StAMINA Releases Student-Led Podcast “Brain Waves”

On any given day, I would estimate that I listen to two or so hours of podcasts. Between a commute that’s often extended by traffic, an energetic dog that requires lengthy walks, and day-to-day chores made more enjoyable with interesting commentary, podcasts are a cornerstone to my everyday routine. It seems that I am not alone in this practice, with the number of Americans listening to podcasts consistently rising 10-20% from year to year. Podcasts allow people to conveniently explore new topics, indulge in their passions, find solidarity among their peers, and make valuable connections.

In September 2018, the Student Alliance for Mental Health Innovation and Action (StAMINA) hosted an “Ideathon” to convene students, parents, educators, and mental health professionals to brainstorm and prototype products and programs around the design challenge: How might we educate and empower families to prioritize youth mental health? One of the answers to this challenge? Quite appropriately, a podcast!

After eight months of student-driven work, StAMINA is releasing their podcast, “Brain Waves.” Students are all too often left out of the mental health conversation and have difficulty finding spaces to learn and discuss the challenges or questions they may have. By utilizing a popular and easily accessible platform to communicate educational and inspirational messages, StAMINA has created a pathway for students to get engaged. “Brain Waves” is StAMINA’s way of prioritizing and amplifying youth voices, increasing mental health awareness, and decreasing stigma. Through stories and interviews, you’ll hear the perspectives of students who tackle these issues in their everyday lives. The season kicks off with an in-depth exploration of the history, definitions, and advocacy surrounding mental health. Throughout the rest of the season, listeners can expect to learn about specific mental health illnesses as well as challenges all students face in their everyday lives. Tips and resources will be highlighted, both from student and expert perspectives.

You don’t have to be a student to listen to and benefit from “Brain Waves.” If you’re interested in incorporating student perspectives into your work, curious about youth experiences with mental health, or you care about improving adolescents’ well-being, “Brain Waves” is the podcast for you. Their first episode in now available for download on Apple Podcasts, Spotify, or wherever you get your podcasts. The season will feature 13 episodes, with a new one being released every Friday.

I have been fortunate enough to participate on the “Brain Waves” team throughout its development and am excited to see the impact that this initiative will have. The passion these students have for claiming their role in the combating the mental health crisis and helping their peers is unparalleled. As a self-proclaimed podcast aficionado, I can confirm that this podcast is one worth adding to your weekly lineup.

Mental Health Month a Time to Focus on the Connection between Physical and Mental Health

(Note: This guest piece was written by Marcie Timmerman, Executive Director of Mental Health America of Kentucky)

Marcie Timmerman
Executive Director
Mental Health America of Kentucky

Mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable. So much of what we do physically impacts us mentally. It is important to pay attention to both your physical health and your mental health, which can help you achieve overall wellness and set you on a path to recovery.

Did you know that Mental Health America (MHA) founded May as Mental Health Month back in 1949? That means this year marks MHA’s 70th year celebrating Mental Health Month! This May, Mental Health America of Kentucky is expanding its focus from 2018 and raising awareness about the connection between physical health and mental health, through the theme #4Mind4Body. We are exploring the topics of animal companionship, spirituality and religion, humor, work-life balance, and recreation and social connections as ways to boost mental health and general wellness.

A healthy lifestyle can help to prevent the onset or worsening of mental health conditions, as well as chronic conditions like heart disease, diabetes, and obesity. It can also help people recover from these conditions. For those dealing with a chronic health condition and the people who care for them, it can be especially important to focus on mental health. When dealing with dueling diagnoses, focusing on both physical and mental health concerns can be daunting but critically important in achieving overall wellness.

There are things you can do that may help. Finding a reason to laugh, going for a walk with a friend, meditating, playing with a pet, or working from home once a week can go a long way in making you both physically and mentally healthy. The company of animals – whether as pets or service animals – can have a profound impact on a person’s quality of life and ability to recover from illnesses. A pet can be a source of comfort and can help us to live mentally healthier lives. And whether you go to church, meditate daily, or simply find time to enjoy that cup of tea each morning while checking in with yourself– it can be important to connect with your spiritual side in order to find that mind-body connection.

Mental illnesses are real, and recovery is always the goal. Living a healthy lifestyle may not be easy but can be achieved by gradually making small changes and building on those successes. Finding the balance between work and play, the ups and downs of life, physical health, and mental health, can help you on the path towards focusing both #4Mind4Body.

Everyone has mental health. Isn’t it time we start taking care of it?

Concerned about yourself or someone you love? Take a free online mental health screening here.

