you can also stay current with the latest episodes o "washington journal" and find scheduling information for c-span's tv networks and c-span radio plus a variety of compelling podcasts. c-span now is available at the apple store and google play. scan the qr code to download it for free today or visit our web site, c-span.org/c-span now. c-span now, your front row seat to washington anytime, anywhere. ♪ ♪ >> form formerman patrick kennedy talks about access to high quality health care including coverage for patients suffering from eating disorders, addictions and men ifal illnesses. he spoke at an event host by the health care innovation company.

[inaudible conversations] [laughter] >> all right. welcome back, everybody. i know folks are making their way back from the track sessions, andir we'll get ready and get going. so welcome back to reminder mai. we're almost there, but i think this is going to be a very terrific and powerful close. the next few sessions are folked on really, truly -- focused on really, truly what can drive innovation forward. without further a, i'd like to welcome back pamela greenberg, the president and ceo of the association for behavioral health and wellnesses, abhw, to moderate the next fireside chat. pamela, come on stage. ♪ i'm still standing better than i ever did -- ♪ looking like a true survivor, feeling like a little kid ♪♪ >> i like the music to give you a little upbeat, and i think i'm

still standing is probably a good -- good for all of us right now on a friday, right? am so pleased today to have with us congressman patrick kennedy and christina --, and we'll being having a fireside chat about quality and parity 32.00 -- 2.00. so, congressman and christina, if you want to to come out? congressman kennedy, as you probably know, is a former u.s. representative and also founder of these kennedy forum. he has used his own personal experience with mental illness and substance use disorders to become one of the neigh's most influential advocate, and he's helped to reduce the stigma around mental illness and substance use disorders and also to make real change in making behavioral health care both acce affordable. he is also the co-author of the landmark legislation, the mental health parity and aa diction equity acts.

we refer to it, and he's cochair of the bipartisan policy center's behavioralir health innovation task force. and we also have christina if saffron with us -- christina saffron, and she is the cofounder and ceo of equip which provides virtual evidence-based eating disorder treatment in the united states. their mission iss to make eating disorders accessible to all patients and their families, and christina has quite a list of accomplishments. she's a "forbes" 30 under 30 social entrepreneur, an honoree of both ink's female founders 10000 and and insider's 30 under 40 in health care recognition list. so i don't think anyone can top that, christina. [laughter] as a i said, the title of the chat today is quality is parity 2.0. and i thought i'd just briefly explainfl what mental health

parity 1.0 is, and it's basically the law that i just mentioned, the mental health parity and aa duction equity -- addiction and equity act. and in one sentence what that said a is that if mental health and substance use disorder insurance coverage is offered, then it has to be no more restrict we've than the insurance coverage for medical conditions. and that law passed in 2008. there was a a new proposed rule that was released towards the end of last year, and we're currently waiting for -- there'- [inaudible] now but it will be replaced by a new final rule we expec and that will change a little bit of the way parity 1.0 is implemented. but now we're going to move on to quality and parity 2.00. and both of you, i don't think anyone doubts the importance of having quality behavioral health care, right? there's no issue there.

but canan you talk about what yu see as a some of the barriers to providing quality mental health and substance use disorder care? well, first off, great to be with you, pamela. thanks foryo your leadership ovr so many years running this whole dialogue around how do we bring greater access and now how to do we marry that access with quality so that it's access to quality. as you know, you know, speed to crap is crap. [laughter] like, we don't want just speed to care where that care isn't what we need for people to actually get better. when my republican colleague who helpedp. me cosponsor parity ani went around the country doing hearings, we had families not only complain about lack of access, but we had families who had taken out second mortgage withs, had spent all they are life savings the take care of their loved one with, and then their loved one wasn't with any better. and so we were really from the beginning about trying to not

only bring access, but access to evidence-based interventions. and that's to part of the reason why i cofounded -- because we wanted. the make sure that we upskilled all the providers out there. most of whom, frankly, only get theoretical degrees in mental health. and cure rate the provider network by specialty. so god forbid we would send people with eating disorders to anan eating disorder or specialized cognitive behavioral therapy organization which is really what christina has done, so i will hand the baton over to you. >> thanks, patrick. really grateful to be here. and i think eating disorders provide a really great request emblematic example of some of the challenges we face. in terms of barriers, eating disorders affect 30 million americans at a some point in their lifetime, that is 10% of the population, and yet 80% of those don't have access to

