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We're here today with Manish Sapra,
the executive director for the Behavioral

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Health Service line at Northwell Health,
Northwell Health.

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For those who don't know,
is a health system based in Long Island,

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New York with 5200 beds, 17,
000 providers across 20 hospitals and

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other care fac.

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Manish,
thank you so much for joining us today.

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Thank you.

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Thank you for having me.

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So let's talk about behavioral health.

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I know there's a lot going on with
behavioral health integration and primary

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care settings, schools, colleges,
faith-based organizations,

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as well as integrating mental health care
into other service lines.

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I know that's core to your strategy.

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I'd like to ask you to elaborate on that
strategy.

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What's unique or interesting about it,
and specifically what role data

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integration is playing in that effort?

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After all, this is healthy data podcast.

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Sure. Yeah. You know, first of all,
thank you for.

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Your giving us an opportunity to talk
about behavioral health and bringing the

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discussion about behavior health into the
into forefront. You know,

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after the pandemic,
we realized that and even prior to that,

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there was a a crisis brewing in
behavioral health, access to care.

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And just me being.

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Able to meet the demand,
we just skyrocketed.

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After the after the pandemic,
we also understood our health care

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disparities in in many of our populations.

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We're we're just not able to provide.

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The the culturally competent access to
care and to provide them.

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In, you know,
at a time when they need the most.

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So one way to address that is really
meeting the patients where they are,

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where they feel comfortable seeing us and.
And So what we're doing at Northwell.

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Well,
we've been in this journey over last

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several years of integrating behavioral
health in our with physical health.

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So in primary care settings,
we've set shop, you know,

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embedded therapists in in primary care.

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Practices in our pediatric practices.
We cover all of our Pediatrics practices

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across the health system.

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Now where we have embedded therapists.

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In the,
we'll provide immediate access to

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services.

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As soon as any conditions are are
identified,

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so therapists are then supervised by
psychiatrists and we're able to provide.

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You know recommendations to the,
to the pediatricians in the primary care

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doctors on how to provide services.
We've taken this further to our schools.

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You know we cover.

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We have contracts with school districts,
so we cover many school districts in in

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Nassau County and Suffolk County and are
now starting to go into Westchester.

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In in our New York geography,
where we have immediate or same day or

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next day access available to child
psychiatry services.

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To students of these school districts,
we cover more than 200,

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000 school students.

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Through that program,
we have partnership with colleges to

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provide behavioral health services,
especially in acute care services.

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We've had soccer,
health side and and recently.

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We went into uncharted territory of
actually embedding.

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Therapist in in our communities in
faith-based organizations.

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So we embedded therapists in a church in
Queens.

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What in Harlem and at a mosque?

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In in, in Long Island and we're learning,
you know,

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as we go to the communities as to how we
can use these services,

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not only to provide care but also build
those bridges with these communities,

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right.

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We're working with trusted community
leaders at these sites.

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And and that is helping us reduce stigma,
you know,

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build trust in these communities to
provide care.

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So that's just,
that's a few things about our team of of

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integration.

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We do work with other service lines as
you mentioned.

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In in specialty care,
so we have programs especially for folks

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who are going through bariatrics
procedures.

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We have folks through perinatal care of
Women's Health issues.

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We have programs that we have set up.

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Or folks going through transplants at at
Northwell.

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So we have a transplant psychiatry
program to name a few psycho oncology,

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which is,
you know providing behavioral support for

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folks going through cancer care.

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So those are some other.

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Descriptions of integration of care.

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You mentioned how does it all work with
integration of data and which is like a

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really.

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You know, it's a,
it's a bit of a struggle in behavioral

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health because sometimes.

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We're not allowed to share.

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Data because it's sensitive or it's
considered behavioral health,

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00:04:58.300 --> 00:05:01.632
though those restrictions are more on the
substance use side.

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But we have done as much as we can to
improve access to those cares,

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at least to the providers within
Northwell.

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So when we see a behavioral health
provider and we also have a primary care

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provider,
the records are shared so they can see

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that information and then we.

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Link to our HIE so.

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That data is available if folks have come
into our hospitals or or had a behavioral

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health visit and then.

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We're working now.

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More on the back end of like you know,
understanding.

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The How all this is actually really
helping our patients, right?

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So we described you the program with
primary care integration.

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We wanna study if in providing behavioral
treatment along with the medical care it

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00:05:49.234 --> 00:05:50.992
in a Co located setting.

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Is that better than treatment as usual
than just referring somebody out to a

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practice?

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So we're we're doing that update
analytics right now to understand.

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Benefits of behavioral treatment on
medical care.

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So many questions I have. After all that,
Manish,

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OK.

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on the last thing you just said asking
does providing care in a Co located

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setting,
meaning some kind of physical care and

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00:06:17.955 --> 00:06:19.222
mental health care.

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Is that better?
If you didn't know that going into it,

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how did you justify this seemingly
expensive investment as an experiment to

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00:06:29.226 --> 00:06:32.662
see suite leaders at Northwell?
Why did you?

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00:06:33.432 --> 00:06:34.632
Say we want to do this.

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Do this and 2nd how did you get, you know,
sign off to get permission and do it if

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you don't have the data saying that this
actually improves outcomes or reduce

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costs or has some other material benefit
to patients or the organization?

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00:06:48.202 --> 00:06:50.733
Well, yeah.
I mean there are multiple ways to answer

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00:06:50.733 --> 00:06:51.402
that question.

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But first of all,
collaborative care which is this model

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00:06:54.420 --> 00:06:58.656
that I described of embedding therapists
getting supervision from psychiatrists

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00:06:58.656 --> 00:07:02.944
but working under primary care physicians
is a well studied evidence based model

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00:07:02.944 --> 00:07:07.021
that has over 20 years of research and
has shown good outcomes and has shown

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00:07:07.021 --> 00:07:07.762
outcomes that.

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00:07:07.762 --> 00:07:10.562
Actually saves healthcare.

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00:07:12.232 --> 00:07:13.432
Costs on these individuals.

