JASON E. KAPLAN When you say 10% of the adult population identifies as having a substance-abuse disorder, or severe and persistent mental illness, do you have any data to compare that to? Do you know what percentage of your population had those issues before? Because I’m a data nerd, I’ll be precise on the words: 10% of that population has an insurance claim that has one of those. It’s probably an undercount. What we saw is in those cohorts of stimulant-use disorder, opioid-use disorder and severe and persistent mental illness — those grew by 5% to 11%, depending on which cohort you’re talking about, whereas our membership grew by more than 13% over the pandemic. So it’s hard to compare apples to apples, then. Yes, but it’s not that we’re seeing proportionately a lot more of folks with those conditions — certainly a little bit, but not relative to the population growth — but that the acuity is much higher. You are starting to talk with community partners about what the need is, and how we address these problems. What are those conversations looking like? What do you think Health Share’s role is moving forward? We’ve made a bunch of investments between Health Share and some of our partners, including Care Oregon, over the last year and a half around low-acuity, peer-led substance-use treatment centers, and each of the three Clackamas, Multnomah and Washington county investments in expanding the behavioral- health workforce. And we’re upgrading into electronic health records. Now we’re talking about how we probably need more inpatient psychiatric service capacity and exploring with partners what that might look like, and how they might be able to build that. We’re working with a series of providers to understand what the availability is, so we build more secure residential treatment facilities. We have the estimates about how many we think we need; we’re working with OHSU in conversations about modeling what happens if we add beds in certain areas, so that we have that evidence-based, data-informed approach as we go. This is raising the question in my head: How quickly can we start to add more beds to the system? The details are complicated, but I think everybody can agree that we need more beds. I think that’s one of the tensions we have right now. It took us 30 years of underinvestment in the behavioral-health system to get to where we are today. I do think some patience is needed around how we are going to get out of this, knowing that these are multiyear investments. I think there are things that we can do right now, when you have housing and behavioral-health providers and mobile crisis lines taking care of the same people, and sharing information and doing a better job at care coordinating. We’re in conversations about how to move in that direction now, and doing some early pilots of that work. We’re doing some feasibility studies around what it would take to build those higher-acuity pieces, and just getting that ball moving, because we know the need is not going away in two years. Is there anything on the horizon for 2024 that you want to talk about? Between [the behavioral-health work] and ensuring that, in redetermination, we’re doing a good job supporting members staying on their health plan, that’s where I spend the bulk of my time. What are you doing when you’re not working? I have three kids. They are 13, 10 and 8, and we have an acre of property with an enormous garden. Sometimes when I’m in one-on-ones with folks that don’t require me onscreen, I’m puttering around outside. And we just got back from the first big vacation since I got the job: Over Thanksgiving weekend, we went hiking, scrambling and climbing in Red Rock just outside of Las Vegas. 15
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