesthere are family members or victims lives to get worse, and so we're notonly paying an economic price but a social price, sometimes a physicalprice. So I think people are saying well, let's intervene early, let's inLoui being arrested. Let's have crisis teams be out with law enforcement.Let's train law enforcement officers, let's train EMTS, I'm Goin a healthcondition. Let's train teachers across the country, including Michigan,there's been a lot of support across the aisle ours and the des puttingmoney into school based metal health they're, realizing that we can do thatin a non stigmatized setting that kids academic performance can go through theceiling again or maybe for the first time, because we're addressing his areher about health needs or substance abuse or their parents. So I think theexpectations are high and my last one...

...time is people do on crisis support. Healways joke that. No one knows about the crisis system from El Health tillthey need it, and I take some days of find it by time they get it. It's notfunded sufficiently. So I've said people expect that, whether they knowit or not, and if they could, if we help people understand their taxdollars needed to support a ubiquitous crisis system, that's available twentyfour seven. Whenever you need it, I think everyone's lives would run awhole last mother, because a little bit of Christ in Er vention early on solvesa problem that can't be stopped in an er or in a police station. Well- and Ithink you, you know you, as you began, there's opportunities here forproviders out there and that because there's new open mindset to venues of care types of care- theydidn't exist even just a few years ago, and so I think that creates anopportunity not only to expand Bogati es but services and where you offerthose services and yet, while you're existing kind of how how things or wereoperating for you will have changed. I do believe, and I tend to be anoptimist- that new ones are opening up that can that can augment any changewithin those organization? That's exactly right time. In fact, the bigone we saw for the last two years is tell a health. We've formed a tell ahealth resource center here to push it and holy smoke. Folks have reallygotten it. Not only audio video but audio al we've had a lot of folks whosaid I like talking to my therapist in the phone or my psychiatrist. ActuallyI don't want them sing inside my house. You know yeah, and that makes a lot ofsense. Some people do better with audio and video some do face to face, and soit's two more tools in the clinicians tool box right, I can talk to you onthe phone and more and more payers are paying for it. Now we're hoping they'llcontinue beyond the pandemic, because actually we just west finished aresearch project that showed providers and clients like a lot when I see asone tool, not the only tool that audio and audio plus video are a nice adjunctto face to face. Well Bob I'm going to bring us in for a landing year, and Iwant to first just thank you for the conversation today, I'm going to askyou a question just for a word or a statement or a thought, and a time whenpeople have dealt with more challenge, more headwinds, more adversity, moreuncertainty than ever. I love for you to just give your encouragement. Whatwill the optimism had you spoke about that we need to be focused on. Has Wenavigated forward in this closing minute? So I think I would giveforwards sorry Tom. I couldn't do it to one. One is community that we're all in thisting together and the second is grit, a strength to put up with tough tough topand grow from it, thou his resilience, the actual growth part up grit and thefourth is host, and so I think we keep those four things in mind: not only thepandemic, but unemployment and strife and poverty can be overcome with thosefor things so community grit, resiliency and O, and that is why, toour listeners, many of you suggested...

...that we talked to Bob and then havethis conversation, because if we all are navigating some of the uniquethings to us, we are more alike than not in our pursuits and helping otherpeople serving our community with great passion and making a difference. BobThanks for sharing your insight on these very key topics during this veryrapidly changing time and to our listeners. If you enjoyed this podcast,please take Im. Ome continue to give us your thoughts. Bob Is on here today,because someone suggested that we talked about the whole intent that wehave around. These is connection and collaboration, and we believe the morewe can work together. The more we can pursue the things that find us morelike the better chance that we have to make a difference and exactly, as Bobsaid, around community resiliency hole and grit. Those are the things thatwill bind us together to make a difference. Thank you all, lookingforward to our next conversation Bob. Thank you and appreciate the time.Thanks Tom Really appreciate at that smart, we understand the challengesfacing provider organizations. Our team will help you navigate changing value,based care models with solutions and services that make person centered careor reality will equip you with technology and services that provideholistic, real time. Views of Care Histories that inform better decisionmay in and better outcomes visit us today. At N Tsom net mart serving you,so you can serve others thanks for listening to the net smart care,threads podcast through collaboration and conversation, we can work togetherto make health care more connected than ever before and better support thecommunities we serve to ensure you never miss an episode. Please subscribeto the show in your favorite podcast player, if you use apple, podcast, we'dlove for you to give us a quick rating for the show. Just have the number ofstars that you think the podcast deserves until next time.

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