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Our Field’s Need for Talented Executives has Never Been Greater
There is a tendency in healthcare to focus on the next big clinical advance. Our field should instead be attending to operations and finance. Behavioral healthcare is being challenged to reconstitute itself inside a consolidated healthcare industry. We are being merged into large health systems at a fast pace. Our field will be changed for generations. We need talented executives to help us make this transition.
Our clinical programs will undergo changes in ownership, followed by uncertain organizational changes. Our executives will be tasked with negotiating how we operate in this new environment and how we are paid as employees of larger healthcare entities.
This may seem to be a straightforward negotiation about new terms of employment. However, it is complicated by the intricacies of medical-behavioral integration and the power struggles inherent in such deliberations. Business consolidation will freeze our care delivery systems in place, with all their current imperfections, until merger activity is complete. System improvements could then resume.
Consolidation presents several opportunities for improvement, and these questions should lead the list:
- How will healthcare organizations boost the chronically poor access rates for behavioral care?
- How will measurement-based care (MBC) be implemented for risk and outcomes management?
- How will behaviorally focused prevention programs be implemented in primary care?
- How will brief clinical interventions by therapists in primary care be managed?
- How will clinicians be paid in new integrated care systems that demand advanced skills?
These questions reflect the complexity of the challenges ahead, and yet much of that complexity can be reduced to a single high-level concern: funding. After these healthcare corporations invest millions to acquire our programs and services, why would they not approach the ongoing management of our field with a priority on minimizing costs?
In the spirit of hoping for the best but preparing for the worst, here are some pessimistic warnings:
- Health systems could address access demands and keep costs low by promoting digital therapeutics platforms and non-licensed behavioral counselors as primary solutions.
- The cost of MBC could be minimized by only collecting clinical results at the end of treatment and not providing feedback to clinicians about ongoing clinical risks during treatment.
- Prevention programs are historically minor investments (e.g., immunization), so programs focused on behavior change could be quite limited and consequently less valuable.
- Ensuring the most effective integration of therapists into primary care calls for a detailed business plan, but the priority could simply be to maintain minimal staffing levels.
- Health systems will prefer to maintain current compensation levels, even though behavioral rates are lower than those in healthcare and salaries should be raised to achieve parity.
Effective negotiators must be clinically informed, financially astute, and cynical about ROI questions. Some ROI questions are legitimate, and others are elaborate ways of rejecting new proposals out of hand. Numerous ROI studies have already shown the value of behavioral services, and yet conservative CFOs may prefer the certainty of cutting costs to the uncertainty of hoping ROI projections materialize.
What might a talented leader do? Two simple ideas are to be proactive and find power in numbers. Leverage is lost by waiting until mergers and acquisitions are closing. One’s priorities come across differently when presented as core principles endorsed by leaders in a field. Negotiating positions that represent common interests appear to be elevated beyond each leader’s self-interest.
The dilemma is simple. Acquiring companies may not be motivated to invest more in the programs they have just acquired. They saw enough value in the acquired entity to make the deal, but now they may primarily want a return on that investment. Consequently, the entity being acquired must justify additional or ongoing investments as bringing greater value to the purchasing company.
While clinicians may believe the best way to respond to such a challenge is with studies showing a substantial ROI, executives know many big decisions are visceral. Our leaders must sell a future vision of healthcare. While that vision cannot be a collection of vague beliefs, neither can it be a series of spreadsheets. Our leaders must sell a compelling story of how behavior drives health status.
Evidence for the importance of narrative can be found by reviewing how deals are closed. Potential buyers bring experts in operations, finance, and deal-making to the table. The focus on net asset value soon gives way to how badly each one wants a deal. Bidders often make widely discrepant offers, even though everyone has the same information. Reasons and feelings are as important as data for decisions.
Our field has advanced considerably in recent decades, but we still fall short on our access goals, our use of MBC systems, and the development of integrated care models benefiting the full range of primary care patients. We need talented executives to sell healthcare leaders on a vision of our field’s capabilities when these goals are more fully realized. The vision presented must be succinct, something like: "We can improve the overall health of populations."
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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