September 23, 2025 • 32 mins
Physical health providers, health systems, and hospitals often struggle with how to handle behavioral health issues as they arise. Anna Whites, Attorney, Anna Whites Law Office, and Matthew W. Wolfe, Shareholder, Baker Donelson Bearman Caldwell & Berkowitz PC, discuss strategies for integrating physical and mental health care. They share their respective journeys into behavioral health law, how providers can add behavioral health care to their practices, legal and compliance challenges, and the future of integrated care. Anna and Matthew spoke about this topic at AHLA’s 2025 Annual Meeting in San Diego, CA.
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Learn more about the AHLA 2025 Annual Meeting that took place in San Diego, CA: https://www.americanhealthlaw.org/annualmeeting
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
This episode of AHLA's Speaking of Health Law is
brought to you by AHLA membersand donors like you.
For more information, visitamericanhealthlaw.org.
SPEAKER_02 (00:17):
Hello, this is Anna White.
I'm an attorney in Frankfort,Kentucky, our tiny state
capital, and I have a solopractice that focuses mostly on
behavioral health.
I'm a healthcare attorney, and Ireally got roped into behavioral
health.
I went to college to be a doctorand was very serious in my
(00:41):
pre-med classes, and then I hitgenetics, and it turns out
genetics is not my forte.
And so I started looking aroundand couldn't find what I wanted
to.
And I took my MCAT, thisadmissions test, got a terrible
(01:01):
score, could not get into medschool.
And I was driving through aMcDonald's, this is a story
anyone who knows me knows, andcrying, but a Diet Coke fixes
everything.
And so the car in front of mehad a Scales of Justice on the
license plate and lots of Longbefore Elle Woods, I thought,
well, I can do that.
How hard can law school be?
(01:21):
And so I take in my healthcarepractice that pre-med focus,
that having worked in anemergency room for all four
years of college, 12-hour shiftsevery weekend, having hung
around with doctors and medstudents, and really my respect
for the medical, nursing,counseling field, and I bring
(01:43):
that to my law practice.
And I tell my clients...
What sounds really good in myhead, your policies or
procedures or what I tell you todo, you know, it sounds great to
me, doesn't always work inpractice.
And so I try and remember toreally honor the providers and
the other attorneys who work inthis space and realize we're
(02:03):
really all in it together.
So I was excited to present atthe AHLA annual meeting in San
Diego this year on mental healthis physical health, behavioral
health is physical health.
It's all part of the holisticwell-being of an individual.
And I was the luckiest woman onearth because my co-presenter
(02:27):
was Matt Wolfe.
And Matt, tell us a little bitabout yourself.
SPEAKER_01 (02:31):
Sure.
Thank you, Anna.
I didn't realize that we weregoing to be making a movie
today.
Anna White's The Prequel toLegally Blonde.
So Matt Wolfe with the law firmBaker Donaldson and I manage our
Raleigh office and also have thepleasure of of co-chairing Baker
Donaldson's Behavioral HealthInitiative.
Anna and I actually got to knoweach other through, at the time,
(02:54):
the Behavioral Health TaskForce, now the Behavioral Health
Practice Group of AHLA.
And we're really excited to be apart of that movement and effort
to put behavioral health on thesame footing as so many of the
other practice groups that aremore focused on sort of
(03:14):
traditional physical healthcare.
In terms of why I becameinterested in behavioral health
as part of my practice, I thinkit really goes back to my
childhood.
I'm not going to bore you withthe full story, but my mom was a
special education teacher.
And so I worked a lot with herstudents on a volunteer basis
(03:35):
and got to learn through hereyes how challenging it can be
to navigate the education systemfor her students and how much
the various systems that impacttheir lives, healthcare,
education, social services,vocational rehab.
And I had then the opportunityafter I graduated college to
(03:57):
teach and became a specialeducation teacher myself.
And through that, got to seeeven more clearly what happens
and what the adverseconsequences are when you have
systems and silos that don'talways work well together.
So went to law school, had noidea what I was going to
practice.
I certainly didn't even thinkthat health care or health law
(04:19):
was going to be a part of mypractice.
But I'm glad it did.
And then behavioral health sortof fell into my lap.
And here I am a couple ofdecades later.
SPEAKER_02 (04:30):
So you can tell that we are both very excited about
what we do and came fromslightly non-traditional ways
into the practice of law.
And I think we see that acrossthe healthcare attorney field.
I don't know that I've ever metanyone, and maybe you kids today
who are going to law school dothis, but I don't know that I've
(04:51):
ever met anyone who said, I'mgoing to be a healthcare lawyer
when I grow up.
I think we all come to itbecause we have a great
fascination for how bodies workand how we keep the people who
take care of those bodies andminds legally compliant.
And as I tell my clients, out ofthe orange jumpsuits.
That's my goal for every client.
(05:13):
No orange jumpsuits for anybody.
So...
When I was younger, my mom was ahippie, and so behavioral
health, mental health was reallypart of what we did.
And she was a midwife, so shealso delivered babies.
But the focus was really more onspirit.
And so my rebellion against thatwas, no, I'm going to be a
(05:37):
surgeon.
I'm going to just focus on thebody.
But then in law school and inpractice in the early days, I
really saw that there was a hugedivide between mental health and
behavioral health to the extentthat each side almost called the
others fake you know you're notyou're not a real provider
you're a psychiatrist or you'renot really treating people
(05:59):
you're just a surgeon you justcut and walk on and I'm glad to
see over particularly the last10 years how physical and mental
health are weaving together thatwe finally understand that we're
we're not silos there's not yourbody and your mind it's all one
package and so So providers arenow recognizing, and it's even
(06:21):
being taught in schools, that weneed both sides to work
together, which suddenly, as myclients, hospitals and clinics
and so providers startedfiguring out, really opened up
the world to them as to whatthey could do, but also created
a lot of new risks and ideas andconcerns they hadn't seen
(06:41):
before.
So to me, it's important toweave the two together and to be
real Thank you so much.
(07:18):
Or here's a physical healthpractice, let's weave in the
mental health.
