Why Should We Integrate Mental and Physical Health?

David Wennberg, CEO at Quartet Health

Why Should We Integrate Mental and Physical Health?

Improving the lives of people with mental health conditions through technology and services

Why Should We Integrate Mental and Physical Health?

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Recommended Books:

All the Light We Cannot See by Anthony Doerr

When Breath Becomes Air by Paul Kalanithi

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Why Should We Integrate Mental and Physical Health with David Wennberg, CEO at Quartet Health (transcribed by Sonix)

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Saul Marquez: Welcome back to the podcast today I have the privilege of hosting Dr. David Wennberg. He’s the CEO at Quartet Health. Quartet Health is a technology company transforming mental health. He previously served as Chief Executive Officer of the Northern New England Accountable Care Collaborative and as Chief Executive Officer of the High Value Health Collaborative at the Dartmouth Institute. A Co-founder of Health Dialog Analytic Solutions, the Atlantic Division of Health Dialog. David served as Health Dialog’s Chief Science Officer. He received his medical degree from McGill University, from the Harvard School of Public Health. And he’s a member of the Dartmouth Institute for Health Policy and Clinical Practice faculty. But most importantly the impact that he and his company are having in the healthcare space by integrating mental health is truly making a big splash in what we do in healthcare so it’s a true privilege to host you David on the podcast. Welcome.

Dr. David Wennberg: Thank you Saul, I’m very excited to be here.

Saul Marquez: So David did I leave anything out in the intro that you want to let the listeners know about you?

Dr. David Wennberg: You know I think the only part I would add to that Saul is you know one of the little known facts about myself as I was actually a philosophy major as an undergrad.

Saul Marquez: Really.

Dr. David Wennberg: And that actually taught me the importance of how to be inquisitive without being accused of being an inquisitor if I will and being in curiosity and so one of the things that’s kind of interesting and it’s like a joke when I first got here with Ted is that you know when our our focus of integrating physical and mental health is like we really should be calling ourselves the company that’s solving that Descartes problem but that well you’d have to be a super nerdy philosophy major to get but it is a sort of historical issues of the separation of mind body. Which was one of the reasons I actually came here. I saw it play out by one of my family members which we talked about at some point it makes sense.

Saul Marquez: That is definitely something we want to dive into and I love the philosophy background David. I mean I’ve been in the Med business for twelve years now and my background is actually not sure if you know but classical humanities.

Dr. David Wennberg: Oh there you go.

Saul Marquez: So you are my brethren in studies my friend. So why did you decide to get into the medical sector?

Dr. David Wennberg: You know this is an interesting question and so what’s pretty well known is that my you know my father Jack Wennberg who is the founder of the Dartmouth Atlas Group was one of the people think I got into it because of him. But actually my mother Roxy is also a physician, she is a GYN physician and so I had two parents both of whom told me not to go into medicine ironically and it wasn’t because they didn’t think medicine was a good career. They weren’t jaded from the standpoint of what you hear sometimes and the current feel was more because they didn’t want me to assume that I should get in there just because they were both physicians and so they were very much asking me about questions that are outside of medicine. But in the end, I originally got into the medical sector because I wanted to be a primary care physician and really take care of patients who I could follow longitudinally over time. And the irony here is I’m now in the tech world and have been in a variety of different entrepreneurial efforts since 2000 and left that primary care route. But I still think very much about the patient as our North Star. I think about how the interaction between patients and providers is not always optimal and how to make that better. And so even though I am no longer taking patients on care of patients on a day to day basis I’m very much thinking about how we can make this world better for people who are in pain and suffering and looking for the providers in the world to help them address the pain and suffering.

Saul Marquez: Well I think that’s such an important focus and vision that you have to integrate the physical and mental and you do it from the heart of a physician but mind of an entrepreneur. It’s a stellar combination. David what would you say a hot topic that needs to be on health leaders agendas today and how are you and the folks at Quartet Health approaching it?

