Abby Burns (00:22):
From Advisory Board, we're bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. Our episode today is exploring the intersection of technology and behavioral health, and it's doing a few things. One, asking the question, as the industry has been hyper-focused on expanding access to behavioral healthcare over the past few years, how effective have we been at impacting quality? Or, in its simplest form, have we truly been providing value? So this is the kind of business value for our investment side of this, which lets not discount, because behavioral health need and demand continue to grow and they continue to drive a lot of spend. Talk to any health plan and they will tell you that after specialty pharmacy, behavioral health is one of the top drivers of trend. So that's one thing.

(01:14):
The other thing today's episode is doing is running at a more fundamental question that frankly becomes more and more relevant every day, how should we think about AI and behavioral healthcare? Behavioral health is an incredibly hot target for AI in clinical care. And at this point, the conversation is no longer theoretical. Even CMS seems to be embracing use of AI in behavioral healthcare through the ACCESS model. We need to unpack that.

(01:39):
So yes, this episode is doing a lot, which is why I needed to talk to someone who could approach these questions through multiple lenses. My guest today is Dr. Tristan Gorrindo. He's a pediatric psychiatrist, a behavioral health business leader, and a longtime researcher of the intersection between behavioral health and digital technologies. He currently serves as the chief medical officer of integrated behavioral health company, evolvedMD. So these questions that we're asking, he's been navigating them for decades. Without further ado, Tristan, welcome to Radio Advisory.

Dr. Tristan Gorrindo (02:14):
Hey, Abby. Great to be here.

Abby Burns (02:16):
I guess I should be saying welcome back, because we did have you on the podcast last year when you participated in Advisory Board's panel from our research summit.

Dr. Tristan Gorrindo (02:25):
Yeah. I mean, this is a discussion you and I have been having for years, I guess, at this point now.

Abby Burns (02:30):
One of the reasons I wanted to have you back on the podcast was I read your article that you published in JAMA earlier this year, about the ACCESS model that you and I will talk about in the course of our conversation today and really what it signifies for the future of our behavioral healthcare industry and how it fits into our healthcare system.

(02:49):
So we're here to explore the intersection of tech and AI-enabled expansion of access to behavioral healthcare and the question of value in behavioral health. Why is it important that we have this conversation right now?

Dr. Tristan Gorrindo (03:04):
I think for the last decade or so, we've been talking a lot about access to care. We've been just trying to get more people connected to behavioral health services. And, as a field, we're ready to start thinking a little bit beyond that. It's not enough to just say we have more doors that people can walk through if walking through those doors doesn't actually get people better. And when we think about value, we often think about it in this really mathematical way, what is the outcomes we get divided by the cost that it costs to get those outcomes?

Abby Burns (03:37):
Yep. Pretty classic definition for value-based care.

Dr. Tristan Gorrindo (03:39):
What is really tricky in behavioral health is that you have lots and lots of people that have behavioral health need, but it doesn't cost the system all that much money. When we talk about trying to find value in behavioral health, it gets really difficult because treating a lot of worried well, these are people that may have subclinical symptoms or they may feel a little bit blue, people that end up using our behavioral health system and using a lot of treatment, but don't actually save the system very much money in the end, don't actually bring a lot of value. It's really valuable to the person who receives the services.

Abby Burns (04:15):
Right.

Dr. Tristan Gorrindo (04:15):
Don't want to take that away from them in any way. But in terms of stepping back and looking at the health of the system and where we find value in terms of moving the field forward, making more access for people with low-acuity illness doesn't actually move the needle. And so there's some interesting things happening, some of which we'll talk about here today, which are around, can we think about payment in a different way, can we think about technology in a different way that will hopefully unlock some of that more traditional value that we've been talking about?

Abby Burns (04:48):
I do want to follow up on one thing that you said, which is that behavioral health doesn't cost the system all of that much. What I hear a lot from payers is that behind specialty pharmacy, behavioral health is driving a lot of trend. How can you square that for me?

