HR1 Is Coming for Your Revenue Mix. Are You Ready for 2027?

Intro: 2027 is coming fast00:00

Gary Garth: Hey everyone. Welcome back to The elev8 Podcast, the thought leadership platform designed for behavioral health executives navigating growth, innovation, and impact. 2027 is coming fast, and a lot of providers are waiting to see what happens on January 1st. My guest today says that's a risk. Today's guest is Eric C. Bailly, who spent years inside Anthem Blue Cross Blue Shield leading the SUD and opioid overdose response strategy, and in his words, he was the payer in the room who was a bit of a Trojan horse, so to speak.

Gary Garth: And today he's the founder and CEO of NorthStar Behavioral Health Advisory, which helps providers and payers work together more effectively. We're gonna be talking a little bit about what's changing in the reimbursement category, how to build a healthy revenue mix, and why outcome data is moving into payer contracts at a fast pace.

Gary Garth: Very excited about today's conversation. I think it's a hot topic. Everybody's wondering, and we've got a subject matter expert in the room. Eric, welcome to The elev8 Podcast. Thank you so much for being here.

Eric C. Bailly: Yeah, thank you very much for having me.

Eric's path: clinician, person in long-term recovery, and "the payer in the room"01:32

Gary Garth: Absolutely. Eric, I would love if you could give our listeners the 10,000-foot overview of your career. What has led you to where you are today? A little background.

Eric C. Bailly: Yeah. Well, I appreciate what you said about the Trojan horse. I actually say that to be intentionally provocative, in a good way. Let me explain what that means. My career has taken a lot of interesting twists and turns, but I started off as a clinician in the field, really focused on treating folks that were struggling with addiction.

Eric C. Bailly: I myself am a person in long-term recovery, so this has been something that I've been very passionate about throughout my entire career: making sure that the voice of the people that we serve is always present in the decisions that are being made, whether it's operations or how we finance things.

Eric C. Bailly: So that's really what I mean by being a bit of a Trojan horse. Throughout my career, as I've advanced, I've gone from being a clinician to more of an administrative capacity in different roles, particularly at Anthem Elevance, as you mentioned, leading the SUD and opioid overdose response strategy. I found myself in a lot of conversations with data folks and key executives in the organization that I was accountable and responsible to, talking about our initiatives and how they were making an impact on the mission and the kinds of things that the organization was really focused on at that time.

Eric C. Bailly: But I consistently reminded everybody of why we had jobs and what our job was, you know? Sometimes there are going to be differences in approach. But ultimately, what I found is that there was a lot more common ground and shared unity with the goals that we were striving towards than there were differences.

Gary Garth: No, that's fantastic. It's very rare to come across a profile with your level of expertise. I think you bring a skill set that, at least speaking for my own clients, is very much sought after.

Gary Garth: So you've done clinical work, then you worked with a payer, and now you're consulting, advising, and helping create that bridge. What was the main motivation for starting NorthStar Behavioral Health Advisory?

From Kaiser Permanente and Anthem Elevance to starting NorthStar04:09

Eric C. Bailly: Yeah, that's an interesting story too. I had worked at Anthem Elevance for 15 years, and prior to that I had worked at Kaiser Permanente for seven, and then at a county health department prior to that for four years. So I went from being a direct care clinician to working in more of an administrative capacity when I went to Anthem Elevance.

Eric C. Bailly: And interestingly, when I got to Anthem Elevance, that was right at the doorstep of the ACA being passed at the federal level. I was really excited. As an organization, we were gearing up. We were getting ready for this legislation to pass, and it ultimately passed in 2010.

Eric C. Bailly: The organization itself could see what was coming down the pike. It was an exciting time to be changing how we thought about behavioral health within that whole spectrum of services that included medical and employee assistance programs. I worked within a slice of the organization that was working with national accounts, so we did a lot of concierge kind of product work.

Eric C. Bailly: We had a number of different systems that I was responsible for weighing in on and helping our staff get familiar with, so that when they were putting pieces and parts together for the members that were calling us for assistance, we were well-equipped to be a one-stop shop for them, to help them navigate the complexities of scheduling an appointment with a behavioral health clinician for whatever reason they were calling.

