Why Behavioral Health is a Critical Part of Advanced Primary Care — and Why the Embedded Model is So Effective

Guest: Justin Hunt, MD

Narrator (00:00):
Welcome to 360 degrees of healthcare with Dr. Stan an in depth. Look at our industry from our very own chief medical officer who will talk with other medical and industry professionals on the changing and evolving landscape of the healthcare system from the inside.

Stan (00:21):
Thanks for joining us. My name is Stan Schwartz. I’m an infectious diseases physician with decades of experience in healthcare. As a student, a teacher, a fellow, a researcher, a practicing physician in both solo and group practices, a health system executive, and now a healthcare entrepreneur. And as I get all older as a patient, I want to share my 360 degree view of healthcare with you. My thanks to zero studios for support of this podcast. Let’s welcome. Our guest, Justin Hunt MD, a psychiatrist who works with Oak street health. Justin, can you introduce yourself and give us a 50,000 foot view you of what Oak street health actually does and what benefits it brings to senior care that can be translated to non-senior care?

Justin (01:10):
Absolutely. Well, first of all, I wanna thank you for having me. It’s really a pleasure to be here today. Um, I’m Justin Hunt, I’m currently the medical director for behavioral health at, um, Oak street health and, um, Oak street health is a actually a network of value-based primary care centers for adults on Medicare. Um, and we are quite large nowadays where, um, we currently operate approximately 125 centers across 20, um, states and our centers are, uh, really strategically placed in communities where access to high quality primary care is, is lacking. And, and that factors into our overarching mission, which is to rebuild healthcare as it should be with a specific focus on health equity, as well as, um, being very intentional with closing health disparities. Um, and our, our value based model of care means that we really focus on the quality of care rather than the, the volume of service services as it’s traditional in the, um, in the typical fee for service model.

Justin (02:19):
And we assume the full financial risk of our patients as, and to, um, be good stewards of the dollars that we get on the front end. We deliver personalized preventative care. And our model was specifically designed to meet the needs of older adults who face, um, chronic illnesses. And as we will concentrate on today, I assume, um, our, it incorporates other things such as behavioral healthcare, uh, addressing the social determinants, um, of health and all these things are easily accessible through, um, in center and home and telehealth appointments, as well as a 24 7 patient support line as well. And, you know, most importantly, um, thinking about the model from kinda 30,000 foot good view, um, it it’s working, we’ve driven approximately a 51% reduction in patient hospital admissions, uh, 42% reduction in 30 day readmission. And, um, also a 51% reduction in emergency, um, department visits. And as a psychiatrist, I would, I would hope that our integration of behavioral health has factored into those numbers as well.

Stan (03:31):
Wow. I mean that those results would be applicable to younger populations as well as older populations. So you’ve made behavioral health an integral part of your primary care model. And on a previous conversation, you mentioned that that was through the use of licensed clinical social workers, two questions. What is behavioral health and how is it different from what we call mental health and psychiatry or psychology?

Justin (03:58):
Oh, that’s an excellent question. The terminology can get confusing sometimes in the, in the behavioral health world, you know, traditionally, um, behavioral health is inclusive of both the kind of traditional mental health diagnoses. So maybe the kinda the traditional DSM five psychiatric diagnoses that you think of such as or bipolar disorder. Um, but it also includes, um, perhaps the, even more of common substance use disorder diagnoses as well. So it’s really kinda all inclusive of both mental health as well as, um, substance use. And as far as like, you know, how does psychiatry, psychology all those different field? How do they all kind of factor into it? Well, they’re, they are, they’re really kind of the providers under the behavioral health umbrella and they all of course can specialize in different things. Some psychologists, you know, PhDs, um, like to focus, um, more on cut to behavioral therapy for depression.

Justin (04:59):
Others might have more of an interest and motivational interviewing for substance use. Um, and so there are lots of different disciplines under the behavioral health umbrella and, and that too can be confusing too. Psychiatrists of course, are the, the professionals that go to the med school and then do a residency in psychiatry. Um, psychologists tend to have a little bit more of a background as they complete a PhD or S I D. And then as we have it, um, earth street, we have master level therapist or LCSW, so they often will get an MSW, but then they have to go through a licensing process, um, within each state to become an LCS. W um, so yeah, and they traditionally provide both, um, psychotherapy, um, as well as care management too.

