Dr. Shawn Hersevoort is the national medical director for Foresight Mental Health. He is aiding in the development of their psychiatry division, focusing on mental health innovation, education, and program design. Foresight is changing the way they deliver care. Currently, they focus on group therapy but are expanding their psychiatry and NP divisions. They employ hundreds of therapists, dozens of NPs and PAs, but only a couple of psychiatrists who mostly fill leadership positions. The group is based in California, and they work mostly with commercial insurance, but they are trying to grow towards working with Medicare.
Foresight has a board vision, they live by their values, which include cultivating positive mental health transformation and transparency. They also aim to be intentional, inclusive, and proud.
Mental health care in the United States has succeeded and failed us. There are many lacking points that have led us down this path of insufficient care. When calling to mind our failures as a system, Dr. Hersevoort discusses the book, “ Healing: Our Path from Mental Illness to Mental Health”, by Thomas Insel. The book states that there is often a failure to choose evidence-based medications and psychotherapies and health approaches. Dr. Hersevoort feels that, in the field, we don't do what we know works. There are also fostered stigmas, not just within the field, but among each other. Care is not collaborative and often does not include data or technology in a way that is meaningful. He also states that there are some points that are evident where there is lacking technology that can progress care.
Even though there are many excellent treatment options available, outcomes still seem to be poor. Outcomes are maintained at this level based on that followthrough with how the care is provided. Dr. Hersevoort discusses the lack of push to follow evidence-based care, as also stated in the book, and that until we can move to follow those care recommendations, the outcomes will remain constant.
Integrated care is discussed in a similar manner to these concerns. One specific form of integrated care is collaborative care. There is a drive to know whether collaborative care is breaking down barriers or not. Dr. Hersevoort notes a quote that he has used for over a decade, that collaborative care is simply rediscovering the neck, meaning connecting the head to the body for total body care. He feels that if you want to treat diabetes, focus on treating depression, If you want to treat pain, treat anxiety, and if you want to treat focus, treat sleep instead. These connections go on and should be a large focus in collaborative care. He feels that the beauty of the collaborative care system is that it meets the patients where they are, it empowers the front-line healthcare workers, primary care providers, the OB guides, the hospitalists, the pediatricians, etc., in order to have the tools to work with these patients at the front.
Dr. Hersevoort is responsible for the handbook of a training textbook book that is used to help train primary healthcare providers on basic psychiatry, in the state of California, based out of UC Irvine and UC Davis. Now, there is an app version of the healthcare decision-making handbook called Call Psych, that is available to help providers to make decisions on psychiatric care. The motto for the app is fast, safe, and evidence-based. You enter the app and input the information, it tells you what the medication is, and how and when to use it. It will be a part of the Foresight methodology. Tying back to Foresight, they are currently working on an Integrated Care Division. The group already functions with a very holistic mindset, and this will continue to progress.
Dr. Hersevoort notes that we still need to focus on the data, like the tests and the labs, along with assessment tools and rating scales to help us know how to move patients in the right direction. He says that by focusing on those SMART goals, specific, measurable, achievable, accountable, and time-bound, we can form a treatment plan backed up by vitals and labs to move us forward.
Dr. Hersevoort informed us that Foresight is aimed at addressing quality by reimaging its dynamic. They are moving towards multidisciplinary teams, multi complimentary service lines that cover the whole mind-body spectrum, to ensure that the patient's needs are addressed. He assured us that all members of this team approach are important and that all members are needed for the patient to improve.
He notes that there are five pieces that are needed to help complete this total body care impact: medication, therapy, health psychology, case management, and education are all crucial to this team plan for care. There is also a need for special teams, which they are currently building up. Those teams specialize in psychosis and bipolar, complex anxiety, complex treatment-resistant depression, substance abuse, kids including teens and ADHD, complex medical including geriatric and cognitive, as well as the personality disorders team. The idea is that each of these teams will be led by a university-level psychiatrist, and then be comprised of prescribers, MDs, NPs, PAs, students, therapists, health psychologists, and social workers.
Now is where access comes into play, which is always a concern. Foresight is going to be accessible to these patients in steps, starting from getting them to the hospital, to exiting the hospital and entering IOP programs. From the completion of the IOP programs, patients can go back to standard care providers, or be placed into the care of one of the specialty teams.
The goals of these programs are to increase overall total body health. The push for these specialty teams and programs will be used in order to treat the patients better, as well as be able to use data from the actual patients in order to help tailor care as the patient progresses, and as the team's programs. Data is at the base of the new programs and can show the trend for the treatment progress, and overall progress of the patients. Foresight really has its mind on the future of mental health care, and technology is right by its side. There are many opportunities that we can continue to look out for from Foresight.
For more information on Foresight, click here.