Eric C. Bailly: So that in and of itself really put me in a position where I was drinking from the proverbial fire hose, learning how different lines of business work. I started with national accounts, then went more into Medicaid, Medicare, and the Exchange when that became a thing. I learned a ton about mental health parity and how that impacted our product and the different decisions that we were making with respect to the interventions that we were propping up, not only within our organization with the staff that were working with members directly, but then who did we partner with from a provider perspective?

Eric C. Bailly: How do we shore up our network to make sure that we had quality providers, best practice scenarios? It really became en vogue for a long time to have best practice pathways for individuals to receive high-quality services. So we were really on the cusp of a lot of change, a lot of things that were coming down the pike.

Eric C. Bailly: I got to a point in the organization where there was quite a bit of funding going towards the opioid overdose response, and rightfully so. We really needed to address that. It was an all-hands-on-deck moment. Other payer organizations were involved in a number of the things that I was involved in. We were all working together, workshopping things, talking about what was working and what didn't work, quickly pivoting as much as we could to try different things.

Eric C. Bailly: I learned an incredible amount. It got to a point where I thought, I think I'd like to try doing this in a capacity where I'm not tethered to a singular organization. What I mean by that is I wanted to let the genie out of the bottle, you know? Let myself out, to be able to work with providers, to be able to work with payers, to be able to work with pharma companies, to be able to work with nonprofits. I wanted to be able to have a bigger splash or impact in a number of different settings, in a capacity that I hadn't been able to up to that point.

Eric C. Bailly: So that's really what led me to starting my own consulting firm in September of 2025.

Gary Garth: Phenomenal. When I labeled you as the payer in the room, a bit of a Trojan horse, I don't know if that's the right label, of course, but you have that unique experience of working so many years for various payers and now facilitating agreements between payers and providers.

Gary Garth: What are some of the blind spots, maybe put it that way, that you help providers identify when facilitating agreements?

Eric C. Bailly: Yeah. I mean, the answer is it depends. It depends on the provider and what kind of assets they're bringing to the conversation. It's interesting. One of the things that I've found is that there's still a narrative that's spun where there's this sort of us-versus-them mentality, where it's providers versus the payers, and there's sort of a setup for contentious conversations as a result of that.

The blind spots: the us-vs-them narrative with payers08:22

Eric C. Bailly: And some of that improved through efforts to engage things like pay for performance or value-based reimbursement methodologies that payers were promoting for a while. Although a lot of the literature I've been reading recently points to the fact that that's been, quote, "glacial" in its implementation, value-based reimbursement in particular.

Eric C. Bailly: But I would say that in my work with providers in particular, some of it is just starting out from a place of, "Well, let's take a look at your internal assets. What is it that you're bringing to the table that demonstrates to third-party payers what your value is? How do you differentiate yourself amongst the other organizations or entities that are providing services that are similar to you?" A lot of times providers will say, "Well, we believe that we provide higher quality services than the folks down the street." And I'll say, "Well, that's great, but tell me what that means."

Eric C. Bailly: And then I start to unpeel the layers of the onion and determine if they do say, "Well, we believe that we bring down the recidivism rate, and that by addressing the SUD or the mental health issues that are bringing the person to our agency, we can demonstrate savings from a total cost of care perspective, by making sure that people aren't going to the ER and actually having long-term physical health issues that can be the downstream consequence of an untreated or undertreated behavioral health condition."

"Higher quality" means nothing until you can show it09:23

Eric C. Bailly: Some providers are more savvy with that story that they can tell internally than others. And there's the narrative piece of it, but then there's also the data. I always remember the motto for the state of Missouri, the Show-Me State. And what that means, for people that don't know, is just, "Well, show me that you can accomplish this." That's really holding organizations accountable for their outcomes.

Eric C. Bailly: And in order to do that, providers have to have access to their own data. Some providers have pretty decent EHRs where they can collect some of that data and then have a backend data repository where they can generate dashboard reporting and so forth. Other providers are nowhere near that. They don't even know what EHRs are the best. Their revenue cycle management system may be completely uncoupled from the data that they're pulling every month.

