■p i thank for conventional health care and for my wife, who decides i should eatetter, reduce my fat and sodium. we know enough to ask the right questions. asked the doctor here.g i he will tell me no. we have a lot to be grateful for in our society. there's lo hopefully we are open enough to accept it. >> wednesday, when the college presented, they said, we don't want to say we are ruling out pharmaceuticals. you want to give someone a choice with education and knowledge. when you look at this in this re panels, it gives you confidence that we will meet the challenge. we have no choice. we must meet it. it is inspiring sitting here with you. thank you for being here. [applause]

[captions copyright national cable satellite corp. 2024] he national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] announcer: more from the food and nutrition summit now with patrick, he and christina safran talked about access to high-quality health care, patients suffering from eating welcome b.

folks are making their way back from the track sessions. we will get going. welcome back to the remainder of our mainstage session. we are almost there. this will be athe next few sesse focused on what can drive innovation forward. without further ado, i'd like to welcome back on sla greenberg, president and of the association for behavioral health and wellness to moderate chat. pamela, come on stage. ♪ pamela: nothing like the music. it's probably good for all of us on a friday.

i'm so pleased to have congressman patrick kennedy and christina safran. we will be having a fireside chat. out? congressman kennedy is a former u.s. representative and founder of the kennedy forum. wgexperience with mental illness and substance use disorders to become one of the nation's influential advocates and has helpedaround mental illness, sue use disorderankechange in makinl health care accessible and affordable. he is also the co-author of landmark legislation the mental health parity and addiction equity act. he is cochair of the bipartisan policy center's behavioral

health integration task force. safran is the cofounder ceo of equipped, evidd eating disorder treatments in the u.s. their mission is to make eating disorders accessible to all patients and their famies. christina has quite a list of accomplishments. ashoka fellow, honoree female founders 100 and 30 under 40 health care recognition list. i don't think anyone can top that. the title of the chat is quality is parity 2.0. i thought i would briefly explain what mental health, what parity 1.0 is. it's the law i mentioned, the

mental health parity and addiction equity act. in one sentence, but it said was if mental health and substance use disorder coverage is offered, it has to be no mo thae coverage for medical conditions. that law passed in '08. a new proposed rule was released toward the end of last year. we are currently waiting. there's a final rule now. it will be replaced by a new final rule we expect sometime this summer and that will change a little bit of the way parity 1.0 is implemented. now we will move on to quality is parity 2.0. for both of you, i don't think anyone doubts the importance of having quality behavioral health care. ■a no issue there. talk about what you see as the

barriers to providing quality mental health and substance use disorder care? mr. kennedy: great to be with you. thanks for your leadership over many years running this dialogue around how do we bring greater access and mary that access with quality so itspeed to crop thes- speed to crap is crap. my cosponsor and i went around the country doing hearings. we had families complain about lack of access mortgages, spentl their life savings to take care of their loved ones, then their loved one wasn't any better. from the beginning we were about trying to bring access and access to evidence-based interventions.

that's part of the reason why i cofounded this. we wanted to make sure we upscaledf whom only get theoretical degrees in mental health, and curate the provider network by specialty. god for bid we would send people with eating disorders to an eating disorders specialized, behavioral therapy organization, which is really what christina has done. i will hand the baton to you. christina: grateful to be here. eating disorders provide this example. eating disorders affect 30 million americans at some point in their lives. 10% of the population. 80% of folks don't have access to treatment. less than■= 1% have access to treatment that works. for a lot of reasons.

i will highlight three. first, trained providers who can identify a effectively with evidence-based treatments. emblematic example. i fit the stereotypica mold of what we think eating disorders look like. it's not true. they do not discriminate. they affect even for me, i was diagnosed with at 10. at 13 i relapsed. my pediatrician didn't bat an eyelash. if i'm being missed, everyone is being missed. that's what we see. if you are diagnosed, it takes three years to be diagnosed. the illness is already more entrenched. not diagnosed. once you get diaospossible to f. we have 5000 eating disorders providerin country.

