“Reducing the occurrence of comorbid mental and physical disorders will require an integrated model combining medical and behavioral health care services. The window of opportunity is open for health insurers and employers to invest in employee assistance programs and telehealth platforms and build on a newfound acceptance of mental health services. Additionally, health care providers can mitigate the cost of care and improve their outcomes with an increased focus on interdisciplinary training that accounts for the common occurrence of both physical and mental health conditions. With a new approach to mental health services, we will see a noticeable decrease of stress levels, happier patients, and higher productivity in the workplace.”

Christopher Valerian is a health care executive.

He shares his story and discusses his KevinMD article, “New strategies are needed for mental health treatment.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show, we have Christopher Valerian. He’s a physician and health care executive. He wrote the KevinMD article “New strategies are needed for mental health treatment.” Chris, welcome to the show.

Christopher Valerian: Thank you, Kevin. I appreciate it. Good to be here.

Kevin Pho: We’ll get to the article in a little bit, but first off, can you share your story and journey to where you are today?

Christopher Valerian: Sure, happy to, Kevin. Thanks. So, I’m Chris Valerian. I’m an ER physician by background and practiced for a little over 20 years. I went back early in my career and was fortunate enough to be able to get an MBA, so that I could understand what the business people were talking about. As I was moving through my career, I was able to see health care from several different angles. I was a hospital executive in a variety of C-suite roles, from community hospitals all the way up to a national chain as well.

Then I got recruited over to the payer side and worked at the Blues, regional carriers, and Cigna as well. It was really in that role that I found my passion around population health and care management interventions around population health, which we can talk about a little bit in the article later. And then finally, I did a short stint in the private equity world, making health care investments and looking at it from there. So I’ve really had a well-rounded career thus far.

Currently, I’m the chief medical officer of Uprise Health, in which I guide all of the clinical development, and we offer integrated behavioral medical services for EAP, which is where the origin of the article came from.

Kevin Pho: On the show, we always talk about why physicians need to pursue more leadership positions, so that hopefully we can have more physicians have a say in terms of the decisions health care organizations make. You have that lens. So, through your experience as a health care executive, what would you say are some of the ways that physicians can go over to the leadership side, or learn some of these leadership skills that they may not have known or learned during training?

Christopher Valerian: Sure, it’s a great point, and we do need more of us out there, no doubt about it. For me, I was fortunate enough that I started with committee work. So I’d recommend starting at your local level, whatever role you’re in. If you’re a community-based physician on staff at a hospital, or if you’re in a large medical group practice, start asking for participation in either community committees, whether it’s quality committees or whatever else is available to you in your local environment. Start to get that exposure, right? Start to get those conversations going. Learn from the people around you. Even if there aren’t others, I’m sure there are some physician executives around there, and it really gives you the opportunity to get that exposure.

If you have the opportunity beyond that to get some sort of formal education in the business world, that would be good too. It’s certainly not required. Like I said, I went for a formal master’s program; everyone doesn’t have to do that. I think there are several certificate programs out there for physicians in the business world and leadership world that make a lot of sense too. So again, it’s more about seeking out that understanding for those areas where we really need to act as a bridge and a translator across the health care system.

Kevin Pho: Now, as you reflect on making that transition from your clinical role into the variety of nonclinical roles that you had later in your career, what are some of the obstacles and challenges that you faced, and how did you overcome those?

Christopher Valerian: Sure. So the first thing you have to get over is that you are not the king of the castle. This is not a physician mindset. When you’re out in the leadership role, your opinion is one of many, usually, especially depending on the size of the organization. You have to learn how to work well with others and listen to other opinions. You may be an expert in your clinical field, but you are not necessarily an expert in that room. So my advice would be to listen to those around you and be a team player. You really have to take that clinical hat off for just a moment and see the world through others’ eyes.

Kevin Pho: All right, let’s transition into your KevinMD article. It’s titled “New strategies are needed for mental health treatment.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Christopher Valerian: Sure, absolutely. As I mentioned, I’ve had a passion for population health for quite some time, and a subcomponent of that is really the integration between behavioral health and physical health. I’ve built programs throughout my career that really integrate the two of those and create interventions that are combined.

So the origin of the article is that one thing the pandemic has done is really bring this issue of mental health to the forefront, right? The isolation and everything else that goes along with it. It’s really created a platform to talk about mental health, how mental health and physical health are related, and things we can start to do to intervene. So that’s the first part of it.

We can talk about why behavioral health and physical health are important. There’s tons of data to support that. If you have a chronic illness, for example, you are more likely, 25 to 50 of the people who have a chronic illness have a concomitant diagnosed or undiagnosed mental health illness that is probably untreated or submaximally treated. And then the data further goes on to support that those patients cost two to three times more, in general, in the health care system. Again, there’s other data to show that treating the behavioral health component alone actually reduces that cost for the physical illness and shows better outcomes clinically for the physical illness as well. The same thing is true on the reverse side as well, although the data is not as clear from a numbers perspective, but the concept is there.

So really, the basis of the article is bringing the concept of behavioral health to the forefront. It’s OK to talk about anxiety and depression and other issues that have been occurring more over the last 18 to 24 months, and then really tying that into physical well-being and finding solutions to manage both of those conditions concomitantly.

Kevin Pho: So what are the current challenges facing mental health or behavioral health treatment in the primary care setting today?