And so what we say pretty muchworks both ways, but it's
important to consider the safestway to integrate mental and
behavioral health with physicalhealth.
What are you seeing in yourpractice?
How did you start putting thetwo together?
SPEAKER_01 (07:39):
Yeah, I mean, I think it was largely a product
of there being a need that myclients were seeing in their
communities that they servewhere they were treating.
And I work with providers of alldifferent stripes and across the
continuum of care.
So I was working withpredominantly behavioral health
(08:01):
clients who were seeing theirpatients not able to access
physical health care.
And then I was working with sortof more traditional physician
practices and hospitals andhealth systems that were seeing
unmet behavioral health needs intheir communities.
And so just working to try totranslate not only the two
(08:25):
different areas clinically, butalso from a compliance
perspective, from an operationalperspective, certainly from a
reimbursement and privacy andsecurity licensure perspective,
and trying to find ways to makethe two different languages
speak together.
(08:45):
And that's not always possible.
And sometimes that's one of themore challenging things is to
talk with a client and explainwhy you could do it in the
physical health context, but youcan't do it in the behavioral
health context or vice versa.
SPEAKER_02 (09:00):
And so we'll get down to a little more nuts and
bolts.
What I'm seeing and what you'reseeing as we talk providers
through this, there's some goodinitial steps.
It's great to think I am goingto expand my practice to include
the other area of law, but thereare some very practical steps we
have to go through first.
(09:20):
And I tell people, first of all,think about what your end goal
is and look around your space,not just your office or your
clinic or your hospital, butyour space as in who else is
doing the type of work you wantto add in your community.
Are you adding a practice thatis going to take every patient
(09:41):
from the primary care officenext to yours?
That's going to make you reallyunpopular.
Are you adding a practice thatis going to have a lot of
patient intensive time likeprimary care is often added to
behavioral health clinicsbecause that's a big need in
that population.
Well, if you have a one-personoffice for your counseling with
(10:02):
a couch, where are you going toput the 25,000 children and
parents who are coming inneeding their earaches looked
at?
And so for me, the first thingis look at where you are, your
office, your community, yourprovider group, and think about
how that's going to work foryou.
What are you starting, Matt,with your folks?
SPEAKER_01 (10:24):
Yeah, no, I think it's the same thing.
I mean, you're really looking atwhat the market is or where the
where the gaps are in thecommunity or communities that
you're operating in.
And then, you know, trying todetermine if there are models or
sometimes partnerships or JVsthat you can work with, because
(10:46):
the answer isn't always, let's,you know, there's a need, let's
go ahead and create a de novoprogram or clinic or program to
be able to address it.
But sometimes it's, okay,there's somebody else that are
does this well, but they justmay not be able to do it the
same scale or they may not havethe same resources or access to
(11:09):
capital to make furtherinvestments or expansion.
So how can we work together tobe able to address that need?
And I think there can beincredible value, again, in both
directions to having somehumility and realizing that,
okay, this is not a space that Ihave operated in for the past X
(11:29):
number of years.
And it may be beneficial tobring people in that have done
that and that can offer thatexpertise.
But I think that's reallyimportant.
And then I think sort ofunderstanding what your goals
are as far as integration.
That was something I think thatyou touched on already, Anna.
I think sometimes becauseintegrated care or whole person
(11:53):
care is in vogue, or at least ithas been for the past decade or
so, sometimes people just do itbecause everyone else is doing
it or they're told that's whatthey need to do.
And, you know, I don't findthose those goals to be
particularly focusing and theycertainly don't help you when
(12:15):
you invariably are going to runinto challenges or setbacks,
whether it be with payors orstaffing or with oversight
bodies.
And so having a clear vision ofwhy it is that your organization
is doing it, I think can helpyou to get through those
(12:37):
challenging times.
SPEAKER_02 (12:39):
Right.
And as you're looking across theplaying field and think, wow, my
friend who owns a lab is doingthis really well.
Maybe I should just work withthem or partner with them.
It's always good to, at thatpoint, tell your clients, you
know, Stark and anti-kickbackand even ECRA in the addiction
space still apply Just becauseyou know your patients need
(13:03):
something and somebody close toyou could partner with you for
it, you still have to go throughthose legal steps and assure
yourself that you're beingcompliant in the way you're
doing this.
So often I get a very excitedclinic owner, and often these
are people who are somewhat newto the space.
They popped up a clinic, it'sworking well, and they say, I'm
(13:26):
spending a ton of money on labsand I'm spending a ton of money
on billing companies.
why don't I just partner withthose people and tell them you
send me all yours I'll send youall mine it'll be great and thus
we see the classic stark andanti-kickback issue arise very
innocently I may be just reallylucky but in my practice I have
(13:50):
never yet had someone comethrough the door who said man I
want to commit some crimes formoney it's always people who
have a good idea and jump inwithout talking to an attorney
to say, hey, can I do thislegally?
And that's also, for those ofyou out there looking for new
clients, super good advertising.
(14:11):
Talk to your behavioral healthgroups in your town.
Talk to your nurse practitionergroups and sort of explain these
concerns so that when they'reworking for someone or they
themselves have these brilliantideas, they know, wait a minute,
Ms.
Anna said I should talk to alawyer first.
And what are you seeing as someof the other stumbling blocks
(14:33):
that people inadvertently runacross?
SPEAKER_01 (14:37):
Yeah, I think there's a number of them.
Certainly fraud and abuse andcompliance concerns is a big
one.
I think not knowing who theplayers are in the other space.
So by way of example, in somestates, the entities that
(14:59):
license mental health providersis completely different and
separate apart from the sort ofmore traditional healthcare
entities.
Sometimes you have differentfunding systems.
Sometimes you have differentMedicaid managed care models,
depending on what population orwhat services that you are
providing.
I know that behavioral healthproviders often don't think
(15:22):
about corporate practicedoctrine issues, or at least not
historically thought aboutthose.
And so if you are a behavioralhealth practice, and you're
thinking about getting intophysical health care, and you're
in a state where you have arobust practice of medicine
doctrine in a state medicalboard that enforces it, you
could find yourself in a veryuncomfortable position really
(15:43):
quickly having to explain to thephysicians that you were seeking
to employ or contract with whyyou may not be able to do that.
