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A Second Opinion with Dr. Sherry Glied

Today I’m joined by my friend, Dr. Sherry Glied, Dean of New York University’s Robert F. Wagner Graduate School of Public Service. Sherry has had a brilliant career conducting health care research and actively creating federal health policy and I’m excited to have her with us today. Before her role as Wagner School Dean, Dr. Glied served as the assistant secretary for planning and evaluation at the Department of Health and Human Services and as senior economist on the President’s Council of Economic Advisers in 1992 and 1993. Her principle areas of research are mental health and health policy reform. She’s authored a number of books, including Better, But Not Well: Mental Health Policy in the US Since 1950.

Bill Frist:                       Sherry, an area that we didn’t cover in our first season, in our second season is a whole area of mental health, which is a little bit reflective of the problem we have today. The fact in our earlier episodes, it just wasn’t the topic. It’s really interesting that it’s that personal to me because I care very much about it.

Bill Frist:                       In the podcast we look at health and healthcare and wellbeing, so it is a big bucket, and then the policy area’s a big bucket and the intersection of those two, with this other sort of third nexus of innovation. Why don’t we take mental health today and talk a little bit about it, since you really are the world expert in both the history and where we are today.

Bill Frist:                       In 2004 to 2006 I was very involved with four people looking at mental health and that was in the United States Senate. There was Paul Wellstone before that period of time, and then Pete Domenici and then Patrick Kennedy. We looked at mental health, recognizing was no parity at all. Ultimately two years after I left was this mental health parity bill of 2008. Tell us, and let’s open with this, tell us a little bit about where we are since that time and then let’s go back and look at the last 50 years.

Sherry Glied:                Let me talk a little bit about mental health parity and how that came about, because there’s actually an interesting innovation story there even in the passage of it. I’m going to start, I have to give you a little history, because you have to understand what mental health parity is. I think the key is that for a long time insurance plans, private insurance plans, even Medicare had very different cost sharing for mental health services and for physical health services. There was a good reason for it, it actually made sense for the plans to behave that way, but what it meant is that if people had a mental health problem, and particularly if they had a really serious mental health problem, they might wind up with extremely high financial out of pocket expenses, much higher than a corresponding physical health problem would lead them to have.

Sherry Glied:                It was really hard to fix this. People have been up in arms about it for a long time, but it was really hard to fix it because if you give people parity in mental health services, in the old world of the way health insurance used to work, they would use a lot of services and there were studies that has shown this. The insurance companies were like, “Okay, if you make us do this, it’s going to cost a fortune and people are going to drop mental health altogether. We don’t want to do it.” Well, what happened that’s really interesting, is a new industry actually innovated around this problem, the managed behavioral healthcare industry. They said, “You know, it would make a lot more sense if we actually did mental health triage in real time instead of having people triaged themselves with a pocketbook.”

Bill Frist:                       Right, yep.

Sherry Glied:                Instead of doing pocket book rationing, what if we actually talked to mental health professionals and we talked to patients and we tried to figure out how many visits people actually need or how many days in the hospital they actually need. Maybe there’s a way to actually control utilization without putting it all on the out of pocket expenses. The industry grew up because they had computers and telephone operators and new innovations in the rest of the world that they could use and began to actually offer a managed behavioral health benefit to companies.

Bill Frist:                       And these were around what era?

Sherry Glied:                Managed behavioral healthcare starts around the mid-nineties, just as managed care starts broadly. Somebody says, “A great place to use these utilization review, these kinds of techniques, will be in behavioral health.” Actually, if you look at the early studies on the effects of managed care, a lot of the savings are from behavioral health, from people who are heavy utilizers of behavioral health without as much reason for it as we’d like.

Sherry Glied:                The managed behavioral health care companies came along and said we can do this. The government decided to do an experiment. They actually had the Federal Employees Health Benefit plan consider implementing parity and the FEHB did it for their regular employees, I think not for the postal workers, if I’m remembering right. There was one group that got it and maybe another group that didn’t.

