Value-based care in behavioral health

[Text On Screen – Optum Transforming the Behavioral Health System, A unique approach to value-based care, Slide 1]

ANGIE STEWART VOICEOVER:  Hello, everyone, and welcome to today's webinar, Transforming the Behavioral Health System, a Unique Approach to Value-Based Care. I'm Angie Stewart, with Modern Healthcare Custom Media. Before we get started, I'd like to thank Optum for sponsoring today's broadcast. Optum is a leading health solution and care delivery organization with a mission to create a healthier world, one insight, one connection, one person at a time. Now, for the technical details. Today's webinar will be pre-recorded, but you may still submit your questions. Following the airing, presenters will respond to as many questions as possible. And to submit a question, you can enter it into the chat feature and press Send. With that, I'm excited to introduce our moderator for today, Alecia Lam. Alecia is Senior Director of Provider Enablement at Optum and has extensive experience working in managed care and behavioral health roles, including working in community mental health centers and in-patient behavioral health settings. In her current role, Alecia is focused on expanding value-based programming with behavioral health providers. Great to have you, Alecia, and our speakers here. The floor is yours.

[SPLIT SCREENS OF THE SPEAKERS, WITH THEIR NAMES AND TITLES]

[Text On Screen – Stanley Williams, PhD., Harris Center, Andy Kelly, Optum Behavioral, Alecia Lamb, Optum Behavioral, Dr. Tristan Gorrindo, Optum Behavioral]

[ALECIA LAMB SPEAKING ON SCREEN]

[Text On Screen – Optum Transforming the Behavioral Health System, A unique approach to value-based care, Slide 1]

ALECIA LAMB: Thank you so much, Angie. I'd like to kick things off by introducing our panelists today. We'll begin with Andy Kelly.

[Text On Screen – Introductions, Moderator, Alecia Lamb, Sr. Director, Provider Enablement Optum Behavioral Health, Andy Kelly, Sr. Vice President, Provider Enablement Optum Behavioral Health, Dr. Tristan Gorrindo, Chief Medical Officer, Optum Behavioral Health, Care Delivery, Dr. Stanley Williams, Director of Integrated Health, The Harris Center, TX, Slide 2]

Andy is Senior Vice President of Provider Enablement at Optum and has worked in healthcare for most of his career, including supporting health systems with data and population health solution implementation, as well as total cost of care initiatives. Today, Andy leads the Development Implementation and Operations of our Value-Based Arrangements for Optum Behavioral Health Solutions. Next, we have Dr. Tristan Gorrindo. Dr. Gorrindo is Chief Medical Officer for the Care Delivery Branch of Optum Behavioral Health Solutions. In his role, he oversees a growing behavioral health care delivery organization that is focused on delivering both high value and affordable integrated physical and behavioral health care. And last but not least, I'm happy to introduce Dr. Stanley Williams, Director of Integrated Health at The Harris Center in Texas. In his role, Dr. Williams directs integrated primary health and behavioral health outpatient programs and has spearheaded the development of The Harris Center Integrated Behavioral Health Home in partnership with UnitedHealthcare and Optum Health. We'll get a chance to learn a little bit more about that program later today.

[Text On Screen – What we’ll cover today: 1) Implementing value-based arrangements in behavioral health care can be challenging – we’ll talk about why provider enablement plays a critical role in creating a successful model 2) Value-based care in action – in partnership with Harris Center, we’ll learn about what it took to set up a successful value-based arrangement to the largest behavioral and developmental care center in Texas 3) The future of value-based care – Our panelists will share how they’re building on this successful partnership to further expand value-based arrangements in their respective areas 4) Tips for taking action – and why focusing on provider enablement and partnership is key to establishing a successful model, Slide 3]

Thank you all for joining us, and I'm excited to dive into our discussion. Before we do, though, I just want to take a moment to level set what we're going to cover in today's panel. Many of you are probably familiar with value-based care arrangements and some of the potential challenges of implementing these arrangements in behavioral health care. Today, we'll talk about why provider enablement plays such a critical role in creating successful models in this space. From there, we'll walk through a real world example of value-based care in action, with our partners from The Harris Center in Texas. And then we'll ask our panelists for their perspectives on what the future of value-based care looks like and tips for taking action. And with that overview, let's get started. We know that the phrases value-based care, value-based payments, value-based arrangements, and those abbreviations VBC and VBP can mean slightly different things to different people. So we want to start off by having our panelists level set and give a quick definition of what we mean today when we're talking about value-based care. And Dr. Gorrindo, I'm going to ask you to lead off just an overall response to what is value-based care? What does it mean?