Dr. Tristan Gorrindo (05:01):
In two ways. So the first way is a lot of people costing a little bit of money, right? So payers see a lot of people utilizing behavioral health services. Interestingly, when you talk to payers, you hear that pharmacy spend over the last few years has been relatively flat. Psychiatry spend, like medication management visits has been relatively flat. It's really the outpatient psychotherapy that's been driving the behavioral health spend. And I think this is where we're seeing a lot of people who are coming either through EAP services at their employer or they feel like they need to go engage with a therapist in their community. Those people actually may be really well positioned to use technology to help address some of those lower acuity symptoms.

(05:46):
The other way to think about it is imagine you are a payer and you have responsibility, let's say for insuring a thousand people, and all the costs associated with taking care of those thousand people. If you have five of those thousand people who are each costing you $3 million each, because they've spent six months on an inpatient unit or they're in the ER every three nights or they're not compliant with their medication and they're constantly presenting in high-acuity settings, it's much easier to reduce the total cost for all thousand patients just by focusing on those five people. And so it's a little bit of, do you want to look at it from the bottom up, the low acuity, large numbers of patients, or look at the high spenders who are costing the system a lot, but are probably pretty few in number?

(06:40):
The other piece that gets really interesting is the interplay with physical health.

Abby Burns (06:44):
Yes.

Dr. Tristan Gorrindo (06:45):
And when we think about savings, we know that actually when you look at total cost of care, you're not just looking at behavioral spend, but when you look at the total cost of care associated with patients, treating their behavioral need reduces their medical spend. Taking care of the behavioral spend helps people get to their PCP more often, helps them be more compliant with their diabetes regimen, helps them manage their heart failure better, helps them manage their end-stage renal disease better. And so the savings to the system actually comes on the medical side.

Abby Burns (07:19):
And I think I've seen numbers to the tune of two to six times ROI of addressing behavioral health need on overall reduction in total cost of care.

Dr. Tristan Gorrindo (07:27):
The company where I work, we did a claims-based analysis just of patients that we were taking care of in the Maricopa County, Arizona area. And we showed that doing collaborative care, integrating behavioral health services in the primary care setting, we reduced the total cost of care for patients with commercial insurance and Medicare insurance about 15%. And most of the savings actually came from reductions in the physical health spent.

Abby Burns (07:59):
Wow. I don't think I know any organization today that would sniff at a 15% reduction in total cost of care.

Dr. Tristan Gorrindo (08:04):
Right. Yes. Scale that up across the entire US healthcare system, it's billions of dollars.

Abby Burns (08:10):
You use the word scale, and I think that is where the industry is looking to technology. In your paper that I referenced earlier, you cited a statistic that 35% of adults reported using a chatbot for mental health on a regular basis, which is a really big number. We also see chatbots starting to integrate into clinical care delivery.

Dr. Tristan Gorrindo (08:31):
Yeah. I mean, I think this is one of the most exciting and terrifying aspects of being a physician these days. We've been dealing with a version of this problem for many, many years.

Abby Burns (08:41):
Sure.

Dr. Tristan Gorrindo (08:41):
Which is kind of the Dr. Google problem. Now put that to the 10th power, because they've had a dialogue with a chatbot around what's going on for them. And the way a large language model technology works, it's going to create a bit of an echo chamber around things that it thinks you're interested in, and we see some bad outcomes for people with underlying mental illness. And those are the ones that I think show up in the newspaper, show up online. But I think there's a lot of people that are using it for this kind of casual promotion of their own wellness.

Abby Burns (09:14):
Yep. I think you put this well, and I promise not to spend our whole conversation quoting your own writing, but I will double down here, the way you put it really stuck with me, which is the question of when AI and clinical care will be used at scale is no longer abstract. In other words, we can't defer decision making or defer engaging with this reality. We really need to pay attention now.

Dr. Tristan Gorrindo (09:37):
Yeah. We have, as a field or as a discipline of medicine, oftentimes we kind of get stuck when these new technologies emerge, debating whether or not it should exist at all. What should AI be allowed to do? What should it not be allowed to do? When should a clinician interact with it? When should it be able to operate autonomously? And while we are having those discussions and debating them in medical societies and national meetings, the technology is racing past us.

Abby Burns (10:06):
Yes.

Dr. Tristan Gorrindo (10:06):
And by the time any sort of consensus is reached around what we should do, the technology is already 10 generations down the road. We have an opportunity here now, I think, to really harness AI, to shape it, to recognize it's here, that recognize our patients are using it, recognize clinicians are using it, and to try to say, okay, where's the good here, and how do we latch onto that and have it help drive clinical care and value? And then where are the outlying areas that we really want to make sure that we're paying attention to as a fetal nest clinicians?

