Reporting Back from the Behavioral Health Tech 2024 Conference
Curt and Katie chat about Katie’s attendance at the 2024 Behavioral Health Teach conference. Katie reported back on investment trends, how Value Based Care is being understood and implemented, and how therapists can navigate these tech disruptors and evolving business models.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we report back on updates in the behavioral health tech space
We decided to have Katie go to the Behavioral Health Tech 2024 conference to learn about innovations and leaders in the behavioral health tech space. This episode is an out brief with updates for all clinicians.
What is the Behavioral Health Tech conference?
- This is a newer conference that brings together VCs, founders, insurance payors, and clinicians
- The focus of this conference is on innovation, especially technology solutions for what they were describing as a broken mental health system
Investment trends in the Behavioral Health space
- AI Therapy
- Self-help tools
- VR for social skills (i.e., in the Autism space)
- Measurement-based care (including wearables, journals, and assessment tools)
- Integrated EHR systems that include the ability to have “interoperability” between providers
“It was interesting to be in a space where the fact that you would be profitable, that you would find a sustainable business model, was just a given. It wasn’t a moral assessment.” – Katie Vernoy, LMFT
What is Value-Based Care and what does that mean for behavioral health providers?
- There is a stepped or tiered process to implement Value-Based Care
- First step is enhanced fee for service, with augmented fees for better outcomes
- The next step is a rate per client model with incentives and penalties (upside/downside)
- The final step is a fully capitated model where the clinician provides comprehensive care, with potential risk (you underestimated the costs) and potential benefit (you price appropriately and have the opportunity for higher per client reimbursement than in a fee-for-service model)
- Solo (or “single shingle”) practitioners will have difficulty with the aggregated data that is needed to negotiate these contracts with payors.
- Larger, potentially VC funded groups are aggregating this data and negotiating higher rates, but may not be passing on much of this increased rate to the clinicians they hire or contract with
What are the opportunities and challenges facing therapists with the advances in tech?
- It is critical for therapists to become more efficient, look for opportunities to collaborate, and incorporate technology effectively to be able to success in VBC models (or in the new marketplace)
- Group or specialized practices are better-situated to navigate these challenges than individual practitioners
- Outcome measures may be key to competing in the new marketplace
How can mental health clinicians advocate related to these new advances in technology?
- Clinicians should be involved in these conversations around how therapy and business models are evolving
- Advocacy to make sure there is clinician and client input on how these systems are put together
“If you’re thinking you want to engage in this space…I would potentially start joining some of these conversations and get into advocacy work. Because if therapists aren’t at the table, if folks with lived experience aren’t at the table, we’ve got people who are just getting information from…the bubble of investors and potentially clients turned founders and so they’re going to have a very different perspective than someone who actually is in the field, doing the work and understanding what can impact some of those outcome measures.” – Katie Vernoy, LMFT
What should therapists do now to future-proof their practice?
- Identify and integrate outcome measures into your therapy practice
- Stay informed about what is up and coming in the field
- Streamline your operations to increase efficiency and prepare for VBC models
- Join advocacy groups to make sure therapist perspectives are represented in the new care models.
Resources for Modern Therapists mentioned in this Podcast Episode:
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Behavioral Health Tech Conference
Relevant Episodes of MTSG Podcast:
AI Therapy is Already Here: An interview with Dr. Ben Caldwell
Is Artificial Intelligence Bringing Bias into Mental Health Treatment?
Is AI Really Ready for Therapists? An interview with Dr. Maelisa McCaffrey
Should We Stop Badmouthing Evidence Based Practice? An interview with Jessica Tappana, LCSW
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that go on in our profession, the things that affect how we practice. And this is an episode where we had Katie go to the Behavioral Health Tech conference where she planted herself as a spy to be able to come back and tell us about what all of the things are that are down the road, impacting things already, and I am here to listen and live react with all of you. She has told me just a little bit about what’s going on, and this is the opportunity for all of us to listen more. So take it away, Katie.