DR. TRISTAN GORRINDO: So the fundamental premise in value-based care is that we're trying to offer the highest quality care at the lowest price. And I'm actually going to challenge today's audience a little bit, in introducing yet another value-based phrase in their lexicon, which is really value-based programs, which is what we're here to talk about today. Value-based care, traditionally, has looked like a payment methodology. So there’s alternative payment methodologies, APMs, and there's a bunch of different frameworks. But one of the ones that we talk a lot about is what's called the LAN framework, which basically breaks value-based payments into one of four categories. Level one is basically not a value-based program. Level two is basically a fee for service program where we're giving people a little bit extra money for doing something on the reporting side of things. Level three is really where we're actually sharing some upside and downside risk. And level four is really where we're talking about incentivizing people to think more holistically around what a patient needs. What we're going to talk about today is how that applies in behavioral, which is, candidly, behind the rest of medicine. So the rest of medicine really started playing this value-based game about a decade ago in earnest, and behavioral is still catching up. Most people in behavioral are still in maybe fee for service and a lot are in cash only private practice. So the idea of value in the behavioral space is still relatively new. And what we're going to talk about today is super exciting because we're really going to be focusing on how Optum is trying to accelerate that within the broader field. Not just for people in our network, not just for our partners, but how we're really trying to help set a standard for what value-based looks like in the behavioral space.

ALECIA LAMB: Thank you for that, Dr. Gorrindo. Andy, anything additional you'd like to add in terms of helping to define value-based programming or value-based care?

ANDY KELLY: Yeah, thanks, Alecia. I think the biggest thing is the paradigm shift, in terms of how we both deliver care, think about the members and patients that we serve, and more importantly, the behaviors behind it. It’s not just about the dollars that come in the door anymore. It's not just about the service rendered at the point of care. But it's what's happening to the member as a whole. And so being able to take the data insights and actionable intelligence that we have and bring that forward, is what makes a value-based care and turns it really into that value-based program. How do you holistically look at these individuals and make sure they're getting the right care at the right time. And as Angie led off with, getting one patient the right care at their right time, is how we continue to drive this forward.

ALECIA LAMB: Thank you for that, Andy. And Dr. Williams, anything additional you'd like to add from the provider perspective?

DR. STANLEY WILLIAMS: Yes. I think when you look at value-based care, it has been from that position of fee for service. And so fee for service kind of provides care when symptoms appear in a clinic. And so it's sort of after the fact. And so when you think about value-based care, as a provider, we need to ask ourselves, can we quantify and ask ourselves, are we making a difference? And when we begin to do that, then we began to look at are we making a difference in the patient experience? Are they improving their overall wellness? And that has to be quantified in a way not only with just reduction in cost of care, but also, are they making changes in their lived experiences that improves their lives? And the only way to do that, we see also is sort of this value-based care approach that begins to look more upstream in our approaches. We began to look at everything from social determinants of health and drilling down to what are some of the root causes of some of the challenges that our clients have.

ALECIA LAMB: Thank you so much. Now that we've put kind of a foundation around value-based programming and value-based care, I'd like to ask each person on the panel, from your respective area, what are you all focusing on to expand the use of value-based arrangements for patients or members? Acknowledging, as Dr. Gorrindo mentioned earlier, that we're much younger in our sort of adoption of this style of arrangement or program. And, Andy, I'll ask you to weigh in first. From Optum's perspective, what are you working on to expand the use of value-based programming?