I think we want these models tobe sustainable.
So we started talking about theneed, but we also have to have
funding mechanism or mechanismsto be able to to sustainably
(16:07):
meet that need.
So reimbursement is anotherreally, really big area.
And to think about in advanceabout not only is this a
billable activity, but how canyou capture the value of it?
And I think there was a varietyof things that we're seeing,
Medicare, private insurers,Medicaid, that are attempting to
(16:30):
encourage integrated care.
But I still think that we are atthe very early stages really
trying to capture the value thatan integrated care model can
provide.
What about you, Anna?
Where do you sort of see thedirection of integrated care if
you were to stare into your
SPEAKER_02 (16:49):
crystal ball?
I think definitely integratedcare is where we're headed.
I think that having providerswork together across the types
and specialties is definitelythe way of the future.
That doesn't mean jump into itand just start practicing and
referring to your friends.
(17:10):
But I know even in Kentucky andTennessee and surrounding
states, a lot of our Medicaidorganizations are offering
providers contracts to do perdiem care or here's a set fee.
Let's do not soup to nuts for apatient, but let's do everything
that we expect to see in thispatient's need.
(17:31):
Let's be their medical home andhere's the fee we pay you for
that.
A glitch that got a client justthe other day was those
contracts are wonderful.
If you know what you can do andshould do for a patient and you
look at the codes with yourbilling team and you know you're
providing these services, that'sawesome.
There's always a small sentenceat the bottom of these
(17:52):
integrated care contracts thatsays everything else is payable
at one penny per service.
And I had a client who did notread the small print and
provided an awful lot ofwonderful primary and family
care that was payable at onepenny a day to about 200
(18:12):
patients.
So props to them.
They did a lot of free medicaland we love them for it.
But it's important to movetowards integrated care,
thinking about how you're goingto do it and how you're going to
be paid.
And another issue that we talkedabout in annual meeting is if
you're in one area of care, youmay not be thinking about what
(18:35):
staff and licensure or you needfor another.
It's pretty easy to find a peercounselor in most states.
So you can grow a behavioralhealth or addiction treatment
practice pretty easily.
In some states, it's very, veryhard to find a PA or an APRN or
a psychiatrist who's going to beable to offer required medical
(18:56):
or mental health care.
And so before you say, I amoffering this, look around and
think, is this even going to bepossible for me to integrate
more care into my practice.
And I know you had some pointsto make on that as well, Matt,
at annual meeting.
SPEAKER_01 (19:14):
Yeah, I think that, you know, we were often talking
about expanding the scope ofwhat you do.
And often we're also talkingabout changing staffing models.
So if you have sort of atraditional physician practice,
right, and that's, you know,office-based care, you have, you
(19:35):
know, clinical staff, you haveyour office staff, and you're
not really typically managing alarge swath of people.
But if you decide, hey, I reallywant to get into community-based
mental health, suddenly you maybe growing your payroll tenfold.
(19:57):
And then the way that youoperate your business is very
different.
The kinds of headaches, thekinds of not just health law
compliance concerns, but justEmployment compliance concerns
can very radically changeovernight.
So again, I think going intothese kinds of models or these
(20:18):
kinds of approaches orexpansions with eyes wide open
can be really helpful toavoiding headaches down the
road.
SPEAKER_02 (20:29):
And I think as I talk about this with clients, I
try and stay in touch with whatthe payers, particularly, you
know, your big, your BCBS, butalso your Medicaid payers are
talking about.
What kind of contracts orproposals are they sending out
to clinics?
And if you ask them, they'lltell you what kind of pilots
(20:49):
they're getting into.
A few years ago, one of thepayers in the state was saying,
we really want to look athome-based detox, home-based
residential treatment.
And they issued a couple pilotsand they went pretty well.
And then nobody heard anythingfor a year and people forgot
about it.
And suddenly they haveresurfaced saying we are going
(21:11):
to pay for detox, but it has tobe home-based.
So only those of you who arepaying attention and have
figured out how you can do thatin a way that's cost-effective
and also safe for the patientare going to get those
contracts.
So kind of staying in touch withwhat the fields are the
different fields of medicine aredoing and what the payers are
(21:32):
doing, make it easier to seewhat's coming in the future.
I think we all know we're goingto be moving to a lot more
integrated care.
We're going to be moving to alot more lump sum payments, or I
guess I think we are.
And I think we're also going tobe really pushed to prove the
(21:53):
value of our services and not, Iknow everyone says value-based
care.
And while there's how do youeven measure that?
But I think we're going to haveto create providers and
frameworks that providers canuse to prove how is this
working?
Why is this the right way to go?
It's no longer we're going tofund every autism treatment
(22:15):
center in the whole state.
It is which ones are moving theneedle in terms of what teachers
think, what parents think, whatpersons with autism think, who
is effective, and how do wemeasure that?
So I think that's also somethingI'm seeing in the future and
trying to stay in touch with.
SPEAKER_01 (22:34):
Yeah.
I mean, I think that value-basedcare and integrated care go hand
in hand.
I don't see how you do onewithout the other.
I think that...
Where I see the industry goingis actually even more involved
(22:56):
than just taking physical healthand the mental health and
behavioral health side andcombining them under one roof or
moving away from fee-for-serviceand more for pay-for-performance
or subcapitation.
I think one of the most excitingthings that's happened, and I
think probably one of thegreatest contributors to
(23:18):
destabilizing stigmatizingmental health care in this
country and around the globe.
It is still very muchstigmatized, but I think one of
the greatest helpful factors wasthe advancement in telehealth
and the ability for people to beable to access mental health
treatment from the privacy oftheir own home, frankly,
wherever they had an internetconnection and could do live
(23:42):
audio video.
And so we saw overnight thedevelopment of these platforms
that exist that allow people tobe able to access mental health
care without having to call allaround.
Finding people that are on yourinsurance still challenges,
obviously, with being able toget coverage for some of those
(24:02):
platforms.
But the costs have gone waydown.
The access, the convenience hasgone way up.