Katie Vernoy 0:32
Well, when I went to the Behavioral Tech conference, what were you most interested in learning about Curt? Because I kind of asked you ahead of time. We talked a little bit, I tried to follow through with that. But what are the things that were most interesting about what was in that conference?
Curt Widhalm 1:15
Personally, with a lot of the conversations that we have, I’m very curious to see what the prospect for AI to take our jobs, and how the tech companies, how the venture capitalists are looking at taking our jobs, and what our jobs are going to look like.
Katie Vernoy 1:40
Okay, so I think that was a lot of people. When I went into our Facebook group, modern therapist group, I did ask that question. I also went into some other groups where there are folks who are equally interested in: What are they doing? And how are they taking our jobs? And so going there was quite different. So maybe I’ll start with what the conference is. The Behavioral Tech conference is a fairly new conference. I think they were maybe doing some virtual stuff during the pandemic. But this was the second year in person. This was our first attendance of either one of us. I think both of us might end up going next year. We’ll see. And it was a very large group of people, very mixed backgrounds. We’ve got insurance folks. Like, there were actually people from the payers: Blue Cross, Blue Shield, you know, other payers, that kind of stuff. There were actual investors, so angel investors, you know, venture capitalists. There were founders and a lot of a lot of different applications and platforms and groups that had some sort of technology solution. There were providers, and some of them were also they had platforms that, you know, Alma, Headway, Grow, Brightside Health. So many different folks that are basically technology solutions for providing mental health care, typically through some sort of insurance payer. And then there were folks like me, you know, a clinician and podcaster.
Curt Widhalm 3:13
Award winning podcast hosts.
Katie Vernoy 3:15
Award winning podcasters. And so it was very interesting, because a lot of the conferences that you and I have gone to are pretty much therapist conferences, right? We go, we we get clinical training. Maybe there’s, like, the business class that’s not CE, or when we were doing a conference, vaguely CE. And very different vibe. Definitely, there was a lot of amazing tennis shoes. So you know, all the startup folks, they were definitely wearing their favorite tennis shoes. Not as many hoodies as I expected, but definitely a lot of really cool tennis shoes. And a lot of people who are very fancy. I was like, oh my goodness, I actually have to dress up. I haven’t done this since the pandemic. And so it was, it was an interesting environment to be in, and we were actually also there during the election. That’s a whole other conversation we won’t have on this episode, but I felt like the conversation was one that I was way behind on. I feel like I’m pretty knowledgeable, and the first day, I was excruciatingly overwhelmed and felt uninformed.
Curt Widhalm 4:22
You know, when I have a lot of conversations with people, or I’m leading workshops around some of the changes that are happening in our field, I feel like we might not be the foremost knowledge of mental health professionals about some of the things that are happening. And if you’re feeling that way at this conference, then I immediately have fear about what is it that we all have no idea coming down the pike.
Katie Vernoy 4:46
For sure. And I think to be clear, part of my goal was to try to understand what this value based care thing was. And I really was struggling because people were coming at it from so many different angles. So I figured that out and so, I will to preview, I will talk through what value based care is from my understanding at the end of this episode. But it was also business concepts. The the alphabet soup was very different. I don’t even know some of the ones that they were using. I was, you know, using my my phone as like a quick Google trying to figure out, so what does that one mean? Investment terms. There was a lot that I felt like this is not what I would imagine in behavioral health. And so it was clear that the technology sector, the business sector, has really come into our profession as folks who want to be here, and some are coming from kind of big tech, you know, the quote, unquote, tech bros. And there are a lot of folks that are actually coming from health tech. And those are, there’s a distinction that I want to make there, because the chaos I think we were experiencing, especially as the pandemic, you know, kind of proceeded, and we had all these big tech solutions were coming in. I think that was more this, this sounds mean, but I’m trying to distinguish. I think that was more tech bros. And I think what’s enduring and what will be lasting are the health tech folks. So when I say tech bros versus health tech what are you what are you imagining? How well am I explaining this?