Stan (05:51):
So, I mean, most people in, in equate the word or the term social work with, you know, people who deal with disadvantaged populations or homeless or impoverished, but it sounds like it’s a whole lot more than that.

Justin (06:04):
Yes, yes. And that, that, you know, we even, um, deal with that confusion. It was inside of our company as well. Cause we actually have in each one of our Oak street, um, centers, um, once they become mature and reach a, a certain number of, um, patients, we ideally would have both an MSW, which would be kind of a classic social worker addressing, um, the social determinants of health and working on housing and food insecurity and perhaps transportation, things of that nature. Um, but then we would also have this other role, which at Oak street, we call a behavioral health specialist, which is the LCSW. And we really think of the LCSW as being providers. Um, just, you know, just like we would think of the psychiatrist or primary care doc or, um, primary care NP as being providers as well. They, they provide billable services, um, that is traditionally evidence based psychotherapy. So that that’s kinda the main differentiator between just the MSW and LCSW is the actual provision of billable psychotherapy services.

Stan (07:16):
So let, let me ask you this, what percentage of your general patients wind up getting behavioral health services and how is that different from what you expected going into the program?

Justin (07:31):
You know, we, we are right around and we’re right around the average, um, across the country. So for the, when you’re gonna go back to some older epidemiology studies of, of depression, uh, maybe depression in, in primary care, they, they usually estimate about, you know, if we’re doing kinda a point prevalence, uh, two to 4% and the general population, although some numbers recently have been higher, we even getting closer to 7%, but in the primary care population that jumps more into like the 10 to 15% range. And that’s, that’s where we are at Oak street. I would say edging more toward the, the 15% range, just because of the, um, the average complexity of our patient and the amount of medical comorbidity. Um, in addition to the behavioral health suffering too,

Stan (08:23):
How does the, I mean, you kind of specialize in taking care of chronic problems. I mean, are the chronic problems exacerbated by the mental health problems or are the mental health problems exacerbated by the multiple physical problems?

Justin (08:38):
You, I think that’s a, that’s a excellent question. And I, I think, um, you know, really just kinda more of a common sensical answer is, um, yes, to both of those. I think it’s, it’s a, it’s a complex bidirectional relationship between, um, uh, medical diagnosis such as diabetes and the concurrent behavioral health diagnosis. We, we know that, you know, sometimes when sugar levels are not well controlled that sometimes can drive downstream psychiatric symptoms. And then if you think about it in the flip way, um, certainly, um, depressive symptoms as low energy, poor concentration, erratic sleep schedules, erratic appetites can have a very direct effect on the ability of someone with type two diabetes, for example, to, to manage their, their blood sugar. Um, and the upstream determinants such as diet and exercise and things of that nature. So highly I, and, and you can do that relationship with a, a wide variety of different combinations between med-surg diagnoses and psychiatric diagnoses.

Stan (09:46):
So when a patient, when, when you see a new patient, for example, do they get a mental health checkup along with a physical checkup?

Justin (09:53):
They do, you know, we’ve actually built it into a, what we call it, Oak street, the rooming module that’s, um, often driven really by our medical assistant on the front end as a, as a patient, um, comes in. So we, we do an annual, um, what we call PHQ two screening, and then if the patient scores three or above on the PHQ two, and the full PHQ nine, um, is then gathered and PHQ nine is a, is a classic, um, scale, um, to measure, uh, major depressive symptoms. So for example, if you give a, get a score of 10 or above, then that is actually will generate an auto referral to the behavioral health team. And that indicates moderate suppression basically.