And so I think what that islikely going to lead to is we're
going to continue to see moreand more of telehealth.
But I think even beyond that,you're going to see more digital
health, right?
We now have with our wearablesand our phones and all the
(24:26):
various apps, we have anincredible treasure trove of
data that providers can use onthe physical health and the
mental health side, and that,you know, that the patient or
client can use to be able toself-direct their care.
So I think we're at a reallyexciting crossroads for
behavioral health, for physicalhealth, for healthcare more
(24:47):
broadly, and for valuation care.
It's just that we still have alot of old models.
We have a lot of sort ofoutdated legal structures and
regulatory overlays that aregoing to complicate how we take
some of these opportunities andtechnology and advancements and
we get to this bright future.
(25:09):
So it's going to be fun to be onthe sidelines and maybe
sometimes even in the arenatrying to help guide providers
And
SPEAKER_02 (25:21):
I think the consumers, the clients or
patients are probably a littlemore advanced than we are in the
legal field because we see evenAmazon, but we see lots of
private businesses.
And every time you turn on yourTV, if you're watching the ads,
companies advertising, hey, youcan get this kind of care.
Just come and type in your nameand number and your symptoms.
(25:43):
We can treat you.
You don't have to see anyone.
So it's digital.
It's telehealth, but it'sdigital.
given the patients theexpectation.
And as a patient myself, I thinkI deserve to be able to get my
earache treated or my strepthroat treated or my other
issues treated immediately.
I shouldn't have to wait twoweeks till my doctor has an
(26:03):
opening.
But I think the patients aredriving what is happening and
providers are sort of scramblingto keep up.
And that's why it's veryimportant as a lawyer to tell
all your clients, no matter howbig or small, all the time,
don't jump before you make surewe've looked to see if there are
sharks in the water you'rejumping into.
(26:25):
Because in healthcare, there'salways going to be a shark.
And this is particularly so withpeople who come from the
business world to the healthcarespace, because what makes sense
in business, if you're marketingyour gas station or your
boutique, it's very differentthan marketing your family care
(26:45):
practice.
And so there are things that wewould do and do in the marketing
space that even lawyers can do,but a healthcare provider
cannot.
And so it's this push-pull, thetension between the patients who
want the newest and the greatestand the shiniest, and most
importantly, the mostconvenient, and the providers
who want to keep up and stillmake a living, and ultimately
(27:10):
also want to do what's best forthe patients.
And so integrating is wonderful,but also exposes you to new
risks.
If you are only used to oneaspect of care, you may not even
be looking out for the thingsthat impact patients.
If you're a physical healthprovider and you've never really
thought about, you know, you'rea dermatologist and you've never
(27:33):
thought about what goes on inthe mind, it may really stress
you to get your first suicidalpatient.
And so people need to also thinkabout not, I want to expand,
this is what my patients want,this is a good revenue stream,
but is this a field I have anyany knowledge of or actual
interest in.
You can't these days practicehealthcare just for the money
(27:57):
because it is so hard to providethe services correctly, build
them correctly, be licensedcorrectly, and get paid for what
you do.
It is not a field for the faintat heart.
But it's certainly not a fieldthat's going away and with as
quickly as things are changing.
I think I'm going to be doingthis till I die, Matt.
My goal is to be a have thejudges say to my grandchildren,
(28:21):
you've got to keep grandma outof the courtroom no more.
I love it.
It's just fascinating to me.
SPEAKER_01 (28:29):
Well, Anna, I'm going to try to retire early.
So I'll be cheering from thesidelines as you're continuing
to practice.
Now, as always, Anna, it'sreally a pleasure to connect
with you.
And I know that we probably needto wrap up.
I know we probably could talkfor hours about this, but any
sort of closing thoughts orcomments before we bid our
(28:54):
audience adieu?
SPEAKER_02 (28:56):
I want to encourage anyone, any attorney in the
healthcare space to really sitdown and think about are they
telling their clients what isout there, what is coming,
integrated care, value-based,weaving together physical and
mental health.
Don't get so used to doing whatyou do that you don't think of
(29:16):
these exciting new opportunitiesfor your clients.
And for attorneys who are braveenough to listen to us and not
be in the health care space,Some of my most successful
behavioral health practiceowners owned gas stations just a
short time ago or even still do.
One of my favorite clients had aminute mart in a very sketchy
(29:42):
part of his town and he boughtup all the distressed properties
around him, made them soberliving homes and then thought,
well, my people can't even, theresidents can't get jobs.
So he started hiring them andthe residents can't get care.
And so he bought a clinic andinstalled some counselors and
now everyone in the neighborhoodhas access to care a safe place
(30:04):
to live and a job so if you'renot in the healthcare space now
encourage your clients to thinkabout should they diversify into
healthcare and big plug forbehavioral health particularly
into behavioral health I thinkit's changing so fast and I'm
loving seeing what's happeningso stay excited about what you
(30:26):
do and really think about arethere new things that you and
your clients could be doing.
SPEAKER_01 (30:33):
I would echo all of that advice.
And the only thing I would addis that if you are a
practitioner or provider that islistening to this podcast
episode, I would sort of endwhere I began talking about
humility and trying to learnmore about the fields that maybe
you did not have as muchexposure to in med school or
(30:55):
grad school or whatever yourformal training was.
Attend conferences, be curious,network or engage with people in
your community so that you canbetter understand what they do
and how they do it.
And those are oftentimes thebest ways to find opportunities
to move towards an integratedcare approach.
(31:17):
So with that, Anna, hopefully wewill see each other before then.
But if not, I look forward toseeing you at next year's annual
meeting in New York City, theBig Apple.
SPEAKER_02 (31:28):
Oh, cannot wait.
Very exciting.
Thank you so much for spendingtime talking to me.
And thank you, Jillette, for theopportunity.
SPEAKER_00 (31:41):
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SPEAKER_02 (00:17):
Hello, this is Anna White.
I'm an attorney in Frankfort,Kentucky, our tiny state
capital, and I have a solopractice that focuses mostly on
behavioral health.
I'm a healthcare attorney, and Ireally got roped into behavioral
health.