Curt Widhalm 6:26
I’m imagining that health tech bros are tech bros who just didn’t cut it on the completely VC side and just found jobs in the healthcare side of things. But I have to imagine that I’m just being very cynical, and these are people who are health people first, and just happen to be bringing technology along, I don’t know. Yeah, I need you to clarify this a little bit.
Katie Vernoy 6:52
Let me clarify that more. So you know, the Silicon Valley Tech bros are typically very quick to market solutions. They have a lot of failure. A lot of, you know, kind of fail forward, fail faster, and lots of big money that comes in because there’s a huge return on investment, very high risk. And that was the model, I think with that was that was coming into our profession. And this is, this is my assumption. I could be wrong. People send me an email: podcast @ therapyreimagined.com. Notice I didn’t put my name on it. Send me an email and let me know if I’m getting this wrong. But the chaos that we were experiencing from regular kind of big tech, tech bros, whatever, was using that same model to try things in the mental health space. They saw an opening in the market, and they used their model. And so they were, by and large…
Curt Widhalm 7:47
Opportunistic.
Katie Vernoy 7:49
Pretty opportunistic, pretty high risk, and they weren’t necessarily considering the specific elements of: a lot of this has to do with patient care. And there are human beings. Sometimes there’s life and death situations. I don’t think that the kind of traditional, I feel like that’s weird to say about Silicon Valley, but the traditional tech bro environment knew what they were getting into. And what I heard in one of the talks from the actual health tech folks were that they have now left the scene. They don’t want the risk that didn’t turn out as they wanted to. And so when we’ve seen companies, you know, leap forward and then fall back, some of that has been traditional Silicon Valley Tech bros are like, Oh yeah, I’m out. This is not, this is not what I meant to invest in. On the other side is health tech. Health tech investors, people that have, for you know, dozens of years, been doing, you know, glucose monitors, or, you know the folks that have, you know Fitbit, you know people who are actually in the health space probably actually know what an IRB is, and can understand that they can’t actually fail in the way that traditional tech solutions can. And so the health tech folks understand the risks, understand the benefits, and are in this space trying to actually move to the next space, the next, you know, step on them on the path, and that actually makes me feel better.
Curt Widhalm 9:26
So this sounds less like the disruptors and more like the people who have been making the technology that we’ve been using all along.
Katie Vernoy 9:36
Yes, they may be disrupting the mental health space, or what they’re calling the behavioral health space, and they’ve already been in the health space for a very long time. And so the VCs that are coming in from health know what it means to take care of patients, by and large. Which I think we’ve been missing a little bit in this initial insurgence from traditional tech VCs. So that was a takeaway. There was a talk that was specifically with these health tech folks, and they talked about what the investment trends are in behavioral health. Would you be interested to hear those?
Curt Widhalm 10:15
Yes, I would.
Katie Vernoy 10:17
All right, so obviously the first one is AI therapists, this is we had the conversation with Dr. Ben Caldwell. We recognize that this is gonna happen, and there are folks investing in it. They’re also finding solutions for measurement based care.
Curt Widhalm 10:35
Go on because this seems like something that would both be very helpful to people who want their clients to get better and having ways of proving it. And it also sounds like something that healthcare companies would be saying, we are going to hold all of you very accountable to all of these things and not pay for anything that isn’t meeting these measurements.
