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Right Executive is Critical in This Era of Healthcare Consolidation
As the healthcare industry consolidates, behavioral leadership matters more than ever. Health systems will increasingly be managing and paying for behavioral services, and we must ask who is an ideal leader for a chronically underfunded field losing its autonomy. Some likely advice from recruiters and management experts should be avoided.
Recruiters might suggest behavioral leaders come from health plans and health systems to give them credibility. Management experts might value leaders who are data-driven and love the mantra, “what gets measured gets managed.” However, this seemingly sound advice could miss the mark. More important than any resumé detail or commitment to data is representing the top priorities for our field.
Beware of Pure Managers From Outside the Field
There is a school of thought that background and experience are less important for executive recruitment than pure managerial skills. This is sometimes taken to extremes as candidates with no experience in human services are judged to be excellent candidates for running a complex healthcare company. Of course, any approach to recruiting can work some of the time.
Proponents of this point of view believe management itself is an expertise, and excellence as a manager surpasses most other qualifications. This can bring some unlikely candidates to the fore, few experienced in the business they would be running. Another approach also favors outside candidates—prioritizing work experience in companies that might control the fate of the hiring company.
This is poor advice. We should prioritize leaders who understand our issues. It is not a time for gambling on outsiders, especially not those from health plans and health systems lacking behavioral experience. We want our leaders to represent our needs and interests. We should assume our leaders will often have to educate their superiors about key aspects of our field and remove biases and misconceptions.
Beware of Expedient Answers About Behavioral ROI
The head of behavioral health for a leading health plan recently disclosed in a public conference that his superiors routinely push him to justify the return on investment (ROI) for his expenditures. A few years back, the top executive for behavioral health for a different health plan told me the same thing. This brings up a quality needed in our leaders. We need executives not inclined to give the most expedient responses to ROI questions.
While it may be practical and self-protective to respond to ROI requests with the best estimates (however far-fetched they might be), this reinforces the legitimacy of the request. Our leaders need not overstate their resistance to such requests and may be best served by adopting an educational strategy. One time-honored approach is to ask a panel of experts to clarify the issue.
Success is not guaranteed with such a tactic. The conundrum is that legitimate examples of ROI can be found. One can cherry-pick those examples and ignore the larger issue. A better option might be to offer a clarifying framework for thinking about that larger issue.
Our Services are “Essential” and Underfunded
The Affordable Care Act (ACA) was historic in many ways. Few of its achievements are so bold and yet so subtle as declaring our health services “essential.” The significance of this designation has not been fully understood. An essential service cannot be omitted from health insurance. It does not need to be justified as paying for itself by reducing other healthcare costs or expenses.
This does not mean everything done in the name of behavioral health is essential. New services could be created that are ancillary rather than essential. Telling the difference may not always be easy. However, we must start by appreciating that access to care needs vast improvement. We should be funding more of our essential services, and those efforts must not be mistaken as ancillary funding.
Consider the example of placing more therapists in primary care. This is one way to expand essential services to those unable to negotiate today’s barriers. Calculating an ROI for this would be irrelevant, and our leaders must affirm so. While more therapists could reduce total healthcare costs, that discussion would deflect attention from the main issue of growing essential services.
A reduction in healthcare costs is speculative (usually based on few studies), but more critically, it is a violation of the principle that essential services do not need ROI justification. Cost savings often occur in healthcare, and multiple parties tend to want credit for creating them. Executives need to resist this temptation and promote our top priority. Our essential services are underfunded. We must fund them.
Our Services are Effective and Valuable
Payers and health systems will rightly persist in raising questions of cost, and we have good answers for them. The proper framework is again critical for these discussions. The focus should be value, a concept that combines outcomes and cost. We can demonstrate that our essential services are not just effective—they are valuable.
Anyone can be data-driven, but the key is choosing the right metrics. Once we have consensus that our field provides essential health services, the next step is to highlight our value with hard data.
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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