“Opioids and the Workplace” Employer Roundtable Paves the Way for Continued Work

If you have visited the Kentuckiana Health Collaborative’s website in recent months, you may have noticed a small box in the lower right-hand corner of the home page. Minute by minute, hour by hour, and day by day this countdown marked the nearing release date of “Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery.” As part of the Kentucky Opioid Response Effort (KORE), the KHC spent the past year convening employers and key healthcare stakeholders alike to guide the development of a toolkit to provide recommendations and tools for employers to support their employees and their dependents in prevention, treatment, and recovery from opioid misuse and opioid use disorder (OUD).

As countdown ended on Thursday April 18, employers and other key healthcare stakeholders gathered at GE Appliance Park’s Monogram Hall for the release of the toolkit and to lay the foundation for next steps and implementation. The four-hour event, presented by the KHC Employer and Healthcare Purchaser Network, was full of presentations and discussions that explored the toolkit’s application and other relevant topics.

DIVERSE PERSPECTIVES BRING THE DISCUSSION FULL CIRCLE

Attendees kicked off the program by answering a poll about what they hoped to gain from the event.

To set the stage for the day, Patrick Kullman, an interventionist, shared his personal story of how an employer can be instrumental in supporting an employee facing substance and opioid related challenges. He was followed by addiction psychiatrist Dr. Kelly Clark, Addiction Crisis Solutions, who presented on facts and debunked myths surrounding opioids, addiction, and what it looks like in the workplace.

With the employee perspective at the forefront of the discussion and the record set straight on the chronic disease of addiction, a panel, moderated by Tiffany Cardwell, Mountjoy Chilton Medley, gave context to the challenges employers face in this area and opportunities for improvements. As employers and early adopters of strategies to address opioid misuse, Dr. Diana Han, GE Appliances, a Haier company, and Amanda Elder, LG&E and KU, highlighted their experiences and paths forward in adapting their data analytics and workplace policies to best support their employees and their dependents, as well as their business. Eric Bailly, Anthem, explored the health plan’s role as an employer partner for determining and provider optimal benefit design. Cynthia Doll, Fisher & Phillips, LLP, addressed many of the legalities that employers may need to consider. Highlights of the conversation included the available of Narcan in the workplace, workplace accommodations for employees on Medication Assisted Treatment (MAT), the identification and utilization of high-quality evidence-based treatment, and the Mental Health Parity and Addiction Equity Act (MHPAEA).

Panelists discuss challenges and paths forward in adapting policies to best support employees and their dependents, as well as their business.

As the lead author of “Opioids in the Workplace,” I presented on the toolkit itself, exploring what exactly employers can expect to learn from it and explaining how it can be used.

Dr. Brittney Allen and Dr. Katie Marks from the Kentucky Opioid Response Effort (KORE) closed out the day of by highlighting available community resources for people facing opioid related challenges, including Find Help Now KY and the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator.

EMPLOYERS TO DRIVE CONTINUED WORK

“Opioids and the Workplace: An Employer Toolkit for Supporting Prevention, Treatment, and Recovery” is now available on the KHC website.

Although the countdown is now at zero, the work is certainly not over. In the upcoming year, the KHC will continue to improve this toolkit based on industry advancements and employers’ needs and feedback. At the roundtable, attendees were offered a chance to communicate their needs and give input on the potential direction of the toolkit. Three key questions were presented:

  • The business community has an active role in supporting the health and well-being of their employees. What should be their primary role in addressing the opioid crisis?
  • What is your biggest personal obstacle in acknowledging substance use in your workplace?
  • What tools can help you overcome this obstacle?

A major theme of this discussion was employers’ role in addressing stigma and creating awareness among employees not only about opioid related risks and addiction, but about what their employer can do to support them. Challenges to fulfilling this role included communication among different parts of the workplace chain of command, lack of understanding around confidentiality, and community culture’s that lacked empathy. Tools to overcome these challenges aligned closely with what the toolkit already offers, but also called for increased interconnectedness and partnership among employers, employees, and community supports.

To continue this conversation, the KHC will be convening a cohort of employers to discuss the implementation of the recommendations presented in the toolkit. Additionally, the KHC will be taking an increased focus on how employers can play a role in chronic pain management – a prominent factor in the development of the opioid crisis. If you are an employer interested in getting involved with this cohort, please contact me at nmiddaugh@khcollaborative.org.

The KHC will also be offering a complementary webinar on May 15 from 12pm to 1pm to review the employer toolkit. The toolkit and registration for the webinar can be found here.

We know employers play an important role in driving health of their employees and their families. By continuing to engage and invest in their specific role of supporting them through opioid related challenges, employers will be best positioned to achieve optimal health and workplace outcomes.

KHC Highlights Work at the Rx Drug Abuse & Heroin Summit

For the past couple of years, Kentucky employers have come together to not only address the opioid crisis within their own population but at a broader community level through the Kentuckiana Health Collaborative, and we had the opportunity to highlight that work last week at the Rx Drug Abuse & Heroin Summit. The summit brings together stakeholders to discuss what’s working in prevention and treatment each year.