treatment, less than 1% have access to treatment that works. i'llof highlight three big reasons, the first being trained provide aers who can both identify and then treat effectively with evidence-based treatments emblematic example. i am somebody who fits the stereotypical mold of what we think eating december orders look like. it's not true. the reality is eating disorders do not discriminate, they affect everybody. and even for me, i was diagnosed with anorexia at 10. at 13 i relapsed, went into my pediatrician having lost 8 pounds from an already small frame, my pediatrician didn't bat an eyelash. if i'm being missed, everybody is being missed. on average if you are diagnosed, it takes three years to be diagnosed. the illness already more entrenched, ask and then most folks are not diagnosed at all. once you get a diagnosis, it's impossible to find a provider.

we havevi 5,000 eating 55 million americans who struggle today, right now. -- 5 million. that is .11%, obviously not enough, and most of them don't utilize evidence-based treatment. they're using treatment that feels good but actually doesn't work. and in this vacuum of good quality outpatient care, facility-based residential care for those few who do get treatment has become the go ever to. relapse is upwards of 50%. which leads me to, number two, which is that we need to have more creative and innovative payment models for insurance companies. we're really lucky at equip that we have amazing partners where they have enabled 100 million americans to have access to care through our services, but we still struggle with many partners who cannot go outside of the traditional fee for service structure. we needvi to pay providers for

getting people better and for getting quality outcomes. and a lot of the things that enable us to do to do that at a equip, our model is that we provide folks with a multidisciplinary care team of a therapist, dietician, medical provider, peer mentor if family mentor. peer mentorship isn't covered, family mentorship isn't covered. the average of 40 messages that are exchanged is not covered. the hundred hours of initial training and ongoing training is not covered. the providers meeting amongst themselves to look at measurement-based outcomes and consult on the treatment plan isn't covered. but what is covered is residential treatment because there's a code for that and it's easy. that needs to change. and that goes into the final piece which is transparency around outcomes and measurement-based care that works which i know we'll talk a lot more about. before i -- >> before i ask my next question, i just want the audience we don't have a

formal q&a piece to this, so if you have a question, please put it in the app. we'll get it here, and we' don'l the end. we've talked about people receiving care that may not be the best, and i think that leads to, well, we need measurement-based care. how do we measure quality care, and and who's -- whose responsibility is that? the provider? the patient? the health p plan? >> yes. >> all of the above? >> all of the above, but i think it starts with the provider. and so at a very basic level, we should s all be measuring symptm reduction, reduction in readmissions to higher level of care, people cycling in and out as patrick talked about and quality of life improvements because we care that people are actually getting their lives back. we, in l addition, at equip look at comorbid symptom reduction because these so rarely occur in isolation and also ad slow cat city and burden. -- caregiver

advocacy and burden. we know that families are the greatest asset in getting their loved ones better, and advocacy is a strong predicter. it's on the providers, but i think we need the infrastructure with the payers are holding thesee providers accountable. it's not enough to just provide access to any treatment. they need to be demanding transparency in measurement-based outcomes, designing re'em with userment plans, benefits designed for reducinggn c rates to providers who demonstrate these outcomes and actually helping patients and families to find treatment that actually works. i talk a lot about the fact that i think steerage a has been a very is dirty word in the landscape, but that's actually exactly what a payers should be doing. they should be helping families to find care that works and not leading them to wade -- leaving them to wade through glossy

marketing materials on their own in their moment of crisis. >> and we're going to have a lot of debates on the new parity rule, but one of the fact patter i get payers to align to clinical indications, and that's going to be over the next few years of implement anticipation of this rule, what we want is people to be put in the level of care that's going to give them the biggest outcomes. so it's not a one size fits all. i, my wife and i have our daughter ind equip. she suffered from an eating disorder, and it's been amazing because i grew up in the old therapy days where it was kind of psychoanalytic, and i'd go and complain and never get better. these days we have cognitive behavioral therapy more wide he practiced but, frankly, not nearly practiced enough. and, of course, there are different types of cognitive behavioral therapy depending on the diagnosis. but what i really love about what equip does is it takes in thee whole family. now,w, that's never been my