Stan (10:38):
Can you tell the listeners, I mean, what is a PHQ two? Is it like a, is it a something the doctor holds in his hand or what,

Justin (10:46):
Well, it, it can be fielded in a, in a lot of, a lot of different ways. Um, ours is built more into our EMR, um, computer system and that drives the, um, in a questioning. Um, and, you know, and nowadays with the, the mini apps that are popping up in behavioral health, that, that often target employers, um, they also can, can be fielded via, via an app where the patient might get a text message saying that they, um, that the app wants check in on their longitudinal mental health status. And then they would go in and, and fill out the questionnaire, which is, is nine questions. And it, it really is largely based on the classic symptoms of major depression as, as listed in the, um, DSM five, which is, you know, kinda the, the Bible of psychiat free, so to speak. Um, so it, you know, it gets a concentration and appetite sleep, um, suicidal thinking as well, which is one of the more, um, acute questions in the, in the mix. So it’s a, it’s a classic one and depression.

Stan (11:56):
Do you find that most, most people answer them? Honestly,

Justin (12:00):
I do, if they understand them. So I think there is, um, definitely a health literacy piece to this to ensure that, um, the patient understands the, the question and what the, the rating scale means as it’s, as it’s delivered to the, to the patient by the ma and what we’ve intentionally had to do some targeted training with our, um, medical assistance to ensure that we’re gathering valid, valid screening information on our, on our patients.

Stan (12:32):
So, mm, when a patient scores above that magic three, and you go to the second test, but they’re not like, you know, suicidal. So at that point, does the LCSW licensed clinical social workers start doing therapy? And, and if so, where does the therapy happen?

Justin (12:51):
Yes. Excellent. Um, excellent question. So it, it would generate, um, so there’s multiple different ways that the patient can get over to the, um, behavioral health team within that same Oak street health center. If, as I mentioned earlier, if it’s a score of 10 or above on the PHQ nine, there’s gonna be an OTA referral sent anyways to the behavioral health specialist, AKA LCSW, but often the, the primary care, um, physician or MP will, will note the behavioral health suffering too. And they, they might trigger a referral on their own and ideally the way the model, um, would, would best work. Although it’s not always possible is to do a warm hand between the primary care physician sitting with the, the patient to the behavioral health specialist, who’s present there in the brick and mortar center. That that’s really the best way to develop that initial treatment engagement that is so important for subsequent engagement and behavioral health care.

Justin (13:55):
Cause, you know, there still has so much stigma, particularly in certain geographic regions of the, of the country when it comes to mental health. So we want them to be as comfortable and as connected as possible on the front end. Now, in reality, it’s not always possible for that LCSW to be available because they’re, they’re providing one-on-one psychotherapy to, to patients too. So, and while we, we really do encourage them to try to eject out of the room as, as much as possible, they, they have to kinda navigate that and ensure that they’re not leaving the current therapy patient behind to go do that warm hand off. So that’s kinda the art of integrated care.

Stan (14:33):
So how long what’s a typical behavioral health therapy session? Is it like 10 minutes, 30 minutes, 60 minutes.

Justin (14:41):
It tends to be kind of long. Yeah, kind of more in the 45 to 50 minute side of things. And, um, they would, when that referral comes into them, their initial appointment, and maybe even going into the second one would be more of an initial assessment. So gathering more validated scales on, you know, other symptom presentations. So for example, we have another scale called the GAD dash seven, which focuses specifically on generalized. We have another one called the PCL five that focuses more on PTSD and trauma. And in our populations at Oak where we’re often in pretty tough neighborhoods, the, the level of trauma is pretty, um, significant. So they, they would gather all that and then ask all the traditional questions of a, of a psych psychiatric evaluation. So, you know, past psychiatric history and social history, what’s the, what’s the family history as well.

Justin (15:41):
And of course the, any concurrent substance use that be, could be, um, complicated in the picture too. So really with our LCS Ws, that initial appointment is approximately an hour. And then they would set up a plan of short term evidence based psychotherapy from that point forward. And those subsequent appointments would be about 45 minutes. And then we really encourage our LLCs Ws to use a evidence based model. So, so for example, like cognitive behavioral therapy for depression, or, um, one for PTSD would be prolonged exposure or cognitive processing therapy for, for PTSD, for example. And, um, and usually those, um, can be completed and, you know, around a 10 to 12 session course of, of psychotherapy. Um, and that’s, that’s certainly what we, um, would ex expect our LCS Ws to do. Sometimes it can be done a little, a little quicker depending on how fast they progress in their, in their work. That that’s kinda course.