Bill Frist:                       Was it throughout the-

Sherry Glied:                Throughout the system and they looked to see what happened and they put them into managed behavioral health care. It turned out spending did not explode. What did happen is that the people with the highest costs, suddenly they actually had real protection. Instead of spending all the mental health dollars on people who were neurotic and needed what would benefit some, but not that much from four times a week psychotherapy. Instead, you were giving the care mostly to people with schizophrenia or really severe bipolar disorders and things like that, giving them more care and they weren’t having to pay these enormous out of pocket expenses.

Sherry Glied:                After the FEHB experience, the Congressional Budget Office and other people looking at parity said, “Congress, you can do this and it’s not going to bust the budget.”

Bill Frist:                       And was that in the 90s?

Sherry Glied:                That was in the 2000s, and that was actually the run up to Congress actually passing parity instead of believing that it was going to cause premiums to go up by 8, 10, 12%, which is what people had been saying. The FEHB experienced suggested you could probably do this with premium increases on the order of 1 or 2% and that seemed like a price that was okay to pay.

Bill Frist:                       Just as an aside, has Federal Employees Plan had been used for other investigations like that?

Sherry Glied:                Sort of, yes. I mean, there have been other- in fact, almost the opposite. The first time… Some of the first lessons that we learned about mental health is that the Federal Employees Plan had a high option and low option Blue Cross plan. The high option Blue Cross plan had very low cost sharing for mental health and their costs exploded. This was way back in the 80s, 80s and 90s. Actually, a lot of our learning came from that experience of the FEHB program.

Bill Frist:                       Did the insurance companies in the period of 2006, 7, 8, were they fighting this or for it?

Sherry Glied:                They were beginning to be okay with it, because they saw that they could do the utilization management and they could contract for the utilization management. They had been really negative about it, but their reasons for being negative began to fall out. Parity came along and it created its own kinds of challenges because it was easy to legislate the parity pieces about your cost sharing. If you think about your insurance plan, it now says that whatever your cross sharing is for physical health, it’s the same for mental health and that was easy-

Bill Frist:                       And caps?

Sherry Glied:                And caps are gone.

Bill Frist:                       Right.

Sherry-Glied

Bill Frist:                       Right.

Sherry Glied:                That was all good and it was all the same. Remember that the way that you got around this stuff is with this managed behavioral health care business. A lot of the advocates felt like what was happening is that the managed care plans were being much more aggressive in policing the use of mental health services than they were in policing the use of physical health services. The 2008 parity bill says you can’t police differently in the two areas either.

Sherry Glied:                That’s turned out to be really hard to enforce, as you can imagine. You’re supposed to think of a comparable service and use that same kind of utilization review. Like physical therapy, and I’m not going to- I don’t know, outpatient mental health therapy should be similarly monitored, but it’s very hard for a patient to actually be able to see that. That’s been a bit of a challenge. On the other hand, you know these cases of people who are really bankrupting themselves because it was often a family with a kid who had a first break psychosis, for example, with serious inpatient service use, that problem has actually really been sort of addressed by the legislation.

Bill Frist:                       Since then, over 2008 to 2019, what have been the big changes either in terms of new barriers or huge challenges that have come forward, or has there been sort of steady improvements?

Sherry Glied:                There has been considerable improvements, so early studies looked at what happened, did insurance plans change, what they did. They did change it and there was improvement. There is definitely concern, I think legitimate concern, that the plans are overly tight with respect to some of the mental health benefits and that people are not getting access to some services that they need. It’s also a really interesting… I mean mental health is just a fascinating field to me, and one of the things that makes it really interesting, and you’ll appreciate this, is you don’t really have to have… I’m guessing you don’t need to have a personal bond with your heart transplant surgeon. You’ve got to believe your surgeon’s going to do a good job, but you don’t have to have a working relationship with them.