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00:07:15.312 --> 00:07:16.472
So there is that.

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Background of research.

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00:07:17.982 --> 00:07:21.766
The second piece is we were supported by
the system,

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00:07:21.766 --> 00:07:25.622
the redesign project to the previous
Medicaid waiver.

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00:07:25.742 --> 00:07:28.542
Or call the dis Rep when within New York.

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00:07:30.072 --> 00:07:34.325
To so which gave a seat funding to get
any of these programs going,

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00:07:34.325 --> 00:07:39.267
and I have to show you the program is
just so popular amongst the primary care

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00:07:39.267 --> 00:07:44.020
doctors and pediatricians that even
though we barely break even at times or

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00:07:44.020 --> 00:07:46.272
sometimes we honestly do not on the.

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00:07:46.272 --> 00:07:49.002
Revenue side,
it is just so popular amongst our

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00:07:49.002 --> 00:07:51.959
providers in primary care and
pediatrician offices,

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00:07:51.959 --> 00:07:54.632
but that is one thing they want to hold
on to.

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00:07:55.592 --> 00:07:57.992
And this will be the last thing for them
to give it up.

e22ce321-8533-41aa-918f-4c43969d087d/1144-0
00:07:58.412 --> 00:08:02.293
So in Healthy Data podcast,
we often like to be very concrete to

e22ce321-8533-41aa-918f-4c43969d087d/1144-1
00:08:02.293 --> 00:08:06.652
provide the most material benefit to
listeners across the United States.

e22ce321-8533-41aa-918f-4c43969d087d/1157-0
00:08:06.772 --> 00:08:11.123
You mentioned that you integrate
behavioral healthcare with a variety of

e22ce321-8533-41aa-918f-4c43969d087d/1157-1
00:08:11.123 --> 00:08:12.852
specialty care service lines.

e22ce321-8533-41aa-918f-4c43969d087d/1171-0
00:08:12.852 --> 00:08:18.516
Bariatrics Women's Health transplants
oncology was just for the sake of getting

e22ce321-8533-41aa-918f-4c43969d087d/1171-1
00:08:18.516 --> 00:08:20.852
concrete. Look at Women's Health.

e22ce321-8533-41aa-918f-4c43969d087d/1175-0
00:08:21.252 --> 00:08:22.812
There's a woman, Jane.

e22ce321-8533-41aa-918f-4c43969d087d/1181-0
00:08:22.812 --> 00:08:24.772
Jane lives in Long Island.

e22ce321-8533-41aa-918f-4c43969d087d/1183-0
00:08:24.812 --> 00:08:27.152
She gave birth three months ago.

e22ce321-8533-41aa-918f-4c43969d087d/1192-0
00:08:27.542 --> 00:08:29.862
And now has postpartum depression.

e22ce321-8533-41aa-918f-4c43969d087d/1197-0
00:08:29.862 --> 00:08:31.982
That's a behavioral health condition.

e22ce321-8533-41aa-918f-4c43969d087d/1241-0
00:08:33.752 --> 00:08:39.273
Please walk us through not only what
James experience of care is in terms of

e22ce321-8533-41aa-918f-4c43969d087d/1241-1
00:08:39.273 --> 00:08:43.001
accessing mental health care while also
doing well,

e22ce321-8533-41aa-918f-4c43969d087d/1241-2
00:08:43.001 --> 00:08:46.801
baby check ups or doing her own OB/GYN
appointments,

e22ce321-8533-41aa-918f-4c43969d087d/1241-3
00:08:46.801 --> 00:08:52.895
but also how is the data being integrated?
Because clearly postpartum depression has

e22ce321-8533-41aa-918f-4c43969d087d/1241-4
00:08:52.895 --> 00:08:54.472
an impact on the baby.

e22ce321-8533-41aa-918f-4c43969d087d/1249-0
00:08:54.472 --> 00:08:57.032
'S well-being and needs to be viewed by
the pediatrician.

e22ce321-8533-41aa-918f-4c43969d087d/1292-0
00:08:57.382 --> 00:09:02.532
Caring for the infant but also in the EHR,
but also needs to be viewed by the

e22ce321-8533-41aa-918f-4c43969d087d/1292-1
00:09:02.532 --> 00:09:07.814
obstetrician gynecologist caring for Jane,
who has a depression and needs to be

e22ce321-8533-41aa-918f-4c43969d087d/1292-2
00:09:07.814 --> 00:09:13.293
aware that she is being treated for this.
And that's gonna have an effect on blood

e22ce321-8533-41aa-918f-4c43969d087d/1292-3
00:09:13.293 --> 00:09:15.472
pressure, other comorbidities so.

e22ce321-8533-41aa-918f-4c43969d087d/1306-0
00:09:15.502 --> 00:09:20.222
Please the patient's journey and also the
data's journey for Jane.

e22ce321-8533-41aa-918f-4c43969d087d/1341-0
00:09:19.882 --> 00:09:23.494
Sure, sure. And by the great question. So,
so, Jane,

e22ce321-8533-41aa-918f-4c43969d087d/1341-1
00:09:23.494 --> 00:09:28.468
if she came to a visit and provided
Northwell or even if she brought her

e22ce321-8533-41aa-918f-4c43969d087d/1341-2
00:09:28.468 --> 00:09:31.602
three month old to a pediatric office,
right,

e22ce321-8533-41aa-918f-4c43969d087d/1341-3
00:09:31.602 --> 00:09:35.282
she'll get a screening instrument and for
depression.

e22ce321-8533-41aa-918f-4c43969d087d/1375-0
00:09:36.712 --> 00:09:39.513
And and for postpartum depression
specifically,

e22ce321-8533-41aa-918f-4c43969d087d/1375-1
00:09:39.513 --> 00:09:43.482
and if she if there is a screen,
a positive Screener or maybe it is

e22ce321-8533-41aa-918f-4c43969d087d/1375-2
00:09:43.482 --> 00:09:48.209
because there was a conversation with her
provider or the pediatrician where she

e22ce321-8533-41aa-918f-4c43969d087d/1375-3
00:09:48.209 --> 00:09:48.792
mentioned.