I went to college to be a doctorand was very serious in my
(00:41):
pre-med classes, and then I hitgenetics, and it turns out
genetics is not my forte.
And so I started looking aroundand couldn't find what I wanted
to.
And I took my MCAT, thisadmissions test, got a terrible
(01:01):
score, could not get into medschool.
And I was driving through aMcDonald's, this is a story
anyone who knows me knows, andcrying, but a Diet Coke fixes
everything.
And so the car in front of mehad a Scales of Justice on the
license plate and lots of Longbefore Elle Woods, I thought,
well, I can do that.
How hard can law school be?
(01:21):
And so I take in my healthcarepractice that pre-med focus,
that having worked in anemergency room for all four
years of college, 12-hour shiftsevery weekend, having hung
around with doctors and medstudents, and really my respect
for the medical, nursing,counseling field, and I bring
(01:43):
that to my law practice.
And I tell my clients...
What sounds really good in myhead, your policies or
procedures or what I tell you todo, you know, it sounds great to
me, doesn't always work inpractice.
And so I try and remember toreally honor the providers and
the other attorneys who work inthis space and realize we're
(02:03):
really all in it together.
So I was excited to present atthe AHLA annual meeting in San
Diego this year on mental healthis physical health, behavioral
health is physical health.
It's all part of the holisticwell-being of an individual.
And I was the luckiest woman onearth because my co-presenter
(02:27):
was Matt Wolfe.
And Matt, tell us a little bitabout yourself.
SPEAKER_01 (02:31):
Sure.
Thank you, Anna.
I didn't realize that we weregoing to be making a movie
today.
Anna White's The Prequel toLegally Blonde.
So Matt Wolfe with the law firmBaker Donaldson and I manage our
Raleigh office and also have thepleasure of of co-chairing Baker
Donaldson's Behavioral HealthInitiative.
Anna and I actually got to knoweach other through, at the time,
(02:54):
the Behavioral Health TaskForce, now the Behavioral Health
Practice Group of AHLA.
And we're really excited to be apart of that movement and effort
to put behavioral health on thesame footing as so many of the
other practice groups that aremore focused on sort of
(03:14):
traditional physical healthcare.
In terms of why I becameinterested in behavioral health
as part of my practice, I thinkit really goes back to my
childhood.
I'm not going to bore you withthe full story, but my mom was a
special education teacher.
And so I worked a lot with herstudents on a volunteer basis
(03:35):
and got to learn through hereyes how challenging it can be
to navigate the education systemfor her students and how much
the various systems that impacttheir lives, healthcare,
education, social services,vocational rehab.
And I had then the opportunityafter I graduated college to
(03:57):
teach and became a specialeducation teacher myself.
And through that, got to seeeven more clearly what happens
and what the adverseconsequences are when you have
systems and silos that don'talways work well together.
So went to law school, had noidea what I was going to
practice.
I certainly didn't even thinkthat health care or health law
(04:19):
was going to be a part of mypractice.
But I'm glad it did.
And then behavioral health sortof fell into my lap.
And here I am a couple ofdecades later.
SPEAKER_02 (04:30):
So you can tell that we are both very excited about
what we do and came fromslightly non-traditional ways
into the practice of law.
And I think we see that acrossthe healthcare attorney field.
I don't know that I've ever metanyone, and maybe you kids today
who are going to law school dothis, but I don't know that I've
(04:51):
ever met anyone who said, I'mgoing to be a healthcare lawyer
when I grow up.
I think we all come to itbecause we have a great
fascination for how bodies workand how we keep the people who
take care of those bodies andminds legally compliant.
And as I tell my clients, out ofthe orange jumpsuits.
That's my goal for every client.
(05:13):
No orange jumpsuits for anybody.
So...
When I was younger, my mom was ahippie, and so behavioral
health, mental health was reallypart of what we did.
And she was a midwife, so shealso delivered babies.
But the focus was really more onspirit.
And so my rebellion against thatwas, no, I'm going to be a
(05:37):
surgeon.
I'm going to just focus on thebody.
But then in law school and inpractice in the early days, I
really saw that there was a hugedivide between mental health and
behavioral health to the extentthat each side almost called the
others fake you know you're notyou're not a real provider
you're a psychiatrist or you'renot really treating people
(05:59):
you're just a surgeon you justcut and walk on and I'm glad to
see over particularly the last10 years how physical and mental
health are weaving together thatwe finally understand that we're
we're not silos there's not yourbody and your mind it's all one
package and so So providers arenow recognizing, and it's even
(06:21):
being taught in schools, that weneed both sides to work
together, which suddenly, as myclients, hospitals and clinics
and so providers startedfiguring out, really opened up
the world to them as to whatthey could do, but also created
a lot of new risks and ideas andconcerns they hadn't seen
(06:41):
before.
So to me, it's important toweave the two together and to be
real Thank you so much.
(07:18):
Or here's a physical healthpractice, let's weave in the
mental health.
And so what we say pretty muchworks both ways, but it's
important to consider the safestway to integrate mental and
behavioral health with physicalhealth.
What are you seeing in yourpractice?
How did you start putting thetwo together?
SPEAKER_01 (07:39):
Yeah, I mean, I think it was largely a product
of there being a need that myclients were seeing in their
communities that they servewhere they were treating.
And I work with providers of alldifferent stripes and across the
continuum of care.
So I was working withpredominantly behavioral health
(08:01):
clients who were seeing theirpatients not able to access
physical health care.
And then I was working with sortof more traditional physician
practices and hospitals andhealth systems that were seeing
unmet behavioral health needs intheir communities.
And so just working to try totranslate not only the two
(08:25):
different areas clinically, butalso from a compliance
perspective, from an operationalperspective, certainly from a
reimbursement and privacy andsecurity licensure perspective,
and trying to find ways to makethe two different languages
speak together.
(08:45):
And that's not always possible.
And sometimes that's one of themore challenging things is to
talk with a client and explainwhy you could do it in the
physical health context, but youcan't do it in the behavioral
health context or vice versa.
SPEAKER_02 (09:00):
And so we'll get down to a little more nuts and
bolts.