Abby Burns (10:40):
Yep. Especially bearing safety in mind. I want to talk about how we got here to this point that we're at in 2026, because there has been a wide expansion of virtual and digital behavioral health access really since I would say the start of the pandemic. We've seen literally hundreds of startups hit the market focused on leveraging digital technologies to improve patient access to primarily lower acuity behavioral healthcare services.

(11:08):
I'm going to ask you to wear your three hats as a clinician, a systems researcher, and a business leader at the same time. What has this expansion in access gotten us and what has it not gotten us?

Dr. Tristan Gorrindo (11:25):
I think it's given us the appearance of more people being able to connect with care. Most of the platforms that have really launched during the COVID pandemic and since the COVID pandemic are really about connecting people, patients with live clinicians. There are very few truly automated, no clinicians in the loop solutions out there today. What is interesting to me is that access doesn't actually mean treatment, right? So what these companies are less likely to report is how many times did the patient come back? Did they come back for a second visit? Did they come back for a third visit? Access to care doesn't mean that they were actually measuring the care.

(12:08):
So we don't, in a lot of these platforms, have any idea, did people actually get better? In this case, it's better or small B, meaning did their symptoms improve? But I'm more interested in the big Better, which is what are the things that brought them to treatment? Is their relationship with their boss improved? Are they no longer contemplating divorcing their spouse? Are they able to function in the world in a more meaningful way? As a field, we don't really know how to measure those things to begin with.

(12:40):
But I think we've kind of convinced ourselves that having all these new tools, particularly since we can match people, you have a trauma history, we can match you with a trauma-specific platform, that this is somehow better for patients. And maybe it is, but there's no data out there to really suggest, A, that this treatment matching connection has been good for patients, did the patient actually get better and did it create any value for the system? We just don't know. I don't want people walking away having seen all these startups feeling like, oh, we solved the behavioral health problem. I think we've just changed the behavioral health problem around. We've changed the configuration.

Abby Burns (13:16):
What you're spelling out with, in particular, how we measure impact, really to me points to the challenge of using value-based care in behavioral health. I've never seen a field in an EMR for I'm less likely to divorce my spouse, I'm fighting less frequently with my partner.

Dr. Tristan Gorrindo (13:36):
Yeah. And I think that actually, ironically, is one of the places where AI might be able to help us. I was brainstorming with a colleague of mine in Texas a couple months ago, and we were kind of joking like, "What if we could create an AI agent that just listened to your life and could tell you if your life was getting better based on the things that were meaningful to you?" Right? Because better for each individual has its own trajectory. It's not like when you have a blood cancer and you can actually say, "Oh, we can see your white blood cell count is trending towards normal." In behavioral, it's so individualized. And ironically, AI may give us one of those tools to measure for the individual are the things that are important to me getting better in the real world.

Abby Burns (14:23):
It's interesting because where I thought you were going to go with that was actually taking unstructured call notes and being able to convert them into measurable outcomes. And you went a hundred yards past, into always on listening.

Dr. Tristan Gorrindo (14:37):
Well, yeah. And I mean, just this week, one of the giant social media companies released basically a device that you would wear around your neck or on your keychain that would listen to your whole life and be your personal assistant. And if that becomes really commonplace in our society, I would be shocked if there is not a behavioral health AI company that would look to create an outcomes-based measurement framework that leverages that.

Abby Burns (15:03):
Man, my sort of safety radars and privacy radars are going off all over the place, but we'll put that conversation to the side. Maybe that'll be what we're talking about next year.

Dr. Tristan Gorrindo (15:12):
Absolutely.

Abby Burns (15:13):
But I think it all does come back to at present, it is hard to measure value in behavioral health, which makes it hard to implement value-based care for behavioral healthcare. My read is we don't see a ton of value-based contracts for behavioral health.