Sherry Glied:                When you’re dealing with mental health care, it really matters. The match between the patient and the therapist is actually quite important for the success of treatment and so there is a concern that if you’re too rigorous, instead of sending people to different providers, you actually could wind up with worse treatment because people are not getting a match to the person who’s best for them.

Bill Frist:                       Yeah, very interesting.

Sherry Glied:                There’s also concern that people are getting too many prescriptions and not enough therapy because of this push towards regulating what they’re getting.

Bill Frist:                       Inpatient care versus outpatient care… Has that been affected by the parity legislation? Obviously it has a huge history and that we can go back to, but did the legislation itself impact relationship between inpatient care, outpatient care?

Sherry Glied:                Not so much. A lot of those really high spenders where people with inpatient care, so up to some extent it actually provided some protection there, but there has been really relatively little shift in the private insurance market between inpatient and outpatient care over time.

Sherry Glied:                Again, I’m sure you’ve talked about evidence based medicine in your podcast before, but the evidence base for inpatient care and mental health is really weak. We don’t know much about it. We don’t know whether it works, for whom it works, how much of it people should have, and there’s huge variations across the country in how much inpatient care people use. I think that’s actually an area where there will be more innovation and more thinking about how to do this the best.

Bill Frist:                       Today, we don’t have enough mental health workers, providers- or that’s my impression. Certainly psychiatrists, there are not enough today, in part because of their mode of therapy. There’s very little tele-psychiatry, very little telemedicine in the psychiatric field.

Bill Frist:                       The flip side of that, there is a lot of behavioral medicine today that used to be either inpatient or outpatient but has become virtual and the virtual has extended over to text world, which is pretty amazing that, today with our new communication techniques, that you can have equally effective therapy, whether it’s video, telephone, telephonic or even text. Again, it comes back to our whole thesis that innovation plays a huge role intersecting with policy and with health and wellbeing. Are there any other innovative, either on the service side or on the delivery side, that you see coming with the mental health, either treatment or management?

Sherry Glied:                Yeah, I think there’s a lot of potential for innovation here, particularly as adjuncts to the prescribing function. There’s lots of really interesting, again in mental health, we have psychiatrists and then we have this entire army of other providers who are not psychiatrists, which is really different from the rest of health care. We don’t have very many psychiatrists and a lot of them don’t actually treat the people who really need it because of the weirdness of mental health care, I don’t even want to go there.

Sherry Glied:                There’s been really interesting innovation in mental health. There are a lot of apps for your phone to help you regulate your depression. There are private companies selling this, but there’s also been big national efforts in different countries. There’s a Australian program called Mood Gym, which is cognitive behavioral therapy online. Apparently works very well, very effectively and it actually helps people who probably wouldn’t want to go to a doctor’s office and get psychotherapy. There’s lots of opportunities for innovation, also opportunities for mood tracking and for helping people manage their own psychiatric symptoms, because mental health conditions tend to be something that is quite cyclical, recurring. I think we really do have the opportunity to apply technologies to help people navigate their own mental health conditions.

Bill Frist:                       And at earlier stages.

Sherry Glied:                At earlier-

Bill Frist:                       -And if there are stimuli that set people off in a certain direction, clearly that can be used from a pretty simple technology standpoint. Going back from the reimbursement, because you’ve studied it, you’ve written about it, you’d speak on it. The reimbursement today versus 10 years ago versus 20 years. How do you characterize that?

Sherry Glied:                For mental health?

Bill Frist:                       Yeah, for mental health.

Sherry Glied:                Psychiatry is one of the very few areas where private payers pay less than Medicare. Very few areas in medicine where that’s true.

Bill Frist:                       That’s so interesting.

