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Study Your Next Move as Healthcare Segments Consolidate
Many behavioral executives will feel growing job insecurity in the coming years. They will see colleagues impacted by the ongoing, unprecedented consolidation in the healthcare industry. No one will be able to predict the next big deal. As health systems acquire behavioral programs and services, they will reduce administrative staff to gain efficiency. Contemplating potential career moves will seem wise.
At a similar point in my career, I became an entrepreneur. Managed care transformed the behavioral healthcare industry in the 1990s, and clinical practices faced a new financial model. I created a group practice with a partner. We contracted with the new managed care companies and hired therapists, psychiatrists, and administrative staff.
Consolidation presents realities as challenging as managed care. Health plans have not only acquired our behaviorally focused managed care companies, but they also own multi-disciplinary provider groups. Health systems now combine hospitals, practitioners, and a range of ancillary services. In step with this consolidation is the industry’s move toward a new financial model, value-based care. Few in our field are prepared.
The Emerging Landscape
Behavioral executives should start exploring future opportunities in health plans and health systems. This should not be driven by a sense of panic or a belief that a new job must be urgently found. It should be undertaken as a personal exploration of the future for someone with behavioral expertise. It is a time to build relationships, understand complex new healthcare entities, and ponder attractive next steps.
This evaluation period involves guesswork. The healthcare industry is dynamic, and how our programs and services will be integrated within diverse organizations is still being determined. It is not likely that today’s prevailing integration models (i.e., collaborative care model, primary care behavioral health) will be templates. They were limited efforts to forge connections within a fragmented industry.
Some behavioral executives might be willing to bet that healthcare companies will retain the expertise of the companies they buy. This is sometimes true, yet many acquiring companies believe any specialty business is manageable based on the general skills of their executives. A better strategy for behavioral leaders may be understanding the emerging power structure in the healthcare industry and fitting into it.
The healthcare industry is grounded in the medical model, but everyone now knows that behavior drives health status. Our behavior change expertise is a strong value proposition. Unfortunately, healthcare leaders are focused on several big issues, and the need for cost containment constantly threatens any value proposition. Healthcare leaders will want us to deliver our field’s value while managing costs.
Behavioral executives will be confronted with some understandable expectations—e.g., maximizing the use of new technology—but others will be “stretch goals.” That might include improving population health and reducing total healthcare costs. While our case is conceptually strong for making big contributions in these areas, our abilities are largely unproven to date.
Having a general return on investment (ROI) model in one’s pocket might be helpful, but attitude is more important. Healthcare executives are unlikely to believe any ROI model—they require proof based on their own numbers and experience. Yet they want leaders eager to tackle tomorrow’s challenges.
Know Your Audience
Healthcare executives are not all alike, and their knowledge of our field varies greatly. Here is a crude typology for understanding their variability:
- Some executives see our field as another step in the inexorable consolidation of the healthcare industry. The critical numbers related to a potential deal take precedence over any other feature or benefit of an acquisition. This perspective may be important and reasonable, but talking with someone focused only on the bottom line has limited value in an exploratory phase.
- Other executives know very little about behavioral services but are struck by the heavy media attention to behavioral health needs. We should educate these individuals. Discussing specific solutions may be less important than conveying the need for experts to address prevalent needs with effective and efficient solutions. They must understand the unique aspects of our field.
- Many executives in healthcare understand our field and its solutions quite well but worry about escalating healthcare costs. They know the value of therapy but worry about its subjectivity and seeming lack of limits. They want sophisticated solutions—e.g., measurement-based care, digital therapeutics, brief primary care interventions. They are a receptive but tough audience.
The time is ripe for behavioral executives to leave their comfort zone. One’s job may be secure for years to come, or not. In the long run, it may be largely beneficial that our field is consolidated into the healthcare industry, but no individual can be assured it will be a positive development in their career.
The near-term priorities for our field are not clinical in nature. Our business leaders have challenges that will decide our readiness for future clinical innovation, and the outcome is not certain. Our executives will negotiate terms for medical-behavioral integration that could take us in two very different directions—either toward an expansive focus on innovation or a restrictive focus on efficiency.
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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