Dr. David Wennberg: Yeah so obviously I’m biased about this Saul but just because you’re biased doesn’t mean you’re wrong. I think one of the missing pieces in the world of care and delivery of care and population health is the fact that for a whole variety of structural reasons there’s been a separation of mental and physical health. Quartet feels very much even in our mission is to improve the lives of patients with people with mental health conditions through technology and services. We really feel that mental health is a health condition no different than heart failure or cancer are from each other. But it’s our focus and my mission and passion to bring those two separate worlds together because I think it’s critical to improve the lives of people. I think it addresses a huge problem that we have right now in terms of delivering people, getting people access to a mental health care. And it also is a critical aspect on that triple or quadruple game depending on which one of us from that perspective. And it’s been a it’s been a missing link and I don’t think it’s for lack of recognition that it’s an issue. I think it’s been a missing link because of the lack of opportunities to address that chasm in a scalable way which is really what our passion and mission is here at Quartet.

Saul Marquez: That’s fascinating and you know just kind of digging into the industry and the workings I mean you take a look at the history of payers on the medical industry and just how that whole evolution occurred. This is where I think it’s super critical for physicians to step up and say hey there’s a connection here. Payers you’ve got to start looking at this.

Dr. David Wennberg: I think the interesting Saul when I think when I sit back and think about like who do we have to convince that this is an important problem. I mean patients actually ironically they get it. Yes there’s stigma associated with many mental health conditions. But once you allow people to have a conversation there you know the prevalence of mental health conditions is so high that it’s the exception rather than the rule of a person hasn’t it themselves or their kids or their parents or their close friends experience the real challenges of getting access to good mental health care in a way that improves people’s lives. So the patients it’s actually yep they get it. The payers interestingly though I’ve been here for three and a half years Saul and if you’re going to say like the evolution of a pitch deck nor evolution of a pitch deck was three slides at the beginning they talked about how health insurers should be thinking about why they should be thinking about integrating mental and physical health. We’re now down to a single slide which.

Saul Marquez: One slide.

Dr. David Wennberg: For me it basically says people get it. They understand…

Saul Marquez: Yeah.

Dr. David Wennberg: A fundamental challenge that having a separation is created in their members. And I think that that’s a sort of indication of over this very short period of time how much the industry at least on the insurer side has changed. The physicians for me and this is like this is a sad story of the state of affairs if you will is that more than half of the primary care physicians when we go to talk about integrated care. They basically said “look I know what’s important. I don’t I can’t have a challenge helping my people with mental health conditions by patients with mental health conditions. I don’t even know the insurers pay me for annual screening with the depression scale. I don’t do it because it’s I don’t know what to do if somebody screens positive.” So they feel so hindered by their inability to get people that need care, true care that they ironically don’t do what they know they should do from a clinical standpoint and forgo opportunities for other pay for performance side because they it’s for them knowing somebody has depression and not be able to help them is worse than not knowing that they have depression in an interesting way.

Saul Marquez: Right.

Dr. David Wennberg: And so being able to work with primary care physicians or usual care physicians so we do work with oncologists and pulmonologist and heart failure specialists and basically allowing them to practice the way they’d like to practice for their patients in a way which doesn’t dramatically hinder their practice their day to day practice workflow is really part of the value proposition for them. So doing the right thing in a way that’s efficient scalable and importantly in the last part, closing the loop. So basically bringing back and creating a collaborative work space for mental health providers both virtual and face to face to work with primary care physicians on patients comorbid physical mental health conditions that actually being able to deliver that for them and proving that that’s something that’s part of not only what promises but what we can deliver has been a huge accelerator if you will to our market presence.

Saul Marquez: That’s powerful David and you mentioned you went from three slides to one and that’s just awesome. I want to just pause there and ask the listeners to think about your approach and what you’re doing. Is your slide back three years later 10 slides instead of three. If it is it’s probably going the wrong direction. My favorite quotes is Richard Branson and he says complexity is your enemy, any fool can make something complicated. It’s hard to keep things simple and David and his team are definitely doing that and that’s why they’re having success. I’d love to dive a little bit deeper David into some of the specifics. Can you share something that you and your team have done to make things better and improve outcomes?