Eric C. Bailly: So again, the answer is it depends. Starting with where the provider is at, what their foundational level of capability is, is the best place to start before going into any kind of negotiations with a payer to talk about value-based reimbursement, pay raises, or increases in payment for certain services and so forth.

Gary Garth: Yeah. I mean, we'll probably talk about this category specifically for an hour, 'cause this is one of the things that I find the most interesting. We help facilities grow their census and market themselves. In most other verticals, this is very common. Here, you're showcasing an alumni testimonial or a few testimonials, but it's very limited, and it's typically disguised for the people who want to be anonymous, right?

Gary Garth: But it just makes sense. And from my understanding from our last conversation, you said that to some extent outcomes data is already part of these payer contract conversations and negotiations. But at the same time, there's no real uniform authority that's the best practice. So it feels like it's a little bit all over the place.

Gary Garth: From your experience, if a provider was looking to say, "Okay, I want to incorporate outcomes data for the long term. I believe in this becoming the standard moving forward in contract negotiations," what are some of the initiatives they should set forth? And how can they build up a credible outcome measurement system that can be taken into consideration from a payer standpoint?

Eric C. Bailly: Yeah. That's a big question. And again, I'm gonna caveat this by saying it depends. It really depends on the provider. And I didn't say this, but when I work with providers across the country, one of the first things I think about... I've always been a bit of a nerd this way, but I love geography. I love knowing about place. I love the United States. It's such a rich, diverse country. And the experience that you as a provider are going to have in Upstate New York will be very different than New York City, let alone California and everywhere in between.

Eric C. Bailly: I live in a border community. I live on the border of North Dakota and Minnesota. I have a shared geography. I literally live in a town that is bifurcated by a river: county, city, state. It's bizarre in some ways, because we share the same geography, but the services that you would receive from a Medicaid perspective couldn't be more different from one another on the North Dakota side versus the Minnesota side.

Eric C. Bailly: So there are those kinds of nuances to consider when framing that up and determining how providers can be poised for success and what kinds of things they really wanna try and solve with the payers that are in their respective markets. For a border community, it gets more complex, because you've got multiple MCOs, perhaps, that you're working with. Not to pick on the state of New York, but the state of New York has multiple MCOs, and depending on the organization or what part of the state you're in, that can be extremely complex, because you're trying to negotiate rates with upwards of 10 MCOs.

Why geography and multiple MCOs change the negotiation12:41

Eric C. Bailly: And then how do you do that? How do you demonstrate your value compared to the other providers who are operating in the same geography? Again, as I mentioned, some of this starts with being able to generate quality data within your organization. And you would ask the question, well, where are some of the places that providers and payers will start, and then what are the national best standards?

Eric C. Bailly: When you and I chatted before this podcast, we talked about best practices for, like, diabetic care or oncology. Now, let's say I'm a patient. I'll just choose diabetes as a chronic condition. So I'm newly diagnosed as diabetic. I have a frank conversation with my doctor about what that means. It's a place to start. The doctor then says, "Okay, here's our recommended treatment path." It probably would involve insulin, and perhaps some technology that would be layered in there to track my insulin levels, my glucose monitoring, those kinds of things.

Eric C. Bailly: And then we'll have a conversation about pharmaceuticals. What are the best medications on the market to address my specific type of diabetes? And oh, by the way, there are some other treatments that we can take into consideration: "Down the hall, we've got a dietitian that we'd like you to connect with on the way out. Do you have time to do that?" Very comprehensive, and what I would call the proverbial healthcare hug, bringing somebody into the system and really working with them in a way that promotes best practices and evidence-based response.

Eric C. Bailly: Now, that said, my provider is then held accountable by payers, by the state, by other organizations to ensure that they are providing that high-quality and evidence-based care, because their numbers are going to demonstrate that in terms of their outcomes. So if my organization has really good HEDIS metrics, for instance, for getting me connected to the best kinds of treatment to address my newly diagnosed diabetes, then that could potentially be a differentiator for that particular healthcare entity.

