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Becker’s Healthcare Podcast
Dr. Tom Allen, Executive Medical Director, Behavioral Health, Blue Cross and Blue Shield
00:09:39
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- [00:00]
A
Evernorth brings the power of wonder and relentless innovation to create world class pharmacy care and benefits solutions. Barriers to care can lead to gaps in care which can drive up the total cost of care. Our capabilities work seamlessly together to create innovative pharmacy care and benefit solutions for today and tomorrow. Our connected health services make the treatment, prediction and prevention of health care's most complex conditions easier and more accessible as we drive organizations and people forward.
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B
This is Haley Rutger with the Beckers Payer Podcast and we are recording live at the Becker's third annual Spring Payer Issues Roundtable. Today I am thrilled to be joined by Dr. Tom Allen, executive Medical Director of Behavioral Health at Blue Cross and Blue Shield of Illinois. Tom, thank you so much for joining me today. Can you go ahead and get us started by sharing a little bit about yourself and your background?
- [00:51]
C
Sure. Well, thanks for having me. So I am a psychiatrist by training. I also trained in hospice and palliative medicine and I work primarily with our Illinois Medicaid plan. And in my role, I provide clinical leadership to our case management team that helps our members get the care they need, but also to our utilization management team that helps our members get the right care in the right place at the right time.
- [01:19]
B
Well, that's amazing. Thank you so much for that introduction. Now, to start off our conversation today, I'd like to talk about balancing affordability and quality. So how is your organization innovating to manage the cost of care while maintaining or improving member outcomes?
- [01:35]
C
Well, you probably know this, but over the last 10 years or so, the rates of depression and anxiety have increased significantly nationwide. I just read a recent study by the CDC that showed that rates of depression have doubled in the last 10 years. So about one in eight people now has depression. So, you know, given the higher need, there's increased need to find treatment for people who need it. And there are certainly many different creative solutions that as a, as a payer we've, we've had one in particular is increasing the availability of telehealth. So, you know, helping people, you know, get the care they need even when it might be challenging for them. So, you know, whether they have challenges with transportation or challenges, you know, getting to a certain location. So we've, we've increased our capacity to provide telehealth. One of our providers is headway, which is a very unique telehealth provider and that they have a nationwide presence, but also they, they have a search engine so people can find a provider based on their preference. So if somebody wants somebody of a particular who speaks a certain language or certain ethnicity or gender. And those are really important because it's important to be able to connect with the person you're meeting with and who's, who's helping to treat your behavioral health condition.
- [03:09]
B
Absolutely. And in the beginning there you said something about how anxiety and depression and disorders like that have been increased in the last 10 years. Have there been any studies or anything that would indicate why that might be?
- [03:21]
C
That's a good question. So obviously Covid was a big factor, significant loss that accompanied that. There have been increased trends toward increased social isolation. You know, definitely economic insecurity is a factor. One demographic where we're seeing some of the highest prevalence is teenage girls. So age 12 to 19. It's about one in four is the prevalence, which is about twice as much as it is in the general population. And so this could be from a variety of factors, not least of which is probably social media. So yeah, definitely. I think it's not a one size fits all approach to treatment of mental illness. You really have to understand these individual segments of the population and their unique needs and then provide a unique solution for them.
- [04:12]
B
Absolutely. And in an ever evolving regulatory landscape, what best practices or tools does your organization rely on to keep quality of care at the forefront?
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C
Well, I think what's really interesting lately is providers and payers are becoming less divided and we're working more closely in sharing data. So as a payer, we get claims data so we can find out about prevalence of certain diagnoses and what kind of treatment people are receiving. But we're also getting information from providers like shared health records. And providers also give us, in the mental health space, there's measurement based care. So we find out using certain instruments, certain tools, how severe one's depression is or one's anxiety is. And we can follow that over time. So we can, we can understand our membership in terms of their needs, the treatment they're getting, but we can also identify rising risk and can intervene not only through our case management program, but also through our network relations and working with our providers to provide creative solutions and innovative service delivery and meeting members health related social needs. There's a whole, whole lot of areas that were as a pair we're able to intervene in now.
- [05:35]
B
Absolutely. That's fascinating. Now I kind of want to pivot the conversation a little bit to member satisfaction, which is essential to thrive in today's competitive health care market. So what experience or engagement strategies have proven effective for your organization and how are you measuring that success?
- [05:52]
C
Yeah, you know as in Blue Cross and Blue Shield of Illinois, our main focus is on member experience. So making sure that they're getting their needs met, but also that they feel comfortable engaging with the healthcare system. So as a payer we can, we can essentially help them navigate this and provide resources for them. One innovative solution we've had recently is using digital solutions for addressing the mental health needs of our members. So Learn to Live is one of them, which is a self directed cognitive behavioral therapy tool and also coaching for people who struggle with anxiety or depression or substance use disorders to help them feel more in charge, in control of taking care of their own underlying mental health conditions.
- [06:44]
B
Would you say that with increased advancements in technology it's easier to satisfy your members?
- [06:50]
C
Absolutely, yes. I mean, you think of 10, 20 years ago when it comes to the main solution was going to a brick and mortar location to see a psychiatrist or a therapist. And now it's really opened up a lot of different opportunities. And one positive kind of way of looking at the last 10 years is it's increased awareness of mental health condition and it's reduced stigma. So people are feeling more comfortable and less stigmatized in saying that they're having some challenges.
- [07:20]
B
Absolutely. Thank you so much for laying that out for us. And for my final question today, I want to talk a little bit more about the future of the payer space. So what do you see are the biggest opportunities for payers to lead the charge in transforming care delivery and driving better outcomes for all stakeholders?
- [07:35]
C
Well, one, one benefit of working at Blue Cross and Blue Shield of Illinois is where we're member owned and so the profits we get go toward improving members health. And so this is an opportunity for us to invest in different approaches. Whether it's addressing social determinants of health or creative service deliveries, or working closely with partners to incentivize them for certain outcomes. Those are all really important. I think one approach also is kind of bridging the divide that historically has been there between providers and payers. There are more opportunities for us to collaborate, to share risk, to have more input into and more kind of engagement and health outcomes, but also bridging the divide between behavioral health and physical health. I mean, it's really artificial in a lot of ways. It doesn't need to be there where you know, we're a whole person. So when you go to see a primary care provider, you know, they're checking your vitals and doing a physical examination, but also needing to check in about how the person's doing in terms of their mental health. So it becomes more of a, you know, it's a holistic view that I think presents a lot of opportunities for, for collaboration moving forward.
- [08:55]
B
Absolutely. And before we wrap up here, is there anything else that we didn't talk about today that you'd like to mention for our viewers?
- [09:03]
C
I think it's no, it's it's an exciting time. And I think one of the biggest excitement, one of the biggest excitements I have is using data, and we're having a lot of more opportunities to understand more about our members and our patients and using that data to improve health, not only for individuals, but also on a population basis. So it's an exciting time.
- [09:26]
B
Well, Dr. Allen, I've really enjoyed our conversation today. Again, this is Hayley Rutger recording live at the Becker's 3rd Annual Spring Parent Issues Roundtable. Thank you so much.
- [09:36]
C
Thank you.