Episode Transcript:
Dr. Melissa Perry
There's still stigma surrounding mental health and substance use disorders, and really substance use disorders can affect anybody. It's regardless of race, gender, age, income, or location.
Demetrios Marousis
And we're touching real people and real people in a longitudinal way, and that's pretty impactful.
Robert Traynham
Welcome, welcome, welcome. I love to open up these podcasts with more of a personal question just to humanize the two of you. And Melissa, I'll start off with you. What do you like to do in your spare time? What do you like to do to unplug? That just take the physician hat off and just be you. What does that look like for you?
Perry
That's a great question and I hope everybody gets some spare time. In mine, I really like to spend my time with family and friends and do some traveling. I love to see different areas abroad and within the United States.
Traynham
Yeah, there's nothing like just decompressing and getting lost in another person's culture, different state, whatever the case may be. Demetrios?
Marousis
Yeah. Well, gosh, thanks for asking. I really like to fix things. I get the opportunity with cars, with my sons, with my daughters, with my son-in-law, just to work on things, whether it's a house, a car, solving a problem that we've created for ourselves sometimes, and getting ourselves out of the bind.
Traynham
Nice. Just kind of getting lost and trying to figure it out, whatever that looks like for you.
Marousis
That's it.
Traynham
So thank you very much for sharing. I know you both obviously work at Highmark, and I would love to know at a pretty high level. Melissa, I'll start off with you. What is the overall mission of Highmark? What does that mean to you and how can you explain that to our listeners and viewers?
Perry
So as a psychiatrist and working with Highmark, Highmark's mission is really to provide access to affordable and quality health care to the people and communities that we serve. And we are committed to providing innovative solutions that meet the needs of our members and our customers to improve mental health and well-being.
Traynham
Demetrios, your words?
Marousis
Yeah. So my words is sort of similar to what Dr. Perry said. We have membership, they have families, and we're trying to get them access to their available benefits. And with that access, they're able to live a more complete life free of whatever problems, illness, ailments may cause them.
Traynham
And Demetrios, why don't I stay with you for a few more moments. Can you drill down a little bit more in terms of what your role is at Highmark? What does that look like on a daily basis?
Marousis
Yeah. So my role is I'm involved with the Enterprise Behavioral Health team, and what I do on a daily basis is look at sort of how behavioral health impacts our membership and how our benefits are available to those members, how those benefits are structured. And because Highmark is also an integrated sort of a provider as well as a payer, looking at how our health system partners work together in the mental health substance use disorder space, with the idea that a person who's free of mental health substance use disorder symptoms, ailments can be a lot healthier even with other chronic physical health conditions.
Traynham
Dr. Perry?
Perry
So I am fortunate as a child and adolescent psychiatrist as well as an adult psychiatrist to be able to work with the Enterprise Behavioral Health side with Demetrios and the team, and also with the utilization management side. So working with the utilization managers, working with the care managers, the nursing staff, and really clinical operations to help with our members to help with member education and analytics as well.
Traynham
One of the things that we've heard over and over and over again, is this opioid crisis that we're currently dealing with. It feels like that it's an every part of the country. I would love to know how is Highmark working to improve care for patients that struggle with substance abuse?
Perry
So I could say there are, as you mentioned, millions of Americans in the United States are struggling with substance use disorders, including opioid use disorders. I'm really proud to be part of the Highmark team that helps with Demetrios and his team as well to work on helping patients, helping members with prevention, mitigation, and treatment. And really one of those first steps that is needed everywhere is to decrease stigma. There's still stigma surrounding mental health and substance use disorders, and really substance use disorders can affect anybody. It's regardless of race, gender, age, income, or location. So that's really one of the primary keys.
Traynham
Demetrios, can you speak to any programs or partnerships that Highmark has in this area?
Marousis
Yeah. As Dr. Perry mentioned, there's this sort of a three-prong sort of let's try to avoid building any new issues. And so with that, we have a partnership with Axial Wayspring, and what they do for us is they help profile our prescribers. And in profiling our prescribers, we're looking for those risk variables, which prescribers may be generating some additional risk that might be necessary. They then reach out to those providers, those prescribers, and try to have those conversations. In essence, some clinical detailing with pharmacists to prescriber to try to identify and how to identify ways to mitigate that risk.
The other prong is where we have members who clearly have pain drivers and they need to be on well-managed pain medication. Knowing that it creates risk, we try to do that at the levels possible without creating additional risk and additional problems.
And then where we have members that have treatment needs, we try to lower those barriers to care such as where we're opting to have prior authorization or concurrent review and where we opt not to in order to reduce those barriers to care. As well as we've also in our third year of a value-based reimbursement program that's focused on the residential treatment and withdrawal management models of care.
Traynham
If we can be even more granular, I would love to know from you maybe Dr. Perry, what are some of the critical challenges that we all face as a society when it comes to care delivery and in particular when it comes to substance use? Can you speak to that?
Perry
Sure. And to go along, I think really that number one is that stigma that's still associated to it. So working on decreasing that stigma as well as there's a lack of access to affordable and quality treatment, either treatment facilities or medication-assisted treatment, sometimes known as MAT, which is a proven and effective treatment for opioid use disorder. So having access to that is really imperative. Also, making sure that it's affordable, making sure that there's care coordination between providers for continuity of care.
Traynham
Demetrios, do you want to speak to this as well?
Marousis
Yeah. I think it's critical. I mean, once again, to improve the literacy of our membership so that they have an idea of where care is available and at what level of care they may be best served. And with that, trying to avoid some of. . . there's a lot of actors out there, bad actors who are occupying the space and with that providing information that may not serve our membership well.