for the 5 million americans that struggle with it right now, that's .1%. not enough. within that most of them don't utilize evidence-based treatments. they are practicing eclectic talk therapy that feels good but doesn't work. vacuum of good quality outpatient care, facility-based residential care for those, the treatment, has become the go to despite no evidence it is effective. relapses in the first year isnue creative and innovative payment models for insurance companies. we are lucky at equip, weve ama. 100 million americans have access throu our services. we still struggle with partners who cannot go outside the traditional fee-for-service structure. we need to pay people better and further quality outcomes

and things that enable us to do that, our model is we provide folks with a multidisciplinary care tm -- p or mentorship is not covered the average of 40 messages exchanged is not covered, the 100 hours of initial training and ongoing training is not covered. the providers meeting amongst themselves to look at measuremenbased outcomes and consult on the treatment plan is not covered. what is covered is residential treatment. there is a code for that. that needs to change. that goes to the final piece. transparency around outcomes and measurement based care, if it works. pamela:■ before ask, we don't have a formal q&a piece to this. if you have a question, please put it in the app.

we will get it here and ask it. do not wait until the end. people receiving care that may not be the best. that leads to measurement based care. measure quality care? whothe provider, the patient, te plan? kristina: all of the above. starts with the provider. basic level we should all be measuring system redproduction o higher level of care, people cycling in and out and quatywe g their lives back. we look at comorbid symptom reduction. these illnesses so rarely occur in isolation. also caregiver self-efficacy and burden. we know families are great at getting their loved ones better.

that's a strong predictor of lasting recovery. it's on providers. we need the infrastructure where the payers are holding providers accountable. it's not enoughthey need to be g transparency in measurement based outcomes, designing reimbursement plans, benefits designs, reducing co-pays, to providers who demonstrate outcomes and helpingnts and families to find treatment that works. about has been a dirty word in the landscape. that's exactly what payers should be doing. they should be helping families to find care that works and not leading them to wade through marketing materials on their own in their biggest moment of crisis. mr. kennedy: we will have debates on the parity rule.

one of the fact patterns, if we can pa indications, that's ■going to be over the next few years of implementation of the rule -- what we want is people to be put in the level of care that will give them the biggest outcomes. that's not a one-size-fits-all. my wife and i have our daughter in equip. disorder. it's amazing. i grew days when it was psychoanalytic. i would complain and never get better. these days we have cog therapy. not practiced enough. there are different types depending on diagnosis. i love about equip is it takes in the whole family. that has never been my experience with any mental illness and addiction is them involving the family.

how do we build reimbursement systems that pay for things that currently aren't paid for? if the family is better enabled to help a loved one, we are going to produce the best outcomes possible. the patient is living with us. we have the biggest influence over their success or failure, if we know what we can do. we are educated through equip as parents. how often does that happen in the rest of mental health care where we pay knowing what they can do to best help you with your outcomes? we don't have it as much in the rest of the addiction world. i'm hoping equip sets the that's why it's appropriate we are using them as a model for oint out. -- quality 2.0. kristina: one of the big barriers in mental health care,

we don't blame parents for illnesses. take individuals out of their households, out of the folks who are most invested in them getting better, and are seeing them day■? today, living with them, it makes me want to pull my hair out sometimes when folks say, you cannot have a family involved tt stuff. first of all, who does not in this society? secondly all the more important you bring the families in and educate them around how to keep their loved one healthy for the long-tm.pamela: they are part ot person's health care system. the inpatient setting for an individual. mr. kennedy: there's a broader debate about mental health. we need to invest in families more. it's the one thing i hear everywhere. when my kid turns 18, i have no involvement in their care.

that's a problem. i think we have to have debates on how to facilitate that without violatingut we need to come up with a better approach than what we are doing now. pamela: switching gears, we have employers in the audience. advice for them. many, if not all, are paying for health care. how do they help ensure they are getting what they think they are paying for? or should be getting what they are paying for? mr. kennedy: they are the fiduciary. yes, they pay your members but they are the ones that own the risk. the risk is not just in the tol cost of care, which as tpa'd payers, they assume, it's in the productivity of employees, and the absenteeism, and the disability of employees.

if you have that as your frame of reference and start to quantify all those other costs o care in their medical spend, well oh my god, employers will say to their tpa's, you better start providing access because i know it will cost me more upfront on the payer side, the insurance cost but i am also going to make it up in these other areas. right now employers do not organize themselves. they sign checks to their tpa's and think they are done. they now know because we are getting better data analytics that they own all these other costs ■at they have not ever discerned, understanding their true overall cost, of whether they have access for their employees to health plans coverage.