Katie Vernoy 11:01
Sure. So I will have a longer conversation of value based care, which will include measurement based care, but I’ll talk a little bit about what these measurement based care solutions are looking like. Some of them might be sending pre and post measures for you know, like the feedback informed treatment stuff. It could also be, there was so much conversation about PHQ-9 and GAD-7 and the limits as well as the benefits of those things. There was social determinants of behavior. There was just a lot of different ways that they were starting to talk about assessments and making sure that we’re doing evidence based practices and assessing our outcomes. And there was ‘gasp horror’ about how many clinicians aren’t doing anything to measure outcomes, and how ridiculous that sounds, because medical folks have blood pressure and weight and all the things they measure at every appointment and, you know, and blood work and all of these things. Whereas mental health professionals, by and large, don’t measure anything according to them. The measurement based care, because there’s such a push to have outcome measures, which I’ll talk about a minute, there are solutions where you have wearables or you have journals that clinicians can see. You know, some of the stuff we’ve talked about before, but there’s investment in that because there is a business case for it, which is the insurance stuff that you’re talking about. They were also looking at stuff for autistic folks beyond ABA, and looking at play solutions, and VR and VR social settings, different things like that. For serious mental illness, talking about, you know, kind of platforms with, I’m gonna try to say the word right, interopterability, so or interoperability, where different parts of the team can communicate through like an EHR, digital adjuncts, which they also use the term co-pilot. So that kind of what you were talking about with having some sort of platform that’s kind of monitoring your client throughout the week, and so seeing anything that’s going to help, you know, human clinicians to do their work. And then looking at some of the other investment trends, potentially psychedelics, that kind of stuff. So it was outside of the the actual tech situation, but I wrote myself a note that Medicaid is also embracing innovation, including peer support and substance abuse disorder treatment, that kind of stuff. So there’s, there’s a lot of discussion around how are we supporting this space with new solutions that align with this idea of value based care, and where is the profit in it? Which I think a lot of people feel really uncomfortable about, but I recognize that, you know, as clinicians, we’re like, oh my gosh, we’re doing this out of the goodness of our heart, but we have to charge our to charge our worth, and we have all the things about that. And it was interesting to be in a space where the fact that you would be profitable, that you would find a sustainable business model, was just a given. It wasn’t a moral assessment.
Katie Vernoy 11:49
How did that feel for you, walking around in that?
Katie Vernoy 14:21
I felt fine about it. I think there are times when I have concerns about capitalism, and there are times when I feel like it’s horrible, but it’s the best thing that is available. It’s like all the systems are worse, but this is the least worse. It was interesting to have that be available. I’m the person who talks to sponsors, and so I’m always looking through that lens a little bit, because I have to be able to talk that language. I think in some of the conversations that happened in the Q and A that kind of stuff, there were folks who really were concerned about the impacts of capitalism and monetizing human suffering. And so that was there, that was part of the conversation. It was more direct, and it wasn’t insidious or or we weren’t we weren’t swimming in it, I guess.
Curt Widhalm 15:16
There was nobody taking over in the Q and A and talking about clients grief, paying for your 401K kind of stuff. It was just kind of all right, this is the system we’re in, and this is how we’re dealing with it?
Katie Vernoy 15:30
I think there were some, none of the, none in the talks that I was in, but I think there were folks who were trying to kind of make a statement here and there. At least I heard tell, I didn’t personally witness it. I think that tension was there. I don’t think it was like everyone was all in on get as much money as you can from the system. In truth, I was actually fairly surprised with a lot of the speakers. Some of them, I wasn’t quite sure I believed, but a lot of the speakers talked about: this is to create more access. This is to create higher quality care. This is about, you know, whether it’s efficiencies or taking care of clinicians so that they don’t have such a heavy workload burden. They were saying the right things, many of them, not all of them, but they were saying a lot of things that I felt like, okay, they understand some of the concerns that clinicians have about their solutions, and they are at least paying lip service to this idea that we want mental health clients or behavioral health clients to get the highest level of care, to have access at the most affordable price point. We understand that clinicians need to work at the top of their license. They need to be doing high quality care to get reimbursed. Or what are we doing here? And all of this needs to make sure that we’re paying attention to whether or not clinicians are going to burn out or not. Like it was really interesting that they had those things. Now, then there was other people are like, Yeah, well, when we’re, you know, when we’re payers, there’s going to be winners and losers, and, you know, you got to prove that you’re a winner to be able to get paid. So, I think that and that transitions into value based care when we want to go there. But, but there were, you know, kind of straight ahead folks that were talking about the issue as pretty straightforward, but a lot of the lip service, or at least the the thematics were about this is because there is a need. The system is broken and we’re trying to fix it.