And so we're constantly trying to counter poor information, incomplete information with factual information as well as what their benefits may be able to take care of with them. They may not need to leave their community and go 3000 miles and ride horses on a beach in order to enter recovery for substance use disorder. They could probably do it at home, do it in their community with the supports necessary to be successful.
Traynham
Demetrios, I've heard that you use this terminology called the digital front door. Can you elaborate on that?
Marousis
So for us, the digital front door is an attempt to sort of add an additional access point so members can access potential benefits and through that, through digitally interacting. And with that, because there is a stigma present, they can do it a little more privately. They can assess their symptoms, assess their needs. If indicated, and if willing, they can interact with individuals and set up chats, et cetera, in order to get access and be linked to care or be linked to... Highmark has licensed behavioral health clinicians as case managers that can help them further identify, stratify their need, and be linked to the right level of care for their need.
Traynham
Dr. Perry, can you please speak to the importance of health care literacy, especially with mental health and substance use?
Perry
Absolutely. Health literacy is so important and it's the ability to understand and use health information to make informed decisions about your health, about your treatments. And it's especially important in mental health and substance use disorder treatment. Sometimes it's difficult to understand the signs and symptoms, the diagnosis, and the treatment options available.
So we at Highmark really like to help where we can provide clear and concise information with our care managers using plain language, avoiding medical jargon, and really offering support and assistance to everybody who needs help understanding any health information. And we encourage our members to talk to their providers and to ask questions if they have them.
Traynham
Demetrios, did you want to add anything to that?
Marousis
Yeah. So as part of that and specific to mental health and substance use disorder, Highmark has partnered with Spring Health to be at that digital front door for mental health well-being purposes. This will allow our membership to access 24/7 questions. I really come from the perspective on the physical health side. If you step off the curb and twist your knee, you've got an idea of what to do. You've got an idea of how bad it should get before you put your hand up, ask for care, and you even have things that you would do in terms of ice it, elevate, things like that. In mental health and substance use disorder, that's not well known. We don't have this sort of common understanding.
And we also understand that it's not uncommon for people to be symptomatic for 8 to 10 years before they get connected to good care. So part of this approach for us is to add some additional avenues for our membership to practice mental well-being, gain access to ask questions, information, and to be guided if necessary to the right level of care, either through Spring Health and the additional providers they've brought to our network or the rest of our Highmark network of providers.
Traynham
Dr. Perry, you mentioned that you are a child and adolescent psychiatrist. How do you apply those skills in that academic learning at Highmark in your current role?
Perry
I think as a psychiatrist working with children, adolescents, and families, it really helps open my eyes working with members on some of the difficulties that there can be with access to care and with treatment being both the therapy and medication treatment. And so the ability with Highmark to help improve that access to care and to really use active listening and to help understand what the problem is and how can we make movements in the right direction.
Traynham
And a question for you both. I'll start with you, Dr. Perry. Any real-life examples in your work that you can provide our listeners and viewers?
Perry
I think one of the best things in the work is following up with some of our nurses and care managers and hearing about success stories about a family that was having such trouble finding a mental health provider for their kiddo, their child. And working with Highmark and finding that access and to hear that the family and the patient, the child is doing better is really great.
Traynham
Yeah. Demetrios?
Marousis
Yeah, I'm sort of in my twentieth year in managed care, and before that as a clinician focusing primarily on families, this idea of a family struggling when symptoms are present and being able to see the relief that is available when a family member is able to have their symptoms relieved, enter recovery. And we have a lot of evidence-based care and where we're able to promote or even provoke use of evidence-based care. The outcomes can be quite remarkable. And we're touching real people and real people in a longitudinal way, and that's pretty impactful.
Traynham
You know this. Technology, but specifically AI is a part of every single conversation that we're having as human beings. And I would love to unpack a little bit from each of you, what is the biggest opportunity for technology in health care? Dr. Perry?
Perry
I think the biggest opportunity for technology in health care is really that digital front door. So having access to coaching or having access to personalized provider matching. So somebody that specializes in post-traumatic stress disorder and can provide the treatment for that and really having that personalized medicine as being a core component to treatment.
Traynham
Demetrios?
Marousis
Yeah, so I think some of the promise for AI is really ingesting the vast data that's available. And with that, being able to sort of identify members that have need sooner and not waiting for them to have an incredible struggle or reach a point of frustration before they get activated to seek care.
The other and more specific to AI is we're also testing out some technology related to digital phenotyping where we're looking at both sort of vocal and semantic components of the verbal interactions that we have with our members and testing that. Now, just because it's there doesn't mean it's useful. And so we're looking at that sort of potential utility of what's possible with that. And does it provide value? That's the other piece of it. Just because you can do it doesn't mean you should. Is it meaningful?
Traynham
So exciting. So exciting.
Marousis
Oh, it's very —
Traynham
Indeed. My last question for both of you, Dr. Perry, I'll start off with you, and that is the next big thing in health, in your own words, is?
Perry
There are so many possibilities for the next big thing in health, with new technology and the world ever evolving. But my big hope for the next big thing in health is to break that barrier fully for the stigma of mental health and substance use disorder treatment. I'm hoping that there's more education around mental health, mental wellbeing. Starting at a younger age, so starting even with our children, adolescents so that they can recognize emotions, feel their emotions, and manage their emotions, teaching those coping skills at a young age.
Traynham
Demetrios?
Marousis
Yeah. So for me, the next big thing in health is really that next member that has the need and being able to link them to care. We have a lot of amazing things. That person with diabetes who has their untreated depression getting in the way of being successful at completely treating and being stable in their diabetes and avoiding the path that is well established if you're not well controlled. The same thing with the anxiety that can come along with congestive heart failure, living your best life, the most complete life you can in the face of chronic physical illness, in the face of mental health, or substance use disorder, and finding that relief.
Traynham
Thank you both.