Dr. Kelly Clark, Dr. Diana Han, and I presented “Employers Respond: Kentuckiana Health Collaborative’s Evidence-Based Approach to Community Health.” Clark, a national expert on opioid use disorder, played a key role in the development of the KHC’s “Opioids and the Workplace” employer toolkit that was released this month. An addiction psychiatrist and KHC member, Clark is the immediate past president of the American Society of Addiction Medicine and founder of Addiction Crisis Solutions. Han, Global Medical Director for GE Appliances and KHC Co-Chair, has also played an integral role with her team in providing boots-on-the-ground feedback for the newly released toolkit.

Clark kicked off the session by explaining the differences between opioid use, misuse, dependence, and disorder and the current evidenced-based guidelines for opioid use disorder treatment. Han then discussed how the opioid epidemic is impacting Kentucky’s businesses and the significant commitment employers are making to identify strategies to better ensure employees and family members are being supported through prevention, treatment, and recovery. Finally, I presented how employers are coming together to find and share opioid-related best practices and how the coalition has prioritized opioid-related initiatives into all four pillars of its work:


Healthcare Measurement: Improving quality and value of care through measurement, alignment, and transparency

Selection of two opioid stewardship measures into the Kentucky Core Healthcare Measures Set

Service on the National Quality Forum’s Opioid Stewardship Committee


Community Health: Improving health and wellbeing

Development and distribution of the Screening, Brief Intervention, and Referral to Treatment guide to 4,000+ Kentucky providers

Partnership with Student Alliance for Mental Health Innovation and Action (StAMINA) to improve youth mental health


Employer and Healthcare Purchaser Network: Engaging employers to drive the Triple Aim goals

Creation and distribution of “Opioids and the Workplace” toolkit

Communication of relevant information in newsletter and action briefs


Education: Catalyzing transformation of healthcare through education, communication, and collaboration

Convening of an employer focus group on the impact and needs around opioid use disorder in the workplace

Hosting of an employer roundtable sharing opioid-related benefits and policy best practices

Hosting of two annual conferences with specific sessions around opioid use disorder


As part of my presentation, I spent a good deal of time focused on the “Opioids and the Workplace” toolkit that was developed through the KHC’s worksite addiction committee, a cross section of employers and opioid use disorder experts. The Kentucky Opioid Response Effort (KORE), which funded the development of the toolkit, has been very visionary about how employers can be key partners in the prevention, treatment, and recovery of opioid use disorder. One of the goals of our session was to help other communities engage the business community in their opioid-related efforts.

The “Opioid and the Workplace” toolkit was released this month with an employer roundtable. The KHC’s opioid toolkit has received excellent reviews and will be distributed more widely in the coming months at the Kentucky Chamber’s opioid summit and the Kennedy Forum Annual Meeting in Chicago this summer. If you would like to learn more about the toolkit, be sure to sign up for our webinar on May 15. The webinar will feature Natalie Middaugh, KHC Community Health Program Manager, who led the development of the toolkit.

The Rx Drug Abuse & Heroin Summit has Kentucky roots and began in 2012 under the leadership of Operation UNITE and U.S. Rep. Harold “Hal” Rogers (KY-5th). Notable speakers in past years have included President Barack Obama in 2016, Congressmen Patrick Kennedy and Newt Gingrich in 2017, former President Bill Clinton and Counselor to the President Kellyanne Conway in 2018. This year, President Donald Trump and First Lady Melania Trump addressed attendees. Unfortunately, I didn’t get to rub elbows with any of the notable speakers, but I did make a commitment to put this event on the KHC’s list of conferences to attend next year.

Mental Health Matters: Importance, Integration, and Intervention Opportunities

(Note: this guest piece was written by Elizabeth Archer-Nanda, DNP, APRN, PMHCNS-BC. Elizabeth is the manager of the Behavioral Oncology Program at Norton Healthcare, which cares for the emotional and mental health needs of oncology patients and their families. In this piece, she shares her reflections from the KHC 2019 Annual Conference, which she attended.)

Last month, the Kentuckiana Health Collaborative hosted their fifth annual conference focusing on opportunities to create high value behavioral healthcare across the region. The room was full of community and national partners and offered comprehensive discussions around closing the gap on how to approach the treatment of mental health and substance use disorders. Speakers gave personal reflections on the impact mental illness has on individuals close to them as well as prospects for how purchasers and stakeholders may address foundational barriers to quality mental health care.

Paul Gionfriddo, President and CEO of Mental Health America, Inc. provided an overview of mental health services in the U.S. from 1970 to current day by poignantly comparing and contrasting his family’s experiences navigating mental health services for his son, Tim, versus medical care for his daughter, Larissa.