Sherry Glied:                The reason is because I think there are so many alternatives. Why do you need psychiatrists, right? You can use clinical social workers and primary care docs to dispense the medication. There’s just a lot of competition. If you think about competition bringing costs down, in some ways mental health is the poster child for this. The mental health share of GDP actually has hardly moved over time. Physical health share has been going up and up and up. The mental health share has been really flat. A lot of these new innovative efforts are not very expensive and again, another aspect of mental health, is that a lot of people get things that are analogous to mental health care They’re not mental health care from other sources. There’s a lot of alternative medicine, if you want to think about it that way, in mental health and some of these new apps and things like that fall into that bucket as well.

Sherry Glied:                I think the challenge we have in reimbursement for mental health is that the most seriously ill patients are not really wanted by anyone. We don’t have a good internal risk adjustment system for mental health to make sure that patients who have really serious problems are being seen by the most skilled providers. The most skilled providers often just don’t even want to deal with those patients. They can be well reimbursed for providing care to out of network, to high paying individuals, leaving the people who really could benefit from a very nuanced understanding of their condition without any care. The challenge in mental health is that there is no lesion. There’s no test, there’s no obvious way for an insurance company to know that this is the patient who really needs to see that top psychiatrist, not that one. Maybe we’ll get better at do- maybe we will see some innovation around that as well.

Bill Frist:                       Just going back to history and we went through, I think a lot of the history itself, but in your book you started around 1950 or right through that era. How would you characterize that, to paint that portrait for us in terms of over time, how it changed, and are there lessons that we can learn to apply to other fields?

Sherry Glied:                I think so. I think one of the really interesting things in mental health, despite my positive views about all the innovations here, is that… It’s a very disappointing thing. We haven’t really gotten any better at curing mental health problems. We are doing better at helping people to cope with their symptoms and we have some medications that help with symptoms but we haven’t actually had a breakthrough as we’ve had in some other areas where we could take a person with mental health problems and just knock that thing out of the park.

Sherry Glied:                Ordinarily when economists have looked at different health conditions and have tried to see what’s happened over time, the general consensus has been, well, we had this new technological innovation, it’s worth this enormous amount because it’s causing people to be so much better off and that’s what’s going on.

Sherry Glied:                In mental health, that’s just not true. We have not seen those kinds of breakthrough technological innovations. I sure hope we do, but so far we have not. Yet people with mental health conditions are way better off today than they would’ve been 40, 50 years ago, especially people with really serious conditions. Why is that? What have we done?

Sherry Glied:                Well, we’ve done a few things. One of them is that we’ve made drugs that don’t actually alleviate symptoms better, but are much easier to tolerate and much easier to prescribe. That’s made doctors more willing to treat people, which means that more people who have anxiety and depression are actually getting some care for that.

Bill Frist:                       Right.

Sherry Glied:                Back in the day when the only care that was available was psychotherapy, that was great if you were the lucky person with enough money and access to a psychopath psychotherapist. Most people got nothing. Primary care doctors did not treat them. They didn’t even ask them if they were depressed or anxious. Now we have a much better way of dealing with those lower level mental illnesses that are highly prevalent and disabling.

Sherry Glied:                I mean, really, they cost people a lot of impairment and we’re able to deal with them better, just because we’re doing better at the delivery of the same medication. We’ve also had this explosion of the workforce. I’m not going to get the rote number right. I may have to call back and give it to you, but I think we were looking at, around 1950, somewhere between a third and 50% of all the psychiatrists in America were operating on the island of Manhattan.

Bill Frist:                       Yeah, wow. Wow.

Sherry Glied:                There just wasn’t access to services. The inpatient facilities that existed around the country, hose were not intended to treat people. They were really asylums. They were places for people to seek, to be housed and clothed, perhaps, in the better run ones, but some of the big state hospitals. When you look at the court cases that led to deinstitutionalization, there’d be 3, 4,000 inpatients and one psychiatrist several days a week. Nobody was treating people. They were just essentially being warehoused in these places.

Bill Frist:                       That whole movement of deinstitutionalization came from where? Where did it start?