Eric C. Bailly: So let's plug that scenario into either addictions care or mental health care. And I don't need to overstate that it's very different. I'll use addictions as an example, and the kinds of treatment that they might recommend. First off the bat, if I'm meeting with my primary care doc, one of the first things that I might experience is the fractured nature of the system, where they're gonna say, "I need to have you call the behavioral health unit," or, "Here's a number you can call to set up an appointment to further talk about this."

Eric C. Bailly: And then it just starts to unravel from there in terms of the fractured nature of that response, number one. Let alone if I decide to continue running the traps and make it into a specialty care provider. At that point, it just depends on who I go to. I have no idea what they're gonna recommend.

Eric C. Bailly: If I start with an outpatient treatment provider, they may very well say that I'm appropriate for outpatient services, but if I go to an organization that primarily offers residential treatment services, there's a high likelihood that they're gonna steer me towards a higher level of care that I really don't need. So it's a very different response with respect to what the patient would experience, and frankly what the entire system experiences from that perspective.

Gary Garth: Yeah, no, I think that's where my analytical mind has been pondering. You could have the provider steering them to certain levels of acuity or care just to consider the outcomes.

Gary Garth: I sometimes compare it to an organization where you have sales, and you have delivery or fulfillment or client success. If you have customer success that's measured on a success rate or retention, they're gonna be almost like a heart surgeon, declining or accepting patients based on how that will impact the scorecard.

Gary Garth: At the same time, this is people's lives, with different circumstances, different substances or disorders. That's kind of hard to standardize, whether they have the opportunity to go into residential inpatient or they're forced to start with outpatient, which is maybe not the right level of care.

The fractured system, and steering patients to a higher level of care16:25

Gary Garth: And at the same time, there are all the different treatment modalities or philosophies, 12-step and non-12-step, a lot of different ways. So how do you standardize it? What's the measurement aspect, in terms of when do you fully look at it as a successful outcome?

Gary Garth: Sometimes I hear providers saying that the patient completed the treatment program. That's really not a success metric. That's a contained environment, in my point of view. It's more like, have you relapsed within this timeframe? Then again, most people relapse because of the condition. So what are the success metrics that a payer essentially could look to negotiate?

Gary Garth: There are just so many different components to it, if you follow me. And then we speak a lot about, you know, the NAATP FORCE component, and the EHR. So where would you start as a facility? If you're a provider and you're like, "Okay, I want to work in the right direction," what's a good first or second step that's a universal best practice that can accommodate a future contract negotiation?

Eric C. Bailly: Yeah. One of the first places to start, you mentioned NAATP, so I'll pick on them a little bit. The National Association of Addiction Treatment Providers is an organization that is membership-based, and treatment providers from around the country can join them.

Eric C. Bailly: There's a component to being a NAATP member where you can be willing to submit your data via your EHR to what's called FORCE. FORCE is, for lack of a better description, a platform or a way to aggregate the data that's coming in from multiple different sources, and then to be able to show and demonstrate outcomes that are resulting from the treatment services that are being provided.

Eric C. Bailly: The goal of all of that is to do exactly what we're talking about: to create something that's consistent and reliable that providers can point to and say, "Well, here are the best practices. We can develop our guidelines based on this." And ideally, payers would be paying attention to that as well.

Eric C. Bailly: Because then, when they go into contract negotiations with their providers, they can say, "Well, according to the FORCE data, we are noticing that the quicker you get somebody started on buprenorphine or methadone for opioid use disorder, the more likely they are to follow through with ongoing psychotherapy or some of the other treatment services that help them address the bigger issues that are going on in their life." And subsequently, they're able to get chronic health conditions under control as well, when you look at the broader aperture and bigger picture.

Eric C. Bailly: That's one way. Something else, and I don't know if this is simpler, but there are certainly HEDIS metrics from NCQA, the National Committee for Quality Assurance. They have specific measures that are required for health plans to basically draw a line in the sand and say, "Hey, we commit to doing a better job of, when someone is newly diagnosed with opioid use disorder, getting them in for an appointment to discuss medications for opioid use disorder within X amount of days."