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Curt Widhalm 17:40
I’m impressed that there is the emphasis that you’re talking about on actually looking at workforce issues and relieved in some way that that’s being discussed. Because, you know, I look at companies like, say Amazon, who kind of incorporate into their business practices that we’re going to set really high standards for the amount of deliveries that drivers put out there, and if they don’t meet it, they’re going to get fired. And they have to look at, okay, eventually we’re going to run through every human on Earth who runs through this. Now, that kind of a job does not require the same entry into the profession as, say, a mental health professional, so I think looking at that higher barrier to entry, as far as workforce, I’m relieved to hear that there’s the discussions around we can’t burn through everybody.
Katie Vernoy 18:32
Yes, and we don’t necessarily need them to do all of the things. And I think that’s where the they’re taking our jobs comes from, right? And there’s a lot of different ways to look at it, but maybe I can frame it in the conversation of value based care, because I think that there is as much emphasis on clients or patients getting value as there is on making sure that clinicians are available and using their skills in the way that they need to be used. When we’ve talked about value based care in the past, just to give a reference point, what is your understanding of it?
Curt Widhalm 19:15
My understanding of it, and I’ll bring us back to our episode that we did with Maureen Werrbach and Dr. Ajita Robinson.My idea of what it is is somebody has a diagnosis, and the payer says, provider, here’s the bucket of money to cover the treatment of this diagnosis. And if you go beyond that, tough nuggies.
Katie Vernoy 19:41
That was kind of my understanding too. This is, this was my whole first day going to different talks and trying to understand it as like, what is this thing? It sounds like it can’t happen for behavioral health at all. What are we talking about? And I just, I could feel my my brain cells burning like my brain, I wrote you an email at the end of the day: like, I am exhausted. Don’t know what’s going on. Here are the people I talk to. What do you think? And really, I think what I came to understand over the course of the two and a half days of sessions: this is something that’s been in process for a very long time. It begins with outcome based therapy. So, outcome measures making sure that you are getting results, that you’re paying attention, you’re assessing. It’s doing something that I think therapists have said they wanted, which is very interesting. They are moving beyond the one to one hour.
Curt Widhalm 20:43
Go on.
Katie Vernoy 20:46
Well, if we, if we think about coaching packages, the whole idea is that you’re not charging, you’re not charging by the hour, you’re charging by the client. You have a package of services, and you provide it to them, right? Everybody’s like, oh, I don’t want to have to be tied to my chair, like, this is the the dream solution. And then insurance companies are like, Sure, here you go. And therapists are like, That is awful. So that’s how I came to understand it. But let me, let me walk back through what it actually is.
Curt Widhalm 21:14
Okay.
Katie Vernoy 21:16
So, the payment structure for value based care is actually pretty diverse. I’ve come to understand that they are trying to implement value based care over time. So, step one of value based care is a supplemental fee. So you have your fee for service, and then it’s enhanced. So it’s an enhanced fee.
Curt Widhalm 21:39
This sounds like Ticketmaster written all over it. Here’s your hidden fees for your therapist having a chair.
Katie Vernoy 21:52
I think that’s that’s where we get kind of caught up, right? Because we’re trying to put it into another model, and it’s hard to figure it out. So, so what happens for therapists is that you have to do these outcome measures. And so you’re you’re doing these outcome measures, the insurance company wants to see them, and you have to show that you are doing something that works, so positive outcomes. And if you show these positive outcomes over time, they will pay you more for your therapy sessions because you’re showing you have positive outcomes. And clinician B over here is just doing therapy as usual. What’s difficult about that is individual therapists have trouble showing that they’re getting a lot of positive outcomes unless all of their clients are on a single insurance panel. So in comes Alma and Headway and Grow and all the people and say, we have all of these clinicians, here are their outcome measures. By and large, we are getting good outcomes. Pay us more money. And we’ll take away some of the administrative burden, because we will be your sole point of contact for 1000s of clinicians. And so they get higher fees. What is troubling is that some of these folks, Alma, Headway, Grow, I don’t know each of their models, they take all of the enhanced fee as their profit. And so clinicians are getting a little bit higher of a rate than they would in their own practice, but they’re not actually getting the full benefit of the stage one value based care, which is, they’re doing outcomes, they’re earning the company for the VC backed company. They’re earning a lot more, and they’re just getting a little bit more. And I think that’s the part that I felt really was frustrating, is that it seemed like there, that’s where some of the predatory things for therapists were. Therapists don’t recognize that they theoretically could navigate that by themselves and get the whole fee themselves.
