This October 10 and 11 marked the 3rd Annual Cohen Veterans Care Summit at the Ronald Reagan Building in Washington, D.C. The conference was nothing short of success, as hundreds of healthcare leaders, veterans and other community members collaborated on effective Learning Mental Health Systems and the CVB-CVN model for continuous growth in the field of mental health treatment and research. The following is a deep dive into the daily agendas at the Summit:
Day 1 Recap:
Cohen Veterans Network and Cohen Veterans Bioscience Founder Steve Cohen Describes Two-Path Approach to Treatment
Cohen Veterans Network and Cohen Veterans Bioscience founder Steven A. Cohen kicked off the third annual Cohen Veterans Care Summit in Washington D.C. by laying out a two-path approach to treating mental and brain health. First, to take care of today’s problems now through treatment at CVN clinics. And second, to look for better answers in the future through CVB’s research into Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).
Taking Care of Today’s Problems and Looking for Better Answers in the Future
Cohen Veterans Network CEO and President Dr. Anthony Hassan and Cohen Veterans Bioscience CEO and President Dr. Magali Haas laid out the efforts both organizations are making to improve mental and health brain care. Hassan highlighted the increasing number of telehealth-enabled CVN clinics that are providing mental health treatment to veterans remotely and noted that more than a quarter of CVN patients are female veterans. Haas spoke about research being performed with wearables to support real-time health monitoring, and efforts to better understand TBI and Chronic Traumatic Encephalopathy (CTE) through studying blood samples. Both highlighted their reliance on partnerships with public and private sectors organizations to advance treatment and research for veterans and their families.
Unveiling New Study on State of Mental Health Access in America
CVN and the National Council for Behavioral Health, the unifying voice of America’s health care organizations that delivers mental health and addiction treatment and services, released America’s Mental Health 2018, a comprehensive study of access to mental health care. The study, which assesses Americans’ current access to and attitudes towards mental health services, revealed American mental health services are insufficient, and despite high demand, the root of the problem is lack of access – or the ability to find care.
Stopping the Addiction Fatality Epidemic
Retired Navy Admiral Sandy Winnefeld and Mary Winnefeld, founders of the S.A.F.E. Project to combat opioid addiction in America, spoke about how their son, Jonathan, died of an accidental opioid overdose after they thought he had overcome his mental health challenges and set himself on a career-focused path. They highlighted the ways in which the system for treating addiction that exists today is imperfect and struggles to combat use of opioids, heroin and fentanyl. Their priorities are teaching communities best practices in combating addiction and helping everyone in the academic space by teaching campuses to create safe educational environments. They called for public-private efforts to combat this epidemic.
Exploring the Future Mental Health Landscape and Possible Effects on Veterans and Families
Monica Oss, Founder and CEO of OPEN MINDS, provided a comprehensive overview of the implications of changing mental health innovations and other developments on veterans and military families. She pointed out a number of areas of major potential for impact and change: brain science, big data and artificial intelligence; enhanced telecommunications; and policy and politics, which she noted can heavily impact what is funded and what is possible in health care. She told the audience that one of the most important changes is how health care is delivered and paid for, with five key factors heavily influencing hospitals and practices in this area. Tech-enabled treatment will be a key facet of addressing and overcoming access to care issues in the next 3-5 years. She also talked about changes in patient expectations and how as consumers of health care services, they increasingly expect timely and convenient delivery, coupled with transparency about the costs and details of their care.
Lessons Learned in Developing Learning Mental Health Systems
Learning mental health system is a system that learns from every patient it sees and evolves based on what It learns. Dr. Tom Foley of NHS Digital, the United Kingdom’s national provider of information, data and IT systems, explained that such systems depend on informatics, and the ability to routinely collect and evaluate data to generate insights into what works and what doesn’t in treating patients. During the panel discussion, Dr. Rinad Beidas of the University of Pennsylvania spoke about implementation science and building on evidence-based practices in providing health care, especially in community mental health clinics, where it has been challenging to create learning systems due to the lack of routine assessments and of electronic health records to enable such assessments. And Dr. Agnes Rupp of the National Institute for Mental Health addressed the challenge facing implementation science of figuring out how to move different stakeholders with different perspectives in the same direction to realize a learning mental health system.
Medal of Honor recipient Sgt. Kyle White Spoke About the Cohen Veterans Network
Sgt. Kyle White, Medal of Honor recipient and Cohen Veterans Network spokesperson, discussed why he’s passionate about the mission of CVN.
Day 2 Recap:
The Future of Access to Mental Health Care
Dr. Jay Shore of the University of Colorado Anschutz Medical Campus highlighted one major change in how he has seen health care delivered due to technology. Telehealth used to take what you could do in person and replicated it over video conferencing. Now video conferencing is shaping how you provide care because of what it allows you to do, in terms of location and team design. Lara Gregorio, founder of 7 Cups of Tea, a website which provides online therapy and free support to people experiencing emotional distress by connecting them with trained listeners, noted that as demand for care grows over time, providers won’t be able to meet demand, so they will have to figure out how to meet people where they are and provide care how they need it by relying on new, revolutionary ways to leverage technology. And Linda Rosenberg of the National Council for Behavioral Health noted that health care innovators must consider the surprising popularity of voice-enabled AI systems like Alexa with elderly Americans, who are not digital natives and prefer to engage verbally with technology.
Michael Sullivan, Chief of Staff at Point72, and Board Member of Cohen Veterans Network and Cohen Veterans Bioscience, kicked off day 2 of the Cohen Veterans Care Summit.