Stan (16:50):
So do you, do you find, or do you have evidence that, that having behavioral health either reduces the amount of drugs prescribed for psychiatric or for mental health conditions? And do they get better results than why not just give, why not just give an Antip pres other than, rather than spending hours in psychotherapy?

Justin (17:18):
Right. Right. Well, you, I would say the first thing is, is, um, one of the, the core, um, principles of our, of our collaborative care model is, is really being patient centric. So a fair number of patients come in with a, a level of, um, behavioral health suffering and they, they really have no interest in a medication at all. So this, um, approach of course meets them where they are when you review the evidence. It kind of depends on what, which diagnosis or kinda symptom cluster you’re you’re thinking about. But in general, psychotherapy is, is very close to being equivalent with, um, psychiatric medication management and what the data traditionally shows in depression and anxiety is really a combination of both of them has the, has the greatest effect. I, I would say in PTSD, it’s, it’s a very close tie between if you’re truly providing a good evidence based psychotherapy is, is just as good as the, the medication management we have for PTSD right now. Um,

Stan (18:20):
But I mean, isn’t it at the end of the day more costly?

Justin (18:25):
It is, um, not necessarily because the, the providers, um, that would be brought in to, um, see a patient one on one, um, from a psychiatry perspective would be, um, much more costly than using the master level therapist. Um, now in our model is we, we really have a mix of both. Um, so we, we, um, our implementing what’s called the, we have to call it the, the capital C collaborative care model, cause it’s a, not a, not a real specific name for a model, but it was a model that was developed, um, largely up at the university of Washington. And they still have a, a center that, that supports its implementation of across the country called the Ames center. And it’s a, that really thinks about both. Um, it includes this LCSW, um, professional on each one of the centers, but then you also have a team of what we call at Oak street, our telepsych, um, virtual team of care. So they’re there to provide consultation back to the PCP to support their prescribing their psychiatric meds. Um, they’re there to support the behavioral health specialist as well, and choosing kinda the right course of psychotherapy. And they’re also there to see folks one OnOne and, and tell a care if they’re really complex and they need the specialty level of care.

Stan (19:50):
Are there examples where the behavioral health approach is clearly safer, more advantageous than psycho-pharmacology AKA drugs?

Justin (20:03):
You know? Yes, I, I think so. I mean, uh, you know, naturally all, all medications carry a, a risk benefit profile. Also if someone, you know, particularly is not interested at all in medications, and then they also present with more, you know, kind of milder symptomology. So anxiety, um, that, you know, is, would almost be considered to be more than the realm of normal. So to speak as, as opposed to being, you know, very pathological or leading to lots of impairment, then, you know, in that case, it really is ideal to, to stick with the, the psychotherapy and not introduce those potential risks and side effects of a, of a medication

Stan (20:49):
You mentioned to me on a previous call and, and it’s, it’s actually all coming together for me now, because it sounds like these clinical social workers will develop a good relationship with a lot of patients, especially the most complex patient patients. But you mentioned to me that they also help with the management of your complex medical patients or help to overcome challenges for people to even get healthcare. And that’s kind of a unique model. I know that, you know, some advanced primary cares have had care navigators care, guidance nurses, or whatever term you want to use, but you’re kind of doing double duty here with your clinical social workers.

Justin (21:27):
It really do, you know, it really the behavioral health specialist job or the LCSW role at Oak street is a, it’s a pretty tough job because of the, the level of, um, multitasking that they must do as other kind of a classic provider. And that they’re, um, doing the one on one psychotherapy. But as again, as part of this collaborative care model that we’re implementing across the, the system of 125 centers, another huge part of their job is the really kinda a care manager role. And it it’s really facilitating this kind of population health approach to mental health care. So every time that person is referred to the behavioral health team, whether it’s because of, um, the PCP wanting it, or because of that PHQ nine score of 10 or above, they’re automatically loaded into a population health registry that we own at, at Oak street.