Curt Widhalm 23:53
Sure.
Katie Vernoy 23:54
So stage one is just enhanced fees if you can show in the aggregate, clinicians are getting better outcomes. So this group gets a higher fee, and sometimes that can happen for individuals, but it’s really hard for individual therapists who are seeing 15 to 20 clients a week and maybe have three to five who are on a particular insurance plan. It’s just hard to have evidence like, Hey, I’m actually my outcomes are beneficial to this client, to the insurance company, and lower medical costs. It’s hard to prove, and so it’s harder for individual clinicians to get these enhanced rates.
Curt Widhalm 24:35
My mind goes to, what about those clients with diagnoses that might not be easy to show improvements or to show improvements consistently? Is this just going to create a system to where clinicians are stepping back and saying you’re not a client that would be likely to be improve under this model, and we’re creating barriers to care in that way.
Katie Vernoy 25:03
I think so. I think that’s a really good point. I stood up a couple of times in different meetings and asked, Who’s determining what progress looks like? What are the outcome measures that we’re looking at? And it was a known issue, you know, it was the day after the election, and I said, Okay, so if we all took GAD-7s or PHQ-9s today, would we show progress? No. It’s it’s so specific to in the moment. And so the the argument back was, well, it’s in the aggregate. You know, in general, if your clients are getting better, you’ll continue to get this enhanced rate. It was something where they don’t really have a great outcome measure that would, by and large, show progress. There was one person I talked to who does seem to have a sense of it. I want to see if I can follow up and get them on the podcast. There may be other ways that their outcome measures there’s not It’s not put across the board like what the outcome measure should be. That’s just people default to PHQ-9 and GAD-7. And so to me, I think that there’s progress there that can happen if actual clinicians get involved. But in this model, I think they’ve been doing it for a while. And so my assumption is people see who they see, and there might be, there might be some problems with it systemically, but so far, this is kind of the one step toward it. So, before we run out of time, I want to make sure I get through all of the stages. But this is something that theoretically all clinicians could do if they’re able to find their path to negotiating with insurance companies, showing value, and being able to move that forward. The next step is a rate per client with an upside and a downside. And so you’re still, I think it moves past fee for service at this point, but you get, you know, a certain amount of money for a client. You get additional money if you’re showing good outcomes, potentially, you might have to give back money if you have negative outcomes. But it’s starting to move into, this is the rate for the client, and you have to have at least this many contacts. This is where it goes past the the one to one hour, I believe, and it starts moving into a more you’re getting paid to take care of this client. I’m going to go to the next step so we can talk about them together. The final one is called fully capitated. Here’s where I’m going into this, you know, business model, and what you’re doing is you’re taking on the risk of the client. And this is something that primary care physicians oftentimes do, where they’ll say, Okay, you’re my patient, and then they kind of coordinate care. And so they potentially get the money for the diagnosis. They get the money for the client, whatever it is, and then they make sure that enough services are attached. When I look at these models, the kind of rate with the upside and downside, or the fully capitated model, what I’m really thinking about are those really comprehensive programs that maybe have case managers or, you know, lived experience coaches or a digital solution or whatever, and there’s a clinician that is managing a group of folks, and they’re able to do really comprehensive care. And if they have negotiated properly, they’re getting paid very well to be able to take care of these clients. And I’m going to put numbers that may have no basis in reality, but let’s say you get $100 for a regular session. The enhanced fee is 120. The upside downside, maybe