ANDY KELLY: There’s really three key things, and they're all a little different in nature, but they all come together to really build that program framework. So the first one is defining quality of care. Historically, you asked a payer and they're going to say, let's all look at the claims data. And, really, I think we've all come to the realization that that's really metric based care. But what we need to get to is the value behind it and the value for whom. And so we've got to look at the value to the members. So looking at outcomes, are they getting better? Do they believe they're getting better? Outcomes from a provider perspective. Are we making it easier for them to deliver the care? And then really value from a payer lens and the system lens, from a both sort of quality from a metric base, but also from a financial base as we try to make health care more affordable. So what is quality? That's sort of the first piece that we're trying to tackle. The second one is this provider enablement concept. No longer do we hope to have this adversarial relationship with providers, where all we are looked at is, hey, you're paying my claims and maybe you're paying them wrong. But, really, how do we develop an enablement capability and partnership, where we collectively, with the providers and other partners in the in healthcare system, work to improve the care that's delivered. That's really the second piece. And the third one, and arguably maybe the most difficult, is how do we scale it? Every provider is unique and every provider would tell you they’re unique. Every payer is unique. And, most importantly, every individual and the care that they need is unique. And so how do we take all our skill sets, data, intelligence, care pathways, how do we bring that together with the definition of quality and this partnership, to put it all together? I think a great example that I've used, and it resonates with me, is fixing a broken arm. A lot of times there is no argument around what's needed to fix a broken arm. It's maybe surgery, it's a cast, you do some PT, and at week, call it 12, you should be back throwing a baseball. With behavioral health, it isn't that easy. And so being able to look at my depression, your depression, anyone's anxiety, everybody needs something a little different. And so with value-based arrangements, and really what Optum's trying to do is allow the provider to deliver the care in the way that they need it, in the way that the member or the individual needs it, without sort of having them think about what's billable each and every single time or following a prescribed pathway. So I just don't think we're there yet. I think we have best practices, evidence-based care, but really putting all of that together is what's needed to make value-based care successful. And it's really what Optum's trying to do.

ALECIA LAMB: Thank you so much for that, Andy. And Dr. Gorrindo, from your perspective in care delivery, how are we working to expand the use of value-based care for patients?

DR. TRISTAN GORRINDO: So I'll just give kind of the flip side to Andy's answer. So I think he really articulated very well what payers are doing to try to enable value from their side. We're doing a lot of similar things, but at the provider level. So if we think about Optum behavioral care, which is the organization I help lead, we have just over 5,000 clinicians. We’re providing care in all 50 states, brick and mortar facilities, and 300 clinics. And I mentioned that behavioral is a little bit behind the rest of medicine in terms of thinking about value-based care, but also in implementing the tools that enable value-based care. So when we think about what do we need in order to measure care, that is something that we're rolling out across all of our clinicians. And so what does that look like? Well, that really looks like measurement-based care, right? So the use of PHQ 9 or GAD 7 or other rating scales to be able to begin to track symptoms. We know that tracking symptoms alone is not equal to value, but it begins to tell us, it begins to quantify an individual's illness so we can have some sense as to whether or not their symptoms are getting better or worse. We're also really acculturating our clinicians to this. So it's one thing to collect all this data from our patients, but then we need to teach our clinicians, how do you use this data in your practice? How do you use it to accelerate care? How do you use it to shape care? So that's another piece of the change management, the cultural change management that we're leading across behavioral. And then the third is really, how do we think about incentivizing our providers, in terms of their own compensation, to align with value-based care? So in a traditional fee for service model, our providers are actually incentivized to see patients more often or to hang on to patients for longer because they're continuing to get reimbursed for just having the patient come and sit in the office, either physically or virtually. So we're now doing the work of how do we create a national value-based program that all our providers can participate in, where we begin to reward based on quality of the care that they're providing based on some of the things that I mentioned. So we'll talk a little bit later, I think, about some of the difficulties around defining quality in behavioral. It's really challenging. Andy mentioned one part of it. From the payer side, they've typically looked at claims data to define quality. On the provider side, we've really looked at rating scale data to define quality. But from a patient perspective, quality means like, am I getting to work every day? Is my relationship with my partner going well? Those are the kinds of metrics we really want to be driving towards at the end of the day. And I think Stanley's going to tell us a lot about the work that they're doing at The Harris Center in that domain. But we don't, either from the provider or the pair of lens, have all the pieces yet, to be able to add up to that value story. And that's one of the things that we're working towards, is how do payers and providers come together, each contributing some of their own data to create a more comprehensive picture of what's happening for the patient so that we can drive towards what we'd all agree, from the patient's perspective, quality looks like.