NAATP FORCE and HEDIS measures: what payers can look at19:20

Eric C. Bailly: And of the patients that have that initial benchmark or that flashpoint, what percentage of them then go on to get an appointment and subsequently a prescription, or a connection to methadone maintenance from an OTP, an opioid treatment program, a claim that would demonstrate that they're actually following through with that?

Eric C. Bailly: So HEDIS metrics are table stakes, in my humble opinion. It's a way to demonstrate that you're connecting the system in a way that addresses the fractured nature of it. But some of the things that are being collected by NAATP or other organizations that are working on this go beyond the table stakes.

Eric C. Bailly: One thing that I like to point out is that historically, and I don't even consider this a benchmark, a lot of what addictions treatment providers have been focused on is self-attestation for whether or not someone has discontinued their alcohol or drug use. Okay? So on the surface, it seems like a no-brainer, right? Someone goes in for SUD, substance use disorder treatment, and they commit to abstinence. But the research doesn't show that that's the only path for people. There are multiple pathways in this journey for individuals. Some of that may be moderation management. What does that look like?

Eric C. Bailly: And, number one, are organizations nuanced enough that they can manage those patients that are coming through their doors? And then if they can, how are they demonstrating a positive outcome for that?

Eric C. Bailly: If someone comes in and they have crossed the threshold, they have an alcohol use disorder, severe alcohol use disorder, and they're not willing to be completely abstinent, meaning that they're not willing to completely give up alcohol, but that organization works with them to reduce their alcohol consumption to a point where it's becoming less disruptive in their life, how can they demonstrate that they're doing that effectively? That is a good example.

Beyond self-attestation: measuring multiple pathways in recovery20:53

Gary Garth: Yeah. Yeah, no, I completely understand. From my standpoint, I'm in recovery myself, and there's not a one size fits all, obviously. Different programs, different approaches work for different people.

Gary Garth: But a self-reported patient survey on anxiety or cravings... Typically people in recovery would lie at times about their state, right? That's been a necessity for them half their life, to play that role. So I don't think that's a tangible measurement. And I'm just wondering about stuff like vitals. I'm looking a lot at substituting bad habits with healthy habits, if, essentially, the payers want to stop reimbursing repeated treatment.

Gary Garth: So it's looking at other aspects beyond just going through the initial treatment. Are there other indicators that get people back on track for long-term recovery? I love that there's such a focus on it in the industry, 'cause I think that's really what we need.

Gary Garth: And I think for better or worse, if the financial discussion is geared toward that, maybe not in the perfect state, at least we'll start having that focus. So I welcome it. I just see there's some work to be done, from my humble point of view.

Eric C. Bailly: Yeah. And speaking of finances, one of the things that providers across the country have been concerned about is the looming Medicaid cuts and changes that are coming as a part of HR1, which was passed in July of 2025.

Eric C. Bailly: All of this becomes fodder for that, because organizations are being confronted with, going back to the example I brought up earlier, a provider entity needing to shore up their data collection capabilities. They need to spend some money on a decent EHR system to be able to collect some of that data, and maybe other digital support tools that they can use to help demonstrate the value of what they're providing.

Eric C. Bailly: There's going to be less money to be able to do that, as people are having to adjust to lower rates in some cases. Unfortunately, some of the trends that we've seen going into the fourth quarter of this year are likely to continue going into the first quarter of 2027, regardless of the results of the election.

Eric C. Bailly: Right now, we're still marching towards implementation of work requirements for Medicaid re-enrollment, a lot of the things that I'm sure this audience is aware of. You can certainly look up some of the ramifications of HR1. But provider entities are being confronted with a constriction of funds that are going to be coming in and actually paying for services.

HR1, Medicaid changes and shrinking risk pools24:05

Eric C. Bailly: Payers are in a position where they may even be losing membership, because people will be becoming uninsured for a variety of reasons. Some of it is that they may not be able to afford the premiums that are offered on the ACA exchange, or they may not qualify for Medicaid or Medicaid expansion, and then the coffers start to shrink.