Sherry Glied:                Oh, it came from lots of different places in the sense of… Some of it was symptom control through medication, which made it possible. Some of it was legal challenges and the general movement towards giving people more rights in their own wellbeing. Some of it actually came from Medicaid. Medicaid came along in the mid 1960s and said we are not going to pay for people who were in institutions for mental disorders because that’s a state responsibility.

Sherry Glied:                If they’re not in those institutions, we’ll pay for them. There was a huge incentive for states to get people out of those facilities. The first people they got out were elderly people, senile people who were- people with senility and dementia, who were a large fraction of the people in the inpatient facilities and they put them in nursing homes, which were not classified in the same way and so could get Medicaid reimbursement. A lot of the, what we call deinstitutionalization, a lot of that was actually trans-institutionalization. Move people from one setting to another in exchange for reimbursement. Some of it was people actually being taken care of in more appropriate settings outside of the hospital. Some of it unfortunately led to more homelessness and bad things. We look at what happened to most people, and most people actually were able to live better lives later.

Sherry Glied:                Another thing that happened is that we expanded social welfare programs, not- we did Medicaid, so you didn’t have Medicaid. If you deinstitutionalize somebody, they had no access to medical care. You didn’t have any community support for them. Even more than that, until we had the SSI program, which was in the early 1970s, if you deinstitutionalized a person with a serious mental illness, maybe they’d have access to medical care, but how are they going to pay for a roof over their heads or food? The other place where that really shows up is a family that had a mentally ill child. If they didn’t get some supplemental income, they wouldn’t be able to afford to stay home and take care of the kid. They’d have to put the kid in an institution, but SSI actually allowed people to provide more care within the family.

Sherry Glied:                We see more people living at home, living with their families, able to do that because of expansions in public programs targeted at incredibly vulnerable and needy population. I think a population that we really don’t have much… I think there’s much less disagreement about the need to provide public spending and welfare benefits to people who truly are not able to function because of severe functional impairment.

Sherry Glied:                All of those expansions of programs, expansions of Medicaid and SSI and things like that, along with deinstitutionalization meant that people were able to live in the community for longer, were more likely to be getting symptom control, so overall we conclude our analysis by saying people with mental health problems are better off, but they’re not well. We still have a lot of trouble. We shouldn’t be nostalgic for the 1950s. Most people were not getting anything, and the few people who were actually being taken care of were mostly in these institutions that were really just warehousing.

Bill Frist:                       As this movement was occurring, what happened to the stigma of mental illness and how would you characterize that and how that’s changed over time?

Sherry Glied:                Mental illness is stigmatized in part because we almost characterize mental illness as the thing that is stigmatized. If you behave in a way that is weird, we say you have a mental illness. It’s almost a self fulfilling prophecy that mental illness and stigma go together in that way. We’ve seen some declines in stigma around mental illness for the conditions that we are getting better at treating.

Sherry Glied:                An important element of reducing stigma is persuading people that these are conditions that can be treated and that can be effectively treated. Around things like depression, we actually see in some surveys, declines in stigma. Those things that we are not really great at treating, like schizophrenia and bipolar disorder, we’re still seeing quite a lot of attitudes that are not healthy.

Bill Frist:                       Research in the field… We’ve sort of talked about the treatment being a lot of symptomatic treatment. This core issue of being able to cure, truly cure, not just managed mental illness. We’re not quite there yet. We’re not there yet. Is the amount of money we spend as a country in research commensurate with the problem.? I know there have to be certain trade offs as you go.

Sherry Glied:                I think one of the questions is are there promising leads that we should be pursuing that we’re not? I’m not sure about that, but I do think these problems do cause extraordinary disability and it’s often invisible, but it really diminishes people’s lives terribly. I think one of the things that we know that’s obviously a problem is suicide. We lose so many people to suicide, which has terrible repercussions for their families and their communities. If we think about prioritizing conditions based on how severe that the consequences are, mental illness is among the most disabling conditions that we see.

