Posts Tagged Managed Behavioral Health Care
Robert A. Mines, Ph.D., Chairman and Chief Psychology Officer
Thank you John Oliver and your staff for a significant public service on your show this week! Your commentary and excellent coverage of a major problem in substance use disorder and alcohol treatment will have an impact far beyond what the insurance and professional communities have been able to do.
MINES has patients who have gone out of network, received poor care, the payors have received outrageous bills, the patients are stuck with bills that can only result in medical bankruptcy and as you noted, people die in these disreputable facilities. A major component that you pointed out is patient brokering. When people Google substance abuse/use treatment, the top 20-30 are facilities, mostly in Florida and California, or are patient brokers. Reputable facilities in the person’s community do not even make the list. Then the facilities sometimes even pay the airfare to fly the patient to their facility and if the patient does not meet medical necessity for that level of care, the facility turns them out on the street to find their own way back to the state/community they live in.
You mentioned addictionologists as a resource for finding reputable care. In addition, Employee Assistance Programs as well as managed behavioral health services (insurance) are knowledgeable and informed about substance use and alcohol treatment. They know which facilities and programs are in network with the insurance and which ones do a good job.
Evidence-based treatment supports the use of a continuum of care from outpatient, intensive outpatient, partial hospitalization, residential and detox (medical and social detox). There are medications that also contribute to sobriety and health.
These are chronic illnesses/conditions that require the patients to cope with all their lives. Learning relapse prevention and adherence skills are essential.
If you decide to delve into this national problem further in a future episode, I would be happy to consult with you and your team.
The following clip may be not suitable for some work environments:
This is a link to a pdf of an article published by the Self Insurance Institute of America on predatory treatment facilities and managed behavioral healthcare strategies for helping the patients and the payors. http://www.minesandassociates.com/documents/Predatory_Facility_Article.pdf
Just a quick update.
Dr. Robert Mines (chairman and psychologist) and Dr. Dani Kimlinger (CEO) from the MINES Team were honored to contribute to an article by Bruce Shutan in this month’s issue of The Self-Insurer. The article is called Beyond Opioids and covers how EAPs, like MINES, and good benefit-plan design can help treat addictions and other substance use issues in an employee population as well as control overall health care spending.
The issue can be viewed here:
Check out other Self-Insurer publications here: https://goo.gl/2TjaUV
And check out other MINES publications here: www.minesandassociates.com/about_staff_publications.html
To your wellbeing,
The MINES Team
Environmental and social stressors often negatively impact an individual’s work performance and mental wellbeing. It might seem as if these stressors are completely out of our control and that one must surrender to their impact. However, it is important to acknowledge that individuals do have control of how they respond to these stressors. Here, we take a look at some common examples of these types of stressors, and some ways in which we can choose to respond.
Environmental Stressors like weather, traffic, and the work environment represent a few examples of things that cannot always be controlled. The way humans respond to these situations can affect wellbeing. If there is no way to change one’s reality, there are likely ways to at least balance it. Consider taking possible measures to balance your own environmental stressors.
- Scheduling: Traffic, for example, can be a huge environmental stressor. Leaving the house late and speeding regularly adds to stress levels. Rather than cursing the freeways and inanity of one’s fellow drivers, a person can leave home in the morning 30 minutes early; they could put on their favorite music while sipping a nice hot beverage of their choice. This might make the commute more tolerable, possibly even enjoyable.
- Personal space: Another aspect of environment has to do with your physical environment. When you walk into your house after a long day of work how does it feel? When you sit at your desk at work all day how does it feel? What can you do to make your spaces feel better, healthier, and more supportive for you? Everyone is different. For some, having pictures of loved ones on your desk makes a big difference. For others, keeping your desk or home uncluttered and clean has a huge effect on their sense of control and wellbeing. Maybe others like to have lots of live green plants around to liven things up, or like to light incense or a candle to clear the air. Maybe you don’t have a window in your office, but is it possible to make sure you take a few small breaks during the day and go outside for a couple minutes to keep you grounded and feel some sunshine? Although these may seem like small efforts, they make a big difference in your emotional health and overall wellbeing.
- We can limit our exposure to environmental stressors. If you are someone who is agitated by listening to or reading the news, you can choose to limit your time doing that activity. We all know that the news tends to focus on negative stories and violence, and it may be beneficial to substitute an activity that is more calming. Limiting our exposure to unrealistic images of beauty that can be found on most magazine covers can lead to higher self-esteem. Perhaps bypassing the tabloid magazine for the bestseller at Barnes & Noble will give you a necessary break to develop self-compassion and inner peace. Things like pesticides, toxins, and pollutants are out of our control, but we can limit our exposure by eating more organic foods, drinking filtered water, and filtering our air with a HEPA filter. Things like noise pollution can be out of our control, but installing a white noise machine can drown out the unpleasant noise.