Eric C. Bailly: And then payers are in a position where they're like, "Well, our medical loss ratio was created assuming that we were going to have this big of a risk pool." I'm putting my hands out. A big risk pool, and it shrunk down to, like, this size, much smaller. They're confronted with some pretty difficult decisions, because in order to account for the reduction in premiums or the revenue that's coming in as a result of that, it's impacting providers and payers both in a big way.

Eric C. Bailly: And not to be doom and gloom-ish, I think it's important to recognize that there are things that providers can do, that payers can do. Some have already been preparing for this; others are thinking about, well, what are we gonna do? And there is an important piece of revenue diversification that should be happening within a provider organization, and that I've talked about over the past—

Gary Garth: And when you say that, would that be commercial versus Medicaid, for example, diversification, or?

Eric C. Bailly: Yeah. That's a great example. Revenue diversification is primarily when you think about your attributed patient population. How many of them are Medicaid reimbursed? How many are commercial insurance reimbursed? How many are ACA? How many are Medicare? How many are Medicare Advantage? That's revenue diversification. You're certainly going to have some money that's also coming in from philanthropic dollars or grant funding.

Eric C. Bailly: There are a number of organizations who unfortunately have set themselves up, for instance, to over-rely on grant funding, and when the grant runs out or it gets cut off at some point in an unanticipated fashion, they're kind of left in a lurch, if 80% of the revenue is coming from a grant and they don't have a mechanism for bringing in revenue from Medicare reimbursement or commercial employer-sponsored health reimbursement.

Eric C. Bailly: So some providers are going to weather this storm fairly well, and others are really going to struggle. That's really where some of my advising has been helpful for organizations over the past six months or so leading up to this point.

Gary Garth: Yeah. No, I've seen it firsthand. We work with facilities, we help drive census, and then all of a sudden there's a payer disruption one way or the other, whether it's contractual or a legislative change, whatever it may be, and that can really disrupt the entire business, like, you know, a 180.

Gary Garth: Besides revenue diversification, what are some other things that you would say providers should be aware of, or maybe some steps they can take to prepare for the changes in January?

Eric C. Bailly: Yeah. There was something I learned early in my career, actually from one of my patients, and as a person in recovery yourself, you can appreciate this. One of the things in recovery that I was taught early on was to take it one day at a time. This comes from the 12-step legacy.

Revenue diversification: Medicaid, commercial, ACA, Medicare and grants27:30

Eric C. Bailly: I had a patient one time say, "Yeah, I get that, Eric. That makes sense. But I always wanna keep an eye on tomorrow." And I said, "Tell me more about that." What he meant was that he didn't want to be in a position where he wasn't at least prepared for what the next day may bring, at the expense of living just for today. And I was like, "Yeah, I can see that."

Eric C. Bailly: I've woven that into my own recovery, interestingly, in a number of different ways. But I think about that too with the position that providers are in right now, and have been for a while. It is very important to be laser focused on executing what it is that you have promised to your patients and to the payers that are working with you. I see this as a team effort.

"Keep an eye on tomorrow": running today while planning for 202728:13

Eric C. Bailly: So, for instance, being able to keep your doors open to provide MOUD for patients with opioid use disorder, to be able to address issues in a trauma-informed capacity, to have staff who can prescribe medications, to have staff who are peer recovery support workers that can approach these sensitive issues in a way that sometimes clinicians can't. All of those things operationally, that's all extremely important. We can't lose sight of that. However, we can't lose sight of what tomorrow is bringing.

Eric C. Bailly: There are some concerns about these cuts and how they're going to impact our ability to do the basics, to be able to keep the lights on, that I've talked with providers about. So it's hard to strike that balance, to really be focused on what today is bringing, because I don't know how much time you've spent in CCBHCs or in community-based mental health clinics, but it's fast-paced, lots of crazy stuff going on.

Eric C. Bailly: Sometimes it's hard to know what the right and left hand are doing, but people just get through the day and address things silently. And again, we don't wanna lose sight of that. But in order to be able to do that noble work, we've gotta have a sense of what tomorrow is bringing.