ALECIA LAMB: Well, sort of adding to that, Dr. Williams and Dr. Gorrindo, thank you for teeing that up ever so nicely, Dr. Williams, would love to hear from your experience there at The Harris Center, how you guys are focusing on expanding value-based care for your patients.

DR. STANLEY WILLIAMS: I think Tristan and Andy teed it up really well. When you look at sort of the healthcare system, payers, and members, automatically you kind of begin to look at this system that sometimes have gaps, where our clients and our members are falling through. And it seems to be that our hospitals and emergency rooms becomes the default system of care. And that's because everyone sort of had different pieces that they do. And I think that what we've done in our partnership with Optum is create this integrated health home. It's kind of like the glue that kind of helps keep things together. So all those things that Tristan mentioned about being able to look at quality by some of those lived experiences of the member, may result in them not taking their medications. So it's like this medication adherence. It may mean that they can't get to care. And so when we look at data, that's one thing, but when you drill down into it, we begin to look at some of these social determinants of health where people live at and they have challenges and barriers to care. What helps us in that partnership with Optum is their Optum portal, which is just amazing data that we can kind of look at on a daily basis with our daily huddles. So we actually created sort of this organizational kind of pathways. Within our organization, we're able to kind of look at what are some of the challenges that the individual has? What resources do they need? And because of some of our strengths in terms of our relationships with providers and social service agencies and so forth, we began to develop partnerships with hospitals in a different way, where we're working with their discharge planners, we're getting data to be able to show patterns of challenges that folks have, and returning into the hospital. And so part of this model, this integrated health model, is really partnerships. That's going to be the key, to be able to look at a person centered approach of how we begin to address some of those challenges of the individual.

ALECIA LAMB: Thank you so much for that. It’s been really helpful to hear the different perspectives all sort of gelling together. Kind of leads us naturally into an area of discussion around what does it look like to be successful? How do these different sort of components or different pieces of the puzzle fit together to really be successful overall, at an industry level? And Andy, I'm going to come back to you to ask, from the Optum perspective, what is success for a value-based program look like?

ANDY KELLY: Great question. And think it's the, call out the biggest number you can think of, that's the question we've got to answer. And I think we have learned over time, I won't say through trial and error, but really through iteration, what it takes to be successful and what success looks like. Early on in our journey with providers, we reached out to the CFOs to talk through, hey, we want to get you on a value-based contract. We very quickly found out that they were not the right people to engage in these clinical initiatives. And so we found the Dr. Williams of the world. We found the Dr. Gorrindos of the world to say, Hey, we want to make this a clinical partnership. And I think that's the first key piece of success is how do you get the clinicians involved? It's not just a financial exercise. It truly is a clinical and financial transformation and partnership. I think the second piece of success is how do you align across the continuum? If Optum cares about one thing, provider cares about another three, and they're not the same things, you're never going to make it work. And so being really up front and being transparent around what that looks like is important. And then I think the third piece, and something that I believe very deeply that Optum is continuing to excel at, is that partnership perspective, and Dr. Williams hit on it. It isn't just a piece of paper. A value-based contract goes far beyond. It has to. And so being able to create that partnership and really trust one another, I think that's oftentimes, maybe a bad word or a word that is hard to get to, in practice between providers and payers. I think getting there and truly believing and trusting in the partner on the other side of the phone, across the table, across the Zoom session, whatever it may be, that's critical. So any piece of that that's missing, I think you're going to fall short of success. But as sort of the theme of this has to all come true, it's not easy. And so when you can find those partnerships, those pieces of success, you celebrate them along the way. And I'll let Dr. Gorrindo and Dr. Williams talk about the patient because that's far and away where the success happens, but from a payor lens, I think those pieces, the partnership, the trust, is really where we define success, aside from the patient level.