is, you start with 150 and the upside is 50, and the downside is 50, and then maybe this fully capitated model, you get hundreds of dollars per quote, unquote session, hour per client. So it theoretically is, you’re taking so much risk and you’re willing to throw services at the clients that need it and and maybe not have as many services for the clients who aren’t in crisis at the moment, where you get enough money that you can just take care of your clients, and you actually have the potential for much higher rates, so to speak, than you would at I’m getting my $100 for for clinician hour or for session hour. And so the idea is this is supposed to be a win-win. And the behind the scenes thing is, they’re willing to do this because theoretically, if somebody’s in mental health services, they are more compliant in medical health and their medical bills will go down. So that’s why insurance companies are quote, unquote going into this arena, into the behavioral health arena with this model, but it still is very brand new. There’s a lot of problems like you talked about, and it, it’s not clear how well, you know, like individual providers could do with it. It’s not well, it’s not clear how well folks who are in the the rate, the, you know, the single rate or the fully capitated models, how well they’re actually predicting, and if they’re getting paid sufficient amount, it seems like they are, which is why they were there talking about it, and, you know, could afford an expensive conference ticket. So I think it’s something where it’s interesting to think about, and I feel like there’s a lot more for us to kind of explore and discuss. I’m hoping that we can get some more folks, you know, from the conference, and, you know, speakers, other people we talk to, to talk more about the details of things. But that’s, that’s kind of what I learned. And I feel like I just was a la-la-la-la-la, you know, talking very quickly, but, but what are your reactions to that?
Curt Widhalm 30:37
I’m glad that you bring up the cost of the ticket to get in, because part of as I’m listening to this, does this sound like what individual practitioners are going to be able to do? Sure it…
Katie Vernoy 30:50
No.
Curt Widhalm 30:50
…okay go on because my the way that I’m listening to this is okay for all of this extra stuff, if I have to see less clients in order to do all of this extra work, doesn’t it all just balance out in the end?
Katie Vernoy 31:07
Yes and no. I think the reason I said no was not about the work. It was about the ability to get the contracts. There are some folks in different settings, and we might end up talking or partnering with some of them who are trying to put clinicians into basically data aggregate groups so that they can have the benefit of being part of this aggregate data and get a an enhanced rate, for example. I think, other than something like that, whether it’s a large group practice, and I’m talking hundreds of clinicians, not dozens of clinicians, large group practices can show this, maybe medium sized practices, especially if it’s very specialized, and maybe you have one insurance contract and you’re talking directly to them. But a lot of these insurance companies want a lot more evidence than an individual clinician can give that they’re providing this value. Now, as far as the actual steps, if we’re looking at the fully capitated model, unless an individual clinician has a team of people to provide different levels of touch points, I think it means a clinician is getting paid to do three therapy sessions a month, and I don’t know that that’s going to be sufficient for this fully capitated model. I think you have to have collaborative care. You need to potentially even have digital solutions, and maybe individual clinicians can do that. But I don’t know that many individual clinicians are thinking in that way, and it doesn’t feel like it’s an individual clinician like solo, you know, they called it single shingle practice. If it’s a clinician with a whole bunch of case managers and behavioral health specialists, right? I think that actually becomes a group practice in and of itself. And so that’s a different model.
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Curt Widhalm 32:59
So should all of our listeners give up on having their own private practices going forward into the future and just succumb to big corporation group practices?