Justin (22:21):
And then really the behavioral health specialist is responsible for really tracking that registry and, and our actively managed patient population. They ideally would be checking in at least every two weeks, even if they’re not seeing them for face to face psychotherapy every two weeks, they’re at least checking in every two weeks to get that follow up PHQ nine for depression, or the follow up GAD seven for anxiety. So we can have a good kind of longitudinal, um, on, and, and they make decisions based on how they’re progressing. And the BHS is really what the LCSW is really the, the wench pen to making all that happen. Um, yeah. And, and then also they will often be the go between between the PCP, as well as the telepsych team who can make recommendations if they’re not showing the progression that they should be showing,

Stan (23:16):
Do the LCS Ws do any of the other traditional advanced primary care things like, you know, checking on people when they’ve gone to the ER or when they’ve gone home from the hospital.

Justin (23:27):
Yes, yes. So right now, and we would like to ex span this, um, approach in the, in the near future. Currently our, um, LCS Ws will do transitions work from inpatient to outpatient on our patients who are specifically admitted to acute behavioral health units. Now we know we have a lot of our extreme health patients that of course are not necessarily being admitted to inpatient psychiatry, but they’re being admitted for, um, CHF exacerbations and all sorts of med-surg reasons. And they also have that comorbid substance use disorder diagnos or psychiatric diagnosis that’s likely driving, um, some of the admissions. So we’re looking at our, you know, current FTE of, of LCSW across our system. And we would love to eventually get them connected into that transitions work from inpatient to outpatient, um, even with many med-surg admissions with that behavioral health comorbidity.

Stan (24:31):
Tell, tell us how having the LCSW in the office is different from, from what most docs do is they just simply refer to a, you know, a mental health center or psychiatric hospital, a private PR this group they’re, they’re not shoulders shoulder.

Justin (24:50):
Yeah. So I think, I think this is where kinda the true value happens. And, and I would, I would like to emphasize that it’s not only the fact that the LCSW is within the brick and mortar center, but I would also say that it’s our application of this evidence collaborative care model. That makes a huge difference too. So sometimes it’s not quite enough to just drop the LCSW in the center. Um, and then you always they’re in the same center and down the hall and you refer to ’em, but in many ways they might still fill up just as fast as that external LCSW might fill up. Now you might have, you know, now actually the communication would, would be better cause they’re right down the hall and they can do the warm handoffs and, and that action. But when you, when you apply the full capital C collaborative care model from university of Washington in all its principles, that’s when you really start to kind of see the, um, positive effect of really being able to spread the telepsychiatry expertise across a population of primary care patients.

Justin (25:54):
And you’re applying that population health approach with the registry and you’re being patient centric. And then another key principle of the collaborative care model is really focusing on what we call measurement based treatment to target. So something that, you know, medical internists they’re very used to and when they treat the diabetes or, or hypertension, but in, in behavioral health, we have not had a grand tradition of, of a lot of measurement just because neuroscience is, is still, uh, a rapidly developing field there, lot of unknown, but that doesn’t excuse us from not measuring things. So we do have this PHQ for depression. We seven for anxiety, we should be doing that initial baseline and tracking it time. And, and then of course making treatment decisions based on that.

Stan (26:48):
So I presume that given that they’re working shoulders shoulder, they doing that old fashioned thing that doesn’t happen anymore, where the two providers actually talk to one another, instead of reading, reading electronic medical records.

Justin (27:03):
Yes, yes. That does definitely happen with the, um, LCSW based in the Oak street health centers. And, and it happens in a wide variety, different ways. We’ve already talked about the warm handoff. So that’s kinda when the patients in the room and the patient is handed off from PCP to, to the LCSW, but then we have other, their daily huddles within the, as well, um, where they, um, hone in on those. Um, what we at Oak street often call V I P patients, which are the very complex, um, often high utilizing, um, patients, uh, of external resources. And then they’re also very intensive, weekly huddles too, when the VHS is, is brought in and usually kind of the whole team is there. So you’ll, you would have the MSW there, maybe more focused on housing and food and security, but then the BHS could talk about those residual psychotic or depression symptoms that might be affecting diabetes management, for example,

Stan (28:00):
BHS behavioral health specialist,

Justin (28:02):
Right? Yeah. AKA LC, sorry. I’m I’m back and forth.