Social stressors can also weigh heavy in a person’s life. An ideal social environment would include meaningful relationships, positive support, and mutual respect. However, sometimes we are forced to learn how to best relate with individuals we encounter who may manipulate, try to exert control over us, or are emotionally or physically abusive.
- Boundaries: Create and maintain strong boundaries. It is okay to limit time with a problematic individual. It is also permissible to say “no” at times. It often feels difficult to set boundaries because the person may be angry or upset; however, in the long run boundaries actually help build much stronger relationships.
- Social support system: Although in some cases we don’t have control over the people in our lives, such as family and coworkers, we do have control over who we invite into our lives for a social support network. A person’s circle of friends has a strong influence on emotional health and overall wellbeing. If someone wants to think more positively and then they surround themselves with people who think negatively, they are likely not meeting their goal. Or take for example a person who wants to get healthier both physically and mentally by partying less. But that person’s friends put pressure on them to drink and go out during the weekends. The person in search of health might feel “out of control” or destined to constantly party. This furthers emotional and physical discomfort while simultaneously being held back from evolving and reaching your goals. You have a choice who to bring into your support system. You can bring people in who lift you up, inspire you, support you, and help you grow. Intimate relationships are another area you have choices in. If your partner is always putting you down or is abusive in any way, they may create a toxic environment that negatively influences your physical and emtional wellbeing.
- EAP and Counseling: Another way to get some support around social and environmental stressors is through counseling or your Employee Assistance Program (EAP). Counseling is a safe, non-judgemental place to get support around things you are struggling with in your life — whether they are related to work or not. Sometimes counseling is helpful just to gain another perspective or to attain some new coping skills. EAP is completely confidential and provides a great way to access free counseling services through your benefits. EAPs often offer telephonic or video sessions if you are too busy to go in for an appointment.
Remember: Our reactions to an environmental or social stressor can determine its impact. It’s always possible to reduce stress levels by consciously responding to these stressors in a way that can balance their effects. By practicing this skill often, you will begin to know yourself well enough to tell if an environmental or social stressor is negatively impacting your wellbeing, and you will be able to promptly take steps to improve your emotional and physical health.
To Your Wellbeing,
Alea Makley, MA – Clinical Case Manager
Alex Rothchild, MA, LPC – Clinical Case Manager
The MINES Clinical Case Management Team
Psychology of Performance – 42: Integration of Behavioral Health and Medicine in Self-Insured Organizations
There are many conditions, both acute and chronic, which have significant psychological components to them. It is well-documented that medical costs for diabetes, asthma, cardiac events, and others are significantly higher when there is a co-morbid diagnosis of depression, post traumatic stress, or substance use disorder. As a function of this relationship and the impact of the Affordable Care Act (ACA), there is a need for integrating behavioral health services.
The integration needs to occur at the strategic/systems and tactical levels. On the tactical side, there are already case studies in the public healthcare sectors and in Kaiser Permanente of placing mental health professionals in medical clinics and offices so the doctors and nurses can just walk a patient down the hall to see them once a psychological component has been identified. At MINES we are piloting a wellness coaching model for individuals who are identified by their healthcare provider as a pre-substance use disorder patient, through a Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant awarded to Peer Assistance Services.
At the strategic/systems level, integration has significant utility and challenges for self-insured organizations whether as an individual entity or a multi-employer trust. At this level, a key component is the ability for the various vendors to cross-communicate on these types of patients. This involves the ability to do data mining to identify the patients, having an intensive case management behavioral health specialist to be the point person, regular communication between the TPA, pharmaceutical vendor, medical utilization review, behavioral health utilization review and the medical/psychological personnel responsible for treatment. An obvious challenge is getting buy-in from all of these stakeholders. There is no incentive other than good patient care for any of these groups to cooperate with each other. To rectify this, incentives would need to be financial or contractual. Employers have leverage on the contractual side as it is their health benefit and their money. At the time of this blog, there are case-studies of organizations moving this direction; however, specifics are a long way from full integration due to the complexities required.
I would welcome your discussion and wisdom on this issue.
Have a day filled with extending loving kindness to all those you encounter,
Robert A. Mines, Ph.D., CEO
The book, Spark, by John J. Ratey, M.D. is the holy grail of research applications related to the interaction of exercise, neuroplasticity, and performance. The information on brain chemistry changes in the areas of learning, addictions, anxiety, depression, women’s issues, ADHD, and aging is priceless. The essence of the book is that the data indicated the brain is able to create new neuronal connections, grow new nerve cells throughout life, manage major psychological conditions, pain conditions, and learning is significantly enhanced through exercise. Ratey stated that “exercise is the single most powerful tool you have to optimize your brain function”- based on hundreds of research studies (p.245). Ratey suggested that the more fit you get (regardless of where you start), the “ more resilient your brain becomes and the better it functions both cognitively and psychologically. If you get your body in shape, your mind will follow” (p. 247).
How much is enough? Ratey stated that walking is enough. Low-intensity exercise is at 55 to 65% of maximum heart rate, moderate is 65-75% and high intensity is 75-90%. “The process of getting fit is all about building up your aerobic base” (p.251). Ratey goes on to discuss the role of strength training and flexibility as important elements of optimizing your brain chemistry and hormone levels.