Gary Garth: Oh, yeah, absolutely. And maybe, I don't know if this is possible, but is there a certain program type or level of care that's more at risk with the upcoming changes than, for example, a full continuum of care? Who's best prepped, and who should really be looking at this extra carefully?

Eric C. Bailly: Yeah. I wish there was a simple answer. That's a really good question. There's not really a simple answer to that. One would think all residential services are the most at risk, and that's simply not the case. If there's a residential treatment center out there that has already cracked the nut with revenue diversification, they may be able to weather the storm quite well, and the same could go for an outpatient clinic.

Eric C. Bailly: So I think the risk out there is equal. It doesn't matter whether it's outpatient, intensive outpatient, facility-based, non-facility-based, or hospital-based. All of these levels of care are at risk. And each one of those is responsible for their own revenue diversification, which factors in, again, their geography and where they may be situated, within a healthcare organization or as an entity that is on their own.

Gary Garth: If I was a provider, I mean, that's terrifying, knowing that these things come up and you gotta take one day at a time, but also look at the future. So maybe that's a good segue. I'll be at the upcoming TCIV in Arizona in December. I can't remember the dates; we'll put them in the show notes. You're actually gonna be leading a roundtable discussion for executives on how to prepare for this in 2027, how to navigate that.

Gary Garth: If folks are interested and they will be attending TCIV, what are some of the things that they can expect to walk away with as far as learnings, takeaways, or things they can apply to their organization? And two, is there anything they can do to be prepared for your session?

Eric C. Bailly: Yeah, and thank you for bringing that up. I'm really looking forward to TCIV this year. I've been attending this conference for, oh gosh, close to a decade, and I find it incredibly valuable. It's an intimate setting, with individuals anywhere from real estate developers to payers and everything that falls in between. It's a fantastic conference.

Eric C. Bailly: One of the things that we'll be focused on in this roundtable is leveraging that diversity of attendees. There are behavioral health executives who will be a part of that roundtable. And number one, let me just point out it's different than going into a session and being talked at for an hour to an hour and 15 minutes, or however long the sessions are. This is a really roll-up-your-sleeves, let's-talk-about-some-pragmatic-issues session, about what's going on within your organizations and, most importantly, solutions.

Which levels of care are most at risk? All of them31:45

Eric C. Bailly: I am a facilitator. This comes back to my clinical days. I am going to facilitate these conversations. I've got some great things for people to be thinking about, including an initial run-up exercise at the beginning of the roundtable for organizations to really map out their assets, kind of like what we talked about earlier.

Eric C. Bailly: And then shifting that to learning from one another about how they're leveraging their assets in a way that is going to address some of what's coming down the pike in 2027 with the HR1 implementation. And then ideally, they'll walk out of that session with an action plan.

Eric C. Bailly: What I mean by that is they will literally have a piece of paper. I'm old school that way. I insisted that they make copies that are sitting there on the tables. Paper and pen, you know? They're going to walk out of there with an action plan that they can go and potentially implement in their respective organizations, in addition to having networked with other people at the event. So they'll have some people that they can call when they run into a jam with different things and ask, "How are you managing this in your organization?"

Eric's TCIV roundtable: walk out with an action plan32:58

Eric C. Bailly: I mentioned earlier that this was an all-hands-on-deck situation when it came to the opioid overdose response. I think it's still the case for mental health and substance use disorder in this country, behavioral health collectively. This is an all-hands-on-deck moment. And this is an opportunity to really all work together and recognize that there's a lot more that we have in common than not.

Eric C. Bailly: So I think it's just going to be a tremendous opportunity for people to have a candid conversation, one that really allows people to talk about what their pain points are, where they're headed, and how they can leave the conference with some pragmatic solutions that they can implement.

Gary Garth: Fantastic. Very excited. I will certainly be attending that session. As somebody who's privileged to look a little bit behind the scenes and talk with many different clients, I know this is a hot topic. So thank you for the great work you're doing, because like my mentor said, without sustainability, you'll cease to exist.