Dr. David Wennberg: Sure I’ll take perspectives of the various people who are experiencing are the work that we’re doing in the field and on the patients side, I think and I would start there. I think on the patients side is we’re actually helping people talk about their mental health condition and get to the care that they may not realize they need but they know they need something. And so really focusing on the patient journey and the navigation side. I mean it’s important to note that we don’t deliver care Saul but we do help people navigate to the right care in the right channel at the right time. And so knowing that we’ve been able to allow tens of thousands and soon hundreds of thousands of patients get to care is a really important piece that we’re learning all the time from the patient’s feedback and how better to engage etc. From the primary care physicians standpoint this is something we spent a lot of time last year working on is how do we become part of the workflow. But in a way that it doesn’t, we’re still top of mind. And so we’ve done some pretty cool integration in the various workflows of the EHR which is where primary care physicians and physical healthcare workers spend all the time. Now some would say an inordinate amount of time and actually I would agree with them that we’ve spent a lot of time working on that and it’s now quite easy. And so you know whether it’s with Southern Northern California or a Allegheny Health Network in Pittsburgh, being part of the default referral for mental health and making that really easy for them to refer and knowing because we send information back and create a collaborative workspace for them that it’s not a black hole that they’re sending patients and they’re actually getting care they need in an appropriate way. And then on the mental health provider side, this is a very disaggregated industry with lots of small mom and pop shops a few large group practices but for the most part it’s a pretty disadvantageous place and these practitioners who are working very hard to improve the lives of patients feel very isolated. So giving them a platform and I mean that not a technical standpoint but in a sort of political standpoint where they’re actually on par working together with primary care physicians is a really important endorsement of the importance of the value we see in them as practitioners. The second thing we learned a lot about is that while they are caregivers they’re also small business people. And so you know the average no show rate for people who are scheduled for no for mental health visits is between 30 and 40% which is extraordinarily high.

Saul Marquez: Too high.

Dr. David Wennberg: It’s quick it’s really it’s really really high. And so working with them and helping patients no show rate get down to what now in our markets is less than 15% is a huge impact. It opens up access because you think about the empty because it’s just basically access, it’s taken away. It improves them from a standpoint of business perspective and coming back to the patient which is our north star. It makes more people get to care because they’re actually getting the care rather than the tended to get the care. And the last part I think is on their part is actually creating an environment where they realize that the care they’re giving is not in isolation but it’s part of the whole person. And that for me is that sort of key part of what we’re trying to do is improving mind body because they are connected in a way was very much focused on the needs and desires of the patient through leveraging existing practitioners in the workplace and supplementing them when necessary from an access issue with virtual care, health therapy, telus atrium and database CBT.

Saul Marquez: Super super fascinating to sort of think of it from all these different angles, the primary care coming part of the EHR, mental health giving them are giving them a platform and why do you think mental health that space is so fragmented David?

Dr. David Wennberg: I think it’s a that’s a policy question and organizational question. And here are my thoughts about that and I’m neither a sociologist or I am an epidemiologist. So I think one thing that I think is that we look at prescribers and not psychiatrists psychologists. So there’s also a study using other types of therapies they all have different training so they don’t interact with primary care physicians so first of all they’ve got a different clubs that they belong to if you will. The second thing is that for a long time we’ve been the mental health and has been a carve out from a payment standpoint. So there’s got a payment structure that reinforces the separation of the two. And lastly I think is that there’s some skepticism on the part of physical health providers about the science behind the therapy which there is a ton of science behind the therapy and brace it basically overcoming that side of it has created it sort of reinforces this the silos that are there and that that’s a big audacious hairy problem to address. But I think it’s one that’s really critical if we believe as we do very strong with that mind and body we could be treated together.

Saul Marquez: Love it. Yeah that’s a really great analysis of the situation and I think with the work you guys are doing the horizon within the I think short term the value will be seen, I mean going from 40% no show to 15% no show is pretty amazing.

Dr. David Wennberg: Thank you for saying that we think so too.

Saul Marquez: And you know and…

Dr. David Wennberg: We’re moving and we’re just you know also and this is maybe a silly it’s from the CEO of Quartet to say “we’re you know pretty early in our journey. I think there’s all sorts of reasons why that’s why we think that well that’s why that we had no show rate will be cut in half of the next twelve months” and so I think for me seeing these very measurable changes in how and experience of both patients and practitioners on a day to day week to week basis is a huge impact for us and keeps us motivated.

Saul Marquez: Very very interesting. No doubt the numbers are showing results there David, give us an example of a setback you guys have had and what you learned from that that’s made you better?