Christopher Valerian: So, as we all know, in primary care, you get what walks in your door, right? And with decreasing reimbursements and just the current state of affairs, it’s really hard for primary care physicians to identify behavioral health and mental health conditions and treat them appropriately. So I think one of the challenges is early identification and recognition, whether primary care physicians implement quick screening tools. There are several of them out there that are validated and clinically relevant, to at least identify the issues. So if they don’t feel comfortable treating them themselves, at least they can make appropriate referrals. I think that’s one of the first issues.

I think the second issue is really around this siloed approach, right? You don’t want to just refer somebody over to a therapist or a psychiatrist and wash your hands of it and move on. There has to be that bidirectional communication, and you really have to develop a treatment plan with your referral provider for the behavioral health conditions, because again, what both of you do in treating that patient is going to impact the other one. And again, like I said, there’s plenty of data to show that doing it in an integrated fashion really has better outcomes across the board.

Kevin Pho: So you mentioned several times that intersection between physical health and mental health and some of the obstacles that we have in approaching that. You mentioned some of the solutions, but in more detail, what are some specific ways that we can address this issue?

Christopher Valerian: Sure. So I think at a global level, we start top-down, right? There’s an opportunity for carriers, insurance companies, and organizations to approach this with more of an integrated approach, a bundled approach, if you will, a population health approach, and break down some of those silos, whether it’s reimbursement silos or referral silos. So I think from a systematic perspective, we need to really start to approach this in a more integrated way, collaboratively.

Going down into the next layer, around the provider level, again, I think it really boils down to that bidirectional communication between your referring providers and your referral providers. Again, primary care is a main entry point into the health care system a lot of times, so the more comfortable primary care physicians are in managing behavioral health conditions, the better off the patient and the system will be as well. So there’s opportunity for education and expertise around, you know, CMEs or whatever, around treating those conditions, because not everyone has a formal diagnosed mental health condition, right? I mean, maybe it’s just simple anxiety around your family or work life, and that’s something that primary care physicians should be able to manage without necessarily a referral out. So I think that’s the second leg of this.

And then I’d say the third one is really on the employer side. I’ve been doing a lot of work with employer groups over the last 18 months, working with them on how to better engage employees in the workplace, because that’s where things show up, right? Whether it’s disruptive employees, nonproductive employees, or people who are struggling at work, people talk. I know we’re in a virtual world, and people are starting to come back more into the office setting now. I’ve done some writing on that piece of it, actually: burnout in the workers who are coming back into the office setting, or even people who may have lost colleagues during the COVID pandemic, and now they’re coming back into the office setting, and that may trigger some emotions and some feelings that affect their productivity.

So I think the employers should really at least have a sensitivity to looking for these items and provide services, whether it’s traditional EAP services or counseling services. Or at least, again, I work with a lot of HR people, and I tell them, “Just ask your employees how they’re doing. Walk the floors. If you have virtual meetings, ask how people are doing.” And then look for some initial signs and offer some support there. So I think it’s a combination of a top-down approach and a bottom-up approach to start to break down those silos and start to engage people in the behavioral health and physical health continuum.

Kevin Pho: So your first point was that we need a more integrative approach, where we include more behavioral health specialists in the continuum of care. So what are some of the ways that we can break down those silos? Is it simply a matter of funding? Is it a matter of reimbursement? Is it a matter of just hiring more behavioral health specialists? What exactly needs to be done for more systems to have this integrated approach?

Christopher Valerian: Yeah, so as you know, there’s currently a massive shortage of behavioral health providers in this country. I have a national perspective in my current role, and it doesn’t matter what state you’re in or where you are; there’s just not enough supply for demand. So to answer your question on that front, I think more access is the first issue, and whether that means more training programs or recruiting into training programs, I think we need a pipeline. There’s no doubt about it. I don’t think the demand is going to go away over the foreseeable future. So that’s the first issue.

The second issue would be creative alternatives, perhaps, for access to behavioral providers: apps. I’ve read one study recently that the number of behavioral health and chronic disease management apps that have popped up since the pandemic started has increased by 50, 60 over previous, and I think you’ll see more and more of those digital engagement tools to try to get people into the system one way or another.

And then finally, I think you hit the nail on the head: It is a reimbursement issue as well, right? It depends on the part of the country you’re in. I’m in the Northeast myself, and finding in-network providers is very difficult, and a lot of that has to do with the reimbursement rates and how the reimbursement occurs. If you’re willing to pay cash, you can pretty much find what you need, but if you want to stay within your health plan, it’s difficult. So again, from my carrier perspective, and maybe even a regulatory perspective, I think there has to be some parity around that reimbursement structure as well.

Kevin Pho: We’re talking to Chris Valerian. He is a physician and health care executive. He wrote the KevinMD article “New strategies are needed for mental health treatment.” Chris, what are some of your take-home messages that you want to leave with the KevinMD audience?

Christopher Valerian: Sure, absolutely, Kevin. I think one of them is the awareness that the pandemic has afforded us around behavioral health issues, and just, again, a general awareness and the ability to talk to patients about it, talk to colleagues about it, and talk to friends and family about it. I think that’s one: breaking down those stigmas. The second one is the interdependency between behavioral health and physical health and how one affects the other. You can’t really treat one without treating the other, and just keeping that in mind as people are moving through the health care system.

Kevin Pho: Chris, thank you so much for sharing your time and insight. Thanks again for being on the show.

Christopher Valerian: Absolutely. My pleasure, Kevin.