Michael Thompson on Influence of Mental Health, COVID-19 at National Alliance’s 2020 Annual Forum

At the National Alliance’s 2020 Annual Forum, a chief focus was spotlighting issues within the workplace exacerbated by the coronavirus disease 2019 pandemic (COVID-19) such as mental health and disparities in availability of health care services, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.

Transcript

AJMC®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences News Network, The American Journal of Managed Care^® is pleased to welcome Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions, or National Alliance.

Great to have you back on, Mike, can you introduce yourself and tell us a little bit about your work?

Thompson: Sure. So, I'm the president of the National Alliance of Healthcare Purchaser Coalitions. That's the umbrella organization for employer coalitions across the country and they really work to support benefits executives for companies and organizations across the country.

AJMC^®: Amid an unprecedented year fueled by the COVID-19 pandemic, social unrest, and related factors such as mental health, can you speak on how this year’s annual forum by the National Alliance was different than year’s past, and what influence these factors had on discussions?

Thompson: Our annual forum always tries to help lead the agenda, but we've never been in a period of change like today. I mean, when you look at the impact of the virus, and how so many things have been turned on their head, we've had to pivot and be supportive of employers in their efforts to support their employees and their families during this period.

So, that manifests itself in a number of areas. It certainly manifests itself in terms of the virus itself. We didn't have a big focus on how the virus was evolving, but more in terms of how it's really impacted our workplaces and our people. A big focus on that was mental health as an area that has become a major issue for employers. We also spent time to look at the issue around race, health and equity. A lot of focus in terms of the impact on high value care—the need for people to get care during a period when they are not readily going to their physician. And then the longer term impact in terms of changes in our health care delivery system. How do we move forward in a way that leads to a higher value, and more flexible system that adapts to the needs of a very diverse population.

AJMC^®: Speaking further on the implications of rising mental health issues among US populations that you just alluded to, the National Alliance in collaboration with Total Brain presented the latest data from your organizations’ Mental Health Index. Can you speak on the current state of mental health in the US and how the National Alliance has advised health care purchasers during this time?

Thompson: Mental health has been an area that we've had a lot of focus even pre-COVID. In part because there's serious concerns about how we are approaching and delivering high quality mental health services to employees and their families generally. We've described it as a public health crisis that people can't get an appointment with a doctor if they're or their family needs services without going on a network. And of course, that has largely led to a 2-tier system.

So, we've had a lot of focus in an initiative called The Path Forward for Mental Health and Substance Use. Of course, COVID-19 has only exacerbated that issue in terms of the need for mental health services. Whether it's because of people being socially isolated, not getting out of their house, not being as connected with other individuals, or the economic pressures affiliated with the COVID-19 pandemic, as well as just the fear of the virus itself.

All those factors are confounding our people in a way that we have more pressure on us that are leading to mental health issues, and we've seen the need for services grow exponentially to 50% to 100% more requirements during this period. It has ebbed and flowed, in terms of what we're seeing the effects to be, but it is plateauing at a fairly high level, and it's actually expected to go up still more as the pandemic continues, even with a vaccine. And as much of the country will be pushed indoors because of the weather.

So, we think it's a very serious issue, it's been mitigated to some degree by the rapid emergence and growth of virtual health care—telebehavioral health—but the underlying issues of improving access and quality have never been more important, and we're doubling down on the Path Forward as a result of that. It's a critical issue.

AJMC^®: What were some notable discussions you observed at the National Alliance 2020 Annual Forum, and what issues should be top of mind for employers as the year comes to a close?

Thompson: I start with mental health. It isn't all about the treatment of mental health, it's also preventing the issues before they arise, and a lot of that is learning how to be good leaders during this period and what are some of the key takeaways. Some of the key takeaways really are about connecting with people in a very real way, and staying connected even when we're physically separated, and that's obviously a key takeaway.

We've also seen a lot of issues around delivery system type reforms. We have been advocating in at least 3 areas where we need to do better on delivery of care. The first is transparency, we don't have as much transparency as we'd like, particularly on hospital services. Where we've seen that transparency has been eye opening, like the RAND study in terms of what we're paying for care—as a percentage of Medicare, for example.

Frankly, as we merge that data with the quality type metrics, it's clear that quality and price don't seem to correlate. It's very much a concern as it relates to the marketplace today. A second big area that we have focused on has been advanced primary care. We have actually taken a position as to what's inclusive in advanced primary care and what does that look like. We're very strong supporters that we need to invest more in primary care, but we're also committed to define what we want to invest in. It's things like better access, more quality time with patients, more discipline to focus on population health, and, frankly, integrating behavioral health into primary care. There's a number of other factors as well, but that's a key focus for us.

Then we also think that we're going to have to be more differentiated in our plan designs and our strategies in selecting higher value and higher performing providers almost with a Center of Excellence mindset, but not one that is unusual, but is actually core and regionally deployed. Again, we're early stage in some of these areas, but we are seeing a lot more activities as well.

Employers are up to their eyeballs in COVID-19, and I think we're also sensitive to the transition as the vaccine emerges, and we know that we can't take our eye off that fall, but they're also anxious to take advantage of this environment, where changes that took a very long time to happen can emerge out of this. We know virtual care has become the rule—it's not the exception, it's the rule. And that with it is enabling us to relook at how good care can be provided at the same time as we're concerned about the continuity issues, continuity of care issues that emerge when people one-off a relationship with a provider on a virtual basis. So, there's a lot of issues.

AJMC^®: Lastly, do you have any other concluding thoughts?

Thompson: Only that this is a period like none other. We have never experienced this level of change and engagement by employers and others in health and health systems. We've always said that you can't be successful as an organization unless you take health and health care, health care being your biggest expense, and of course, the health and well being of your employees being critical. Well, that has never been more true than today, right? I mean, the virus has just escalated our game, and we need to be focused on health care, health care delivery, health care value, the health and well being of our workforce. And frankly, we also need to be focused on the variation in that and that really speaks to disparities and equity. So, I think from our standpoint, leading that change, leveraging what we're learning in this period, and localizing solutions is really part of what the National Alliance focuses on and is bringing to bear.

AJMC^®: To learn more, visit our website at AJMC.com. I’m Matthew Gavidia, thanks for joining us!