I just returned from a very thought-provoking week at the mhca 2020 Winter Conference & Annual Meeting where I had the honor of delivering the keynote address, “The Future Has Already Happened—Looking Back To Predict The Future” during the association’s 35th anniversary celebration. In preparation for the event, I had fun reviewing the events of the past three decades – with a focus on those with the biggest impact on consumers with complex needs. During this review, I was reminded of the sage words of two of my favorite authors. “Past is prologue,” from William Shakespeare—the premise that there is a direct link to the present from the actions of the past. And “the future is embedded in the present… The most reliable way to forecast the future is to try to understand the present,” from John Naisbitt, whose work was based on the belief that by understanding current events and thinking about their logical impact, you can predict the major market forces of the future.
In my analysis of the last 35 years, I put together a few industry timelines but the two that really caught my attention were the slow path to technology adoption in the field – and the path to integration. The first became more obvious comparing the overall adoption of technology with adoption in the field. The health and human service field has been “insulated” from the need to adopt many commercial consumer technologies (see How Do You Compare On Tech Spending & Adoption?). We’re just seeing the “tip of the iceberg” as value-based reimbursement makes the full-scale deployment of these developments a reality (and a necessity) in the field. (For a futuristic look at technology in the health and human service field, see the great keynote by Jonathan D. Linkous, MPA, FATA, chief executive officer, The Partnership For Artificial Intelligence, Telemedicine & Robotics In Healthcare from The 2019 OPEN MINDS Technology & Informatics Institute: AI, Telemedicine Robotics & Id and for our coverage, see Augmented Intelligence In The Here & Now and Is The Health Center Of The Future In The Palm Of Your Hand?).
The other observation is that the path to moving services for consumers with complex conditions to value-based arrangements had two phases. The first phase was adoption of managed care using specialty horizontal carve-out models. The behavioral health carve-out was born in 1985 with the formation of American Biodyne, American PsychManagement, Preferred Health Care, and a host of startup companies founded by entrepreneurial clinical professionals. The second phase is the decade-long push for “integration.” The seeds of decline for the specialty carve-out model were sown by passage of the Patient Protection And Affordable Care Act. Payers are pushing “integration” to succeed in a relatively new landscape with no pre-existing condition exclusions and no annual and lifetime limits. (For the current market intelligence reports on behavioral health carve-outs, see State Medicaid Behavioral Health Carve-Outs: The OPEN MINDS 2020 Annual Update, The Medicaid Vertical Carve-Out Landscape: The 2019 OPEN MINDS Update, and The Health Plans Have It!)
What does the present landscape tell us about the future strategic drivers? In my closing, I outlined what I think are the six big challenges for traditional behavioral health provider organization executive teams. The competition from “virtual” service and new models of primary care top the list. The move to value-focused contracting (whether that includes financial risk or not) for specialty services – and the need for “tech substitution” to improve the “value equation” of services are additional challenges. Overall, traditional specialty provider organizations face declining total market potential in the Medicaid market (and, according to our analysis, Distribution Of The U.S. Adult Population With A Serious Mental Illness By Payer: An OPEN MINDS Market Intelligence Report, large numbers of consumers with complex needs are now served in commercial and Medicare plans.
Beyond optimizing the current service line portfolio, the big decision for executive teams is about the “next big thing.” The challenge is future market positioning—and with that market positioning, the new service lines of the future. To take Mr. Naisbitt’s sentiment one step further: “Strategic planning is worthless — unless there is first a strategic vision.” For more about how to get there, check out our strategic planning toolkit – How To Develop A Strategic Plan: An OPEN MINDS Executive Reading Book On Best Practices In Strategy, Portfolio Management & Scenario-Based Planning. And join me on June 3 at The 2020 OPEN MINDS Strategy & Innovation Institute for my keynote presentation, Transforming Organizational Performance: Using Data To Find Advantage & Sustainability.