Bill Frist:                       Yeah. There’s so many cross currents coming through. Let me just take a couple. The addictions in relationship to opioid, is there anything that disorders share with our listeners about the uniqueness of opioid addiction and mental illness?

Sherry Glied:                Well, one of the things that we know about opioid addiction and substance use generally is that it’s often co-occurring with mental illness. One of the things that makes people, I think, susceptible is being depressed or having mental illness problems. People self-medicate using inappropriate substances and those substances in turn exacerbate people’s mental illnesses. I think one of the weaknesses of our current system is that we think a lot about the integration of mental health and primary care, and that’s obviously very important. We also really should be thinking a lot about the integration of mental health and substance use care.

Bill Frist:                       Yeah.

Sherry Glied:                Those systems have really grown up quite separately. The funding streams are often quite separate, but really people who are interacting with one of those systems, a very large fraction of them probably could benefit from interaction with the other.

Bill Frist:                       The second area that that mental illness comes up a lot is the comorbidity and presentation to emergency rooms that my friends who are running emergency rooms, in emergency rooms, treating patients there, that comorbidity is as high as 60 or 70%. Is there anything in particular that that can be done? If you take 60 or 70% away, a lot of people wouldn’t come to the emergency room. Is there anything on the forefront in terms of how hospitals are either pioneering to take care of those patients or treating them? Right now, that’s a huge number coming in that have a primary diagnosis or a secondary diagnosis of some sort of mental illness.

Sherry Glied:                This population with co-occurring mental illness and other things has been a big focus of a lot of this hotspotting initiatives that hospitals have gone after. Actually social welfare systems too, so for example, a lot of those people are cycling between homeless shelters, emergency rooms, jails, the police and incurring enormous costs across our entire social welfare system, not only in medicine but elsewhere.

Sherry Glied:                I think a lot of effort has gone into this and I don’t think that we have great models yet. I would say the one thing that’s been shown to be more effective than other things, which is not the highest praise that I can give it, but is getting people stable housing. That seems to really be helpful and maybe stable housing with some supports, some people around who can help when people are in crisis, but that’s a costly solution, a difficult one, and again, I feel like this is an area that really could benefit from more

Bill Frist:                       There’s one where there is a lot of innovation with bonds being issued and those of the Robert Wood Johnson Foundation on his board, I said has got a huge focus now on this integration of housing. Not just because as a social determinant, but specifically as it relates to the mental health names and their innovation, again, coming back to the thematic that we keep coming back to of this podcast is that innovation gives lots of opportunities to solve, ultimately really solve, some of these seemingly insurmountable problems. It’s been interesting to watch how the Robert Wood Johnson Foundation is now spending a huge amount of research and funding working with housing organizations and people who are considering alternative [inaudible 00:29:26]. How did you get interested in it, and was there a pivotal moment in your career as an economist that brought you to the mental health arena?

Sherry Glied:                Everything that’s ever happened in my career has been a complete accident.

Bill Frist:                       Yeah.

Sherry Glied:                I’m really a bad person to talk about how you get into anything. In this case what happened is, I had taken a job at Columbia, which there’s a long story behind that too, but I’d taken a job at Columbia and there were a bunch of psychiatric epidemiologists at Columbia. They had submitted a grant to the NIH, and one of the reviewers of the grant had said, “You need to talk to an economist.” I was the economist around, so they called me and I got interested in it.

Sherry Glied:                It’s such a fascinating area because it touches on so many different fields and because a lot of the questions that, you know, the things around prices and competition and people making choices and moral hazard and adverse selection, which are the big issues in health economics. Everything in health economics that’s a problem is a bigger problem in mental health. From a purely scholar point of view, a super interesting area.