experience with any mental illness and addiction, is them involving the family. how do we, as kristina said, build reimbursement systems that a pay for things that currently aren't paid for? if the family is better enabled to help their loved one, we're going to produce the best outcomes possible because, quote, patient is living with us. we have the biggest influence over their success or failure if we know what we can do. we're educated through equip as parents. how often does that a happen in the rest of mental health care where we actually pay for either your original family or your chosen family knowing what they can do to best help you with your outcome. we don't have it as much in the rest of the addiction world, but i'mm hoping equip kind of sets an example, and that's why it's appropriate that we're using equip as kind of a model for the quality 2.00. >> i really appreciate that,

patrick. and just to say one of the big barriers in menial health care is not only -- mental health care, is not only have we not involved parents, we still blame parks and take individuals -- parents and take individuals out of their households. and as you see, they're seeing them t day-to-day, living with them. it make me want to pull my hair out when folks say to me, well, you can't have a family involved that has their own issues with food body stuff, and i say, well, firs not?wh [laughter] in this society. >> right. >> but, secondly, all the more important that you bring the families in and you educate them around how to keep their loved one healthy for the long term. >> that's right. >> yeah. they are part of that a person's health care system, basically. they're almost the patient if setting for an individual. >> broader debate with about -- [inaudible] we need to investen in families more. i mean, it's one thing i hear everywhere i go.

when my kid turns 18, i have no involvement in their care. and that that's a real problem. and i think that a we'll have to have the debates on how to facilitate that without kind of violating privacy, but we definitely need to come up with a better approach than what a we'ree doing now. >> righter right. switching gears a little bit, i know we have some employers in the audience, and i'm wondering if you have advice for them. many, if not all, employs are paying for health care, and how do they help insure that they're getting what they think they're paying for or, you know, should be getting what they're paying for? are there things they can do? >> well, first of all, they're the fiduciary. so, yes, they pay your members, or pamela. but they're the ones that own the ultimate risk because the risk is not just in the total cost of care which as tpas and payers, you know, they assume. it's in the productivity of

employees. it's in the an absenteeism of employees. it's in the disability of employees. if you have that as a your frame of reference, then you start to quantify all of those other costs as to whether someone gets access to care in their medical spend oh, my god, the employers are going to say to their tp if a as, you had better start providing access because i know it's going to cost me more up front on, you know, payer side for the insurance costs, but i'm going to also a make it up in these other areas. right now employers do not organize themselves in that. they just sign the checks to their tpas and think they're all done. they now know because we're getting better data analytics that they own all these other costs that they haven't ever discerned in understanding their true overall costs of whether they had is access for their

employees to health plans' coverage. so these are the new, you know, issues we have to start. so employers have to start leading on policy because policy's going to have a direct impact onec their bottomloyers g more employees because of all a those that areor churning out. we also know because of all those that are not showing up. like, it's factored into the cost of employers now. you can address this a little bit more effectively through the medical side and even spend more on the medical side, you could probably justify it in terms of the other savings downstream. >> yeah, i couldn't agree more. employers hold the power. they pay the bill. so what we're talking about in terms of insuring that your employees and their families have access to care that a works, that is the strongest evidence-based treatment, we do this in medical disorders all the time. if you had lung cancer, you are

going to get the treatment with the highest evidence-based -- of course, no treatment works for everybody, and so if that doesn't work, you go to the one with the next highest evidence base. you pivot, you tweak. but we should always be giving families the best treatment option that is going to have the biggest success of getting them better and be asking your payer, how are you doing that? how are you insuring that these providers are measuring outcomes? our payment models moving to value-based care, to actually getting paid when people get better? you know, ask them, to you -- why is it demanding that you are covering a $45,000 a month facility-based treatmentnot covering something that would actually produce much stronger outcomes for much lower costs getting somebody better over the course of a year? i think employers have the power to start demanding accountability. >> kristina, sticking with you for a minute and focusing on the

