Where is Behavioral Health Going?

1. Where is Behavioral Health Going?

2. Corporate Partners/Affiliate Members Spring Meeting June 3, 2013 Contact: Communications@TheNationalCouncil.org | 202.684.7457

3. National Council Membership # of members year

4. Strategic Areas of Focus • Assertive national and state advocacy that ensures access to treatment • Public education and communications that impact communities • Initiatives that position members as high-performing healthcare organizations • Programs that promote development of an effective workforce

5. 1. ADVOCACY

6. The greatest danger intimes of turbulence is notthe turbulence. It is to actwith yesterday’s logic. Peter Drucker

7. Payment & Delivery System Changes • Rapid expansion of Medicaid managed care • Health homes and ACOs • Dual-eligible initiatives • Rethinking substance use treatments –future of residential • Fee-for-service to case rates, bundled payments and capitation – risk • Health reform rollout: • Medicaid expansion • Exchange enrollment

8. Policy Agenda: Offense Not Defense • PCBHI Grant Program • Health Homes • Excellence in Mental Health Act (S. 264) • Mental Health First Aid Act (H.R. 274/S.153) • Behavioral Health IT Act

9. 2. PUBLIC EDUCATION Contact: communications@thenationalcouncil.org | 202.684.7457

10. Defined by Tragedies Sandy Hook Grand Rapids Aurora Red Lake Tucson Fort Hood Virginia Tech Columbine

11. Mental Health First Aid • Early Identification & Intervention • More than 100,000+ trained • 3,000+ instructors • Youth version • Spanish version • President’s recommendations • Policy and media attention Partnership withMaryland and MissouriState Governments

12. 3. HIGH-PERFORMING ORGANIZATIONS

13. Vision without execution is a hallucination. Thomas Edison

14. Behavioral Health Centers of Excellence • Rapid access/open accessBe there when I need you • World-class customer serviceKind words are easy…echoes are truly endless • Comprehensive whole-person careProvide or help me get the healthcare and services I need • Outcomes-based careMake sure I receive the best possible health care • Staff engagementBeing part of something bigger than themselves

15. Organizational/Clinical Supports • Same day access • Co-occurring disorders learning community • Depression care collaborative • Contracting learning community • Advancing standards of care for bipolar disorder • Trauma-informed care • Child conduct difficulties learning community • Early intervention in first episode psychosis

16. Integration Navigation • SAMHSA-HRSA Center for Integrated Health; NY State Geriatric Technical Assistance Center; and Ohio Training & Technical Assistance Center • FQHC Look-alike learning community • Consulting — state and local governments, organizations

17. Digital Connections • Bosch Health Buddy System gathers vital signs and symptoms, educates, and reinforces positive behavior; data reviewed by provider to identify need for intervention. • myStrength – Health Club for Your Mind – online help with anxiety and depression

18. Outcomes-based Care • SPQM Dashboards • Comprehensive quality management system • Supports data-informed decision making • Measures performance outcomes and analyzes organizational practices • Provides essential information to demonstrate program value • Increases quality, accountability, compliance, efficiency of services

19. 4. WORKFORCE DEVELOPMENT

20. People want to be part of something larger than themselves. -Howard Schultz

21. Excellence in the Workplace • Staff feel they have the opportunity to do what they do best every day • Committed to quality work • Growth and development encouraged • Physical and emotional wellness prioritized through group activities and employee development

22. Integration Training • Psychiatrist curriculum for integrated settings • MSW integrated healthcare curriculum and field placements • Case managers to care managers • Whole Health Action Management (WHAM)

23. Leadership Programs • Middle Management Academy • Addressing Health Disparities Leadership Program • Executive Leadership Program • Seasoned Leaders at Conference

24. E-learning Partnership with Essential Learning, a Relias Company • Leading provider of verticalized e-learning solutions • Compliance with regulatory and accreditation requirements • Continuing education solutions for employees

25. Can’t Stop Thinking About the Future • The healthcare system of the near future will not look much like the present. • The implications for our members and those they serve are enormous.