What I'm seeing and what you'reseeing as we talk providers
through this, there's some goodinitial steps.
It's great to think I am goingto expand my practice to include
the other area of law, but thereare some very practical steps we
have to go through first.
(09:20):
And I tell people, first of all,think about what your end goal
is and look around your space,not just your office or your
clinic or your hospital, butyour space as in who else is
doing the type of work you wantto add in your community.
Are you adding a practice thatis going to take every patient
(09:41):
from the primary care officenext to yours?
That's going to make you reallyunpopular.
Are you adding a practice thatis going to have a lot of
patient intensive time likeprimary care is often added to
behavioral health clinicsbecause that's a big need in
that population.
Well, if you have a one-personoffice for your counseling with
(10:02):
a couch, where are you going toput the 25,000 children and
parents who are coming inneeding their earaches looked
at?
And so for me, the first thingis look at where you are, your
office, your community, yourprovider group, and think about
how that's going to work foryou.
What are you starting, Matt,with your folks?
SPEAKER_01 (10:24):
Yeah, no, I think it's the same thing.
I mean, you're really looking atwhat the market is or where the
where the gaps are in thecommunity or communities that
you're operating in.
And then, you know, trying todetermine if there are models or
sometimes partnerships or JVsthat you can work with, because
(10:46):
the answer isn't always, let's,you know, there's a need, let's
go ahead and create a de novoprogram or clinic or program to
be able to address it.
But sometimes it's, okay,there's somebody else that are
does this well, but they justmay not be able to do it the
same scale or they may not havethe same resources or access to
(11:09):
capital to make furtherinvestments or expansion.
So how can we work together tobe able to address that need?
And I think there can beincredible value, again, in both
directions to having somehumility and realizing that,
okay, this is not a space that Ihave operated in for the past X
(11:29):
number of years.
And it may be beneficial tobring people in that have done
that and that can offer thatexpertise.
But I think that's reallyimportant.
And then I think sort ofunderstanding what your goals
are as far as integration.
That was something I think thatyou touched on already, Anna.
I think sometimes becauseintegrated care or whole person
(11:53):
care is in vogue, or at least ithas been for the past decade or
so, sometimes people just do itbecause everyone else is doing
it or they're told that's whatthey need to do.
And, you know, I don't findthose those goals to be
particularly focusing and theycertainly don't help you when
(12:15):
you invariably are going to runinto challenges or setbacks,
whether it be with payors orstaffing or with oversight
bodies.
And so having a clear vision ofwhy it is that your organization
is doing it, I think can helpyou to get through those
(12:37):
challenging times.
SPEAKER_02 (12:39):
Right.
And as you're looking across theplaying field and think, wow, my
friend who owns a lab is doingthis really well.
Maybe I should just work withthem or partner with them.
It's always good to, at thatpoint, tell your clients, you
know, Stark and anti-kickbackand even ECRA in the addiction
space still apply Just becauseyou know your patients need
(13:03):
something and somebody close toyou could partner with you for
it, you still have to go throughthose legal steps and assure
yourself that you're beingcompliant in the way you're
doing this.
So often I get a very excitedclinic owner, and often these
are people who are somewhat newto the space.
They popped up a clinic, it'sworking well, and they say, I'm
(13:26):
spending a ton of money on labsand I'm spending a ton of money
on billing companies.
why don't I just partner withthose people and tell them you
send me all yours I'll send youall mine it'll be great and thus
we see the classic stark andanti-kickback issue arise very
innocently I may be just reallylucky but in my practice I have
(13:50):
never yet had someone comethrough the door who said man I
want to commit some crimes formoney it's always people who
have a good idea and jump inwithout talking to an attorney
to say, hey, can I do thislegally?
And that's also, for those ofyou out there looking for new
clients, super good advertising.
(14:11):
Talk to your behavioral healthgroups in your town.
Talk to your nurse practitionergroups and sort of explain these
concerns so that when they'reworking for someone or they
themselves have these brilliantideas, they know, wait a minute,
Ms.
Anna said I should talk to alawyer first.
And what are you seeing as someof the other stumbling blocks
(14:33):
that people inadvertently runacross?
SPEAKER_01 (14:37):
Yeah, I think there's a number of them.
Certainly fraud and abuse andcompliance concerns is a big
one.
I think not knowing who theplayers are in the other space.
So by way of example, in somestates, the entities that
(14:59):
license mental health providersis completely different and
separate apart from the sort ofmore traditional healthcare
entities.
Sometimes you have differentfunding systems.
Sometimes you have differentMedicaid managed care models,
depending on what population orwhat services that you are
providing.
I know that behavioral healthproviders often don't think
(15:22):
about corporate practicedoctrine issues, or at least not
historically thought aboutthose.
And so if you are a behavioralhealth practice, and you're
thinking about getting intophysical health care, and you're
in a state where you have arobust practice of medicine
doctrine in a state medicalboard that enforces it, you
could find yourself in a veryuncomfortable position really
(15:43):
quickly having to explain to thephysicians that you were seeking
to employ or contract with whyyou may not be able to do that.
I think we want these models tobe sustainable.
So we started talking about theneed, but we also have to have
funding mechanism or mechanismsto be able to to sustainably
(16:07):
meet that need.
So reimbursement is anotherreally, really big area.
And to think about in advanceabout not only is this a
billable activity, but how canyou capture the value of it?
And I think there was a varietyof things that we're seeing,
Medicare, private insurers,Medicaid, that are attempting to
(16:30):
encourage integrated care.
But I still think that we are atthe very early stages really
trying to capture the value thatan integrated care model can
provide.
What about you, Anna?
Where do you sort of see thedirection of integrated care if
you were to stare into your
SPEAKER_02 (16:49):
crystal ball?
I think definitely integratedcare is where we're headed.
I think that having providerswork together across the types
and specialties is definitelythe way of the future.
That doesn't mean jump into itand just start practicing and
referring to your friends.
(17:10):
But I know even in Kentucky andTennessee and surrounding
states, a lot of our Medicaidorganizations are offering
providers contracts to do perdiem care or here's a set fee.
Let's do not soup to nuts for apatient, but let's do everything
that we expect to see in thispatient's need.
