What are we FOR? Part deux.
This the second post in a series that looks at what we are trying to accomplish at YourPath. The first post looked at what we have been doing in preparation for our formal launch in early summer. This post will look at the plans we have for YourPath in the coming years. There will likely be a third installment around policy at the state and federal level, if not a semi-monthly series.
This stuff changes daily, so we’ll see where it actually ends up going, but this is where our thinking is at today. Maybe we will get into the t-shirt game someday. Everybody likes t-shirts. Maybe pogs will make a comeback?
Anyways…
We have opted to focus our initial efforts almost entirely on improving access to care. We are attempting to move the needle on access with as small a footprint as possible. We believe that our system becomes exponentially more effective when we are able to add the ability to scale services via medications for opioid use disorder (MOUD), peer support steered via evidence-informed curricula, and technology supports. Ultimately, once we address issues related to access at the local level, they morph into policy and workforce issues at the population level. More on that in another blog…
Our secondary efforts — and parallel efforts that are occurring behind the scenes here at YourPath — aim at improving quality via an open-source, tech-driven, collaborative, systems approach. Every single startup in the healthcare space claims to be taking aim at the cost/quality curve, but few are actually hanging their hats on care quality based on publicly-available outcome measures. Even fewer attempt to address costs via an open-source, collaborative approach. Honestly, most of what we have seen, even from the giant unicorns in the virtual behavioral health space has been CBT = evidence and anything else = garbage.
That’s…. Well, there are lots of words for what that is, but we’ll go with oversimplified and typical of businesspeople...
Almost every pitch we have seen prior to starting this operation (While we were at Hazelden Betty Ford and Livio) was focused on what basically amounts to rationing care — albeit with a scalpel instead of an axe — and establishing narrow care networks. We have learned that the limiting factors in care models and healthcare systems are not the ceilings, but the floors. We have seen across the country what happens when individual’s care trajectories intersect with poor quality of care — the care is terminated. It isn’t a referral or handoff at that point. It is a disruption in the entire process that results in individual and group trauma and often jeopardizes future care by increasing distrust of services.
This needs to be addressed via swift and heavy-handed regulatory and policy measures as well as as incentive-based contracting via value-based reimbursement. The dinosaurs are going to thrash and wail the entire time, but they need to change or go out of business. Period. Sorry, not sorry. Alas, another blog for another day…
We have been fortunate to be part of some of these quality improvement conversations at the state and federal level. I was able to be part of Facing Addiction’s discussions around quality improvement and on the sidelines of Shatterproof's efforts through ATLAS. We are fortunate to call Dr. Annie Peters from the National Association of Addiction Treatment Providers a friend and a member of our advisory council. NAATP’s outcome measures and quality improvement programs are a welcome and desperately-needed part of our systems puzzle, especially among NAATP members.
Those of us doomed to a life in this space are all familiar with HEDIS, JCAHO and CARF, which — in our humble opinion — have been proven unable to meet the demands of our times.
So, what’s the plan?
We are faced with the issue of attempting to align ourselves with efforts highlighted above, or we can set off on our own.
We are doing a little of both.
We fundamentally agree with the theory behind ATLAS and I really enjoy NAATP’s approach to outcome measurement, which is an open-sourced combination of some proprietary measures and existing instruments (PHQ-9, GAD-7, BARC-10, TEA, and maybe something else that I can’t remember…). We also believe from (what’s left of) our hair to the tips of our toes that effective services can only exist in the context of the hyperlocal cultures we all exist within. By addressing needs within this context and around the social determinants of health, we are able to meet the basic needs that people have which interfere with stability and access to care. If you are working with somebody who is getting great anxiety-focused therapy but goes home to sleep in a tent under a tree off a bike path, doesn’t have enough to eat, and is being abused by their partner, you’re probably missing the boat.
To effectively address these needs, we need to expand our definition of what constitutes “substance use disorder” treatment. Think of the Certified Community Behavioral Health Clinic (CCBHC), but unbundled and available on-demand, in-person and virtually and combined with all of the other, already-available supports in the community. This vision is why we are building partnerships across not just the medical and clinical behavioral health space, but also with all of the services that our folks usually need, including benefit advocates, community health workers, harm reduction and safer use services, food support, education and vocational supports, housing assistance (especially recovery housing that operates from a Housing First perspective), childcare, transportation, and the list goes on...
While we align with the national standards and benchmarking efforts mentioned above, we aim to collect — actively and passsively — granular outcome data that will be analyzed via machine learning and artificial intelligence. We are certain that there are as-yet undiscovered correlations between services and outcomes that can be best found through large-scale data analysis. And sometimes we’re convinced the only thing our EHR is good for is collecting vast reams of irrelevant data.
And billing. It’s good at billing, probably.
Our longer-term goal is to use this data, our technology products, and our flexible and nimble collaborations with likeminded service providers to offer a proven model of scalable care to payors and large, tech-driven behavioral health focused intermediaries like Lyra, Modern Health, TalkSpace, MindStrong, etc… While we build out our services, we will be measuring and refining as we go.
The end goal is that we have a solution set that addresses as much of the continuum of care as possible via various evidence-informed practices, offering a blueprint, roadmap, or menu for communities and payors to support effective population health management. Our hope is that we will be able to help support similar efforts across service systems and regions via our (and others) technologies, content and curriculum, and data analysis capabilities.
What this might look like in practice is a confederation (not limited) of the following:
School-based prevention and screening efforts
EAPs and workplace wellness plans
Syringe access and safer use services
Peer-based harm-reduction outreach models, including naloxone distribution
Primary care clinics
Culturally-specific healing, recovery, and treatment programs
Office-based opioid treatment programs and Opioid treatment programs
Specialty treatment across the continuum
Community-based mental health services including individual and group therapies
Diversion programming and post-arrest and post-conviction programming
Recovery support via professional and non-professional peer-driven models
This is a super-limited, back of the napkin grouping of services, but it shows the promise of these services working together. All of these efforts are in existence in most settings across the country. If anything doesn’t exist, it is usually services like OBOTs/OTPs and harm reduction services. Our experience seeing the dire need for conscientous, recovery-oriented MOUD treatment is one of the reasons we started YourPath. We know that the need for MOUD providers can be addressed via scalable telehealth practices or collaboration via federally-qualified health centers (FQHCs) or other primary care clinics. We also have seen the explosion of harm reduction services through grassroots communities if they have a little support and mentorship.
And, with the recent news that the Biden Administration will be kicking in $30m for harm reduction (search for it, it’s long…), we are FINALLY seeing explicit institutional and fiscal support for harm reduction at the federal level. That brings along a whole other problem of colonization of these services (a blog for another day), but we love to see the support.
These services also operate in silos, at best. Usually, there are significant conflicts between the operating theories and orientations for these approaches. Sometimes, these groups are “on sight” with each other, which does so much harm to the folks we serve it’s heartbreaking. Our hope is that we can help the participating organizations and individuals realize that we have so much in common with each other that the maybe 4% of stuff that we might not agree on is irrelevant if we focus on the needs of the individuals we serve and not our own opinions or agendas.
Live and let live, I think. Or, fight endlessly on the internet while alienating your potential allies and comrades in the fight against this thing. Either way…
Let’s just be person-centered, yeah?
This cohesion and collaboration — when supported via various technology products and services that establish and measure efficacy — would have the power to shift entire systems of care. At least that’s our hope.
Thanks for reading and for joining us as we start this wild ride. Stay tuned for the next blog focused on state and federal policies that we believe would benefit the folks we serve.