DR. TRISTAN GORRINDO: I think what I would add to that, Andy, is that I think a little bit about when we first started talking about the triple aim, which was maybe more than 10 years ago. And if you guys remember, the triple aim was patients - the goal of a quality healthcare system should be providing the highest quality care at the lowest cost, with the best patient experience. And what we quickly learned from that exercise was that we were basically squeezing our clinicians really hard in order to drive those three things. And it was actually contributing to a ton of burnout in the field. And so they revised it a few years back to be the quadruple aim. They added a 4th pillar to basically say, now it's high quality care at the lowest cost, with highest patient satisfaction and provider satisfaction. And so when I think of value-based programs and how we think about success, I really think about the quadruple aim. It should be a win for all four of those pillars. It should promote high quality care. It should help reduce costs appropriately. Patients should find a better experience with the healthcare system. And providers should feel like they're operating at the top of their scope with the tools to affect patient care in the way that they feel is appropriate. And that quadruple aim lens drives everything that we do within Optum Behavioral Care. Because we know, that at the end of the day, our most precious resource is our clinicians, without a question, particularly behavioral. Without our clinicians, we can't do any of our work. We are fundamentally in a transactional business between people. And so all these programs have to really serve, does this help our clinicians be the best clinician they can be and have that drive through to really helping patients live their best lives.

ALECIA LAMB: Thank you so much for that. Sort of tying into that, actually, we have a great example of how this all comes to life with a provider and for that provider's patients, with a short video from The Harris Center. And Dr. Williams, do you want to share a little bit, just to introduce what we'll see in this video?

DR. WILLIAMS: Yes. When you begin to look at, I like the comment, it's just not a piece of paper with a name on it. We're talking about lived experiences, with people having real emotions and real challenges in life. And when you begin to look at this case study of a family that involves an individual named Oscar, and you can hear in the mother's voice, of the pain and suffering that they were having. Because some of the challenges of accessing care, some of the domains that we talked about was actually the idea of taking his medication, how he was doing in school, and the idea that he was hurting the pets in the family. And these are very tragic things for families to go through. I've just been very impressed with the compassion of the Optum staff when we began to staff cases like this. And it begins to show that we have the same common values about patient first. So this particular case will definitely demonstrate how this model works.

[HARRIS CENTER VIDEO PLAYING]

[Text On Screen – The Harris Center for Mental Health and IDD Transforming Lives]

[VICTORIA RODRÍGUEZ SPEKAING ON SCREEN]

[Text On Screen – Victoria Rodríguez]

VICTORIA RODRÍGUEZ VIA A TRANSLATOR: Victoria Rodríguez, I am the mother of Oscar Perez. He's my son, and he was a victim of abuse as he was a child.

[VIDEO SHOWING PICTURES OF OSCAR AS A CHILD]

His father abused him and he just had a lot of resentment, and he suffered. He had autism. He tried to take his own life, and I didn't know how to help him. I was so frustrated. I felt like I was walled in and I just felt so much darkness around me. Until the hospital contacted The Harris Center.

[DENEISI GUETO SPEAKING ON SCREEN]

[Text On Screen – Deneisi Cueto, Integrated Care Coordinator]

DENEISI GUETO: I've been privileged to work with Oscar and his family and also see the transition that he has made. Initially, when I started working with Oscar, he was having a hard time at home and at school. He had a poor relationship with his family and also with his pets. He was being bullied at school. He was also verbally and physically aggressive. Oscar, unfortunately, was hospitalized, due to reporting that he was suicidal and homicidal

[VICTORIA RODRÍGUEZ SPEAKING ON SCREEN]

VICTORIA RODRÍGUEZ VIA A TRANSLATOR: I was trying to knock on different doors just to help my son and to help with his thoughts of suicide, the thoughts of harming animals, or harming others. He was also bullied, and there were so many things that he went through. So from there, God put The Harris Center in our path, and The Harris Center has helped us so much.

[DENEISI GUETO SPEAKING ON SCREEN]

DENEISI GUETO: We were able to reduce the admissions that he was, the hospital admissions at the hospital, and also make improvements in school. Oscar was able to benefit from all the various resources that we provided to him and his family, from food resources, clothing resources. We were able to help and monitor Oscar’s medication adherence, make sure that we scheduled and stayed on top of with his appointments. And also make sure that the family continues to have all the basic foundations grounded, when it comes down to food and other financial resources.