Dr. Tristan Gorrindo (15:29):
Yeah, we don't see a lot of value-based contracts, mostly because they're hard to do. We have such course measures for determining success that when somebody gets better, particularly if the value-based contract is tied to total cost of care savings, that it's easy to ascribe, "Well, the real reason they got better was because the PCP adjusted their insulin medication. Their transportation need got addressed." And so it's really hard for payers to go in and ascribe and give credit to the behavioral health company or provider based on that intervention. It's just a large data problem, and there just aren't enough people with exactly the same disorder to be able to piece out the signals very well.

Abby Burns (16:17):
And to your point, that does seem like a place where AI could play a role in helping do some of that parsing, which is maybe a good entry point to talk about the ACCESS model. Because on its face, this is essentially a mechanism to expand one flavor of value-based chronic care management, behavioral healthcare being one of them.

(17:35):
I don't want to assume that our listeners are intimately familiar with this payment model from CMS Innovation Center, especially since they've put out somewhere in their realm of 12 to 15 in the last 10 months. So can you give us a high level of what the ACCESS model is and what we need to know about how it works for behavioral healthcare specifically?

Dr. Tristan Gorrindo (17:54):
CMS released a new model in the summer of 2026 that was a value-based payment framework, which is to say, "We are going to pay you the provider based on outcomes, not based on whether or not there was an encounter, not based on whether or not there was a monthly case rate."

Abby Burns (18:14):
Putting process measures down.

Dr. Tristan Gorrindo (18:15):
Yeah. CMS went even further, which is to say, "We recognize that sometimes these outcomes take a while to achieve and there are operational costs, so we can't just wait until the very end to give you the money for having reached a treatment target, but we'll give you half the money." So the way the CMS payments work is they decide, okay, for a year of depression care, for example, or anxiety care, we're going to allocate, to make the math easy, $150. We will give you that divided by 12, so on the order of $12.50 a month to take care of that disorder, and we will give you the half of that each month, $6.25 per month. And then if the patient reaches the target at the end, we will give you the other $6.25.

Abby Burns (19:04):
Sure. Yep.

Dr. Tristan Gorrindo (19:05):
So now the challenge of the model comes out, which is to say, what kind of treatment can you actually offer a patient for $6.25 a month?

Abby Burns (19:15):
I was trying to do the back of the envelope math of how much would it ordinarily cost to take care of a patient per month for their behavioral healthcare needs?

Dr. Tristan Gorrindo (19:21):
Well, so let's take somebody who's just in psychotherapy. Most people who are doing psychotherapy are doing weekly visits. So if we do four visits a month, and let's say on average, payers are paying between 85 and $120 per payment, let's say a hundred to make it easy, that's $400 a month going to a provider, versus the ACCESS model, which is paying between six and $7.

Abby Burns (19:47):
That is wildly different.

Dr. Tristan Gorrindo (19:49):
Wildly different, right? So we should be cheering for the success of this program, the ACCESS program, in terms of proving out that you can have a value-based payment model, an outcomes-based payment model. The question is, is the bridge between what they're offering and what normal care looks like today too far? Because, in reality, the only way you can provide care to lots of people at scale for $6.50 a month is if you're using AI.

Abby Burns (20:21):
Yeah. It's not a human delivering that care.

Dr. Tristan Gorrindo (20:23):
There's just not enough to make it work.

Abby Burns (20:26):
That feels like a very important thing to understand about this model is that essentially what we can read from the unit economics is this is AI-delivered or let's say technology-delivered care.

Dr. Tristan Gorrindo (20:39):
Right. And it could be cognitive behavioral therapy modules, and those are not AI driven, they're just something the patients do. Now, what's really interesting is that CMS doesn't prescribe what the care needs to look like, right? They say on the standardized depression rating scale, we call it the PHQ-9, if you come in with a score of 12 and you get it down to a score of 5, then we will give you your full payment. It doesn't really care what the intervention is.

Abby Burns (21:11):
How you get there, sure.

Dr. Tristan Gorrindo (21:12):
How you get there. So the intervention could be, I don't know, you show people pictures of puppies or it could be AI-delivered cognitive behavioral therapy, or it could be giving them a subscription to a guided meditation app. It's agnostic to what the intervention looks like as long as they get the outcome that they're really looking for.

Abby Burns (21:34):
A bit of a more clinical question for you. As a pediatric psychiatrist, going from a PHQ score of 12 to 5, how realistic is that without human-driven intervention?