What does this have to do with optimizing your performance at work and in all areas of your life? Everything! Get started today and stick with it.
Have a day filled with optimal brain chemistry,
Robert A. Mines, Ph.D.
CEO & Psychologist
I ran across some interesting information on the role of niacin, depression, and alcoholism in performance at www.doctoryourself.com. It is well documented that depression and/or alcoholism may negatively affect performance across just about any domain one can perform in. In the treatment of depression and alcoholism there are very effective cognitive-behavioral psychotherapy interventions. In addition, exercise and medication may add additional therapeutic effects. The role of nutrition may have further potentiating influence.
According to this site, Bill W., the founder of AA, was successfully treated for depression with 3,000 mg of niacin a day. Unfortunately, this information has not been widely discussed or published in the media. I would be interested to hear from any of you who have used niacin as a means of treating depression or alcoholism and what your results were. Please let us at MINES know.
Have a day filled with mindfulness,
Robert A. Mines, Ph.D.
CEO & Psychologist
Posted by minesblog in Alcoholism, Anxiety, BizPsych, business psychology, C Level, Centering, CEO, depression, Employee Assistance Programs (EAP), Leadership, Managed Behavioral Health Care, Management, Mines and Associates, Psychology of Performance, Stress management, substance abuse, Supervisor, The MINES Team, Tips, Work Performance on September 20, 2010
In his book The Mindful Therapist, Dr. Dan Siegel discusses the role of mirror neurons in actions that have a perceived intention behind them. He stated that the mirror neurons function as a bridge between sensory input and motor output that allows us to mirror the behavior we see someone else enact (p.36). Practically this means that when we see someone drinking from a glass, the mirror neurons become activated (firing off electrical currents called an action potential). If we were to drink from the same glass, the same specific neurons that fired when we saw someone else drinking also become activated. Dr. Siegel said “We see a behavior and get ready to imitate it,” (p.36).
The implications of this line of research are significant for performance. For example, if you watch a movie with alcohol being consumed and you are in recovery, now you have internal neuronal firing similar to drinking the alcohol yourself. Now you have to override the neuronal firing with “white-knuckling it,” or better yet with mindful awareness, or you will increase your probabilities of a relapse.
The upside of this research is that seeing others perform a behavior successfully – mentally rehearsing the image – would theoretically strengthen the neuronal firing and increase the probabilities that you will execute the behavior successfully. This concept is foundational to performance coaching. As coaches, therapists, and bosses we need to think about our current training techniques and how they incorporate watching, rehearsing, and doing as part of the sequence.
Have a day filled with Mindfulness,
Robert A. Mines, Ph.D.
CEO & Psychologist
MINES and Associates
In our consulting through BizPsych (www.BizPsych.com), organizations ask us to assess and intervene with vertical relationship conflicts as well as cross-departmental conflicts on a regular basis. These conflicts are often rooted in unclear accountability and authority for the C-level, vice-presidents, managers, supervisors and front line producers. This creates significant performance and execution problems throughout the organization.
Elliot Jacques, in his numerous publications defined accountability and authority for management at all levels. Accountability and authority establishes where people stand with each other. They determine who is able to say what to whom, and who under given circumstances must say what to whom. They establish who can tell who to do what, especially, in the managerial hierarchy, if one person is being held accountable for what another person does or for the results of what the other person does.
Accountability and authority define the behaviors that are appropriate and necessary in the vertical relationships between managers and their subordinates, and in the horizontal, cross-functional relationships between people. The vertical relationships are the means by which the work that needs to get done is assigned, resourced, and evaluated; cross-functional relationships are the means by which the flow of work across functions gets processed and improved through time.
He noted that it is absolutely imperative that organizational leaders be clear not only about their own decision-making accountability, but they must also make it equally clear for each and every manager below them in the organization. All of these managers must also meet regularly in two-way discussions about major issues with their immediate subordinates, in order to get their help in making decisions for which the manager alone must be accountable. In discussions between managers and subordinates, it is always the manager that is ultimately accountable for decisions. Even when the subordinate has more knowledge than his or her manager on a given matter and tells the manager what he or she thinks should be done; if the manager accepts the subordinate’s view then it becomes the manager’s decision. There will be times in an organization’s growth or life span when a manager may have multiple roles/levels that they are accountable for. The manager may be a manager, a supervisor and a front line producer on a given day if the department or work group is small enough or does not have the resources to accommodate separate levels and roles. This is a situation referred to as “down in the weeds”, “wearing many hats”, or “collapsed strata (time span).” This is not ideal; however, at times it may be the best we can do.
How does your organization define accountability and authority at each role? What impact has the clarity or lack of clarity had on your organizations effectiveness and performance?
Have a day filled with equanimity,
Robert A. Mines, Ph.D.
CEO & Psychologist
Mines and Associates