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Promote Change at an Institutional Level for Behavioral Healthcare
Privately funded M&A deals have not greatly changed the behavioral health field over the past decade. The targets have been as broad as valuations have been high. Mental health, substance use disorder (SUD), and autism programs have been acquired, and outpatient group practices have been consolidated. Digital companies have moved from angel to institutional investors. Yet our field’s configuration and its problems remain the same.
While this was occurring, the healthcare industry drove its consolidation to new heights. Health plans acquired standalone managed behavioral healthcare organizations and expanded into care delivery. Health systems consolidated both vertically and horizontally. While no official registry exists, it seems behavioral leaders are not advancing in number or power within the healthcare industry.
The priorities of investors are well-known. They combine existing entities or add new ones to “platform” companies, usually without a new operating vision. Tech products are especially attractive as scalable and profitable nuggets. Financially oriented executives tend to replace homegrown behavioral leaders—after all, the focus is mainly on the financials. What might investors be missing?
Short and Long-Term Investments
Investors see that our field has a combination of vast unmet needs, effective services, and stable funding through health insurance. Uninsured Americans are at an all-time low, and behavioral health benefits are “essential” by law. This makes our field an excellent investment target, but for what duration? Investors take a perspective that is best described as transactional or opportunistic.
Opportunism lacks any perspective or deep concerns about the long run. It means being primarily focused on current circumstances. Yet, one can have a long-term vision while being opportunistic—a balance is rarely achieved, but a healthy tension can exist. In most cases, people with deep industry knowledge must offer strategic, long-term views.
Might our behavioral leaders give investors advice (unsolicited) about how our field should deliver care? For example, might we help ensure they reform care access and reduce system fragmentation? People face several obstacles to care today, and our historical divisions—between mental health and substance use services and between physical and behavioral care—make holistic care aspirational.
Expanding Current Systems or Embracing New Ones
Our field evolved as a cottage industry and is now being consolidated into health systems one transaction at a time. Private investors start with the low-hanging fruit. However, some will risk developing more complicated opportunities over a longer timeline. The growth horizon for our field could be lengthy given its unmet needs, but a long-term strategy is needed.
Our programs and services increasingly will become part of health systems, and we have an opportunity to educate healthcare executives and investors to ensure this process fits an overall strategy for our field. Our goal should be to ensure patients have easier access to better-integrated services. This means helping to transform our field rather than just moving it under new ownership.
The main point is that we should not grow our current flawed systems. Healthcare thrives on specialties, so retaining today’s mental health, SUD, and integrated care structures would be easy. However, more ambitious ideas should be considered. For example, what about transforming the primary care setting into a distinct behavioral level of care? Let us agree on the best solutions to pursue and press the levers of change.
The Uphill Climb of Institutional Change
We must face 2 realities:
1) Large health systems have competing priorities beyond growing their behavioral services; and
2) Our field lacks clout as it approaches consolidation into the healthcare industry. Institutional change is not easy, but critical lessons can be found in the gritty work of behavioral entrepreneurs and investors over the past decade.
Most entrepreneurs who created behavioral health tech products had no behavioral training. They had personal reasons for caring about the field and built multi-million-dollar companies from nothing. Our established leaders need similar tenacity. Our once-independent field can emerge stronger as part of the healthcare industry, but we are underpowered for a climb that will be all uphill.
Healthcare leaders will be primarily guided by tradition and convenience in integrating our services into their multispecialty organizations. They will gladly proceed with little input from us, but we may not like their vision for our field. We will need to push them to consider new views.
Time is growing short for our leaders to articulate a strategy—health systems need us to outline the institutional changes that will foster better behavioral care. Just as critical, we will not succeed without vocal support from all stakeholders in our field.
A 1971 song cautioned, “the revolution will not be televised.” The basic insight contained in this jarring line is still relevant. Institutions rarely make basic changes on their own, so waiting passively for progress to happen is foolish. We must imagine better institutions and then engage others in the uphill process of changing them.
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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