Dr. Tristan Gorrindo (21:48):
The nature of depression in particular, anxiety to some extent as well, has some natural waxing and waning, right? So when we talk about depression, we typically talk about episodes of depression, that people have six months of major depression and then they tend to come out of it. And so that's the other piece about this model or any payment model that's tied to rating scales, is that these scores do have a natural course to them tied to the natural course of the illness. And this becomes really interesting because it drives when do we discharge a patient from the model? The PHQ-9, for example, asks you to look at your scores over the last two weeks. And so if the last two weeks have gone really great and now your score is in the normal range, whoever's providing the services in this model, are they going to immediately discharge you from the program because now they've reached a clinical threshold for better?

Abby Burns (22:40):
Yep.

Dr. Tristan Gorrindo (22:40):
But it doesn't mean having two good weeks, you're not going to have two bad weeks following it. So that is one of the things in more traditional care, there's a little bit more longitudinal follow-up, making sure that response or remission has some stability to it before we really discharge a patient from care. These are the things that we're going to learn. We're just getting started with the model.

Abby Burns (22:58):
Yeah, I believe we're three months in, so recognize we don't have a long track record here to learn from yet. So as this program gets started, I'm going to ask you to almost debate yourself here to help us interpret the upsides and the potential vulnerabilities of this model, and the impacts we think it'll have on the industry.

(23:18):
So if we start on the upside, what makes you optimistic about this model?

Dr. Tristan Gorrindo (23:23):
The idea of proving that we could do an outcomes-based payment at scale is, in my mind, the biggest win for the field, right? If we can prove that this can work in lots of settings, that lots of different providers, lots of different interventions can all work on treating depression and anxiety, and we can shift towards a payment model that rewards for outcomes, that in behavioral is a huge advancement for the field. So that's the part that I'm really cheering for.

Abby Burns (23:54):
Yep. I think to your point, it's also the diversity of providers and interventions. It's really interesting since we'll be able to get the data on it. Because if you look at, I believe it's 97 different organizations have signed up to participate in the behavioral health track, some are behavioral health specifically, some are not, the range of interventions you can imagine would be quite different.

Dr. Tristan Gorrindo (24:14):
And the other thing is that I think this will provide some services that will really benefit a lot of low-acuity individuals, those worry well that we were talking about at the beginning. And if we can provide those services using an insurance-based framework at a low cost, that's really good for the system as well. I think it's worth noting that many private payers are intently watching what's happening with the CMS ACCESS project.

Abby Burns (24:43):
I have to imagine, yeah.

Dr. Tristan Gorrindo (24:45):
Because if it works for them, if it works for CMS, then I think what we'll start to see is more of the private payers also adopt these types of frameworks and programs so that, again, primary care physicians who are referring folks to these solutions aren't necessarily having to pick and choose based on insurance type. Those are the two things that I'm keeping a close eye on that I think could be really good for the field, can we prove an outcomes-based payment model and can we find new, novel, low-cost interventions that help lots and lots of people with low acuity symptoms?

(25:18):
On the other hand, there are a couple pieces that I think are working against the success of this program, which is slightly different than the question of what do we need to look out for, which we can also talk about.

Abby Burns (25:29):
Sure.

Dr. Tristan Gorrindo (25:30):
This is a Medicare program. Most of the individuals enrolling in these solutions are Medicare beneficiaries, right?

Abby Burns (25:39):
Meaning over the age of 65.

Dr. Tristan Gorrindo (25:41):
And a lot of these are technology-based solutions. And so part of what I worry about is that we might lose some of the signal for the good. Some of these solutions might actually work, but not work for this patient population.

Abby Burns (25:54):
Yes.

Dr. Tristan Gorrindo (25:55):
And so that's going to be one of the confounders that I think the evaluators at CMS are going to have to really deal with when they start to analyze the data, how much of this was a tech problem versus an intervention was not well suited for the clinical diagnosis we were trying to treat problem?

Abby Burns (26:14):
Yeah. I think I'll be really interested because you mentioned private payers are watching this closely to sort of extrapolate, and I know a number of them have signed a pledge actually to create comparable models by, I think it's 2028. I wonder who does the work of that translation of this work for a Medicare population or didn't work for Medicare population? What does that mean for how I apply it to my commercial population?