care being delivered via telehealth which existed before can covid but certainly now except especially for behavioral health has become really integral the care, behavioral health care. do we measure quality differently there when treatments have -- happening over the phone? >> i mean, this is the beautiful thing about americament-based care -- measurement-based care is it actually doesn't matter what as long as you're getting ■;goodti quality outcomes. leave it to the providers to figure out how whether it's in person, whether it's on phone, whether it's on video. i say, you know, we conduct -- we're entirely 100% telehealth, almost all done via video and asynchronous messages and exchan actually think in many illnesses virtual is not only just as good, but actually can be better for these disorders because we often talk a lot

about we want to give people the right amount of care in the moment when they need it and not overdose people on treatment that they don't need. so this enables folks with eating december orders, you're fighting your brain upwards of six times a day. you are not just having symptoms tuesday at 2 p.m. when you go to your therapist. it enables us to be there when patients need it but then also say, go out, build a life worth living. be involved in hobbies and activities can and school and work and build up reasons to drown out your eating disorder. the other reason is, as patrick mentioned,de families are so, so critical. and wea broad, expansive definition of family. are disorders that require you to fight your brain six times a day. it's not only ineffective, but kind o' mean to ask people to do that alone. and yet it's really, really hard to get a whole family involved in a treatment provider's office a, you know, in a brick and

mortar. and and so we haveic the ability to bring in, you know, patrick, dad's traveling all over the country, he can zoom in to appointments. we have focused deployed in ore countries, folks with a grandmother in another state who can come in. it really enables that accessibility for people that produces longer term outcomes. >> that's -- >> such a great point. >> -- for our veterans. our active duty military, many of whom who have eating disorders as a by-product of keeping below body mass index, and they're a very concerned about a how they look. they move from base to base, all over the place. so having that virtual -- and this is true for everybody. it allows you to move around and keep some consistency in the care. >> yeah. that's -- allows you to be there without being this, right? perfect. so we have a question from the audience about a paying for pmeasurement-based outcomes, ad i think the question is how do

you do that when the outcomes might not come immediately? so i'm offering my care and offering my caring but it may bn actually show you that the outcomes are good. whatme happens kind of senate in the interim somewhat does that model look like? thoughts on that? >> it's a great question with, obviously. i think with what we've seen be successful is you have the base payment, and you say i am going to to get upside based on the outcomes i produce and patients getting better. so you're get bonus, if cash flow is an issue, we also have arrangements for where we agree to kind of a rate and if we don't hit, and, y, z metrics that we really need to hit, we'll take a rate cut. and that's some of the ways that you start to think about how do we move this system towards paying for outcomes that matter. >> yeah. ultimately, we need to align financial incentives which means we have to get payers to maybe

figure out a public health fund thathey all pay into that can kind of pay for the things that have longer term that none of the individual payers can justify in the short term. we all know there is a huge roi, but for many payers it doesn't come soon enough for them to justify a big investment in prevention up front. as policymakers, we can solve for that a problem. but we need f to solve for thata problem. now we have these expensive single therapy cures that are going to save the money if you -- [inaudible conversations] millions of dollars. how do you amortize that over time? it's going to be true with a lot of mental health condition, especially since they manifest early. and if you treat them early, guess what? the outcomes are better because we're not waiting til they end up as a crisis situations which, unfortunately, in mental health and aa diction these days we don't treat people until it's a stage four illness. and so i don't know exactly, but

i have to think there's got to be a new mousetrap here. and, frankly, the government needs to be paying in to also supplement the premiums because the return on investment to the government and all the government programs that end up picking up the costs of denied care because it isn't quite effective in the if short term ous. so we have to monetize that and then build, you know, a more holistic system where, as kristina said,for those social f health because we know it's going to reduce the chance of people ending up on, you know, public assistance, on public insurance if programs, in the je like. soin these are models that cnmis just starting to push forward, but we need even bigger models that start to involve, you know, the governments at all levels. that has to be kind of a braided

funding, pool funding approach. >> we had -- here this morning -- [inaudible conversations] >> yeah. >> start with you on this next question, came fromhe audience. have you seen any good training so that family members can be a part of it that would help them better engage in■a their inpatit care for a family member if they're not lucky enough to be in --p [inaudible] [audio difficulty]