Stan (28:06):
So these folks are getting care even when they’re not in their office in that situation, not in your office.

Justin (28:12):
Yes, yes, totally. Um, yes, that’s right. So there’s still discussions happening and O Oak Street’s very much still in the place where we’re trying to meet the patient where they are with, um, comfort with K or two. So they often will be seen in the center and we have a great kinda transportation system that can get ’em to their appointments at the street center. Um, but then we’re also doing quite a few televideo visits still, or, um, even phone visits as well during the public health emergency. And that, that will goes for both our LCSW as well as our, um, telepsych virtual team.

Stan (28:52):
So as you discussed at the beginning, Oak street is a, you know, a care model right now for seniors. What about what you’ve learned at Oak street would inform employers as far as the need to look for primary care that embeds, or at least offers behavioral health for, for their employer sponsored healthcare members, especially, you know, people that are younger, which, you know, that’s where you start to have drug abuse, alcohol problems. Oh. And behavioral problems may actually be more intense than physical problems.

Justin (29:28):
Yeah, absolutely. When you think about what the burden is on that, you know, for example, the 18 to 25 year old population, um, behavioral health is really where it’s at. Um, and many, many college student counseling services across the, across the country who are just overwhelmed at this point, can, can certainly attest to that. And, you know, the prevalence is higher in depression and that range too. So it’s, you know, approximately 7% in the general population in that 18 to 25, which would be, I guess, gen Z to millennial population. It’s 11%. Wow. Uh, so it’s very prevalent. Anxiety’s even more prevalent than depression. It’s, um, 19%, it’s almost one outta five. And then of those folks who have anxiety, um, it’s been said that approximately 56% faults are actually impaired by the anxiety, anxiety. There’s kinda a spectrum. It can be of course, healthy at times to have anxiety when you’re running away from a, a danger. But, um, it’s in over half the cases, they, they feel like they’re impaired by a, from a functional perspective. So we’re, we’re, we’re talking high prevalence, uh, and the, the young population.

Stan (30:45):
So if you were advising and, and again, we’re gonna have behavior, uh, we’re gonna have benefit consultants and employers listening to this podcast. If you were advising an employer that was interested in doing some kind of employer sponsored primary care, like direct primary care, you know, near site or onsite, what would you tell them about what they need to have on their checklist for behavioral health to really get advanced care?

Justin (31:15):
Yeah. I mean, I, there is great evidence to support this, this current model that we’re using at at street. And, um, even if you don’t go with this kinda official collaborative care model is defined, um, by the university of Washington, their initial work, at least thinking about an integrated approach of some kind. So, you know, there’s a, there’s a spectrum there. So, you know, sometimes primary care clinics are happy with just having that LCSW within the center. Um, but they, but they might not be applying this full collaborative care model with all the registry tracking and population health management and all the kinda other principles of the, the collaborative care model. But it is just when it comes down to it. And I, I think most primary care physicians would, would agree with the, the psychiatrist talking right now. It is, it’s impossible to separate behavioral health from classic primary care because of all the things that we’ve talked about, the, the kind of bidirectional relationship between, um, the medical conditions and the, and the psychiatric ones.

Justin (32:23):
And I, I think as we, um, go through the next 10 to 20 years, we’re really gonna have a, a much better understanding of, you know, what’s truly behind these psychiatric disorders, you know, is it, is it inflammation that is often driving depression or there’s so many things that are just exploding in neuroscience right now that will, I think if anything, it will not separate behavioral health from, um, classic primary care. It will bring everything much closer together. And I think, I think neurology and psychiatry will, will come back together in a, a much more cohesive fashion than, than we’ve been within the past 30 to 40 years too, where, you know, it’s, it’s all brain based is the bottom line.

Stan (33:10):
Hey, um, that two more questions before we wrap up the first is, you know, for a patient that’s not an emergency problem, you know, a suicide or something like that, you know, you’re, you’re gonna have kind of an almost instantaneous handoff, if a employer were looking at direct primary care or any type of primary care, what’s an acceptable referral time. I mean, should they say, I want to see a week or four days or a month, or cuz I’m know it could be a month or more in some practices.