e22ce321-8533-41aa-918f-4c43969d087d/1406-0
00:09:49.142 --> 00:09:54.380
State that needing some help or support
that will be quantified using these

e22ce321-8533-41aa-918f-4c43969d087d/1406-1
00:09:54.380 --> 00:09:59.962
standardized scales and a referral will
be made to an embedded therapist in that

e22ce321-8533-41aa-918f-4c43969d087d/1406-2
00:09:59.962 --> 00:10:00.582
practice.

e22ce321-8533-41aa-918f-4c43969d087d/1411-0
00:10:02.032 --> 00:10:03.552
The therapist can do a few things.

e22ce321-8533-41aa-918f-4c43969d087d/1435-0
00:10:05.272 --> 00:10:07.704
They can. First of all,
they do an assessment, right,

e22ce321-8533-41aa-918f-4c43969d087d/1435-1
00:10:07.704 --> 00:10:10.135
their license,
mental health providers as to what the

e22ce321-8533-41aa-918f-4c43969d087d/1435-2
00:10:10.135 --> 00:10:13.512
situation is and based on what the
situation is, they can do a few things.

e22ce321-8533-41aa-918f-4c43969d087d/1447-0
00:10:13.632 --> 00:10:17.485
They can provide care coordination to a
provider in the community or within

e22ce321-8533-41aa-918f-4c43969d087d/1447-1
00:10:17.485 --> 00:10:17.992
Northwell.

e22ce321-8533-41aa-918f-4c43969d087d/1452-0
00:10:18.502 --> 00:10:20.102
Be here for health services.

e22ce321-8533-41aa-918f-4c43969d087d/1457-0
00:10:20.302 --> 00:10:22.502
They can actually provide treatment.

e22ce321-8533-41aa-918f-4c43969d087d/1496-0
00:10:22.502 --> 00:10:28.175
They can do time limited 8 to 10 therapy
sessions right there with the patient on

e22ce321-8533-41aa-918f-4c43969d087d/1496-1
00:10:28.175 --> 00:10:33.363
on, on, on, on a frequent basis,
they can refer the patient to a perinatal

e22ce321-8533-41aa-918f-4c43969d087d/1496-2
00:10:33.363 --> 00:10:38.137
psychiatry program which we,
which is a specialized programs that if

e22ce321-8533-41aa-918f-4c43969d087d/1496-3
00:10:38.137 --> 00:10:41.042
the condition is such that it requires to.

e22ce321-8533-41aa-918f-4c43969d087d/1502-0
00:10:41.032 --> 00:10:42.542
Be seen by a reproductive psychiatrist.

e22ce321-8533-41aa-918f-4c43969d087d/1505-0
00:10:43.312 --> 00:10:43.632
They can.

e22ce321-8533-41aa-918f-4c43969d087d/1530-0
00:10:43.632 --> 00:10:46.884
They can be seen by that individual or
they can just be seen by a general

e22ce321-8533-41aa-918f-4c43969d087d/1530-1
00:10:46.884 --> 00:10:50.312
psychiatrist who may have interest in
women's behavioral health or expertise.

e22ce321-8533-41aa-918f-4c43969d087d/1532-0
00:10:50.662 --> 00:10:51.222
That area.

e22ce321-8533-41aa-918f-4c43969d087d/1534-0
00:10:51.962 --> 00:10:52.162
Mm hmm.

e22ce321-8533-41aa-918f-4c43969d087d/1570-0
00:10:52.992 --> 00:10:57.775
At times they can also recommend,
after discussing it with psychiatrist

e22ce321-8533-41aa-918f-4c43969d087d/1570-1
00:10:57.775 --> 00:11:01.096
medication,
set up OB GYN or can prescribe to the

e22ce321-8533-41aa-918f-4c43969d087d/1570-2
00:11:01.096 --> 00:11:05.812
patient if that is the person who's
holding the care of that person or

e22ce321-8533-41aa-918f-4c43969d087d/1570-3
00:11:05.812 --> 00:11:07.472
patient during that time.

e22ce321-8533-41aa-918f-4c43969d087d/1589-0
00:11:07.472 --> 00:11:12.737
So that's sort of the the patient journey.
And if they do receive treatment with

e22ce321-8533-41aa-918f-4c43969d087d/1589-1
00:11:12.737 --> 00:11:16.312
this care manager who we have embedded,
there will be.

e22ce321-8533-41aa-918f-4c43969d087d/1598-0
00:11:17.792 --> 00:11:21.032
Monthly, you know,
assessments on what is their.

e22ce321-8533-41aa-918f-4c43969d087d/1603-0
00:11:21.422 --> 00:11:22.942
Depression scores, if you will.

e22ce321-8533-41aa-918f-4c43969d087d/1612-0
00:11:24.592 --> 00:11:28.232
Using standardized instruments to measure
that.

e22ce321-8533-41aa-918f-4c43969d087d/1653-0
00:11:29.912 --> 00:11:32.811
And that way we can at a on a population
basis,

e22ce321-8533-41aa-918f-4c43969d087d/1653-1
00:11:32.811 --> 00:11:37.764
maintain a registry of all the patients
that we are treating and also measure the

e22ce321-8533-41aa-918f-4c43969d087d/1653-2
00:11:37.764 --> 00:11:41.387
clinical outcomes.
You know if people are getting better or

e22ce321-8533-41aa-918f-4c43969d087d/1653-3
00:11:41.387 --> 00:11:45.192
not and as I mentioned we we do have,
we do follow that track.

e22ce321-8533-41aa-918f-4c43969d087d/1671-0
00:11:45.192 --> 00:11:49.241
That at this time,
but we're we are trying to analyze now is,

e22ce321-8533-41aa-918f-4c43969d087d/1671-1
00:11:49.241 --> 00:11:51.592
is that what are the effects on the?

e22ce321-8533-41aa-918f-4c43969d087d/1678-0
00:11:52.422 --> 00:11:55.022
Physical health outcomes, yeah,
but you help.

