if you ever miss any of c-span's coverage, you can find it anytime online at videos of key hearings, debates and other events feature markers that guide you to newsworthy highlights. these points of interest markers appear on the right-hand side of your screen when you selected videos. this makes it easy to get an was debated and decided in washington. scroll through and spend a few minutes on c-span's points of interest. announcer: more from the food and nutrition summit now with former congressman patrick kennedy, he and christina safran talked about access to high-quality health care including patients suffering from eating disorders and mental illnesses. care including patients

suffering from eating disorders and mental illnesses. >> welcome back everybody. 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 a terrific close. the next few sessions are focused on what can drive innovation forward. without further ado i'd like to welcome back on stage, pamela greenberg, president and ceo of the association for behavioral health and wellness to moderate the next fireside chat. pamela, come on stage. ♪ pamela: nothing like the music.

it's probably good for all of us on a friday. i'm so have congressman patrick kennedy and christina safran. we will be having a fireside chat. if you want to come out? congressman kennedy is a former u.s. representative and founder of the kennedy he's used his own personal ex illness and substance use disorders to become one of the nation most influential advocates and has to reduce the stigma around mental illness, substance use disorders and make real change in making behavioral 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. christina safran is the cofounder ceo of equipped which provides virtual evidence-based eating disorder treatments in the u.s. their mission is to make eating disorders accessible to all patients and their families. christina has quite a list of accomplishments. ashoka fellow, 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 1.0it's the law i mentioned the mental health parity and addiction equity act.

in one sentence, but it said was if mental ubstance use disorder coverage is offered, it has to be no more restrictive than insurance 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. 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 it is access to quality? speed to crop these krapp -- speed to crap is crap. my cosponsor and i went around the country doing hearings. we had families complain about lack of and who had taken out second mortgages, spent all 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

upscaled all the providers out there most of 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 reallya 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. first, trained providers who can identify and treat effectively with evidence-basedemblematic example.

i fit the stereotypical mold of what we think eating disorders look like. it's not true. they do notiminate. they affect everybody. even for me, i was diagnosed with anorexia 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. most are not diagnosed. once you get diagnosis, it's impossible to find a provider. we have 5000 eating disorders providers in the 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. in this vacuum of goodient care, facility-based residential care for those, the few who get treatment, has become the go to despite no evidence it is effective. relapses in the first year is upward of 50%. number two, we need to have more creative and innovative payment models for insurance companies. we are lucky at equip, we have amazing partners. 100 million americans have access through our services. we still struggle with partners who cannot go outside the traditional fee-for-service structure. we need to pay providers forgetting people better and further getting quality outcomes and things that enable we provide folks with a multidisciplinary care team -- p or mentorship is

not -- 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 measurement based outcomes and consult on the treatment plan is not covered. s covered is residential treatment. there is a code for that. that needs tothat 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. you've talked about people receiving care that may not be that leads to measurement based care. how do we measure quality care? who is responsible? the provider, the patient, the

plan? kristina: all of the above. starts with the provider. basic level we should all be measuring system reduction productionf care, people cycling in and out and quality of life improvements. we care that people are getting 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. e infrastructure where the payers are holding providers accountable. it's not enough to provide access to any treatment. they need to be demanding transparency in measurement based outcomes, designing reimbursement plans, benefits

designs, reducing co-pays giving higher rates to providers who demonstrate outcomes and helping patients and families to find treatment that woi talk a lot about, steerage has been a dirty word in the landscape. that's exactly what payers should be doing. they shoelping families to find care that works and not leading them to wade through 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 get payers to align to clinical 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.

she suffers from an eating disorder. it's amazing. up in the therapy days when it was psychoanalytic. wo these days we have behavioral therapy. not practiced enough. there are different types depending on diagnosis. what 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 thehow 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. g 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 example. that's why it's appropriate we are using them as a model for the quality to point 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, today, living with them, it makes me want to pull my hair out sometimes when folks say, you cannot have a family involved that has their own issues with food and body stuff. first of not in this society? secondly all the more important you bring the families educate them around how to keep

their loved one healthy for the long-term. pamela: they are part of that 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 the that's a problem. i think we have to have debates on how to facilitate that without violating privacy but 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 ensur 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 yourat own the risk. the risk is not just in the total cost of care, which as tpa's and payers, they assume, it's in the productivity of employees, and the abs disability of employees. if you have that as your frame of reference and start to quantify all those other costs as to whether someone gets access to 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 they sign checks to their done. they now know because we are getting better data analytics that they own all these other

costs that 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 employers are now hiring more employees because of all those that are churning out. lso know because of those who are not showing up. it's factored into 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 employees

and families have access to care that works and is the strongest evidence-based treatment, we do this in medical disorders all 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 families the best treatment option that is going to have the biggest chance of getting better. asking your payer, how are yohow are you ensuring these providare your payment models moving to value basedactually 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 meone better over the course of a year? 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 behavioralome integral to care. do we measure quality differently when treatment is happening over the phone or zoom? kristina: the beautiful thing about measurement based care is it doesn't matter. as long as you are getting quality outcomes, leave it to the providers to figure it out. we conduct, we are 100% telehealth. that is done via video and asynchronous messaging. in many mental illnesses virtual is not only just as good but actually can be better for these disorders. we often talk about