Gary Garth: You can't expand. You can't make an impact. You can't change the world. I mean, you can have the best intentions and mission in the world, but that aspect of navigating such a delicate matter and sustaining the business in order to get more people access to care, it's mission critical.

Gary Garth: So thank you for being a facilitator of that, and I'm very excited to see you at TCIV. Final question before I let you go. With your background, you've been on the clinical side, you've been working with the payers, and you've been more than a decade in this category.

Gary Garth: If you were appointed president tomorrow and you had a magic wand, and you said, "I'm gonna change this," and it's one thing about the industry, what would that be and why?

Eric C. Bailly: I love this question. I've been trained in how to leverage solution-focused brief therapy techniques, and one of the exercises that I've used with patients that I've worked with, and also in my work with the people that I'm advising, is something called the miracle question.

Eric C. Bailly: I don't know if you've heard this before. The miracle question is a different spin on this whole wand-waving thing. With the wand wave, it's kind of like everything just happens and it's different. With the miracle question, it's very different, because what you do is you define how it is that things will be different once there has been effort to get to that point.

Eric C. Bailly: The whole purpose of the miracle question is to lift people up out of the problem, have them live in the solution, albeit briefly, to get a flavor for how life can be different, and then bring 'em back here and say, "Okay. If that's zero, and 10 is you're living in the moment, what does a one look like? What needs to be—" Yeah, so that's so Minnesota of me, isn't it?

Gary Garth: No, I love it. So pragmatic.

Eric C. Bailly: Pragmatic. So when I think about this, what I would see as that miracle moment, that 10, would be a system that has managed to address all of the fractured nature of the service delivery. What I mean by that is, going back to the example I brought up earlier about a newly diagnosed diabetic and the response that they get from the system: if I've got a mental health issue or a substance use disorder issue, I get that healthcare hug.

The miracle question: a "healthcare hug" for behavioral health37:01

Eric C. Bailly: You know? That's what that 10 looks like. I get that hug. I have a clear sense of where it is that I'm headed. I have clear people that I can contact. I can get in expeditiously, with a sense of drive and purpose and passion, that would be every bit as committed as for someone who's getting oncology or diabetic care.

Eric C. Bailly: So if I were in a position where I were helping to orchestrate making those policy changes, there are a lot of things that we could do, stepping from one to two to three to four, getting up to that 10, that I think we had made some progress on with the ACA.

Eric C. Bailly: But we need to really have a moment of reflection to determine, okay, what has continued to be broken, and where are some areas that we can really address and do things better from a policy perspective, whether it's national, state, or local, to try and get to that unified goal. Now, not everyone may share my goal of having a fully integrated system, but you know what? I'd be hard-pressed to find somebody who would say, "I don't want that."

Gary Garth: Yeah. No, exactly.

Eric C. Bailly: That's the irony of it, yeah.

Gary Garth: That's the end goal. No, I love that. Thanks for sharing that, and I second that wholeheartedly. I think people who are suffering have enough worries and concerns, health-wise, mentally. The families are impacted. There are just so many things going on. So removing that fear and making sure that there is predictability toward treatment and recovery, I think it's everything.

Gary Garth: And ensuring that, with the financial components and the program, there's a clear path that's universal for everyone. I think it's not a simple ask, but it almost has to be a requirement with time. Hopefully we get there.

Gary Garth: Thank you so much, Eric, for being on the show. It's been a true pleasure. I would love to pick your brain, and I look forward to seeing you at TCIV and learning much more during your session. If anybody wants to get ahold of you and tap into your advisory work or anything else, what's the best way to get in contact with you?

Eric C. Bailly: Yeah. I mean, probably the best way is just to go to my website. It's northstarbhadvisory.com. Go there, and then you can either fill out a form or, if you'd rather, email me directly from there. You can get ahold of me that way too.

Gary Garth: Excellent. Eric, thank you so much for being on The elev8 Podcast, and I'll see you in a couple of weeks in Arizona.

Eric C. Bailly: Yeah. Thanks again. Thanks so much for having me.

Gary Garth: Absolutely.