Katie Vernoy 33:08
No, it was interesting to be there with folks who really saw the whole picture. And I don’t remember why we were talking about this. I think it was just, you know, we were wearing fancier clothes or whatever, and it seems like for mental health services, unless the big corporation, VC backed stuff gets a lot better as far as how they’re actually taking care of clinicians, and the work that the clinicians are able to do, it kind of is like those are fast fashion, and those of us in solo practitioner, private pay, private practices are tailors, and it is harder to get enough clients as a tailor, but it’s still possible, and I think that there are potentially groups that can come together in a way that’s not exploitative of therapists, potentially to engage in these models and actually do support single shingle therapists in getting some of these enhanced rates. So, I think that there are ways that if folks want to take insurance, they can. But as far as someone that wants to keep doing therapy the way they’ve always done without any outcome measures, and without negotiating with insurance companies, I think an insurance based solo practitioner is going to really not make a whole lot of money, or have to see a very a ton of clients to be able to make the same money that someone in one of these other setups could. And insurance practices or the insurance payers were even talking about determining who they refer to based on outcome measures and compliance with some of these things. And so folks may be seeing that they’re not getting as many referrals from insurance companies, even, if they’re not doing outcome measures, they’re not engaging in those things. It’s kind of like we have to show up in a much different way if we actually want to be competitive in this environment. And I think there’s therapists who will feel like that is unacceptable, and so yeah, maybe some of those folks will need to figure out a different way to practice. But it is, it’s a different world and how we’re seen outside of you know, the clinician community is a whole bunch of folks who are doing the bare minimum and aren’t necessarily getting great outcomes, and are charging a whole bunch of money, so it’s not accessible. There’s no way to prove that they’re doing good work, and they’re really resistant to being observed in any and assessed in any way.
Curt Widhalm 35:44
Do you think that those people are going to listen before it affects them?
Katie Vernoy 35:49
No, because they’re probably not even listening to our podcast. I don’t think so. I think there’s a lot of folks who are in their own world, and I think that some of the folks who are really concerned are joining together, and there’s a group that’s out there, maybe I’ll talk with them to see if they want to, as they’re developing that maybe they want to come talk with us. Folks who are in the know, I think can get into the advocacy spaces to make sure that these things actually make sense. I think folks who are unwilling to think about outcome measures and change and that kind of stuff, and/or focus on their private pay private practice, I think they will be left behind and will find themselves with fewer insurance contracts, substandard rates and and it’s sad.
Curt Widhalm 36:39
What is your advice to people now if they want to do something with this information?
Katie Vernoy 36:45
I have not fully embraced outcome measures in my practice, and I think that that’s short sighted of me. And so my advice that I’m going to also be taking, I’m going to find ways that I can do a bit more outcome informed treatment, so that I can feel confident in the work that I’m doing, the value that I’m providing. And should I need to do value based care at some point in the future, I will have those mechanisms in place. I don’t know exactly what that looks like, because I don’t love the PHQ-9 and the GAD-7. One of them was actually created by a marketing professional to sell more anxiety drugs. So, you know, I think that there are better measures, and so I want to do some investigation on that. And I don’t think that they’re actually doing the ORS and SRSs as a measure of progress and success. I think it’s other things. But I think if, if people want to be involved in this, I think there’s: line up your practice to be efficient and streamlined and do good work for you, and do some outcome measures. And then if you’re thinking you want to engage in this space, I would, I would potentially start joining some of these conversations and get into advocacy work. Because if, if therapists aren’t at the table, if folks with lived experience aren’t at the table, we’ve got people who are just getting information from, you know, kind of the bubble of investors and potentially clients turned, you know, founders and so they’re going to have a very different perspective than someone who actually is in the field, doing the work and understanding what can impact some of those outcome measures.
Curt Widhalm 38:32
We would love to hear your thoughts on this and continue on with this conversation, because Katie is spending just over half an hour here trying to take something where, when Katie comes out of a conference overwhelmed with information, it’s a lot of information. I’ve been to enough things with her to say that there are things that she walks out of there with: I didn’t really learn anything new. But if she’s walking out overwhelmed like this, there is a lot more to be said, and you should continue on with those conversations, conveniently, do it on our social media or in our Facebook groups, The Modern Therapist Group to let us know the further questions that you have. And I’m sure that we’re going to invite some of these people for episodes coming up in the next year or so, so that way we can do something before everybody’s job gets taken away. So until next time I am Curt Widhalm with Katie Vernoy.
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