Although Larissa ultimately died due to breast cancer at age 34, her health journey was met with opportunity for personal growth throughout her four-year illness. Tim’s health journey, however, which began at age five and now spans close to three decades, has been riddled with years of pending diagnoses, deteriorating mental health, homelessness, and – on more than one occasion – imprisonment.

Following Gionfriddo’s talk, Mike Thompson highlighted that for mental health care to be truly accessible, barriers must be removed, including:

  • eliminating obstacles to provider credentialing,
  • improving, vastly, the mental health provider reimbursement models, and
  • Increasing incentives to attract psychiatrically trained providers to work within health systems where the majority of patients are receiving care.

The impetus for these recommendations is solid. The prevalence of mental health conditions far exceeds the number of available psychiatric providers trained to treat these conditions. The healthcare system must begin to think creatively regarding how to care for individuals with mental health conditions. Only 20 percent of individuals with co-occurring mental health conditions will receive specialty mental health and/or substance use care intervention. Meanwhile, approximately 21 percent receive care through routine primary care; this leaves the remaining 59 percent of individuals not to receive care at all (Robinson & Reiter, 2016). The ability to weave the care of mental health conditions throughout routine care provides an enhanced opportunity to promote earlier intervention and adequate treatment for co-occurring mental health and substance use conditions.

Both presenters reinforced the 2017 position statement by the American Psychiatric Nurses Association that “whole health begins with mental health.” Specifically, the negative impacts of mental health and substance use on our productivity and wellness as a nation are widely known, yet movement toward early intervention for mental health conditions remains scarce in most communities.

This is reflected in the research.

Approximately 56 million American adults experience mental health or substance use conditions each year, with three-quarters of all chronic mental health conditions beginning by age 24 and the first intervention occurring almost 10 years later. Among individuals affiliated, 68 percent have co-occurring medical conditions, as was discussed by Intermountain Healthcare’s Brenda Reiss-Brennan at last year’s KHC Annual Conference. Further, worldwide depression is the leading cause of disability and by 2020 it is estimated that there will be one death by suicide every 20 seconds. Lastly, the cost of (untreated) mental health and substance use conditions in the U.S. is equally staggering at $201 billion annually – exceeding all other conditions.

A shift must occur in which we build systems capable of caring for a whole person’s health needs at the onset of symptom distress across their healthcare journey, rather than providing reactive crisis related care intervention. An individual’s health relies on their mental health to fully embrace the challenges presented in life. The ability to access care that embraces mental health as part of personhood is needed in order to truly promote health and wellness.

Gionfriddo’s honest account of two of his children’s journeys highlighted the disparity experienced among those with mental illness. He urged attendees to consider what might be if mental health conditions were met with the same resource allocation as other illnesses. What might happen if instead of attempting to “rescue” individuals from already debilitating symptoms of mental illness, earlier intervention strategies were employed to treat individuals before advanced stages of mental illness?  

As a psychiatric advanced practice nurse embedded within an oncology setting, we widely recognize the disadvantage of a later stage cancer diagnosis. The campaign launched by Mental Health America to treat mental illness before stage IV should not be a goal that is considered unattainable; rather, it is a call to action for each of us to begin movement toward reducing barriers to care and enhancing lives.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

We packed a ton of great content into a small amount of time, so we didn’t get to all of the questions submitted by participants on our web application.

Let’s remedy that.

The KHC has spent the last couple of weeks following up with speakers on these questions, and we’ve compiled them below. Note that some answers have been edited for space.


“For Mental Health, Let’s Act Before Stage 4”

Paul Gionfriddo | President and CEO | Mental Health America

In other countries they have programs to integrate mental health treatment and the community. What do you think the barriers are to doing that in the US?

We tend to favor the system with which we have the most experience. In the United States, that has been characterized by separate and unequal care, first in state hospitals, now in jails and prisons, for people with mental illnesses. Our challenge is to change the way we think about mental health conditions, because thinking about them as public safety concerns (i.e. dangerous to self or others) makes it hard to fully integrate the services and treatment for them into the community.

How do we get people to seek treatment without the fear of retribution or ostracization?

First, we should screen everyone for mental health conditions as ubiquitously as we screen for blood pressure in adults, and hearing and vision in children. That’s what’s recommended for everyone over the age of 11 by the U.S. Preventive Services Task Force, but it’s just not done. By screening, we normalize mental health and mental health care and make this a part of overall health and health care. And then we can treat right away when it’s warranted, instead of letting up to ten years pass between the emergence of symptoms and getting the right diagnosis and treatment.


“Roadmap for Employers to Achieve High Value Behavioral Healthcare”

Mike Thompson | President and CEO | National Alliance of Healthcare Purchaser Coalitions

The National Alliance recommends ensuring health plans have network adequacy for behavioral health services. How is this best measured?