Justin (33:42):
Oh, absolutely. I mean, gosh, where, where you in some of our geographies, sometimes it’s three months to get in, particularly to a prescriber or, or a psychiatrist slash um, psychiatric nurse practitioner. We, we really, I mean, that’s, that’s the reason we’ve implemented the collaborative care model approach. We, we really believe that it’s best to take care of it right then, or at least within a few days, rather than kicking the can down the road for, you know, even, even two to four weeks can be a very miserable period. If you have a severe depression, it’s also dangerous too. Cause of potential for self harm, not to mention all the maybe medical conditions that could be worsened by it, um, as well. So that that’s really, I would say the, the main driving force for the choice of this collaborative care model is having meaningful access on the, on the front end. And, and we’re lucky at Oak street, um, because we have that upfront capitated funding in the value based care model where we don’t have to worry as much about kinda fitting this model into the, into a, kinda a classic fee for service design. But I will say that many private insurers, and this is all initially driven by CMS. They they’ve developed codes for the collaborative care model, um, where you can be emersed on a fee for service basis for, for doing this, um, innovative, integrated behavioral health work.

Stan (35:12):
Yeah. And I imagine, you know, it’s shortage of funds is maybe a less of a problem than shortage of providers. Yes. I’ve got one last, very timely quite for you, Justin. And that is what are you seeing in terms of behavioral health? Uh, uh, as far as post COVID or long COVID, which by the way, there was just a publication showing inflammatory markers in the central spinal, in the Cerebra spinal fluids surrounding the brain in people with long COVID. Have you guys been dealing with that very much?

Justin (35:46):
Yes. You know, we, um, I would, you know, what’s so hard sometimes is to separate the kind, the social determinants of mental health from on the potential actual biological determinants of, of long COVID. So sorting that out is a challenge, um, from a diagnostic standpoint, but I, um, certainly have seen some folks with, um, long COVID that have, um, a treatment resistant depression is the most common presentation. There, there are have been reports of even more severe presentations, um, including psychosis and things that would be even more concerning. But, um, the majority, um, of the folks whom I’ve seen, it’s been more of a treatment resistant depression. And again, so to separate that, you know, and is particularly when you think about the employer, um, employee population, is it a, you know, a mother that’s trying to manage three children at home with virtual schooling and her full-time job and how much of it’s that versus versus the, of social out there too right now,

Stan (37:00):
Before we leave anything that you’d like to leave our audience?

Justin (37:05):
You know, I, um, I just, I guess if I had to put a, kind of a plugin for two things that I’ve kind of learned when I’ve been at, at Oak street, it’s, um, it it’s been wonderful in many ways when you’re I a, uh, innovative model where you don’t fit into that fee for service system, it’s been wonderful to have that kind upfront capitated, full risk kind of model cause it’s, um, allows you to be creative and really feel like you directly help patients without having about it’s that put a plug in for an overarching reimbursement model that that’s been wonderful. And, um, and then again, I, I’m a, um, a huge fan of this collaborative care model and, um, and the, the impact that not only has on the, the patient’s health, but it really can have a, a significant ROI it as well. When you, when you think about not, not only the cost that you’re saving in external behavioral health costs or acute behavioral health admissions, but the amount of money that you’re likely saving on med-surg admissions that, um, were prevented because you treated that depression, the patient, um, did better with their Metformin and, and improve their diet and exercise.

Stan (38:27):
Right. Our guest, today’s been Justin Hunt, chief medical officer for behavioral health at Oak street health and Jason, Justin, we sincerely appreciate your participation today. Thanks to everybody listening. And if you hadn’t been vaccinated, probably a good time to do it,

Narrator (38:45):
We hope you’ve enjoyed the time with our very own doctor Stan for 360 degrees of healthcare with Dr. Stan Schwartz, a part of zero studios tune in subscribe and review our podcast to keep current with the ins and outs of the medical and healthcare industry from the inside out.