I was not sure what to expect this year at the National Council For Behavioral Health Annual Conference. They always provide thoughtful and engaging content. However, this at a time of serious change for the mental health industry. The Affordable Care Act under attack, payment reform, increasingly complex regulatory environment, and workforce shortages have made for a stressful time for mental health leadership. All the while knowing that people are working hard to keep up and not losing sight of our mission. We go into this field to help people in pain but to provide this, #NatCon19 forced me to see how we have to work even harder to achieve this goal. Not only to keep our clients healthy but to keep our organizations healthy.
This post was inspired a bit by this tweet from someone who didn’t even attend the conference…
To address the above challenges in mental health is facing, leaders have been faced with tough decisions. This is not always proceeded nor followed by the easiest path. This certainly picks up where my pre-conference post on change management leaves off. The conference was full of examples of to how step back, look at problems differently, use data, and make tough decisions; mental health organizations here able to better suit the needs of their clients.
The opening keynote was provided by Dr. Atul Gawande. Author of “On Being Mortal”. Also he is CEO of the new Amazon/Berkshire Hathaway/JP Morgan backed company Haven. Sadly there was little substance about this new venture so we will have to stay tuned. He drew from his experience as a cancer surgeon to ask tough questions of the healthcare system and how they view end of life care. His research challenged the status quo that interventions meant to prolong life often do the opposite. In these surprising results people who received hospice care outlived those with people with who received treatment as usual. When we give people choice and agency, their care improves… Imagine that…
This represents a shift that is difficult for some clinicians. We often have to face the “challenge” of letting go of our expert stance and allowing people to make choices. That what works for one person might not work for the next.
This was the over-arching theme of the sessions I attended. Splinting my time between sessions on technology and value-based payments (sometimes they overlapped) it became clear to me that the way forward in mental health was going to be fraught with decisions that require a shift in thinking. This is not revolutionary but there are two keys to success I noticed about changing the business model in mental health. First, It is imperative that we start thinking about what we are measuring and why. Second agencies need to adopt a team approach to examining outcome and financial data.
Again.. not revolutionary but the mental health field is often plagued with “but that’s how we have always done it” thinking. Throughout the conference it has became clear that in order to keep up with changes we need to make the shifts…
Another thread in the systems improvement and tech sessions was the importance of multi-disciplinary teams. If your Chief Financial Officer is the one solely working on the value based contract, it will probably fail. If your Chief Information Officer is the one doing the technology implementation, it is doomed. Agencies need to think strategically about cross-pollination of teams…
Not revolutionary but to quote one of favorite presenters at the conference, David Lloyd Founder of MTM Services, “You all have seen this before… right?” Think back to the last major change your organization made. What worked? What didn’t? My guess if it didn’t, it either lacked direction or the wrong people where sitting at the table.
We have to challenge our assumptions about change and leadership. Keynote speaker Becky Margiotta did this in amazing way. Through stories she pointed out 10 keys to leadership (well… actually 9 because the 10th was “leaders like to count to ten”) Words can’t do justice about how passionate she was about creating leaders who can shift and be selfless. I captured some of her most quotable times in this twitter moment…
We have to challenge our assumptions about what we do and how we do it. This leads one of the other currents of the conference… hope you are sitting down… here we go… it’s going to be a surprise….
Data
If I had a dime for every time I heard the word “data” or “analytics”, I would be a rich man. It’s important to talk about it but the challenge is taking the mounds of data we are faced with then find meaning. Combining these concepts of shifting business paradigms, teamwork, and leadership that challenges assumptions is key to the success of this.
Danielle Schlosser of Verily Life Sciences presented on how they are using data and partnerships to build an addiction treatment center in Ohio (launch info here) . She talked about how they are focusing on how care is delivered especially between sessions. She gave examples of ways technology and data has changed the experience of retail and finance. Through our understanding of data, it has created new pathways for purchasing products and managing our money. How can we use data challenges our assumptions on the way addictions care is delivered? All the while being ethical and transparent (I added that point).
That is the challenge they choose to accept. We have to drill down on understanding the data of the challenges we choose to accept. Here are some tips to achieve this…
The challenging part is when we are this critical of our data we might not like what we see. It may force us to cut a program, develop a new form, get rid of a process we think has been effective for 5 years… alright re-hashing my last post on change management.
The changes ahead are going to be work but being strategic yield positive results. Here are some of the results from change in processes I heard about at the conference…
-Switching to a new EHR to increase efficiency. -Addiction mobile applications taking some clinician time but improving engagement. -Partnerships with police to do telemedicine screening in the field with laptops. A heavy lift but going to about 116 inpatient admits a month was worth it. -Mental Health clinics changing to a same day access model to improve productivity and patient satisfaction. -Contracting with the pharmacogenomic company GeneSight to that uses cheek swabs to better understand which genes match best to psychotropic medications; reducing the trial and error of multiple medical trials.
All of these changes required investments in money and staff time were tough. However when we consider the current mental health environment we are left with little choice. The need to let go of the current status quo begs for a shift in our thinking around teamwork, leadership, and data.
The closing keynote was Charles Duhigg, an expert on productivity and team building. His paradigm for productive teams and innovation invites a combination of both the “familiar” way of doing things with being able to take a step back and examine it a new way. Most innovative things have been born out of this strategy.
Yes these are challenging times for mental health leaders but we need to ask hard questions about effectiveness, technology, innovative payment models, partnerships, data, and outcomes. It may feel right to us to keep relying on grants to fund our programs but is it easy to change? No. As insurance companies are switching from Fee For Service to Value Based Care is it easier to “try to make things work they way they always have? Yes. Not doing the tough change and the accompanying tougher work may cost the of opportunity to move from the familiar to something more innovative.