these are the new issues we have to start with. employers have to start leaning on policy. policy will have a direct impact on their bottom line. employers are now hiring more employees because of all those that are churning out. we also know because of those who are not showing up. it's factored into the cost of employers now. if you can address this more effectively through the medical side, even spend more on the medical side, you could probably justify it in terms of savings downstream. >> i couldn't agree more. employers hold the power. they pay the bills. in terms of ensuring and families have access to care that works and is the strongest treatment, we do this in medical disorders all the time. if you have lung cancer, you're going to get treatment with the highest evidence-based.

no treatment works for everybody. if that doesn't work, you go to the next one. we should always be giving option that is going to have the biggest chance of getting asking your payer, how are you doing that? how are you ensuring these providers are measuring outcomes? ■;are your payment models moving to value based care, to actually getting paid when people get better? ask them, why is it, demanding your covering a $45,000 a month facility based treatment and not covering something that would actually produce stronger outcomes for lower costs getting employers have the power to start demanding accountability. pamela: sticking with the care being■ delivered via telehealth,

which existed before covid but;■ certainly now, especially for behavioral health, has become integral to care. do we measure quality zoom?rently when treatment kristina: the beautiful thing about measurement based care is it doesn't matter. as long as you are getting quality■u outcomes, leave it to the providers to figure it out. we 100% telehealth. that is done via videond asynchronous messaging. in many mental illnesses, virtual is not only just as good but actually can be better for these disorders. we often talk■9 about, you wanto give people the right amount of care in the moment they need it

and not overdose people on treatment they don'tthis enableg brain upwards of six times a day. you're not just having symptoms at 2 p.m. on a tuesday when you go to see your therapist. go out and build a life worth living. get involved in hobbies, activities, school, work, and build up reasons to drive out your eating disorder. families are so critical. definition of family. ers that require you to fight your brain six times a day. it's ineffective and mean to ask people to do that alone. yet it's really hard to get a family involved in a treatment provider's office in a brick-and-mortar. we have the ability, patrick is

traveling all over the country, he can zoom in, we have folks who are deployed, we have a grandmother in another state who can come in. that accessibility for people. mr. kennedy: that's important. our active-duty military, many of whom have eatingthey have toy mass index and they are they moved from base to base all over the place. having that virtual -- this is true for everybody -- it allows you to move around and keep consistency in the care. pamela: it allows you to be there without being there. we have a question from the audience about paying for measurement based outcomes. how do you do that when the outcomes might not come immediately? offering my care but it may be a

month or longer before i can show you the outcomes are good. what happens in the interim? kristina: great question. what we've seen be successful is you have the base payment then you say i am going to go based on the outcomes i produce. you're getting a bonus, if cash flow is an issue for smaller providers, we also have arrangements where we agree to a rate and say if we don't hit xyz metrics, we will take a break, a rate cut. those are some of the ways you start to think about how to remove move the system toward paying for outcomes that matter? mr. kennedy: need to align financial incentives. we have to get payers to figure out a public health fund they pay into that can pay for the things that haveonger-term,

that none of the individualtifyt term. there is a huge roi but for many payers it doesn't come soon enough to justify a big investment in prevention upfront. as policymakers we consult for that problem. but we need to solve for that. e expensive single-payers tt will save the system money if you spend upfront millions of dollars. how do you amateur eyes that over time? gnthat's true with pharma and mental health conditions, when they manifest early. if you treat them early, guess what? the outcomes are bettewe are noy end up as crisis situations, which unfortunately mental health and addiction these days, we don't treat until it is a stage for illness. i don't know exactly. there has to be a new mousetrap here.

the government needs to be paying in to supplement the premiums. the return on investment to the government and all the government programs that end up picking up the cost of denied care because it isn't effective in the short term, is in norma's. we have to monetize that and buil a more holistic system where, we stt to pay for social drivers of health, because we know it will reduce the chan of people ending up on public assistance, public insurance programs, like. these are models that see mmi is just starting to push forward but we need bigger models that start to involve theerels. that has to be a pool funding approach. pamela: we had here this

morning. that was great. question came from the audience. trainings that family memrs can be a part of that would help them better engage in their inpatient care presumably for a family member if they are not luckyenoe doing things like equip? ■w mental health america have tremendous trainings. amilies need to be better involved in care. oeducation that needs to happen. my parents didn't it's hard to e going through a mentalss where a core part of it is not knowing how sick you are and not wanting to get better. understand neurobiology behind it.

