National Health Policy Conference

Shana Neelu Coshal, MD

Resident in Public & Community Psychiatry at MGH

PGY 5

March 1, 2019

“It’s about life, not about health.  Health is simply a tool to live your life.”

-Dr. Charlotte Yeh (ER physician) during Value Based Reform workshop

I had the privilege of attending the National Health Policy Conference in Washington, D.C. in February 2019, during a pivotal time in health care reform.  Sadly, what was most apparent was the lack of mental health parties at the table along with the persistent theme that our current mental health system will remain abysmal without reform.   There is no health without mental health.  Therefore, if the social determinants of health i.e. the conditions in which we work, live, and age, are responsible for 90% of all health (as opposed to our actual health care system which only attributes 10% to overall health), then all policies are health policies, and if all policies are health policies, then all policies are mental health policies. 

Value based reform was the hot topic of the conference.  This type of program rewards health care providers for quality of care delivered to the patient.  Psychiatry, largely, has nervous to this type of model as behavior determines outcome, something that we do not usually see within our control.  The greatest lesson I took away was that the solution to this problem is that what is missing on the consumer side is trust.  And trust can be developed through co-creation of healthcare with the consumer, and collaboration with the community.  Combined strategies for providers and consumers working in concert have shown to have the best effects.  Consumer engagement provides real-time feedback and shapes the program over time for the better.  Mental health would benefit from a creative design makeover to improve its overall structure by focusing on making the provider’s life and the consumer’s life better.  A new concept, “consumer work flow of life” highlights an approach to model delivery of care that is simple, relevant, and easy to use.  I am very familiar with “provider work flow of life”, being the provider, but I had never stopped to think about our patients’ workflow of life and what would practically make it easier and more enjoyable to consume care.  The average doctors visit is 2 hours, someone with a chronic illness like severe mental illness could spend up to 10 hours a week at doctors appointments.

Most people in healthcare are familiar with the aforementioned social determinants of health, but this was the first time I was introduced to the personal determinants of health, which include resiliency and adaptation, purpose, optimism, and social connection.  These all ultimately contribute to how consumers cope and build assets.  Fostering these characteristics and targeting them in healthcare and societal interventions is essential.  Interestingly enough, studies found loneliness to be the greatest similarity between all frequent flyers in the emergency room.  Loneliness is the strongest predictor of dissatisfaction with our health care system.

Currently we are in the digital health revolution and the culture of innovation has spawned digiceuticals, defined as technology that has clinical outcome.  These technologies can be used to close health disparities as opposed to expanding them.  Artificial Intelligence should not be programmed with human biases that would maintain these health disparities.  The cell phone is showing to be an amazing platform for behavior change.  Applications have been clinically proven by the FDA to treat substance use, attention-deficit disorder, and emotional dysregulation.  These mobile interventions have no side effects.