Dr. Tristan Gorrindo (26:36):
Yeah. And I think that payers have really struggled in general with figuring out how to pay for things that weren't traditional fee-for-service care. They've really struggled to figure out how to pay for apps that are in the marketplace that they think would be really good for their commercial patients or their managed Medicaid patients. Outside of some true full risk-bearing arrangement, they can't figure out what is the right mechanism to price these solutions. Do they just buy a subscription to a meditation app for their members? Does that have the right ROI? So I think one of the things they're really looking at is how is CMS judging the value, the impact of this program? What is the methodology that they're using to measure the success of this program? Because those are questions that they've been struggling with for a long time.

(27:29):
And if CMS opens up this kind of new way of thinking about paying for these services, outside of just buying a subscription for a member, then I think that would be very exciting to them to move towards an outcomes-based framework. So they're watching closely.

Abby Burns (27:42):
Yep. As we're thinking about this new way of paying for behavioral health, I do want to come back to this is predicated on $6 a month instead of $400 a month, so I'm a little nervous, frankly. Can you talk to me about whether it is unintended consequences or vulnerabilities that we need to be watching for, and frankly, that CMS will be watching for? Again, we're three months into a 10-year program.

Dr. Tristan Gorrindo (28:06):
Bad outcomes in behavioral health are not common, but they do happen. And my biggest concern is that for $6.25, the types of solutions that can be brought forward and make sure that there's never a crack that a patient will fall through, that 0.1% of patients who might attempt suicide, that the technology, the intervention, whatever it is, is robust enough to be able to catch that person and route them at that point into the traditional system. That's challenging. I think the unit economics there are really hard.

(28:45):
And I think in the short term, there will be the disclaimers. If you are having suicidal thoughts, hang up and call 988 or go to your nearest emergency room. But when you're thinking about a system, that's not what you want. Those are exactly the kind of high-cost events that we are trying to prevent with this program.

Abby Burns (29:05):
Right.

Dr. Tristan Gorrindo (29:06):
I think this is going to be where the rubber meets the road. In some ways, I think about the CMS ACCESS project as being a proof of concept around the two things that we talked about as potentially being the goods that we could really hope to get out of this program. But I still think a lot of these patients, people who are really sick, the people who have moderate or severe illness, are still going to get routed into the traditional behavioral health system and are still going to continue to cost the system a lot of money. So I don't know that we're actually going to see a whole lot of savings coming out of this program because our high-cost individuals are going to continue to be high cost.

Abby Burns (29:43):
And my understanding is actually there might be something in the mechanism of how the program works that makes it a little bit more complicated to hand patients off. Is that right?

Dr. Tristan Gorrindo (29:51):
Right. When CMS was designing this program, they wanted to make sure that providers weren't essentially double billing for providing multiple kinds of behavioral services at once, right? So there is basically an exclusion that says if you're participating in this payment model, then you can't also provide traditional behavioral health services from your organization. But they recognize that patients may have an outside therapist or they might end up in the ER at some point, or they might have a psychiatrist who's doing med management. If your patient in the ACCESS project is using some of those outside services, CMS has a way of adjusting down the payment to you for that patient. Essentially, they don't want to pay two different groups of people to both provide behavioral health services at the same time, which works against all the ideas around integrated holistic care that we have been talking about for the last couple decades, which is how do you take a patient and you pass them up the acuity ladder and you pass them down the acuity ladder-

Abby Burns (31:00):
Exactly.

Dr. Tristan Gorrindo (31:01):
... based on what they need in that moment? And if you now have to do that and you have to bounce a patient between various solutions or various organizations or various provider groups, the end result ends up being more fragmentation as opposed to less fragmented care. That'll also be something really interesting to see is how do these folks that end up needing more care, what is their trajectory? What happens to them? Where do they go? How do these systems interact with each other?

Abby Burns (31:29):
It'll be really interesting to see too, because I know a number of the participants in the behavioral health track are digital and virtual. And I almost wonder if we will see a network of access providers that figure out how can we deploy our different level acuity services to patients that are participating in ACCESS across this network of participants.