[VICTORIA RODRÍGUEZ SPEKAING ON SCREEN]

VICTORIA RODRÍGUEZ VIA A TRANSLATOR: I have seen just so much progress. He hasn't gone to a hospital since February. He has taken his medication, whereas before, he didn't want to take his medication. And I have seen a lot of improvement. He has changed so much.

[PHOTOGRAPHS OF OSCAR IN A CAP AND GOWN AT GRADUATION]

DENEISI GUETO VOICEOVER: Oscar eventually graduated high school, and he was able to get his diploma. He's now working at a part time job.

[DENEISI GUETO SPEAKING ON SCREEN]

And also, due to the progress that Oscar has made, I no longer have to provide weekly services. I now provide monthly services.

[VICTORIA RODRÍGUEZ SPEKAING ON SCREEN]

VICTORIA RODRÍGUEZ VIA A TRANSLATOR: And I'm just so happy for our effort and also so thankful to The Harris Center, because The Harris Center has helped us so much. Once they called, The Harris Center told me how they would be able to help me and what services my son could qualify for. And once I got that call and after our conversation with The Harris Center, I felt so much better. I felt so much at peace because that is exactly what I was looking for. Somebody who would guide me, somebody who would tell me where to go. So I felt so much peace when I had the conversation with The Harris Center. This program has really helped me and my son.

ALECIA LAMB: Thank you so much for sharing that video, Dr. Williams. Any additional comments or feedback you'd like to share regarding the success?

DR. STANLEY WILLIAMS: I think that you can see, at the end, that I think the question I asked earlier is that we need to be able to quantify are we making a difference. And I think you can see that at the end, when you begin to see how he was able to graduate from school, be able to look at employment, take his medications, all of those are different domains in life that have really improved in their lived experiences. And so we're very excited and celebrated that success with the family and with Optum.  

DR. TRISTAN GORRINDO: And I'll just, echoing that, what they didn’t talk about was, I was so happy that my PHQ 9 score went down. Or that my claims data was like, you know, I cost the system less money. So, again, this really speaks to, we have to, as a field, find that sweet spot between, that kind of sits in the overlapping of the four pedals of the, of the quadruple aim that's really around, as Stanley talks about, the lived experience of the patient. What's important to them and are we help facilitating their goals? That’s really what a healthy health system does. And that’s the journey we're on together.

ALECIA LAMB: Well, I think you've all given us a lot to think about, relative to the success and the potential benefit of a value-based program. We got a chance to see that impact one family. It was a fantastic example. So as a provider or as a system, if they start, if they're listening to this and they're thinking about getting engaged in some type of value-based arrangement, how do they know when they're ready? And if they are ready, what are the next steps to get involved? And, again, I will kind of tee that up to Dr. Williams to weigh in first. From your experience at The Harris Center, how does one know when they're ready to engage in value-based care?

DR. STANLEY WILLIAMS: When you think about community mental health centers, there are some innate qualities that you can kind of look at. One is that we have strong provider relationships in the community. That’s very important when we begin to look at some of the challenges that our clients have in their lived experiences, in terms of referral processes to everything like the food bank, being able to deal with employment and some of those areas like that. The other quantity that you kind of have to have is the ability to do change management. Change management is very important. We talked about moving from a fee for service model to a value-based model. And so it's going to really cause the organization to be able to think differently in terms of change management. I think the other part of that is having the strong case management. I think the case management, as you can see from that case with Oscar, is very critical. I think that the case management probably needs to be changed a little bit, in terms of the framework, to be able to align with dealing with issues like social determinants of health and some of the lived experiences folks have, because I do believe that kind of the fee for service is a different model. So I think that has to be dealt with. But the other factor has to deal with data. And I think that's where most of the mental health centers are having challenges with, in terms of real data, actionable data, claims data, to be able to do your daily huddles and respond to some of those needs.

ALECIA LABM: Andy, what about from Optum's sort of perspective or Optum's viewpoint? What do you look for in providers as potential candidates for a value-based program?