Most health plans have directory of network psychiatrists. However, few know whether those psychiatrists are taking new patients – ask them, by specialty if possible (eg child psychiatrists), what percentage of network behavioral health specialists are taking new patients.

Most health plans measure access to network providers by driving distance but few know or monitor how long it takes to schedule an appointment – ask them, by specialty if possible, what is the average wait time for an appointment for a new patient?

Most health plans will indicate that it is difficult to get behavioral health specialists to join networks but few have taken a positive step toward change this trend – ask them, by specialty if possible, how do network reimbursement rates for behavioral health specialists compare to non-behavioral health specialists? How do network reimbursement rates compare to out-of-network charges for behavioral health specialists? What is you plan to improve network participation rates of behavioral health specialist?

What do you think has shifted within our world society to now have this be recognized as a top 5 issues when it’s always been perceived as a personal and economic issue?

Three things that have contributed to Mental Health rising to be among the top issues facing companies and organizations globally:

1) growing recognition of the huge and disproportionate economic impact of the issue to companies and societies, well beyond the costs of treatment (e.g. impact on co-morbidity, impact on productivity. Impact on caregivers).

2) growing understanding of the physical and environment underpinning of behavioral health issues (genetics, social determinants and trauma, brain science) as well as how to prevent and treat it.

3) cultural change giving a growing voice to its wide prevalence and new acceptance as a human condition rather than a character flaw. This has been led by advocates, celebrities, businesses and policy makers.


“Unaddressed Drivers of Poor Mental Health (PANEL)”

Aja Barber | Community Health Administrator, Center for Health Equity | Louisville Metro Dept of Public Health

When is the next Health Equity Report slated to be released?

In keeping with the timeline so far, we’re anticipating releasing a 2020 or 2021 Health Equity Report.

From the CHE perspective, what can be done on a policy level to help close mental health disparities throughout our community?

We’re currently in process of building the legislative agenda for Public Health & Wellness so I don’t have a specific answer to this yet. But I do believe policies ensuring physical and mental healthcare as a guaranteed right for every individual are critical first steps.

Danesh Mazloomdoost, MD | Founder | Wellward Regenerative Medicine

What can we do as community members, professionals, and advocates for change to get the appropriate word out about the model that Wellward works off of?

Wellward looks for opportunities to work with the community and educating both patients and clinicians on this paradigm shift in addressing painful conditions. Any opportunity to speak or inform the public about Fifty Shades of Pain would be welcomed. While the book became an international bestseller, any purchase or review helps boost its visibility to the public, even a $0.99 Kindle purchase does a lot. Our goal is to simply create greater awareness about sustainable ways to think about pain in improved the health of our community such that pain problems become less prevalent. Your assistance in spreading that message in any capacity is helpful.


“Incenting Recovery Rather than Relapse through Bundled Payments (PANEL)”

Kelly Clark, MD | Founder, Addiction Crisis Solutions | President, American Society of Addiction Medicine

David Smith | Founder| Third Horizon Strategies

In a bundled payment model for medications treatment for Opioid Use Disorder, what non medicine therapies should be included?

Clark: In the PCOAT payment model, medications themselves are not core services/products being delivered.  The core elements to be covered are those consistent with the ASAM Guidelines for Use of Medications in the Treatment of Addiction Involving Opioids: Medical services for diagnosis, treatment planning and medication management; core psychosocial interventions including the levels of counselling which can be done by the prescriber with sufficient time and expertise; and care coordination activities.  There are different approaches in this bundle, depending on the capacity and capabilities of the provider/provider group.  More information can be found here.

Smith: We would be deferential to the professionals empaneled to provide care for the patient. The entire ARMH-APM turns on the axis of a treatment and recovery plan that addresses a range of mental and social considerations (in addition to clinical) that support a patient’s recovery. The clinical professionals and support teams that work with the patients are required to work with the patient in identifying specific therapies, in addition to addressing exogenous determinants that would interfere with the recovery plan and facilitate resources accordingly. The concept APM does set general guidelines regarding the need for evidence-based approaches to therapies holistically, but we also believe that the payment mechanism and the associated risk will play a role in motivating the underlying delivery system to provide non-medical services and therapies in a way that will sustain impact.

How do we move to a model that values quality care and implements metrics around performance?

Clark: We start by defining quality and performance. We can use the Triple Aim concept of Value = Quality/Cost, but quality of care in medical systems is an ever-expanding construct…Beginning by ensuring baseline process measures are used to ensure standards of care are being met – we don’t want to incent performance of cost savings by allowing care considered not to meet baseline standard of care quality metrics…Next, we need to consider the goals of managing chronic diseases: Decreased disease related morbidity, early mortality, total cost of care, and increased functioning/quality of life…To be operationalized, “Quality” is a very granular concept, and we must move boldly ahead to save lives.