e22ce321-8533-41aa-918f-4c43969d087d/1708-0
00:11:56.112 --> 00:12:01.166
So and the the data journey,
how are you integrating the behavioral

e22ce321-8533-41aa-918f-4c43969d087d/1708-1
00:12:01.166 --> 00:12:07.408
health with the traditional clinical EHR,
especially when there's such overlap with

e22ce321-8533-41aa-918f-4c43969d087d/1708-2
00:12:07.408 --> 00:12:09.192
one affecting the other?

e22ce321-8533-41aa-918f-4c43969d087d/1750-0
00:12:10.032 --> 00:12:14.164
So one of the things that all
documentation that that happens is is

e22ce321-8533-41aa-918f-4c43969d087d/1750-1
00:12:14.164 --> 00:12:18.903
happening in right in the medical EHR,
there is no separate behavioral health

e22ce321-8533-41aa-918f-4c43969d087d/1750-2
00:12:18.903 --> 00:12:23.886
EHR in this condition except if they get
went to the to the specialized perinatal

e22ce321-8533-41aa-918f-4c43969d087d/1737-0
00:12:19.622 --> 00:12:19.742
Hmm.

e22ce321-8533-41aa-918f-4c43969d087d/1750-3
00:12:23.886 --> 00:12:26.802
program that they would have that that
sort of.

e22ce321-8533-41aa-918f-4c43969d087d/1767-0
00:12:26.792 --> 00:12:32.303
You know a separate EMR cause because we
are embedding these providers in the in

e22ce321-8533-41aa-918f-4c43969d087d/1767-1
00:12:32.303 --> 00:12:34.072
the physical host setting.

e22ce321-8533-41aa-918f-4c43969d087d/1784-0
00:12:34.872 --> 00:12:37.801
They're using the same Emrs,
so the they're provide referring

e22ce321-8533-41aa-918f-4c43969d087d/1784-1
00:12:37.801 --> 00:12:40.872
providers are getting access to all the
behavioral health nodes.

e22ce321-8533-41aa-918f-4c43969d087d/1801-0
00:12:41.462 --> 00:12:45.938
And in the standardized instruments,
they can graph out the depression scores

e22ce321-8533-41aa-918f-4c43969d087d/1801-1
00:12:45.938 --> 00:12:49.782
and they can follow all that right there
in their radical records.

e22ce321-8533-41aa-918f-4c43969d087d/1827-0
00:12:50.742 --> 00:12:55.648
So just to be clear,
the epic electronic health record as a

e22ce321-8533-41aa-918f-4c43969d087d/1827-1
00:12:55.648 --> 00:13:02.352
portal is either available to providers
on a phone or in a desktop at schools and

e22ce321-8533-41aa-918f-4c43969d087d/1827-2
00:13:02.352 --> 00:13:03.742
churches as well.

e22ce321-8533-41aa-918f-4c43969d087d/1835-0
00:13:04.612 --> 00:13:06.932
Well, when I've yet on epic, but we will.

e22ce321-8533-41aa-918f-4c43969d087d/1842-0
00:13:07.622 --> 00:13:09.942
Right, all scripts.

e22ce321-8533-41aa-918f-4c43969d087d/1846-0
00:13:08.872 --> 00:13:10.832
Be a journey over the next two years.

e22ce321-8533-41aa-918f-4c43969d087d/1891-0
00:13:10.832 --> 00:13:13.668
Yes,
but the all scripts program is is

e22ce321-8533-41aa-918f-4c43969d087d/1891-1
00:13:13.668 --> 00:13:19.050
available to all the providers in who are
coming in the medical settings.

e22ce321-8533-41aa-918f-4c43969d087d/1891-2
00:13:19.050 --> 00:13:22.250
Also in in the school and colleges
program,

e22ce321-8533-41aa-918f-4c43969d087d/1891-3
00:13:22.250 --> 00:13:28.214
we do have a separate way of documenting
for the faith-based program just because

e22ce321-8533-41aa-918f-4c43969d087d/1891-4
00:13:28.214 --> 00:13:30.832
of the community based setting that.

e22ce321-8533-41aa-918f-4c43969d087d/1893-0
00:13:30.832 --> 00:13:31.192
We are in.

e22ce321-8533-41aa-918f-4c43969d087d/1900-0
00:13:31.982 --> 00:13:33.782
And so how does that data?

e22ce321-8533-41aa-918f-4c43969d087d/1930-0
00:13:34.622 --> 00:13:38.802
I'm really trying to hone in on data
since that's the focus of this, this,

e22ce321-8533-41aa-918f-4c43969d087d/1911-0
00:13:36.812 --> 00:13:37.372
Sure, sure.

e22ce321-8533-41aa-918f-4c43969d087d/1930-1
00:13:38.802 --> 00:13:41.142
this,
the audience expects that with this

e22ce321-8533-41aa-918f-4c43969d087d/1930-2
00:13:41.142 --> 00:13:44.375
episode is is, you know,
how are you integrating whatever

e22ce321-8533-41aa-918f-4c43969d087d/1930-3
00:13:44.375 --> 00:13:46.102
electronic data is being input?

e22ce321-8533-41aa-918f-4c43969d087d/1946-0
00:13:48.392 --> 00:13:53.912
In kind of a remote community based
location into the organizational

e22ce321-8533-41aa-918f-4c43969d087d/1946-1
00:13:53.912 --> 00:13:55.112
enterprise EHR.

e22ce321-8533-41aa-918f-4c43969d087d/1951-0
00:13:56.242 --> 00:13:57.522
Yeah. So it is not different.

e22ce321-8533-41aa-918f-4c43969d087d/1973-0
00:13:57.522 --> 00:14:02.015
Right. It is in the organizational EHR,
it is not a separate behavioral health

e22ce321-8533-41aa-918f-4c43969d087d/1957-0
00:13:59.582 --> 00:13:59.942
OK.

e22ce321-8533-41aa-918f-4c43969d087d/1965-0
00:13:59.942 --> 00:14:00.302
Got it.

e22ce321-8533-41aa-918f-4c43969d087d/1973-1
00:14:02.015 --> 00:14:02.242
EMR.