Dr. David Wennberg: So that’s a good question Saul so setbacks you know I think when we first started Quartet we spent a lot of time building a great product experience and in that product experience we were expecting people to you know if you build it they will come. And I think we learned both in our interactions with users and are watching the workflow that the key thing is being in the workflow. I’m speaking specifically to a primary care physicians on a day to day basis. And so just you know that that’s in retrospect of course the answer you should have done then. On the other hand we all have aspirations to build beautiful product that overcomes some of the deficiencies in some of the other products that technology products that are in healthcare but in the end we need to help users do what they need to do. And so that means getting in the workflow of primary care physicians, forgoing some of the beautiful interfaces so that you can make the workflow work really well and then pulling people along into the workflows as the technology target evolves and as our understanding of the workflow of so that was a hard knock that we overcame and we’ll learn more.

Saul Marquez: That’s for sure and I think a lot of people tend to fall in love with their product and will fall into that silo and and totally miss the train when it comes knocking and I got to give big kudos to you and your team for not having done that for seeing where you could add value and just latching on and not letting go.

Dr. David Wennberg: Thank you.

Saul Marquez: So what would you say one of your proudest moments has been to date David?

Dr. David Wennberg: Well I will say you know whether this is a recency issue or not Saul I mean I think the last few months being able to work with an amazing team at Quartet. Focusing on a patient as our North Star and really with lots of feedback are articulating a clear vision of where we’d like to be has been both. I felt really good about that and I also have gotten a lot of feedback both from the team about how what I’ve done that could be better and what I’ve done that has been done well and I think being a setting yourself out there and being vulnerable is a really important part and my perspective is an important part of good leadership and having a team that allows you to do that in a way which is critical with critical feedback not criticism. So again harping back to philosophy aside that feedback is something where you learn about something going better has been a really for me it’s a great and I feel very proud about what we’re building here and in the most recent aspect has been super exciting to me.

Saul Marquez: Very cool. That’s definitely a lot to be proud of David. Tell us about an exciting project or focus that you guys are working on today.

Dr. David Wennberg: So one of the things I’m very excited about and one of our major initiatives is how we can more effectively support patients who have Medicaid as their primary insurer. If you step back can ask which of all the various government and private entities which is a population that has the most challenges in getting good integrated mental or physical health. Medicaid population form of sociodemographic issues for social determinants of health and also because of the way the program is created from a disability perspective, it has the highest proportion of individuals insured with mental health condition and actually if you include the Medicaid expansion the absolute number of people list in the states the most numbers of people with mental health conditions is insured by Medicaid as well and so for me that’s a really exciting thing to grasp and do. It has particular challenges because the provider networks or the mental health providers are very different. The good part about it is that Medicaid for a long time has emphasized team based care and after it’s C type model it’s really a multidisciplinary approach. So that part is great and we don’t have to work very hard in the practitioner side to the provider side excuse me to convince that this isn’t important because they see that on a day to day basis. But for me, it’s such an important population to fulfill our mission that it’s a really that for me it’s the most exciting thing we’re working on right now.

Saul Marquez: Yeah that’s a fascinating niche to tackle and I think as you guys work on your solutions, these software based approach his ability to integrate to various EHR’s. I think it’s exciting to think about what the future holds for this population.

Dr. David Wennberg: I agree. Obviously I’m biased by again but I agree.

Saul Marquez: Yeah. That’s fascinating. And folks these interviews oftentimes you wish they were a little bit longer as well as today with the Dr Wennberg but nevertheless this is a fascinating work that we’re getting to hear about Quartet Health. David let’s pretend you and I are building a medical leadership course on what it takes to be successful in healthcare. I’ve got five lightning round questions for you followed by a book that you recommend to the listeners. You ready?

Dr. David Wennberg: I’m ready.

Saul Marquez: All right let’s do it. What’s the best way to improve healthcare outcomes?

Dr. David Wennberg: I think the best way for me is to focus on the patient and their multitude of journey over time. Remember even though you’re stuck in transactional efforts a lot of times it’s not about what’s happening today but it’s what’s happened the past, what’s going to happen in the future.

Saul Marquez: What’s the biggest mistake or pitfall to avoid?

Dr. David Wennberg: Don’t assume that you know the answer. Look for others to help you build what we’re trying to build and recognize that really good leadership requires really good teams. And that’s part of your how you’re going to be graded on how well you’ve led a team from that perspective.