Smith: It’s a collaborative enterprise and requires a payer to lean into a payment model that provides adequate resources for care that has a long-term orientation and supports the delivery system in its integration for the purpose of a more seamless patient experience. Our approach is to facilitate this through a risk-bearing provider entity capable of centrally managing a care team and the associated care transitions through a network of providers that engage the patient based on need and subsequently (or initially, depending on the patient) supports the patient’s assimilation back into their environment (or a new environment depending on the underlying circumstances).

Why don’t all clinics require counseling along with the administration of these medications? How is a patient supposed to differentiate between these clinics?

Clark: In an ideal world, people with any disease would have access to whatever interventions they need to help them manage their chronic disease at the time they need it, and also have access to things which would possibly benefit them. In the case of addiction, an individual at one point in time may require 24-hour care in addition to ongoing medication management, or require intensive outpatient care at another point in time, or require no further outpatient services than meetings with their prescriber. There is no one size fits all… 

We do not expect people with brain or other diseases to “talk their way out of their illness.” The currently available data we have for opioid addiction does not show improved outcomes by adding 60-minute formal counselling sessions to the regular physician medication management visits (which include supportive counselling and other techniques)…And forcing people into higher than needed levels of care does not improve outcomes – I have seen it simply discourage them from receiving the care they do need. Finally, there are structural and payment barriers to providing psychotherapy (done by licensed masters level professionals) in the same offices as prescribers which include licensing and payment issues as well as a shortage of either psychotherapists or counselors of lower educational requirements.

Patients and their families currently have few ways to determine the quality of care being provided by any provider or program. The ASAM/CARF certification, as well as the proposed Shatterproof rating system, are looking to make information about programs more transparent by means of independent site surveys (ASAM/CARF) or provider/patient/payer data collection (Shatterproof).

Patients with opioid addiction and their families can look here for information:

http://eguideline.guidelinecentral.com/i/706017-asam-opioid-patient-piece/0?

https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Where are these programs being piloted?

Clark: The P-COAT model does not currently have formal piloting occurring, but it does delineate the types of bundled payment approaches which are already being provided in some communities by forward thinking health plans working with engaged providers. 

Smith: Like everything in health care, we are living under our potential. We don’t get the results we pay for and have developed a delivery system that receives enormous financial benefit when patients have a recovery disruption or cycle through recovery. Our perverse incentives prevent us from driving the type of alignment across this diffuse ecosystem of resources that does a tremendous disservice to patients and their families.

Are recovery models serving people equally across socio-economic levels, including the homeless?

Smith: Today, no, not generally (in my opinion). This is where we need to go. Most Americans can access some form of coverage (non-expansion states notwithstanding). Even for those Americans unable to access coverage, the financial burden of addiction on our entire emergency infrastructure creates an economic rationale for society to provide these services. If we build a delivery model that supports this and link patients under the auspices of their coverage/non-coverage considerations, an underlying economic calculus that isolates value for parties (government, society, payer, etc.) should be a catalyst for establishing the right access to services for patients.

KHC Continues Conversation Around Behavioral Health with Successful Annual Conference

At the KHC 2018 Annual Conference, “Connecting Mental and Physical Health,” our organization pledged to continue to focus on the what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. In addition to the many projects and grants related to behavioral health that we’ve had in the last year, our KHC 2019 Annual Conference continued the conversation started in 2018, titled “High Value Behavioral Healthcare.”

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Details about the conference agenda and speakers can be found here, but some of the highlights included:

  • A motivating opening speech by Mental Health America President and CEO Paul Gionfriddo, which got a standing ovation – a first ever for the KHC Annual Conference. If you are unfamiliar with Gionfriddo’s story or work, take few minutes to read his essay for “Health Affairs.”
  • An employer roadmap for achieving high value behavioral healthcare, developed by the National Alliance of Healthcare Purchaser Coalitions, to ensure that organizations’ health plans drive high value care.
  • Panels on the unaddressed drivers and contributors of behavioral health and new bundled payments to incent addiction recovery. Stay tuned for follow-ups with more discussion from these panelists on our blog!
  • A story of successful implementation of behavioral telehealth medical services by the Kentucky Employees’ Health Plan, presented by Commissioner Jenny Goins.

New Strategies Improve Interaction, Engagement

A record 212 individuals attended this year’s conference, and 75 of those individuals attended the pre-conference reception the evening before the conference, where they were able to meet with other attendees, conference speakers, sponsors, and exhibitors. Although always a challenging endeavor because of people’s demanding schedules, there was an increase of more the 40% in attendance and more food had to be ordered to accommodate. A fantastic problem to have!

KHC 2019 Annual Conference attendees listen to a panel.