Dr. Tristan Gorrindo (31:51):
And if they can figure that out, again, we should cheer that, because that would mean, again, we have figured out a new way to present care, we figured out a new way to pass patients around. I think this is consistent with where CMS is at this moment, which is let's reward the marketplace for being creative and figuring out solutions if we can get the outcome we want on the backend. And so yeah, might we see some alliances, partnerships, maybe even joint ventures that would allow complimentary services to be stitched together? I mean, I think that'll be one of the exciting things to see as this program rolls out.

Abby Burns (32:30):
Before we move on, are there any other considerations, potential unintended consequences that we should be watching for?

Dr. Tristan Gorrindo (32:38):
The impact on the existing behavioral health workforce is also worth tracking. If we have a lot of our low-acuity patients ending up receiving strictly digital solutions, what's left for the traditional behavioral health system are patients with much higher acuity. And any clinician out there will tell you that if all you saw all day were the hardest patients, that it makes remaining in clinical care as a clinician difficult. It's a driver of burnout. You need a soft pitch every once in a while. A patient who gets better quickly, a patient that is appreciative of what you're doing, those kinds of things make you feel valued as a clinician.

(33:21):
And so will these solutions grow to a point where they're actually eating away at the referral volume that traditional clinicians receive? I don't know. But if we start to see payers paying for this model, if we start to see all the government channels, Medicare, Medicare Advantage, Medicaid programs, all adopt this as a payment model, you start to change the type of patients who end up going to the human behavioral health providers. And there may be an impact there that we'll want to understand.

Abby Burns (33:50):
Yeah. Which I can imagine not only would have impacts on the existing workforce, but the workforce pipeline, especially as we see where is it healthiest? It's healthiest in APPs. Where is it least healthy? It's least healthy in psychiatrists. Right? So definitely an important thing to watch.

(34:04):
As we wind down our time, our goal with every Radio Advisory episode is to help healthcare leaders to think and/or act differently about the topic at hand. Most of our listeners, I will say, are not behavioral healthcare leaders specifically, but I would argue that the work that they do intersects, whether knowingly or unknowingly, with behavioral healthcare. With that in mind, what do you want healthcare leaders to understand about the future of healthcare delivery as they think about charting their own courses forward?

Dr. Tristan Gorrindo (34:38):
One is where we started today, which is this idea that having a lot of digital platforms doesn't necessarily mean you have created valuable access for your patients or for your communities. Just because there's a signup page, the work isn't done, right? Unless we know that there are measurement-based care happening on the other side of that, that they're treating towards target, that there's some sort of outcomes-based framework, don't be deceived around what's being offered. So that's important, I think, for leaders to understand.

(35:07):
I think the second thing is really that we are at a transformative moment for digital health platforms. In some ways, the CMS ACCESS program could be the ultimate stress test for digital behavioral health companies. If we really start to impose a framework where we say you will only be able to play in the insurance space in an outcomes-based framework, we will have some winners and a lot of losers, and it will dramatically reshape the landscape in terms of what solutions are available. And hopefully, it'll create fertile ground for new solutions to come forward as well.

(35:47):
We're at a really exciting time, I think the next two, three years, particularly as this pilot, if it truly does catch on and we start to see tens of thousands of patients start to flow through this program, I think there will be a real market pressure that will begin to start changing how we invest in behavioral health companies and who the winners and losers are in this digital health race.

Abby Burns (36:12):
Well, Tristan, thank you for coming back on Radio Advisory.

Dr. Tristan Gorrindo (36:16):
A pleasure as always, Abby. Thanks for having me.

Abby Burns (36:22):
It's fair to make an argument that we are at an inflection point in behavioral healthcare. The ACCESS model is still in its earliest days, but we'll learn a lot about the future of behavioral healthcare delivery from the early innings here. We did nerd out on the specifics of the ACCESS model, but at the end of the day, as long as you're walking away from this episode feeling more informed about how our behavioral health landscape is reshaping and more equipped to engage with these realities as you consider how behavioral health plays into whatever service you provide or support in our industry, I think we've done our job.

(36:55):
And for more detail on how CMS may have quietly created the first major reimbursement pathway for AI-delivered behavioral health, I highly recommend checking out the article Tristan and his co-authors published in JAMA earlier this year. I'll link it in the show notes, because remember, as always, we're here to help.

(37:37):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by Rae Woods, Chloe Bakst, and me, Abby Burns. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Dominique Del Gaudio. We'll see you next week.