with eating disorders, we know people are much more attuned to hen reward. that's helpful in saying it wasn't going to be helpful for me when my parents were like, df you do what you need to do for your eating disorder. say if you don't finish breakfast, we are not going to school. that was my consequent brain. in is so critical. my mom tried to start a family support group for folks with eating disorders in new york city two decades ago. she couldn't. she needed that family support so badly. embedded in our model is pierced support forr families, to have someone else who has been there and can6z say, i know how challenging this is to support a loved one through this and keep

going. it's possible and worth it. that's incredibly valuable for all mental illnesses. my mom has bar. on the flipside i am her i need support around me. i need support for engaging with other individuals who have gone through this that can help guide me often really hard treatment but if you stick it o, pele i'm sure you soalso,t your new book? mr. kennedy: after i did my or book i really was how many people said that happened in my family. wh is common about kennedy family? secrecy. the shame, the silence. that's common. even though everyone knew our

business, there was a million books, categorized in describing every member of my family, we still didn'tk about spilling the beans. i interviewed book i just finih stephen friede called profiles in mental health courage. cancer, we all get behind someone who is fighting. ■ynot so with mental illnesses/addictions. to kristina's wanted to get to what is the real life manifestation of these illnesses?ne biles says i have a mental health issue. eans in her life. how does she cope? what does her life look like? what is it really like for people navigating their personal relationships? we have several couples, by the way everyone of the profiles i

members, colleagues andeally honest trutl stories is incredibly honest.eal when people read the book they will be anyone told everything about themselves. ironically the more they tell, the less it becomes them and the moreou people and them dealing with horriblethat rob ts people -- that's why saving people from mental illness and addiction is not just about savingoées, we know about suicide and overdose, but saving people from a lifee not really g their full lives. that's a shame. myom is in h 8she's lived a lone 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 thmorbiditys much as we understood the mortality. we all talk about how many pele die. how many people are living as walking dead streets, living captive in their down, living miserable lives, not able to fully function? we havtoimpact these illnesses d until we do we are not going to put money into doing what we know can make a difference. i can tell you, your in

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 say something has to change. kristina: it's unacceptable that we haves that work and yet people cannot access them. when i was going through 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-basedth'd i've helped thousands of peothen to the professionals and they have spent decades in treatment that doesn't work. mr. kennedy: we finally have to educate consursfor in

treatment. that's a piece to this that is worth another fireside chat. 3.0. we are over to thank both of you. i want to let the audience congressman kennedy will be available at 12:25 p.m. some books will beable for the first 25 or so people. you might want to get early. congressman kennedy will be signing them. it's a great opportunity to get a copy of his book. thanking christina and congressman kennedy. é] it. [applause] announcer: senator joe m announced heashanged his party+

according to his spokesperson. he said "our national politics are broken. neither party is willing to compromise. to stay true to myself and remain committed to country before party, i've decided to register as independent wh affe to fight for america's sensible majority." chamber to 47 republicans, 49 demos independents. the last time there were four wt democrats or republicans was during the 1976 conference, 1939 -- the 76 congress, 1939. ♪ announcer: watch she spans 2024 campaign trail, a weekly round

up c-span campaign shop to findvoters, along with updatell numbers, fundraising data and campaign ads. today at 7:30 p.m. eastern on c-span, online at www.c-span.org or download the podcast oni% now, our free mobile app. c-span, your unfiltered view of politics. >> the house will be in order. . >>■/ c-span celebrates 45 yearsf congress like no other. primary source for balanced, unfiltered view of government.

45 years and counting. thursday, c-span will commemorate the 80th anniversary coverage with a ■k■ from normandy featuring a speech from president biden. :gwe will take your calls. join us for a celebrati -- ceremony at the world war ii museum. stay with us as we continue to commemorate d-day back at presidential speeches and othei+special programs. watch the day coverage of the 80th anniverry of d-day