The KHC also implemented a new system of commenting and asking questions, through Slido.com, which allowed more questions to be asked more efficiently. Compared to the previous app that we had used, this got a lot more engagement. We were able to archive additional questions that weren’t addressed and followed up with our speakers on them – stay tuned for those answers, coming soon!

The comments received from participants were overall very positive and educational. We are reviewing the feedback now and will use it to guide our future conference planning.

KHC conference achieved directive and financial objectives

The KHC staff, Executive Committee, and members appreciate our community coming together for another outstanding conference examining how to create a high value behavioral healthcare system. The conference met attendee’s expectations and provided finances to further the work of the KHC. The success of the conference would not have been possible without the support of our sponsors and exhibitors. A huge thank you to our Gold sponsors Pacira Pharmaceutical and Artemis Health, who each presented a showcase. An immense thank you to our partner Norton Healthcare, who has been a Silver sponsor for the fifth year. We also want to thank our partners Kentucky Primary Care Association and LG&E-KU for being Bronze sponsors. This year many of our partners and community organizations sponsored tables, allowing many of their employees and associates to attend the conference. A big thank you to table sponsors Norton Healthcare, Baptist Health, CHI Saint Joseph Health Partners/Our Lady of Peace, Anthem, Novo Nordisk, Department of Behavioral Health, Developmental, and Intellectual Disabilities, Trager Institute, Blue and Co. CPA, Commonwealth of Kentucky Personnel Cabinet, and Louisville Society of Human Resource Management. A pre-conference reception allowed attendees, exhibitors, and speakers to network. Thank you to Humana for sponsoring the reception. Finally, we want to say thank you to all of the exhibitors and attendees who participated in this year’s conference.

There is no rest when it comes to the KHC Annual Conference, so we’ve already begun planning the KHC 2020 Annual Conference, our sixth. Save the date for March 11, 2020, and stay tuned for the conference title!

KHC Fifth Annual Conference to Focus on High Value Behavioral Healthcare

On March 5, the KHC’s annual conference will move from a broad based view of value-based healthcare innovation to a deep dive into what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. This conference will examine how employers, payers, and providers can ensure individuals have access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Mental health and substance use disorder continues to rise to the top of many healthcare purchasers’ costliest and most prevalent conditions. Yet, these conditions are not treated by plans and providers the same way as physical health conditions. In fact, mental health is the only chronic disease in America that is not treated until Stage IV. And individuals facing substance use disorder continue to receive treatment that does not comply with current medical recommendations. Research consistently demonstrates smaller payments to behavioral health providers and higher out-of-network use for patients with mental health and substance use disorders, despite parity being law. All of these barriers create a system that often does not meet individuals’ behavioral healthcare needs.

The night before the conference a networking reception will be held, during which a short role-playing exercise by local high school students and a psychologist will demonstrate to attendees how adults and students can have positive mental health dialogue. Appetizers and drinks will be served, and exhibitors will be available.

The morning of the annual conference will kick off with Paul Gionfriddo, President and CEO of Mental Health America. Gionfriddo will provide an overview of mental health status and access in the United States, with a personal reflection on how, through policy decisions, he helped create a flawed mental health system that has failed millions, including his son.

Dr. Stephen O’Connor, University of Louisville Department of Psychiatry and Behavioral Sciences, will moderate four panelists, who will discuss several drivers and contributors to poor mental health often overlooked:

  • Dr. Joseph Bargione, a school psychologist, will discuss how healthcare networks can address adverse childhood experiences (ACEs) in patients
  • Dr. Danesh Mazloomost, anesthesiologist and pain management specialist, will discuss a new framework for treating pain that avoids addiction and has better outcomes
  • Aja Barber from Louisville Metro’s Center for Health Equity will explain how the relationship between mental health, social determinants of health, and institutionalized systems of power/oppression keep us from experiencing the kind of world we all deserve
  • Allison Tu, StAMINA and student at duPont Manual High School, will share youth insights into the factors influencing mental health from a series of focus groups conducted with high schoolers across Kentucky

Mike Thompson, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, will discuss the roadmap and checklist his organization developed for employers to use in designing high value behavioral healthcare. All attendees will receive a copy of the roadmap, which includes an assessment of current performance of health plans and behavioral health organizations across key areas. The KHC is a member of the National Alliance, which represents more than 50 business coalitions in the U.S., supporting more than 12,000 healthcare purchasers and 45 million Americans.