ANDY KELLY: I think Dr. Williams hit it spot on from a provider sort of capability perspective. And I think that all of that gets together to be a willingness to do something differently or a willingness to think about care differently. And so I think the biggest thing is, is realizing and understanding and sort of accepting that care doesn't just happen in the four walls of a clinic, whether it's virtual or in person. And so having a provider think holistically about the member, from an SDOH perspective, sort of from just a holistic management perspective, maybe is the right way, which is this case management example. I think the second one, and sort of as table stakes, are things like evidence-based practices and sort of good standing with their payer partners. I think that's sort of un-shiny as that is, I think that's sort of just foundational to having a good relationship. And then I think the last piece of this that we really look for, at this point, is volume. As we think about being very new in this space, trying to figure out how we prove out these models, how do we get to scale, really looking at the providers that’ll have the biggest impact on the most number of our members. Transparently, that's not where we want to be forever. I think what we want to do is sort of prove out how these things work and be able to roll it out and scale it. But at this point, trying to use the resources we have and the resources the providers have to impact the most amount of members is something else we look for. But I think it all really goes back to being willing. I think that is something that maybe is under emphasized, is we don't want to be going out to these providers to make them do something different. We want it to be a partnership where both parties come together and say, hey, we have new, innovative, evidence-based things we want to practice. And here's how the payment’s going to match that. Here's how the clinical is going to match up. Here's where the data comes in. And so I think looking at all of those things from a culture perspective, and a willingness to do something different is key to how we craft these partnerships.

ALECIA LAMB: That's super helpful to hear. Thank you. And Dr. Gorrindo, I'll ask you, from your perspective, what can a provider group or a system do to get ready? Are there things they can be doing to get prepared for a value-based program?

DR. TRISTAN GORRINDO: I think Stanley alluded to something really important when he talked about the importance of change management. So, historically, I think people have leaned on value-based contracts as a quick way to increase reimbursement rates. That's not really what we're talking about here. To do value-based programs, we're really talking about getting people, clinicians, operators, front desk staff, everyone in the health system, thinking and working in a different way. And that's a huge culture change. And so whenever we think about culture change, there are a couple of key questions that I always think about. We have change managers that help us determine whether or not our organization is ready to embark upon a change. But some of the key questions that groups should be asking themselves is, what does success look like for us, for the patient? What is the risk of changing? What is the risk of not changing? Why now? There are a couple seminal questions that you have to be able to articulate, not just to your leadership or who your CFO who's going to be signed in the contract, or to your CMO who's going to basically be responsible for helping the clinicians implement it, but how do you explain this to your patients? How do you explain this to your frontline clinicians? And so this is fundamentally an exercise in change management. This is how we, as a field, progress. And so that's the other resource that I would encourage people to think about, is whether or not they have someone in the organization who leads them through change or if they have a resource that they can access that can help them do a preparedness assessment. Because if we just walk in one day and say we're implementing a value-based program, we're going without getting any of the buy in of the stakeholders that are going to be responsible for doing this work, it's destined to fail. I think a little bit about what IHI does around safety. And so they have a really nice framework that basically asks organizations to assess themselves as to where they are on their, where they are on their patient safety journey, recognizing that it’s that, it's a journey, with many steps along the way. And there are activities folks should be doing at each step. And this is another one of those changes where you don't just start it one day, but you have to prepare the organization, find the right partners. Those might be community partners, those might be payer partners, to really help lead each other, work together through this work.

ALECIA LABM: Very helpful. Thank you so much, Dr. Gorrindo. This has been an incredibly informative conversation and discussion, and I want to take a moment to thank all of our panelists,

[Text On Screen – Thank you, Contact us, To learn more about Optum or to get in touch with us, scan the QR code with your cell phone, Slide 4]

so Dr. Williams, Dr. Gorrindo, and Andy Kelly. Thank you for sharing your insights and experiences with us today. There is going to be a QR code that shows up on the screen here for those attending the panel. If you're interested in next steps, certainly make use of that code. And then I want to thank you all for your time today. We look forward to hearing much more about the continued expansion of value-based programs for behavioral health care. And with that, I'll hand it back to Angie.

ANGIE STEWART VOICEOVER: Thank you so much, Alecia. And thank you, speakers, for your fantastic insights. Unfortunately, that is all the time we have for today. And I'd like to give a final thank you to Optum for sponsoring and helping to organize today's excellent webinar. A recording of this webinar will be made available on demand after the event concludes. Thank you, audience, for joining us and enjoy the rest of your day.