(17:31):
Let's be their medical home andhere's the fee we pay you for
that.
A glitch that got a client justthe other day was those
contracts are wonderful.
If you know what you can do andshould do for a patient and you
look at the codes with yourbilling team and you know you're
providing these services, that'sawesome.
There's always a small sentenceat the bottom of these
(17:52):
integrated care contracts thatsays everything else is payable
at one penny per service.
And I had a client who did notread the small print and
provided an awful lot ofwonderful primary and family
care that was payable at onepenny a day to about 200
(18:12):
patients.
So props to them.
They did a lot of free medicaland we love them for it.
But it's important to movetowards integrated care,
thinking about how you're goingto do it and how you're going to
be paid.
And another issue that we talkedabout in annual meeting is if
you're in one area of care, youmay not be thinking about what
(18:35):
staff and licensure or you needfor another.
It's pretty easy to find a peercounselor in most states.
So you can grow a behavioralhealth or addiction treatment
practice pretty easily.
In some states, it's very, veryhard to find a PA or an APRN or
a psychiatrist who's going to beable to offer required medical
(18:56):
or mental health care.
And so before you say, I amoffering this, look around and
think, is this even going to bepossible for me to integrate
more care into my practice.
And I know you had some pointsto make on that as well, Matt,
at annual meeting.
SPEAKER_01 (19:14):
Yeah, I think that, you know, we were often talking
about expanding the scope ofwhat you do.
And often we're also talkingabout changing staffing models.
So if you have sort of atraditional physician practice,
right, and that's, you know,office-based care, you have, you
(19:35):
know, clinical staff, you haveyour office staff, and you're
not really typically managing alarge swath of people.
But if you decide, hey, I reallywant to get into community-based
mental health, suddenly you maybe growing your payroll tenfold.
(19:57):
And then the way that youoperate your business is very
different.
The kinds of headaches, thekinds of not just health law
compliance concerns, but justEmployment compliance concerns
can very radically changeovernight.
So again, I think going intothese kinds of models or these
(20:18):
kinds of approaches orexpansions with eyes wide open
can be really helpful toavoiding headaches down the
road.
SPEAKER_02 (20:29):
And I think as I talk about this with clients, I
try and stay in touch with whatthe payers, particularly, you
know, your big, your BCBS, butalso your Medicaid payers are
talking about.
What kind of contracts orproposals are they sending out
to clinics?
And if you ask them, they'lltell you what kind of pilots
(20:49):
they're getting into.
A few years ago, one of thepayers in the state was saying,
we really want to look athome-based detox, home-based
residential treatment.
And they issued a couple pilotsand they went pretty well.
And then nobody heard anythingfor a year and people forgot
about it.
And suddenly they haveresurfaced saying we are going
(21:11):
to pay for detox, but it has tobe home-based.
So only those of you who arepaying attention and have
figured out how you can do thatin a way that's cost-effective
and also safe for the patientare going to get those
contracts.
So kind of staying in touch withwhat the fields are the
different fields of medicine aredoing and what the payers are
(21:32):
doing, make it easier to seewhat's coming in the future.
I think we all know we're goingto be moving to a lot more
integrated care.
We're going to be moving to alot more lump sum payments, or I
guess I think we are.
And I think we're also going tobe really pushed to prove the
(21:53):
value of our services and not, Iknow everyone says value-based
care.
And while there's how do youeven measure that?
But I think we're going to haveto create providers and
frameworks that providers canuse to prove how is this
working?
Why is this the right way to go?
It's no longer we're going tofund every autism treatment
(22:15):
center in the whole state.
It is which ones are moving theneedle in terms of what teachers
think, what parents think, whatpersons with autism think, who
is effective, and how do wemeasure that?
So I think that's also somethingI'm seeing in the future and
trying to stay in touch with.
SPEAKER_01 (22:34):
Yeah.
I mean, I think that value-basedcare and integrated care go hand
in hand.
I don't see how you do onewithout the other.
I think that...
Where I see the industry goingis actually even more involved
(22:56):
than just taking physical healthand the mental health and
behavioral health side andcombining them under one roof or
moving away from fee-for-serviceand more for pay-for-performance
or subcapitation.
I think one of the most excitingthings that's happened, and I
think probably one of thegreatest contributors to
(23:18):
destabilizing stigmatizingmental health care in this
country and around the globe.
It is still very muchstigmatized, but I think one of
the greatest helpful factors wasthe advancement in telehealth
and the ability for people to beable to access mental health
treatment from the privacy oftheir own home, frankly,
wherever they had an internetconnection and could do live
(23:42):
audio video.
And so we saw overnight thedevelopment of these platforms
that exist that allow people tobe able to access mental health
care without having to call allaround.
Finding people that are on yourinsurance still challenges,
obviously, with being able toget coverage for some of those
(24:02):
platforms.
But the costs have gone waydown.
The access, the convenience hasgone way up.
And so I think what that islikely going to lead to is we're
going to continue to see moreand more of telehealth.
But I think even beyond that,you're going to see more digital
health, right?
We now have with our wearablesand our phones and all the
(24:26):
various apps, we have anincredible treasure trove of
data that providers can use onthe physical health and the
mental health side, and that,you know, that the patient or
client can use to be able toself-direct their care.
So I think we're at a reallyexciting crossroads for
behavioral health, for physicalhealth, for healthcare more
(24:47):
broadly, and for valuation care.
It's just that we still have alot of old models.
We have a lot of sort ofoutdated legal structures and
regulatory overlays that aregoing to complicate how we take
some of these opportunities andtechnology and advancements and
we get to this bright future.
(25:09):
So it's going to be fun to be onthe sidelines and maybe
sometimes even in the arenatrying to help guide providers
And
SPEAKER_02 (25:21):
I think the consumers, the clients or
patients are probably a littlemore advanced than we are in the
legal field because we see evenAmazon, but we see lots of
private businesses.
And every time you turn on yourTV, if you're watching the ads,
companies advertising, hey, youcan get this kind of care.
Just come and type in your nameand number and your symptoms.
(25:43):
We can treat you.