Saul Marquez: How do you stay relevant as an organization despite constant change?

Dr. David Wennberg: Always ask the question “are we doing the right thing and how can we do it better?” So always recognize that what you’re doing now even if it’s good is could always be made better and constantly challenge yourself to improve what you’re doing.

Saul Marquez: Love that. What’s one area of focus that drives everything in your organization?

Dr. David Wennberg: I think the patient focus is the critical aspect Saul and I know I talked a lot about that here but it is our North Star and we we try to follow that North Star in all the different aspects we do.

Saul Marquez: Oh that’s great David and I feel like the great leaders have you ever seen that Saturday Night Live skit where Will Ferrell is hitting the bell constantly… a little more cowbell. I love that because it’s really a comical way to remind us as leaders in this business that once isn’t enough and you’ve done such a great job and in our talk today David to really let it be known that the North Star is a focus on the patient. And so I appreciate you being so clear about that.

Dr. David Wennberg: Thank you Saul it’s fun. It’s true.

Saul Marquez: And I agree. So this last question is a two part question more sort of fun personal question. Number one, what is your number one health habit?

Dr. David Wennberg: What is number one health habit actually is also my number one recreational habit which is riding my bicycle.

Saul Marquez: Nice, is it mountain biker?

Dr. David Wennberg: It’s actually a road I’m a road bike. So as I think about that, I don’t do it much in New York City but when I’m home in Maine on the weekends I ride as much as I can. And it’s just for me it is the only kind of exercise I do where I don’t feel like I’m exercising.

Saul Marquez: That’s awesome. And what is your number one success habit?

Dr. David Wennberg: I think the success habit is what I try to remind myself is it’s all about the people around me and how do I make them successful because they’re successful drive success for myself as well.

Saul Marquez: Love it. What book would you recommend to the listeners?

Dr. David Wennberg: So you know I thought hard about this because you know I think that one of the things you ask me before my all time favorites hard I think I have I’m actually going to say something which I know you don’t want to do. I’m gonna talk about two books.

Saul Marquez: That’s fine.

Dr. David Wennberg: The first one is All the Light We Cannot See which is an a novel by Anthony Doerr. It’s an amazingly well-written and beautiful novel that takes place in France in around the world war 2 and it’s an amazing story told through the eyes of a young woman and I highly recommend it. And then the other one which is I’m not much one to read much about medicine books but one of my teammates actually recommended in the fall that I read When Breath Becomes Air by Paul Kalanithi. It’s an amazingly strong book told through the eyes of a surgeon who develops cancer at a very early age and his struggles to maintain his individuality, his persona as a surgeon and his persona as a husband and father. I will tell you it’s a sad read but it’s actually one which is also very motivating in terms of what actually makes this person realize that his end of life is coming soon, get up and work every day. And it’s a great book.

Saul Marquez: Some great recommendations there David. Listeners want access to these books the entire transcript of today’s interview as well as the show notes, just go to outcomesrocket.health and in the search bar type in quartet health you’ll find all that come up or you can also type in David Wennberg both of those searches will give you this entire interview. David before we conclude I love if you could just share a closing thought and then the best place where the listeners to get in touch with or follow your work.

Dr. David Wennberg: Great. So the closing thought I think is that doing the hard thing is hard but it often is really rewarding. And so narrowing in on something that is your North Star and for ours is the patient for others it will be the primary care physicians or specific population. I think is really important because it allows you to continuously keep moving forward when starting something new. I mean entrepreneurship is by definition hard and having that having your own personal North Star for me is a really important aspect. And in terms of how you can get in touch with us, our website quartethealth.com is a great place to start and you will find the team there, you’ll see what we’re working on from that perspective. And also because we are in the age of if you do a google search on me you will find lots of links back to me and how to get back in touch with me.

Saul Marquez: Outstanding David, this has been a real pleasure. Diving through some of your thoughts, keeping the patient at the center, and integrating the physical and mental. Folks if you learn more again, check out quartethealth.com or check out outcomesrocket.health and type in quartet health in the search bar. David this has been a pleasure. Thanks again for spending time with us today.

Dr. David Wennberg: It’s been my pleasure as well Saul. Thank you and I look forward to seeing you in the future.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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