A light continues to shine on the fact that many patients do not get appropriate treatment for substance use disorder. As a result, two new payment models have been designed to help incent effective treatment and recovery. Dr. Kelly Clark, an addiction psychiatrist and the President of the American Society of Addiction Medicine, will present the new Patient-Centered Opioid Addiction Treatment (P-COAT). The model is designed to increase the utilization of office-based treatment of opioid use disorder by providing adequate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services. David Smith from Third Horizon Strategies will then discuss the new Addiction Recovery Medical Home (ARMH) receiving significant national attention. The model establishes a continuum of care from the time a patient enters an acute-care setting and is diagnosed with a substance use disorder through their recovery process. ARMH incorporates quality payments and bonuses for achieving certain outcomes and cost savings.

Telehealth has quickly gained the attention of employers and payers working to increase network adequacy of medical and behavioral health providers. Commissioner Jenny Goins will present examples of how Kentucky’s Department of Employee Insurance has implemented telehealth behavioral health along with the data related to utilization and financial savings.

Dr. Diana Han, Global Medical Director for Louisville-based GE Appliances, a Haier company will explore the reactions of local health plans to the day’s presentations. She will discuss with plans how their organizations are innovating to help individuals gain access to timely, effective, and affordable behavioral healthcare. Eric Bailly from Anthem and Dr. Stephen Houghland from Passport Health Plan will discuss their latest strategies to address network adequacy of high quality behavioral health services to their members.

Several other behavioral health innovations will be highlighted at the conference as well. Attendees will learn about a new non-opioid alternative for reducing opioid exposure post-surgery. A new MOMS Partnership that makes mental health within reach of over-burdened, under-resourced mothers will be presented. The KHC will will share the six priority behavioral healthcare measures selected to align Kentucky’s primary care providers and will provide a sneak peek into the soon-to-be released toolkit for employers on benefit design and workplace policies for supporting prevention, treatment, and recovery.

The conference will provide excellent networking opportunities for all types of healthcare stakeholders. Over 20 exhibitors will be available to discuss their latest products and services. If you have any questions about the conference, be sure to call the KHC office at 502-238-3603 or email info@khcollaborative.org. We hope to see you there next month!

SBIRT: Why Should I Care?

(Note: this guest post was written by Mallori De-Salle, Outreach Coordinator and Lead SBIRT Trainer, Indiana Prevention Resource Center)

I hate thinking about what I’m not doing ‘right’ when it comes to my health. I eat pizza. I’m not overweight, so it must not be a problem. I add salt to my food (without tasting it). I don’t have high blood pressure, so it must not a problem. I drink coffee in the morning, mid-day, and sometimes in the evening. I still sleep, so it must not a problem. This is my logic when deciding if I have to make a change. If it isn’t a problem, I don’t think about the health behavior at all. So, why should I care about how much alcohol I drink, if it’s not a problem?

Does this sound familiar? It’s not a problem, so why even think about it? Is the lack of highly problematic symptoms of an illness the only way to measure the existence or severity of a health problem? Or could we as an “illness focused” culture be missing an opportunity to focus on wellness instead of lack of illness?

For decades, our healthcare system has operated under the belief that “health” is defined through the absence of symptoms. In other words, concerns aren’t addressed or even considered a problem until the symptoms can be diagnosed. But, is it possible that problems exist on a wider spectrum? Is it possible that you or I could improve our health by reducing our risks even before problems are visible? Think about using a seat belt. Most of us wear seat belts automatically. It’s a habit (thank you public health) that we no longer think about. We wear seat belts, but not because it makes us better drivers or because we plan to crash. We wear seat belts as prevention because it lowers our risk IF we experience a situation where harm is possible. Not wearing a seat belt increases your “risk” for harm, even in minor vehicle incidents and most importantly, in severe circumstances. Wearing a seat belt doesn’t remove the risk of crashing; it reduces the risk of harm WHEN a crash occurs. Seat belts lower risk for a problem that doesn’t even exist yet.

Seat belts are fairly concrete (actually they are fabric, but you understand). However, other health behaviors, such as alcohol or substance use, can be more abstract. What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts? Public health is back again with a new preventive practice to do just that!

SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is a public health approach which changes how we view alcohol use. Instead of simply looking for indications of diagnosable problems, it examines all levels of use and how use impacts all levels of wellness. This suggests that wellness can be enhanced by understanding that health is not simply the absence of illness. SBIRT asks all patients (even the little neighbor lady down the street) annually about their alcohol or substance use. Doing so helps increase the chances that a person considers how their level of use is influencing their quality of health. SBIRT is not a diagnostic process, but instead a conversation that helps support intrinsic motivation for behaviors that support wellness and not just the avoidance of illness (in this case, addiction). SBIRT, like all other new movements, viewpoints and culture shifts (remember how people hated seat belts at first?) takes time to feel comfortable. Once it is in place, everyone starts to think, “Why haven’t we been doing this?” So, buckle up! SBIRT is taking the driver’s seat and letting us know that improving our health, wellness, and happiness is why we should care.

For more information on SBIRT or to download KHC’s toolkit for primary care providers, click here

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.