e22ce321-8533-41aa-918f-4c43969d087d/1980-0
00:14:02.242 --> 00:14:05.082
So anything that's getting integrated is
getting integrated there.

e22ce321-8533-41aa-918f-4c43969d087d/2026-0
00:14:05.582 --> 00:14:09.676
And we're running dashboards on
depression screening across the system.

e22ce321-8533-41aa-918f-4c43969d087d/2026-1
00:14:09.676 --> 00:14:14.167
We have a initiative to do depression
screening, not just in OB/GYN practices,

e22ce321-8533-41aa-918f-4c43969d087d/2026-2
00:14:14.167 --> 00:14:18.147
but across all our specialties.
Whether you went to a dental visit to

e22ce321-8533-41aa-918f-4c43969d087d/2009-0
00:14:16.252 --> 00:14:16.452
Mm hmm.

e22ce321-8533-41aa-918f-4c43969d087d/2026-3
00:14:18.147 --> 00:14:22.752
your rheumatologist or dermatologist,
they're also screening you for depression.

e22ce321-8533-41aa-918f-4c43969d087d/2026-4
00:14:22.752 --> 00:14:23.662
And all that is.

e22ce321-8533-41aa-918f-4c43969d087d/2041-0
00:14:23.662 --> 00:14:28.793
Being monitored for all the service lines
across the system in data that sits with

e22ce321-8533-41aa-918f-4c43969d087d/2041-1
00:14:28.793 --> 00:14:30.462
just a General Medical ENR.

e22ce321-8533-41aa-918f-4c43969d087d/2075-0
00:14:30.982 --> 00:14:36.564
And So what are some of the obstacles to
providing care in these settings if one

e22ce321-8533-41aa-918f-4c43969d087d/2075-1
00:14:36.564 --> 00:14:41.181
of our listeners says, hey,
I'm in Minnesota and I would love this

e22ce321-8533-41aa-918f-4c43969d087d/2075-2
00:14:41.181 --> 00:14:44.902
program to begin to be rolled out at my
organization.

e22ce321-8533-41aa-918f-4c43969d087d/2089-0
00:14:44.942 --> 00:14:48.939
You know what are some of the challenges
that I need to be aware of going into

e22ce321-8533-41aa-918f-4c43969d087d/2089-1
00:14:48.939 --> 00:14:50.862
trying to set up this kind of program?

e22ce321-8533-41aa-918f-4c43969d087d/2098-0
00:14:51.862 --> 00:14:54.622
Yeah, there,
there are a few challenges for sure.

e22ce321-8533-41aa-918f-4c43969d087d/2109-0
00:14:54.622 --> 00:14:59.502
One, you know the medical community,
the non behavioral health, right?

e22ce321-8533-41aa-918f-4c43969d087d/2132-0
00:14:59.502 --> 00:15:04.141
They have to to really want this and
adopt this and be be friendly to it and

e22ce321-8533-41aa-918f-4c43969d087d/2132-1
00:15:04.141 --> 00:15:08.841
and you know they suddenly see a lot of
behavioral health in their day-to-day

e22ce321-8533-41aa-918f-4c43969d087d/2132-2
00:15:08.841 --> 00:15:09.142
work.

e22ce321-8533-41aa-918f-4c43969d087d/2136-0
00:15:09.422 --> 00:15:10.582
But do they really?

e22ce321-8533-41aa-918f-4c43969d087d/2146-0
00:15:10.582 --> 00:15:13.387
What?
What are they gonna do to to bring in a

e22ce321-8533-41aa-918f-4c43969d087d/2146-1
00:15:13.387 --> 00:15:14.302
new discipline?

e22ce321-8533-41aa-918f-4c43969d087d/2150-0
00:15:14.582 --> 00:15:15.102
Excuse me.

e22ce321-8533-41aa-918f-4c43969d087d/2161-0
00:15:15.102 --> 00:15:19.221
Into their practice and integrate them
well and endorse them. So Andre,

e22ce321-8533-41aa-918f-4c43969d087d/2161-1
00:15:19.221 --> 00:15:20.822
for patients to them, right.

e22ce321-8533-41aa-918f-4c43969d087d/2189-0
00:15:20.942 --> 00:15:27.205
So I think the 11 challenge is to to just
working with our medical community to to

e22ce321-8533-41aa-918f-4c43969d087d/2189-1
00:15:27.205 --> 00:15:30.902
be adapters of of behavioral health
integration.

e22ce321-8533-41aa-918f-4c43969d087d/2223-0
00:15:31.502 --> 00:15:35.879
The second challenge is which is I think
is much better now than it used to be

e22ce321-8533-41aa-918f-4c43969d087d/2223-1
00:15:35.879 --> 00:15:38.815
when when we started in this journey 1520
years ago,

e22ce321-8533-41aa-918f-4c43969d087d/2223-2
00:15:38.815 --> 00:15:42.638
just having behavioral health providers
who worked in that settings,

e22ce321-8533-41aa-918f-4c43969d087d/2223-3
00:15:42.638 --> 00:15:45.242
you know it used to be we we had,
you know, a.

e22ce321-8533-41aa-918f-4c43969d087d/2240-0
00:15:45.232 --> 00:15:47.631
Therapy offices on our couches and and,
you know,

e22ce321-8533-41aa-918f-4c43969d087d/2240-1
00:15:47.631 --> 00:15:50.942
do not disturb signs of the door.
When we were in a therapy session.

e22ce321-8533-41aa-918f-4c43969d087d/2277-0
00:15:51.062 --> 00:15:55.746
You cannot work like that in a medical
setting where you're where the you know,

e22ce321-8533-41aa-918f-4c43969d087d/2244-0
00:15:51.482 --> 00:15:51.682
Mm hmm.

e22ce321-8533-41aa-918f-4c43969d087d/2253-0
00:15:54.352 --> 00:15:54.552
Mm hmm.