A Journalist’s View on Military Mental Health
Dr. Caitlin Thompson, CVN’s Vice President of Community Partnerships, turned the tables on Military Times reporter Leo Shane by interviewing him about his perspective on health care in the community. Shane noted that people are paying attention today to veteran issues that used to be considered a sleepy backwater for news. Thompson said that as a mental health specialist, the last thing she wants to see is news that makes people avoid seeking care. Shane explained that his reporting goal is not to hurt people, but the role of oversight is adversarial, including to the VA, though he feels like he should caveat stories by noting that VA does lots of good before homing in on specific problems. He does hear from many veterans about the good care they do get from the VA, but that they want things to also get better. As the budget grows, that brings with it more scrutiny.
According to Shane, Secretary Wilkie has said his biggest issue is implementing the VA Mission Act and addressing the question of how much new care goes outside the VA to private sector doctors and clinics, and what that balance is. Shane said that it is important to ask why people want to push care outside VA, is it because they’ve given up on VA or because they see private care as complementary? There is a balance to be found where public-private sector collaboration establishes optimal equilibrium for veterans. Turning to mental health issues, Shane noted that while everyone knows VA has a shortage of mental health experts, filling those jobs is not easy. Interviewing veterans over the years about mental health, he has been shocked about how open veterans are about their mental health problems; they’ll often overshare in the hope that their story will help someone else.
Global Perspectives on Military and Family Mental Health
According to Dr. Carl Castro, Director of USC’s Center for Innovation and Research on Veterans and Military Families, most service members, veterans and their families are doing fine; most veterans don’t have PTSD; most Americans support the military; and the military is a great organization to work for. He implored the audience to not lose sight of how well veterans are doing and how positive military service is, before looking at what is not going well in the health care space. In seeking to solve the problems that do exist, Castro emphasized the importance of having a solid theory to test, which is critical for studying problems or proposing solutions. Without clear theories and hypotheses, comparative data can be misread or misconstrued to arrive at inaccurate conclusions, as has been done when trying to draw lessons from the comparable combat trauma experiences of US and UK service members. As part of his talk, Castro focused on sexual assault, where he noted that rates of military sexual assault were very similar to college campus rates, and consistent in the US and internationally. Additionally, most sexual assaults occur within two years of joining the military. He noted that suicide rates in the military were also much higher in the first two years, and also in the first six months after a deployment. With data like this available, good theory tells you where to look, and helps you develop more effective interventions. Intervenors need to focus attention on where problems–whether they be sexual assault or suicide–are most likely to occur, and then spend time and resources in the time periods and areas of greatest need, versus blanket attempts to solve problems universally. The current system is designed to wait until a veteran’s health problems are acute and then spend lots of money, versus investing to get ahead of the problems in targeted, data-driven interventions. Castro closed by noting that there is a growing awareness around the world of the need to focus on supporting and studying military families, not just those who have served.
Utilizing the Tools of Change
Dr. Anthony Hassan, CEO and President of CVN, kicked off the panel discussion by emphasizing the importance of more effectively targeting treatment for patients by relying on increasing access to comprehensive data and new tools in place. Aaditya Bhat, a CVN data scientist, told the audience that as an engineer by training, he is a skeptic. To counter his skepticism, he looks for knowledge, not data. His end goal is to generate wisdom that informs people and makes them more knowledge. At CVN, we have consolidated data across the clinics, but this is only a starting point, as we work to leverage learning processes to gain information from the raw data. Dr. Adam Chekroud, co-founder of Spring Health, talked about the process of bringing data, extracting information that is relevant to a specific patient, and then providing it to the provider to help influence outcomes and improve care in a targeted manner. Damian Mingle, chief data scientist of Raiven Healthcare, warned the audience about the importance of not confusing basic decision-making programs with advanced artificial intelligence, as technological terms get thrown around casually and without precision. Technology that helps business processes is not necessarily up to the task of helping improve care.
Looking ahead to future, Bhat said that it’s important as data scientists to start defining better and more accurate questions to answer. We start with big ambitions for healthcare, but if we start with small, very exact questions, we will make progress more quickly through iterative processes and small steps. Mingle opined that it will be important for data scientists to fail faster to help organizations move at scale, without compromising best practices. Important to learn if they are asking the wrong questions. And Chekroud focused on the need to increase access to mental health care for people in US, starting with options through peoples’ employers, who will benefit from a mentally healthy workforce. Hassan closed by reminding people that the bottom line is whether patients are getting better due to innovations in data science.
The Future of Innovation: Breaking Down Data Silos
Ardy Arianpour, CEO and co-founder of Seqster, took the stage to lay out a vision for what can happen when you take disparate data sources and combine them into one to improve health care, solving interoperability from a consumer standpoint. Seqster is a consumer-driven platform that disrupts data silos and brings together a person’s health information into a single place. While this approach has promise for big data and research, it’s primary purpose is about seeking more information about an individual’s health and the health of their family. Seqster has worked to standardize and harmonize the leading EHR systems’ data to solve interoperability from the consumer standpoint. The siloing of data is affecting consumers’ lives today. There are three types of data collected for the consumer. First, medical data from the EHR. Second, DNA information from genetic tests, which is not valuable unless it is paired with medical information. And third, wearables and the fitness tracking data that they collect. The purpose is to bring clarity to health data by allowing consumers to collect, own and share health data on their own terms to unlock optimal health and discoveries. In follow-up comments, Cohen Veterans Bioscience (CVB) CEO and President Dr. Magali Haas highlighted CVB’s new BRAIN Commons, a scalable, cloud-hosted big data repository for data-driven brain health that is built around data, analytics and community to support patients, providers and researchers. At the event, Haas announced that the Michael J. Fox Foundation would join the BRAIN Commons, which will go live in 2019.
The summit wrapped up with a special performance of the stage show Modern Warrior Live, and then attendees traveled to Silver Spring, Maryland to tour the Steven A. Cohen Military Family Clinic at Easterseals.