awed. [audio difficulty] >> like i'm going to, you know, get you a dog if you do what you need to do for your eating disore. it was more helpful for them to say if you don't finish your breakfast, we're not going to go to school. and that was my consequence. and then in addition to the psychoeducation, i think support is so, so, so critical. my mom tried the find, she tried to start a family support group for folks with eating disorders in new york city two decades ago, and she couldn't -- i mean, she needed that family support so badly. and that's part of why embedded in our model is not only support for individuals, but also for their a families to have someone else who's been there who can

say i know how challenging this is to support a loved one through this and keep going. it's possible, it's worth it. and that'uable for all mental illnesses. my mom has bipolar disorder and, you know, on the flipside, i'm her caregiver, and i need support around me. i need s support for engaging wh other individuals who have gone through this and can help guide me throughs what is often really, really hard treatment. but if you stick it out, people do get better. >> patrick, i'm sure you have something to add to that and also whenever you have -- whatever you have to add a, can you also the tell us about your new book? >> yeah. so after i did my original book, a common struggle, e really was amazed at how many people said, oh, that happened in my family. the reason i say a common struggle, most people say what's common about kennedy family -- [laughter] but it was all the sre shame an.

that is common. even though i -- everyone knew our business. there was aw million bucks on e book shelf to categorize and describe everything, every addiction of every member of my family. we still didn't talk about it because we were -- [audio difficulty]stre courageoe all get behind someone who's fighting an■e■a illness, but noo is with mental illness and addiction. to kristina's point, i wanted to get to what the is real life -- you have simone biles who says i have a mentall health, you you don't know what that means like in l real life. we need to understand what is it really like not just navigating care, but navigating their

personal relationships? you have several -- [audio difficulty] everyone i interviewed their family members -- [audio difficulty] and everything about their stories is incredibly honest. when people read the book they will be amazed that anyone told everything about themselves. ironically the more they tell, the less it becomes them and the more you can distinguish between them as great people and them dealing with rr illnesses that rob them of who they are as people -- that's why saving people from mental illness and addiction is not just about lives, we know about suicide and overdose, but saving people from a life where they are not really there or living their full lives. that's a shame.

my mom is in her 80's. she's lived a long le on the numbers. but how much has she been present because she dealt with such a debilitating disease, a mood disorder and alcoholism, that hasn't been properly treated by the way because we don't treat them as chronic illnesses. i wish in this country we would start to understand the morbidity, disability cost as much as we understood the mortality. we all talk about how many people die. how many people are living as walking dead in this country because they're living on the streets, living captive in their homes, shades down, living miserable lives, not able to fully function? we have to appreciate the real impact these illnesses have and until we do we are not going to put money into doing what we know can make a difference.i can

your lived experience in creating a company like equip is a fantastic. there are a lot of great companies out there doing this because they are started by people who have run up against the system and say something has to change. kristina: it's unacceptable that we have treatments that work and yet people cannot access them. when i was going through this, i cycled in and out of facility based treatment for my freshman year of high school. the doctors told my parents sent her to a facility across the country, don't have a lot of hope. people don't recover from these disorders. i'm so grateful they didn't listen. they dove into research and found out about family-based treatment. that's the reason i'm here i've helped thousands of people. there are people who did listen to the professionals and they have spent decades in treatment that doesn't work.

mr. kennedy: we finally have to educate consumers on what they should be looking for in treatment. this that is worth another fireside chat. pamela: 3.0. we are over time but i want to thank both of you. i want to let the audience know congressman kennedy will be available at 12:25 p.m. some books will be available for the first 25 or so people. you might want to get in line early. congressman kennedy will be signing them. it's a great opportunity to get a copy of his book. please join me in thanking christina and congressman kennedy. really appreciate it. [applause]

>> coming up friday morning, markets reporter for axios, emily peck, talks about the economy expect u.s. labor market. -- and the lay labor market. then joe simms talks about the communist party's national convention this weekend and their campaign 2024 platform. and libertarian presidential candidate chase oliver will talk about his presidential campaign and the role of the libertarian party in the campaign. c-span's "washington journal." join in the conversation live at seven eastern friday morning on c-span, c-span now or online at c-span.org. former republican esential candidate vivek ramaswamy and the newly-elect chair of the rnc, michael -- michael whatley, discued the economy during remarkses at the north caroli gop convention in

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