26. Strategic planning is worthless – unless there is first a strategic vision.John Naisbitt Contact: communications@thenationalcouncil.org | 202.684.7457 25

27. Forces at Play • Experimentation • Liberation of information • Demand for impact • Monopoly economy

28. Entrepreneurs & Investors Eager to tap $2.6 trillion healthcare economy Fix impossibly inefficient & bureaucratic system Boost transparency and communication Digital healthcare receiving greatest share of total investment dollars — up 73% since 2011

29. It’s All Online Doctor will see you now — ZocDoc Online service to research & schedule doc appointments Doc ratings from patients Addresses underused health supply Free to patients, practices pay $300 a month $50 million (of $95 million) raised from DST Global, Russian billionaire 1.5 million users a month in 20 markets

30. Information Liberation Computer becomes exam room — HealthTap Army of docs online 24/7 — building reputation among patients and peers 15,000+ docs answering questions, online conversation for $9.99 Docs rate each other’s responses and algorithm direct questions to specialists

31. Going Mobile Texting can make you healthier —CareSpeak Communications Simple mobile technology to encourage adherence (Noncompliance causes hospital re-admissions and even death) 2-way testing — reminders to patients and caregivers. United Health hopes it will lower their costs.

33. Big Data Meets HR Big data myth busting to build better workers — Kenexa IBM buys workforce science company for $1.3 billion Myths busted Supervisors’ communication skills and personal warmth more important than worker experience/attributes Work history not a good predictor of future results Most important salesforce quality is not extroversion but emotional courage Those who score high on “honesty” stay 20-30% longer in their jobs

34. Monopoly Economy Big chains thrive Greater variety, better quality, lower cost Buying power Centralized common functions Fast adoption and diffusion of innovations 4 airlines = 69% travel Walmart = 57% of all groceries Intel = 85% of micro processing chips Doctors = 75% are employees

35. Profit from Size & Efficiency Cheesecake Factory Medicine — Steward Health Care System • Cerberus, a private-investment firm, bought 6 failing Catholic hospitals in Boston area • Cerberus has stakes in Chrysler, GMAC, Albertsons, Austria’s largest retail bank chains, and Freedom Group (world’s biggest gun-and-ammunition manufacturers)

36. WHAT DOES THIS ALL MEAN FOR US?

37. The measure of intelligenceis the ability to change. Albert Einstein

38. Shift in Market Power • Market power = Degree of influence one organization has over another • Market power = Ability to raise prices without losing business In the U.S. health system, the market power and market position of specialists is shifting “downward”

39. Strategic Challenges for Specialty Behavioral Health • Redefining “demand” for specialty care • Managing unit costs in an era of declines • Competing for ‘profitable’ consumer segments • Investing in new services • Marketing and business development • Maintaining competitive advantage in face of • New technology • Rules-based treatment options • Industry consolidation • Health reform

40. Scenarios for Behavioral Health Elimination of ‘Safety Net’ Funding for Uninsured Decrease of Fee-For-Service Rates Medicaid/Medicare Coverage of SPMI Moved to Managed Care/ACOs Expanding Role of Urgent Care Clinics in Community Payers Increase Coverage of E-Health Services & Remote Monitoring Responsibility for Health Outcomes and Costs of Defined Populations Mandatory Adoption of EBP via Comparative Effectiveness Research Medication Assisted Treatments for Addictive Disorders Widespread Adoption of Neurotech (Scans, Avatars, Cognitive Retraining, Etc.)

41. We must reorganize and prepare for new ways in which services will be provided and paid for.

42. What is Required of Us? Competing for customers (consumers and payers) Moving to highly regulated, any “willing provider” model Participating in value-based purchasing arrangements New management knowledge/infrastructure Delivering services at market rates Knowing costs and cost-cutting techniques Integrating new technologies into service models

43. Skills in Demand Transactional LeadershipCoping with complexity — keep current system functioning and improve • Planning and budgeting • Organization structure and staffing • Organizational controls, monitoring, and problem solving Transformational Leadership Coping with change — produce useful, non-incremental change system • Setting a direction • Aligning people in the organization • Motivating people in the organization

44. Bigger IS Better Collaborations and consolidations are the future Growth allows organizations to Leverage expense Diversify risk Enhance talent recruitment and retention Be competitive

45. The pessimist complains about the wind. The optimist expects it to change. The realist adjusts the sails. William Arthur Ward