e22ce321-8533-41aa-918f-4c43969d087d/2277-1
00:15:55.746 --> 00:16:00.079
the primary care physician or knock on
your door and introduce a patient,

e22ce321-8533-41aa-918f-4c43969d087d/2277-2
00:16:00.079 --> 00:16:02.831
you know,
to you right then at that spot time,

e22ce321-8533-41aa-918f-4c43969d087d/2277-3
00:16:02.831 --> 00:16:03.182
right.

e22ce321-8533-41aa-918f-4c43969d087d/2302-0
00:16:03.182 --> 00:16:05.675
So,
so having behavioral health providers who

e22ce321-8533-41aa-918f-4c43969d087d/2302-1
00:16:05.675 --> 00:16:10.011
want to work in medical settings and do
time limited treatment do a lot of care

e22ce321-8533-41aa-918f-4c43969d087d/2302-2
00:16:10.011 --> 00:16:12.450
coordination.
I think we have done a lot in,

e22ce321-8533-41aa-918f-4c43969d087d/2302-3
00:16:12.450 --> 00:16:14.022
in developing that workforce.

e22ce321-8533-41aa-918f-4c43969d087d/2313-0
00:16:15.472 --> 00:16:20.512
I think many of these EMR related
integration over the years.

e22ce321-8533-41aa-918f-4c43969d087d/2352-0
00:16:20.862 --> 00:16:24.471
It is much better now,
but that is certainly a thing to make

e22ce321-8533-41aa-918f-4c43969d087d/2352-1
00:16:24.471 --> 00:16:29.263
sure that you know the electronic medical
records are integrated and are part of

e22ce321-8533-41aa-918f-4c43969d087d/2352-2
00:16:29.263 --> 00:16:32.044
that.
And if I need a big one is the financial

e22ce321-8533-41aa-918f-4c43969d087d/2352-3
00:16:32.044 --> 00:16:36.422
reimbursement right that that always
lacks all the innovation that we do.

e22ce321-8533-41aa-918f-4c43969d087d/2362-0
00:16:36.422 --> 00:16:38.582
In in in the medical community.

e22ce321-8533-41aa-918f-4c43969d087d/2371-0
00:16:38.582 --> 00:16:41.622
So you know,
we just need a reimbursement models.

e22ce321-8533-41aa-918f-4c43969d087d/2372-0
00:16:41.622 --> 00:16:43.102
That's that.

e22ce321-8533-41aa-918f-4c43969d087d/2388-0
00:16:43.102 --> 00:16:47.440
Do reimburse well for non reimbursable
activities of care coordination of

e22ce321-8533-41aa-918f-4c43969d087d/2388-1
00:16:47.440 --> 00:16:49.902
reaching out to patients and helping them.

e22ce321-8533-41aa-918f-4c43969d087d/2399-0
00:16:50.532 --> 00:16:56.252
Through these behavioural journeys,
and I think that that's only lagging area.

e22ce321-8533-41aa-918f-4c43969d087d/2406-0
00:16:57.242 --> 00:16:58.802
I appreciate that, Manish.

e22ce321-8533-41aa-918f-4c43969d087d/2416-0
00:16:58.802 --> 00:17:01.350
We are approaching the end of this
podcast episode.

e22ce321-8533-41aa-918f-4c43969d087d/2416-1
00:17:01.350 --> 00:17:02.722
A few more questions though.

e22ce321-8533-41aa-918f-4c43969d087d/2436-0
00:17:02.922 --> 00:17:06.886
I just asked about some of the obstacles
to providing care with this integrated

e22ce321-8533-41aa-918f-4c43969d087d/2436-1
00:17:06.886 --> 00:17:09.562
model of behavioral health in multiple
service lines.

e22ce321-8533-41aa-918f-4c43969d087d/2443-0
00:17:09.802 --> 00:17:12.482
I like to ask the converse,
which is what are the benefits?

e22ce321-8533-41aa-918f-4c43969d087d/2455-0
00:17:12.482 --> 00:17:15.654
Why do and?
You already spoke improved outcomes

e22ce321-8533-41aa-918f-4c43969d087d/2455-1
00:17:15.654 --> 00:17:17.042
reduce cost, but why?

e22ce321-8533-41aa-918f-4c43969d087d/2462-0
00:17:17.082 --> 00:17:21.004
More specifically,
why is there such high engagement among

e22ce321-8533-41aa-918f-4c43969d087d/2462-1
00:17:21.004 --> 00:17:21.602
patients?

e22ce321-8533-41aa-918f-4c43969d087d/2470-0
00:17:21.602 --> 00:17:24.262
Why do the patients love this integration
and behavioral health?

e22ce321-8533-41aa-918f-4c43969d087d/2485-0
00:17:24.492 --> 00:17:28.599
In traditional physical,
physical clinical care and why do

e22ce321-8533-41aa-918f-4c43969d087d/2485-1
00:17:28.599 --> 00:17:29.852
providers love it?

e22ce321-8533-41aa-918f-4c43969d087d/2492-0
00:17:29.852 --> 00:17:32.972
Why would a primary care provider love
this delivery model?

e22ce321-8533-41aa-918f-4c43969d087d/2495-0
00:17:33.012 --> 00:17:34.012
Why would a patient love it?

e22ce321-8533-41aa-918f-4c43969d087d/2521-0
00:17:34.902 --> 00:17:38.688
So I think the patients like it because
it is done in a medical setting,

e22ce321-8533-41aa-918f-4c43969d087d/2521-1
00:17:38.688 --> 00:17:42.422
it's destigmatized and it also meets the
patient where they are, right.

e22ce321-8533-41aa-918f-4c43969d087d/2546-0
00:17:42.422 --> 00:17:47.034
So so they don't have to like now be
labeled as a behavioral health patient,

e22ce321-8533-41aa-918f-4c43969d087d/2546-1
00:17:47.034 --> 00:17:50.089
mental health patient and go to a
separate clinic.

e22ce321-8533-41aa-918f-4c43969d087d/2546-2
00:17:50.089 --> 00:17:54.342
They're getting the treatment in a very
destigmatized medical setting.