You don't have to see anyone.
So it's digital.
It's telehealth, but it'sdigital.
given the patients theexpectation.
And as a patient myself, I thinkI deserve to be able to get my
earache treated or my strepthroat treated or my other
issues treated immediately.
I shouldn't have to wait twoweeks till my doctor has an
(26:03):
opening.
But I think the patients aredriving what is happening and
providers are sort of scramblingto keep up.
And that's why it's veryimportant as a lawyer to tell
all your clients, no matter howbig or small, all the time,
don't jump before you make surewe've looked to see if there are
sharks in the water you'rejumping into.
(26:25):
Because in healthcare, there'salways going to be a shark.
And this is particularly so withpeople who come from the
business world to the healthcarespace, because what makes sense
in business, if you're marketingyour gas station or your
boutique, it's very differentthan marketing your family care
(26:45):
practice.
And so there are things that wewould do and do in the marketing
space that even lawyers can do,but a healthcare provider
cannot.
And so it's this push-pull, thetension between the patients who
want the newest and the greatestand the shiniest, and most
importantly, the mostconvenient, and the providers
who want to keep up and stillmake a living, and ultimately
(27:10):
also want to do what's best forthe patients.
And so integrating is wonderful,but also exposes you to new
risks.
If you are only used to oneaspect of care, you may not even
be looking out for the thingsthat impact patients.
If you're a physical healthprovider and you've never really
thought about, you know, you'rea dermatologist and you've never
(27:33):
thought about what goes on inthe mind, it may really stress
you to get your first suicidalpatient.
And so people need to also thinkabout not, I want to expand,
this is what my patients want,this is a good revenue stream,
but is this a field I have anyany knowledge of or actual
interest in.
You can't these days practicehealthcare just for the money
(27:57):
because it is so hard to providethe services correctly, build
them correctly, be licensedcorrectly, and get paid for what
you do.
It is not a field for the faintat heart.
But it's certainly not a fieldthat's going away and with as
quickly as things are changing.
I think I'm going to be doingthis till I die, Matt.
My goal is to be a have thejudges say to my grandchildren,
(28:21):
you've got to keep grandma outof the courtroom no more.
I love it.
It's just fascinating to me.
SPEAKER_01 (28:29):
Well, Anna, I'm going to try to retire early.
So I'll be cheering from thesidelines as you're continuing
to practice.
Now, as always, Anna, it'sreally a pleasure to connect
with you.
And I know that we probably needto wrap up.
I know we probably could talkfor hours about this, but any
sort of closing thoughts orcomments before we bid our
(28:54):
audience adieu?
SPEAKER_02 (28:56):
I want to encourage anyone, any attorney in the
healthcare space to really sitdown and think about are they
telling their clients what isout there, what is coming,
integrated care, value-based,weaving together physical and
mental health.
Don't get so used to doing whatyou do that you don't think of
(29:16):
these exciting new opportunitiesfor your clients.
And for attorneys who are braveenough to listen to us and not
be in the health care space,Some of my most successful
behavioral health practiceowners owned gas stations just a
short time ago or even still do.
One of my favorite clients had aminute mart in a very sketchy
(29:42):
part of his town and he boughtup all the distressed properties
around him, made them soberliving homes and then thought,
well, my people can't even, theresidents can't get jobs.
So he started hiring them andthe residents can't get care.
And so he bought a clinic andinstalled some counselors and
now everyone in the neighborhoodhas access to care a safe place
(30:04):
to live and a job so if you'renot in the healthcare space now
encourage your clients to thinkabout should they diversify into
healthcare and big plug forbehavioral health particularly
into behavioral health I thinkit's changing so fast and I'm
loving seeing what's happeningso stay excited about what you
(30:26):
do and really think about arethere new things that you and
your clients could be doing.
SPEAKER_01 (30:33):
I would echo all of that advice.
And the only thing I would addis that if you are a
practitioner or provider that islistening to this podcast
episode, I would sort of endwhere I began talking about
humility and trying to learnmore about the fields that maybe
you did not have as muchexposure to in med school or
(30:55):
grad school or whatever yourformal training was.
Attend conferences, be curious,network or engage with people in
your community so that you canbetter understand what they do
and how they do it.
And those are oftentimes thebest ways to find opportunities
to move towards an integratedcare approach.
(31:17):
So with that, Anna, hopefully wewill see each other before then.
But if not, I look forward toseeing you at next year's annual
meeting in New York City, theBig Apple.
SPEAKER_02 (31:28):
Oh, cannot wait.
Very exciting.
Thank you so much for spendingtime talking to me.
And thank you, Jillette, for theopportunity.
SPEAKER_00 (31:41):
If you enjoyed this episode, be sure to subscribe to
AHLA's Speaking of Health Lawwherever you get your podcasts.
For more information about AHLAand the educational resources
available to the health lawcommunity, visit
AmericanHealthLaw.org.
And stay updated on breakinghealthcare industry news from
the major media outlets withAHLA's Health Law Daily Podcast,
exclusively for AHLAComprehensive members.
(32:04):
To subscribe and add thisprivate podcast feed to your
podcast app, go toAmericanHealthLaw.org slash
Daily Podcast.
UNKNOWN (32:11):
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My Favorite Murder is a true crime comedy podcast hosted by Karen Kilgariff and Georgia Hardstark. Each week, Karen and Georgia share compelling true crimes and hometown stories from friends and listeners. Since MFM launched in January of 2016, Karen and Georgia have shared their lifelong interest in true crime and have covered stories of infamous serial killers like the Night Stalker, mysterious cold cases, captivating cults, incredible survivor stories and important events from history like the Tulsa race massacre of 1921. My Favorite Murder is part of the Exactly Right podcast network that provides a platform for bold, creative voices to bring to life provocative, entertaining and relatable stories for audiences everywhere. The Exactly Right roster of podcasts covers a variety of topics including historic true crime, comedic interviews and news, science, pop culture and more. Podcasts on the network include Buried Bones with Kate Winkler Dawson and Paul Holes, That's Messed Up: An SVU Podcast, This Podcast Will Kill You, Bananas and more.
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Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com