Two leaders behind national behavioral health group Concert Health — co-founder Virna Little, PsyD, and CEO Spencer Hutchins — recently joined Becker's to discuss their vision of incorporating collaborative care models, measurement-based treatment and more.
Question: What is your main mission and priority at Concert Health?
Spencer Hutchins: I'd say it's a pretty simple vision. It's the pretty basic idea that every American deserves access to high quality behavioral health services alongside their most trusted healthcare provider. So everyone is important to our vision, regardless of insurance type.
We're really proud that 60 percent of the patients we've cared for had Medicaid or Medicare. We're not only focusing on those people that can pay cash or that have the best commercial insurance in the market. There's a lot of talk about access. We're glad that exists in the world, although we very firmly believe that needs to be paired with high quality. So, a huge part of one of our core values is rigor — focusing on really measuring the impact we're having on patients from the speed of treatment and amount of symptom reduction that we see. It's a core aspect of the care model that we focus on, which is called collaborative care. Then the final piece that's really critical is that "alongside" word, that behavioral healthcare needs to happen, embedded into the organization people trust the most, with the provider that they trust the most, which is normally their primary care provider or pediatrician.
What we're trying to do is make that happen. It's not ever happened in the world before. Frankly, we weren't even really trying until five to 10 years ago, right? In this country, at an individual level, we thought of mental health as something you ignored or was less than or something you work on with your friend, minister, or maybe pay out of pocket for a therapist... but it wasn’t healthcare. Then as an industry, healthcare takes the same approach, like it's a different thing than physical health. Our view is it needs to be together, needs to be integrated, so we're trying to build the best behavioral health medical group in the country to sort of make that vision a reality by doing a lot of the work ourselves and treating a lot of patients — we just started care for our 53,000th patient — and to grow and be a part of contributing to the field through research, advocacy, and other things so that other people can the solution as well.
Q: That's great. I think you're definitely jumping in at the right time.
Dr. Virna Little: Especially giving access. When you think about the percentage of people that live in a community where there is no access to evidence-based behavioral health treatment, to be able to get it the same day next day from their own primary care provider that they already have a relationship with is really critical.
SH: Yes, really building the connectivity. We think that mental health needs to not be thought of as a separate industry and the majority of behavioral health support needs to be happening in primary care, because for decades, it's shown to be more impactful. [Primary care providers] are the only providers that have the relationships with patients and the scale to meet everybody. There's no world in which we can arrange the deck chairs where psychiatrists are taking care of everyone with depression and anxiety, there's just not enough of them.
Q: You mentioned you specialize in same day access to care. How have you seen that affect patients?
VL: That for me has always been a gold standard. Right when we started Concert, I said, "We need same day and next day. One thing we know is that every day that goes by, you have a 2 to 4 percent less chance of actually engaging someone in care. To me, that's too much and also it's interesting to hear patients say, "Wait, somebody is going to call me later today?" but also I've had primary care providers tell me this the first time in my career that I made a referral to behavioral health. Through getting patients into care quickly, we hold ourselves to what I think is the gold standard in behavioral healthcare.
SH: We haven't talked too much about the specific, evidence-based care model we use called collaborative care. A really important aspect of that is that we have more hand raising happening in this country. We have more people that are aware at a societal level that they need help with mental health. It's one of the reasons that waitlists are starting to happen, because more people are searching for care. But an enormous number of people still don't, who think therapy is for wimps, or that depression happens to other people. That's a real power of embedding behavioral health into primary care. Using that moment in which they trust their primary care provider, say yeah, I will take a call from someone you know, a little bit of help, a little bit of coaching or goal setting, I could use that. It's a moment you need to cherish and if you deliver on it, it also means you're more likely to engage people that are likely older adults, more likely immigrants or first generation.
In America there are pockets of people that for whatever reason, are less likely to recognize the symptoms in themselves. If you move quickly, you end up engaging with the care and can have some of the most dramatic outcomes. They often might be people that have many other comorbidities, who may really identify with how their diabetes is holding them back or their COPD is a disaster for their life. Recognizing sort of broadening the aperture and letting them know if you also attack your underlying depression, it's gonna make it easier for you to mobilize around those other things. You can create a virtuous cycle where a vicious cycle exists today.
Q: What is your treatment philosophy and what makes Concert different?
VL: Concert Health really specializes in collaborative care, which is a very specific evidence based model. CMS recognized collaborative care in 2017 with specific codes to be able to reimburse properly. It's very specific and adds two people to the healthcare team: a collaborative care clinician that really works with the patient and the provider, and a psychiatric consultant to give recommendations to that healthcare provider. Providers meet with that collaborative care clinician weekly to talk about patients who aren't getting better, or getting worse, who are having side effects, or who aren't getting better, so something can be done about that. That's this very tree-to-target approach. If you're not getting better, we're doing something about it right away. We're not waiting 30 days to see if your meds work and we're measuring progress. I think two years ago, I had an occasional meeting on measurement-based care and now I have probably four national meetings every month on measurement-based care in behavioral health. Collaborative care was one of the first models that promoted measurement-based care and quantifiable outcomes, using the PHQ for depression and the GAD for anxiety, looking for a 50 percent or 10 point reduction in the symptoms. We're super proud to have about half of our patients reach that goal in 90 days, which when you think about taking away half of someone's symptoms, it makes a tremendous difference. It's getting super interesting as we think about expanding collaborative care and measurement-based care to include ADHD and bipolar and other patient questionnaires. I think we're going to see really big expansions to what falls under the collaborative care umbrella.
SH: If you're thinking about a market map of where we're trying to build Concert versus alternatives, our belief is that fundamentally, you need to have great clinicians involved here. It's not a tech-only solution. We are really building what we think of as a high-performing medical group model, with our clinicians all being employed and being on a journey of building their career with us, as opposed to some others that are trying to be more marketplace matching supply and demand with a group of independent contractors. Our view is that this care model has shown through so much research to be effective. It's not simply "Oh, I'm going to find someone with the right license type, connect them with patients and hope it goes well." It's real, measurement-based care that we think can drive a really satisfying professional experience for those two clinicians in the collaborative care coalition and as a psychiatric consultant. That's best done when they really feel like they're part of a coherent organization.
VL: If you talk to a lot of primary care providers or even behavioral health providers, they don't actually know there's benchmarks for depression or anxiety outcomes. It's pretty incredible to be able to move this work forward.