5 Questions with David Lim, Chief Medical Officer, Quartet
1. There appears to be an exponentially growing interest on the part of employers in managing behavioral health needs differently than in the past. Why do you think this evolution is occurring so rapidly?
I believe we are seeing the convergence of a number of forces in behavioral health leading to this change. First off, there is not a day that goes by we do not see, hear, or read about how substance use and, in particular, the opioid crisis is decimating our society across all socioeconomic classes. The tragedy has become too large for employers to ignore.
Second, the younger generation of employees is much more open and willing to talk about behavioral health, seek help, and speak up when they cannot find adequate care or services. HR divisions are hearing their voice and acting.
Finally, employers and the healthcare sector overall are seeing the writing on the wall: "happier individuals get healthier and are more productive." What could be simpler than that? Needless to say, it's an exciting time for behavioral health.
2. Do you believe primary care providers have the tools and skills necessary to identify, manage, and coordinate care for members with behavioral health needs?
Short answer: "woefully no." Most primary care physicians are not attuned or accustomed to thoroughly look for behavioral health symptoms from depression, anxiety, or substance use. When we do notice these conditions, it's usually when the patient is rather progressed and desperately asking for help. Since most primary care physicians don't train and routinely practice in collaboration with behavioral health providers, the two sides of the house are divided. No one knows one another. Primary care physicians do what they know best and that's prescribe antidepressants and give the patient a list of phone numbers - something I used to do. Many times care coordination stops there.
Now contrast this to cardiology where primary care physicians not only know each cardiologist by name but their specialties (e.g., electrophysiology, heart failure, coronary catheterization, etc.). PCPs can pick up the phone and get expedited appointments and, most importantly, will continue to dialog with the cardiologist to co-manage their shared patient.
3. How do we take away the stigma associated with mental health issues and encourage people to actively seek care in their moment(s) of need?
The most effective primary care physicians whom I've seen do this often schedule an appointment for the patient solely dedicated to discussing their behavioral health needs. Then in a very open, not-judgmental manner, they talk about the underlying behavioral health condition. Empathy is relayed in either a personal behavioral health experience or a clinical scenario that compelled the primary care physician to truly dedicate themselves to behavioral health. Finally, providers "plant the seed" that enables the patient to either contemplate, plan, or actively engage into care.
The good news is that this effective approach is not restricted to primary care physicians but open to any individual be it friend, family member, co-worker, behavioral health provider - really, anyone. As a society, we need to be comfortable discussing these topics. Most importantly, we need to both provide support to one another as well as be willing to seek and accept help for ourselves when our time comes.
4. There is very little quality data in the behavioral health space at this point in time. How do you view provider quality in BH, and is it measurable over time?
Quality data in healthcare only comes in the measurement of standardized patient outcomes at regular intervals. The good news is we have tried and true behavioral health measurement scales such as the PHQ-9 for depression and GAD-7 for anxiety as well as many others. What is needed, however, is the proper incentive and reimbursement structure to reward quality (e.g., pay-for-performance). Efforts are already underway as seen in CMS' MIPS (Merit-based Incentive Payment System) particularly with the behavioral health quality measures - all part of the broader MACRA (Medicare Access and CHIP Reauthorization Act).
I am hopeful that commercial reimbursement will soon follow suit. Achieving quality in behavioral health must be scaled and technology will certainly play a key role from (1) faster broader access to behavioral health resources, (2) asynchronous but effective communication between providers, care team members, and patients, and (3) real-time behavioral health assessments followed by timely, appropriate care path intervention or change.
5. What's next, and who is driving it?
We are seeing an explosion of different behavioral health companies with many approaches from mobile patient apps, web-based telepsychiatry or teletherapy, employee platforms, and provider-facing tools. Quartet has a unique approach. As the name suggests, four key players are required to "play in harmony": (1) patients, (2) primary care physicians, (3) behavioral health providers, and (4) health plans. At our core, we are using technology to improve behavioral health access, drive provider collaboration, and rigorously measure and reward quality. Our model will accrue savings to the health plans who sponsor Quartet's work in each of our markets. Thus, our software and services come at no-cost to the providers.
To-date Quartet's initial work has focused on building the communication channels between primary care and behavioral health providers. We also offer online CBT (cognitive behavioral therapy), telepsychiatry / teletherapy, as well as curbside consultation capabilities (on-demand psychiatrist clinical advice for PCPs). Later this year we will launch our patient-facing portal to further enhance our virtual, integrated behavioral health model. We are currently live in Eastern Massachusetts, Western Pennsylvania, Puget Sound, and New Orleans, Louisiana. We plan to expand into additional markets across the U.S. in 2017.