Healthcare Reimagined
On Healthcare reimagined, we speak with clinicians, entrepreneurs, and provider and payor executives who are innovating within US Healthcare.
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Healthcare Reimagined
Dr. Drew Pate - Chairman, Division of Psychiatry & Behavioral Health, LifeBridge Health
A month before the start of the Pandemic, Dr. Pate stepped into a new role at Lifebridge. As the Chairman of the Division of Psychiatry and Behavioral Health at LifeBridge Health, he was charged with uniting the behavioral health leadership of the 5 hospitals for psychiatry. We touched on a number of interesting topics throughout our discussion.
Cost of care: Maryland has a total cost of care model that uses a hospital rate setting commission to set rates across the state on a yearly basis in order to create budgets. While it has resulted in reasonable cost containment, it excludes mental health, psychiatry, and outpatient care.
Telehealth: Prior to the pandemic, Maryland Medicaid had a narrow definition of who could receive or deliver tele-health, which made it very restrictive, and inaccessible to most. That definition was relaxed based on CMS guidelines during the Pandemic, and allowed patients who couldn't travel to continue getting treatment. One of the main points Dr. Pate sought to drive home was that in psychiatry, there is no statistical difference in the effectiveness of care based on the mode of delivery. Though change came slowly, and was brought about in large part due to the Pandemic, there is now legislation in MD to make tele-health a permanent change.
One of the more shocking stats that Dr. Pate shared was that although there is a 2-4x higher cost associated with a co-morbid psychological diagnosis, as a country, we're spending half of what we spent 30 years ago on behavioral health services.
One of the quotes from our conversation that stuck with me touched on the disparity between the way physical and mental health are addressed in this country. "There are 2 health care systems in this country, which are separate and unequal. We have a medical system which is more open and permissive in the way its allowed to bill and admit and treat patients, and then we have a mental health system which is incredibly restrictive in terms of access to quality and to services. "
When I asked who was to blame for this, though Dr. Pate believes for-profit-payors are a large part of the problem, he also holds himself and his peers responsible. He noted that for a long time, his profession refused to meaningfully participate in a more medicalized approach to treatment, and in measurement based care.
When I asked Dr. Pate how we could make things better, he had several solutions:
- Reintegrate mental and physical health services.
- We should federally legislate medical necessity criteria, which currently have nothing to do with quality, and were created by MCO's.
- We have to legislate the types of organizations that are able to manage the healthcare of our systems - we should not allow for-profit insurance companies to be in the Managed Care business. Tens of billions of dollars in pure profit are being drawn out of the pockets of patients who have the greatest needs, since most of the big insurers manage most of the medicare and medicaid across the country.
- If we can provide folks with incentives to produce high quality care, that is one of the solutions to our health care criss. The more we can globally budget and include all services, and move towards national healthcare, the more we can improve healthcare.