e22ce321-8533-41aa-918f-4c43969d087d/2549-0
00:17:54.942 --> 00:17:57.022
There is great communication between.

e22ce321-8533-41aa-918f-4c43969d087d/2568-0
00:17:58.462 --> 00:18:01.557
Their medical provider and behavioral
health provider, which you know,

e22ce321-8533-41aa-918f-4c43969d087d/2568-1
00:18:01.557 --> 00:18:04.346
benefits the patient,
but that's it's a good segue into why the

e22ce321-8533-41aa-918f-4c43969d087d/2568-2
00:18:04.346 --> 00:18:04.782
providers.

e22ce321-8533-41aa-918f-4c43969d087d/2593-0
00:18:05.132 --> 00:18:08.963
Like if they're not sending these
patients into some behavioral black hole

e22ce321-8533-41aa-918f-4c43969d087d/2593-1
00:18:08.963 --> 00:18:13.202
out there where they will never hear back
from the psychiatrist or therapist is to

e22ce321-8533-41aa-918f-4c43969d087d/2593-2
00:18:13.202 --> 00:18:15.092
go how that treatment is progressing.

e22ce321-8533-41aa-918f-4c43969d087d/2613-0
00:18:15.132 --> 00:18:19.638
Everything that is being done every every
wizard is documented right there with

e22ce321-8533-41aa-918f-4c43969d087d/2613-1
00:18:19.638 --> 00:18:22.962
with their own notes,
and they can see the progress of the

e22ce321-8533-41aa-918f-4c43969d087d/2613-2
00:18:22.962 --> 00:18:23.412
patient.

e22ce321-8533-41aa-918f-4c43969d087d/2625-0
00:18:23.852 --> 00:18:29.012
They like it that they can do curbsides
with actually actual experts,

e22ce321-8533-41aa-918f-4c43969d087d/2625-1
00:18:29.012 --> 00:18:30.412
like psychiatrists.

e22ce321-8533-41aa-918f-4c43969d087d/2637-0
00:18:31.342 --> 00:18:35.742
When things get tough and they also like
the fact the providers that.

e22ce321-8533-41aa-918f-4c43969d087d/2669-0
00:18:36.052 --> 00:18:39.741
If there are some care coordination
available, because honestly,

e22ce321-8533-41aa-918f-4c43969d087d/2669-1
00:18:39.741 --> 00:18:43.429
like navigating the mental health space,
it's hard for patients.

e22ce321-8533-41aa-918f-4c43969d087d/2669-2
00:18:43.429 --> 00:18:47.685
But it's also hard for for providers as
to where do they send this person,

e22ce321-8533-41aa-918f-4c43969d087d/2669-3
00:18:47.685 --> 00:18:51.657
who has? You know, there's depression,
anxiety. They started a treat.

e22ce321-8533-41aa-918f-4c43969d087d/2669-4
00:18:51.657 --> 00:18:52.792
But I don't know if.

e22ce321-8533-41aa-918f-4c43969d087d/2677-0
00:18:52.782 --> 00:18:54.012
They're looking like a bipolar disorder.

e22ce321-8533-41aa-918f-4c43969d087d/2681-0
00:18:54.012 --> 00:18:55.212
Or is it looking like OCD?

e22ce321-8533-41aa-918f-4c43969d087d/2688-0
00:18:55.732 --> 00:18:57.252
Who's an expert in what?

e22ce321-8533-41aa-918f-4c43969d087d/2699-0
00:18:57.572 --> 00:19:01.410
Which place we send them and they're they
have somebody in their practice who can

e22ce321-8533-41aa-918f-4c43969d087d/2699-1
00:19:01.410 --> 00:19:01.972
handle that.

e22ce321-8533-41aa-918f-4c43969d087d/2709-0
00:19:01.972 --> 00:19:05.852
So I think that's great for them.
And I'll lastly I'll say why for the.

e22ce321-8533-41aa-918f-4c43969d087d/2745-0
00:19:06.292 --> 00:19:10.714
Or the senior leadership or large health
systems. You know you want everybody.

e22ce321-8533-41aa-918f-4c43969d087d/2745-1
00:19:10.714 --> 00:19:15.080
We're working in this world of narrower
and narrower networks and and and and

e22ce321-8533-41aa-918f-4c43969d087d/2745-2
00:19:15.080 --> 00:19:18.606
large health systems.
Wanna make sure that their patients have

e22ce321-8533-41aa-918f-4c43969d087d/2745-3
00:19:18.606 --> 00:19:21.572
access to all care within that health
system. Right.

e22ce321-8533-41aa-918f-4c43969d087d/2755-0
00:19:23.102 --> 00:19:26.222
And what better way of expanding
behavioral health care?

e22ce321-8533-41aa-918f-4c43969d087d/2779-0
00:19:27.822 --> 00:19:31.566
Then you know the integrating care in
medical settings because it costs much

e22ce321-8533-41aa-918f-4c43969d087d/2779-1
00:19:31.566 --> 00:19:35.262
less. And even if you lose money,
you're losing much less than if you work.

e22ce321-8533-41aa-918f-4c43969d087d/2794-0
00:19:35.772 --> 00:19:42.182
You know, just opening our, you know,
dozens of outpatient practices out there

e22ce321-8533-41aa-918f-4c43969d087d/2794-1
00:19:42.182 --> 00:19:44.292
and it's a real, you know.

e22ce321-8533-41aa-918f-4c43969d087d/2823-0
00:19:45.782 --> 00:19:51.045
Booster for patient experience in in A
and if if any systems get ready for value

e22ce321-8533-41aa-918f-4c43969d087d/2823-1
00:19:51.045 --> 00:19:54.943
based care or population health that
really sets them well.

e22ce321-8533-41aa-918f-4c43969d087d/2815-0
00:19:54.042 --> 00:19:54.122
Mm.

e22ce321-8533-41aa-918f-4c43969d087d/2823-2
00:19:54.943 --> 00:19:57.542
You know if there's a program like this.

e22ce321-8533-41aa-918f-4c43969d087d/2837-0
00:19:58.662 --> 00:20:02.982
So the last question I'll ask you, Manish,
before we wrap up this episode.

