Winners Will Be Those Who Realize We’re Part of the Medical Field

We are entering a new era for our field. Healthcare is now one field, and those with behavioral healthcare skills will be finding their place in a medically dominated world. We will need to find our way in business by adapting to this reality. Functioning as a siloed specialty will rapidly diminish over the next decade. The question is how it all ends and who will benefit.

The most obvious sign that we are being absorbed is the rise of mergers and acquisitions led by medical entities. Many behavioral companies remain independent, but this is just timing. The trends are not driven by idiosyncratic forces. Many economic factors are at work, and healthcare funding will change. A key indicator to follow is the growth of value-based contracts. These impact primary care companies.

The government manages their funding trials through the Centers for Medicare & Medicaid Services (CMS). It is widely accepted that fee-for-service medicine will end since it mainly rewards the volume of services, and CMS has been experimenting with rewarding quality at a predictable cost. They have been contracting with accountable care organizations (ACOs) in risk-sharing arrangements.

The various programs have not all been successful, and in fact CMS announced in May that its “next generation” ACO model would end due to mediocre results. CMS is shifting to another model called “direct contracting” that is a variant of value-based reimbursement. Our field has played virtually no role to date. Our executives should be developing mutually beneficial collaborations to propose.

The outline for one such proposal seems clear. Medical providers must reduce costs for chronic medical conditions. They account for about 75% of total healthcare costs in most systems. ACOs have gotten weak results with their usual medical solutions. We know many of these patients have comorbid behavioral conditions and/or unhealthy behaviors. We can impact these major contributing factors.

This is one area of focus, and there may be several productive ways for our field to approach the critical need for behavior change. There are surely clinical settings for every type of medical care with expensive combinations of medical-behavioral problems. Innovative ways of changing behavior await discovery. Does our field have its best and brightest focused on these problems?

We clearly do not, and so a more basic question must be asked: How would our innovators know they should be focused on these problems? Those inside any field tend to focus on the problems generated by it. We are consumed with everyday internal issues. A quick scan of newsletters and blogs confirms this. Industry leaders must decide when external problems are enough of a priority to ring alarm bells.

One way to refocus the attention of the best minds is through financial incentives. This need not involve artificial inducements like rewards. The more natural way for focus to shift is as business opportunities shift. This process is exemplified in the 1998 business parable “Who Moved My Cheese?” This allegorical tale suggests we should anticipate change and be ready for the cheese (i.e., success) to move.

That is the current state of our field. Our old ways may still be productive, but signs of change are clear. The cheese at stake for most of us is a rewarding career. As we become established within the medical field, many good careers will be developing in new settings that require slightly different skills. Business leaders quickest to recognize change will find less competition to create big, new enterprises.

We exist in a massive industry. U.S. health expenditures hover around $4 trillion each year. Behavioral health disorders have steadily gained recognition for their prevalence and impact over the years, but we will increasingly compete with other health disciplines for funding. This is especially likely with value-based funding. Our field has long been underfunded, and there is no inherent reason for this to change.

It is sometimes helpful to approach current problems with the knowledge of history. The replacement of fee-for-service healthcare will be a monumental and lengthy process. The last time such an historic funding change occurred in healthcare was the emergence of the HMO model in the 1990s. The coming changes will be at least as disruptive for us as the era of managed care.

We can prosper in the future if we own the problems of the medical world as being our own. There may be real benefits. Our alignment with physical healthcare may be a gift that allows us to reach more people in need. New career paths may open up for our clinicians. We will succeed to the extent we minimize defensive reactions. Future winners are adjusting to this impending reality now.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.