you want to ve care in the moment they need it and not overdoseeople on treatment they don't need. this enables folks with eating disorders, you are fighting your 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. we take a broad expansive definition of family. these are disorders 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. it enables that accessibility mr. kennedy: that's important. our active-duty military, many of whom disorders. they have to keep a low body mass index and they are concerned with how they look. they moved from base tol having that virtual -- this is true for everybody -- it allows you to move around and keep consistency in the care. pamela: it allowsou 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 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? ultimately we 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 have longer-term that none of the

payers can justify in the short term. there is a huge roipayers 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. now we have expensive single-payers that will save the system money if you spend upfront millions of dollars. how do you amateur eyes that over time? that's true with pharma and mental health conditions, when they manifest early. if you treat them early, guess what? the outcomes are better. we are not waiting until they 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 exactly. there has to be a new mousetrap here. the government needs to be paying in to supplement the premiums. e return on investment to the government andment 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 build a more holistic system where, we start to pay for social drivers of healt reduce the chance of people ending up on public assistance, public insurance programs, in the criminal justice system and the like. these are models that see mmi is just starting to push forward but we need bigger models that start to involve the government at all levels. that has to be a pool funding approach. pamela: we had cmmi here this morning. that was great. this next question came from the audience. have you seen good trainings

that family members can be a part of that would help them better engage in their inpatient care presumably for a family member if they are not lucky enough to be in equip or someone doing things l kristina: mental health and organizations have tremendous trainings. we are moving toward an understanding that families need to be better involved in care. there's a lot of psychoeducation that needs to happen. my parents didn't know anything about eating disorders. hard to support a loved one going through a mental illness where a core part of it is not knowing how sick you are and not wanting to get better. you have to understand neurobiology behind it. with eating disorders we know people are much moreuned to punishment then reward. that's helpful in saying it

wasn't going to be helpful for me when my parents were like, i'm going to get you a dog if you do what you need to do for your eating dit was more helpful to say if you don't finish breakfast, we that was my consequent brain. in addition, support is so critical. 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 for individuals but also for their families, to have someone else who has been there and can 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 bipolar. on the flipside i am her caregiver and i need support around me. i need support for engaging with

other individuals who have gone through this that can help guide me through what is often really hard treatment but if you stick it out, people get better. pamela: i'm sure you have something to add to that. also can you also tell us about your new book? mr. kennedy: after i did my original book i really was amazed how many people said that happened in my family. what is common aboutit was all the secrecy. the shame, the silence. that's common. even though everyone knew our business, there was a million books, categorized in describing everything, every addiction of every member of my family, we still didn't talk about it because we were worried about spilling the beans. people for this new book i just finished with stephen friede called profiles

in mental health courage. cancer, we all get behind someone who is fighting. not so with mental illnesses/addictions. point, i wanted to get to what is the real life manifestation of these illnesses? simone biles says i have a mental health issue. you don't know what that means in her life. how does she cope? what does her life look like? what is it really like for %2people navigating their personal relationships? we have several couples by the way everyone of the profiles i interview, their family members colleagues and therapist, so we have a really honest truthful transparent reckoning for what it's like in their lives. everyone uses their real names 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 horrible illnesses that rob them of who they are as people -- that's why saving people from mental illness and addiction is not just about saving 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 life 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,costood the mortality. we 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 illnessesavre not going to put money into doing what we know can make a diffence. i can tell you, your take 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 system and say something has to change. kristina: it's unaccept 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. 't listen. they dove into research and found out about family-based treatment. that's the reason i'm here and 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. that's a piece to this that is worth another fireside chat. pamela: 3.0. 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 copyplease join me in thanking christina and congressman kennedy. really appreciate it. [applause] ♪ announcer: spends "washington journal," are live for a in evolving you to discuss the latest is using government politics, and public loc from washington d.c. to across the country. saturday morning, a senior associate at the center for strategic and international studies previous mexico's presidential election and the potential impact of new leadership on cooperation with the u.s.. and a journalist talks about his reporting on 2024 and his podcast. c-span's "washington journal,"

join in the conversation live at 7:00 saturday morning on c-span cspan now app, or c-span.org. >> other ideas of how you secure a border, how you continue to be humanitarian, how you can allow immigration. i get painted as a racist and all this other stuff, and yet i talk about the illegal immigration, but how do you boil that down to individuals living in kansas and nebraska and others? where they started to head home and i assume it is the same overseas is the impact on local communities. it is floods of migrants coming in and taking over a hotel, a condominium, taxpayer dollars in their city, the african-american community standing up saying why are our tax dollars going to give benefits to folks that just got here.

that is an america first approach. announcer: former act homeland security chad wolf end of former trump administration discussed the impact of global migration and how border policy could impact upcoming elections in the u.s. and europe. watch the full discussion saturday at 7:00 p.m. on eastern on c-span, on c-span now or on c-span.org. announcer:been delivering unfiltered congressional coverage for 45 years. >> to my colleagues, my friends and most precious -- most especially my wife and family i have for you will deeply and i beg your forgiveness. i was prepared to lead our narrow majority as speaker, and i believe i had it in me to do a fine job but i cannot do that

job or be the kind of leader that i would like to be under current circumstances. so i must set the example that i hope president clinton will follow. i will not