e22ce321-8533-41aa-918f-4c43969d087d/2851-0
00:20:02.982 --> 00:20:06.782
Someone's listening to this episode and
they love everything that you're saying.

e22ce321-8533-41aa-918f-4c43969d087d/2855-0
00:20:06.782 --> 00:20:10.142
Again,
the Minnesota example I want to do this.

e22ce321-8533-41aa-918f-4c43969d087d/2861-0
00:20:10.222 --> 00:20:13.382
What's 1 word of advice that you'd give
to them?

e22ce321-8533-41aa-918f-4c43969d087d/2876-0
00:20:13.382 --> 00:20:18.277
Or perhaps a word of advice that you'd
give to yourself five years ago before

e22ce321-8533-41aa-918f-4c43969d087d/2876-1
00:20:18.277 --> 00:20:20.222
you start this kind of journey?

e22ce321-8533-41aa-918f-4c43969d087d/2882-0
00:20:20.502 --> 00:20:23.902
What would should someone do or keep in
mind as?

e22ce321-8533-41aa-918f-4c43969d087d/2887-0
00:20:24.622 --> 00:20:26.142
A begin to move in this direction.

e22ce321-8533-41aa-918f-4c43969d087d/2910-0
00:20:27.642 --> 00:20:31.001
Yeah. I mean,
I think especially in a large health

e22ce321-8533-41aa-918f-4c43969d087d/2910-1
00:20:31.001 --> 00:20:34.162
system where I work,
it's it's a constant work.

e22ce321-8533-41aa-918f-4c43969d087d/2919-0
00:20:34.162 --> 00:20:37.522
It's as I said,
you're introducing new discipline in in

e22ce321-8533-41aa-918f-4c43969d087d/2919-1
00:20:37.522 --> 00:20:38.242
an existing.

e22ce321-8533-41aa-918f-4c43969d087d/2929-0
00:20:39.742 --> 00:20:44.142
Space that has honestly been been the
same for decades, right? So.

e22ce321-8533-41aa-918f-4c43969d087d/2954-0
00:20:45.742 --> 00:20:48.192
You know,
getting as senior an executive

e22ce321-8533-41aa-918f-4c43969d087d/2954-1
00:20:48.192 --> 00:20:51.001
sponsorship,
you can get you know a a top down

e22ce321-8533-41aa-918f-4c43969d087d/2954-2
00:20:51.001 --> 00:20:55.542
approach on saying that this is the
strategy of where the system is moving.

e22ce321-8533-41aa-918f-4c43969d087d/2957-0
00:20:55.702 --> 00:20:57.502
You know, why is it important to treat?

e22ce321-8533-41aa-918f-4c43969d087d/2964-0
00:20:58.492 --> 00:21:00.372
Depression and primary care setting.

e22ce321-8533-41aa-918f-4c43969d087d/2967-0
00:21:00.412 --> 00:21:01.852
You know why?

e22ce321-8533-41aa-918f-4c43969d087d/2976-0
00:21:01.852 --> 00:21:04.741
It's it's, it's,
it's actually your job to, you know,

e22ce321-8533-41aa-918f-4c43969d087d/2976-1
00:21:04.741 --> 00:21:06.132
screening for suicide and.

e22ce321-8533-41aa-918f-4c43969d087d/2986-0
00:21:06.212 --> 00:21:09.932
And having those discussions were in a
busy medical office.

e22ce321-8533-41aa-918f-4c43969d087d/3004-0
00:21:10.052 --> 00:21:14.445
That message really needs to come from a
senior leadership in the organization,

e22ce321-8533-41aa-918f-4c43969d087d/3004-1
00:21:14.445 --> 00:21:16.532
so getting that in is the first thing.

e22ce321-8533-41aa-918f-4c43969d087d/3039-0
00:21:16.532 --> 00:21:19.569
Then, of course,
analyzing what are the resources are

e22ce321-8533-41aa-918f-4c43969d087d/3039-1
00:21:19.569 --> 00:21:23.956
available in the Community and and just
doing a very good analysis of of that

e22ce321-8533-41aa-918f-4c43969d087d/3039-2
00:21:23.956 --> 00:21:28.399
primary care setting or medical setting
where we want to integrate services is

e22ce321-8533-41aa-918f-4c43969d087d/3039-3
00:21:28.399 --> 00:21:31.942
done prior to moving in.
I think those will be two big things.

e22ce321-8533-41aa-918f-4c43969d087d/3041-0
00:21:31.942 --> 00:21:32.372
There.

e22ce321-8533-41aa-918f-4c43969d087d/3043-0
00:21:33.242 --> 00:21:33.922
Well.

e22ce321-8533-41aa-918f-4c43969d087d/3051-0
00:21:35.342 --> 00:21:37.062
Manish,
thank you very much for joining us today.

e22ce321-8533-41aa-918f-4c43969d087d/3058-0
00:21:37.402 --> 00:21:39.322
Sure. Thank you for having me.

e22ce321-8533-41aa-918f-4c43969d087d/3056-0
00:21:38.772 --> 00:21:39.332
For those.

e22ce321-8533-41aa-918f-4c43969d087d/3077-0
00:21:39.332 --> 00:21:43.164
For those who've been listening,
this has been Manish Sapra,

e22ce321-8533-41aa-918f-4c43969d087d/3077-1
00:21:43.164 --> 00:21:47.812
executive director of Behavioral Health
service line at Northwell Health.

e22ce321-8533-41aa-918f-4c43969d087d/3088-0
00:21:47.892 --> 00:21:51.532
And again,
very glad to have you on today Manish.

e22ce321-8533-41aa-918f-4c43969d087d/3087-0
00:21:51.712 --> 00:21:52.232
Thank you.

e22ce321-8533-41aa-918f-4c43969d087d/3090-0
00:21:52.232 --> 00:21:52.792
Thank you.

e22ce321-8533-41aa-918f-4c43969d087d/3091-0
00:21:52.792 --> 00:21:53.352
Talk to you later.