Bill Frist:                       Yeah. Yeah. Some of these issues haven’t been addressed or have been addressed 50 years, 100 years later than on the physical side. If you did have a magic wand and, given where we are today, is there one thing that you would recommend or one thing you’d do or put above others in terms of addressing the issue of appropriate care and access and cost and quality and all of them in the field of mental health care?

Sherry Glied:                Well I think really encouraging a focus on the people who are most vulnerable, the people who are really the most impaired. Thinking about how we use our Medicaid programs, particularly because this is usually a pretty impaired population, to target efforts and to use evidence based practices around this population. I think to try and think about how to work the policy and innovation together, by which I mean this, we’re going to have a lot of innovation and some of it’s going to be successful and a lot of it is not going to be successful. The trick in policy is to build a policy environment in which you can try stuff and dump it if it doesn’t work. You don’t wind up wedded forever to a model that turns out not to be effective, but you’re actually receptive to new things coming along.

Bill Frist:                       I think that the way you express it is so critical because many people look at policy as something as fixed, unchangeable, doesn’t allow change. I think it as a former legislator and a policy maker, it was always a challenge to give that framework, but a framework in which people can still try things and if they don’t work, put them to the side and try things and be rewarded appropriately. That is one of the challenges, but I think it’s an optimistic view of what policy is all about.

Bill Frist:                       Well, I know we need to bring things to a close, but as you look over this 1950 up to 2000, 2008, the period of 2004 to 2008 when I was involved, and then you look over the last 11 years since then, does it lead you to be optimistic in terms of that trajectory or pessimistic or as we’ve got so much more today that you can’t say?

Sherry Glied:                Yeah. Well, there’s always more to do. The nice thing is in the old piece and the new piece, like at the 1950 to 2000, 2010 to 2018, 19 or whatever, policy’s actually been a force for good here, which is a nice thing. I mean expanding coverages has been a good thing. The ACA, people love it, people hate it, but for people with mental health conditions, it was a real blessing. Again, you’re talking about people who are typically low income and are not going to be able to find coverage on their own. The ACA actually gave them coverage. It ensured that non-group coverage includes mental health benefits. That’s important, brought benefits that parity.

Sherry Glied:                All of these things really mean that people are going to have a chance to access new services and innovations as they come along. What I learned here is when you have a really vulnerable population of people, there’s a lot of good you can do for them. You shouldn’t give up. There isn’t a magic cure for the mental health conditions that affect people, but that doesn’t mean we shouldn’t and can’t make their lives better.

Bill Frist:                       I think that’s so well said and I think that when we look at health, it used to be… An economist would do the same, but as clinicians we’d look at healthcare, how much process can we put out there? How many patients can we take care of, wanting to do the very best heart transplant and that’s important. I think in the last 10 years people recognize that true health is not just healthcare. In fact, true health and wellbeing is much, much greater than physical health and mental health obviously is a huge component of that.

Bill Frist:                       Sherry, thank you so much for being with us.

Sherry Glied:                You’re welcome.

Bill Frist:                       You’ve really hit the sweet spot in terms of that nexus between health and mental health and wellbeing with innovation and with policy. Thank you very much.

Sherry Glied:                You’re very welcome.

Bill Frist:                       Appreciate it.

Sherry Glied:                That was fun. Thank you.

Bill Frist:                       Thank you.

Bill Frist:                       This episode of A Second Opinion was produced by Todd Schlosser, the Modus Creative Group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcast or wherever you are listening right now. Be sure to rate and review A Second Opinion so we can continue to bring you great content.

Bill Frist:                       You can get more information about the show and our guest and sponsors at asecondopinionpodcast.com. That’s one word, asecondopinionpodcast.com.

Bill Frist:                       Be sure to join us for our third episode in our four-part healthcare economists series where we are joined by Harvard universities, Dr. David Cutler, who was a key advisor in the formulation of Romney Care, who advised presidential candidates on healthcare, including Barack Obama, and his beloved by his students for his outstanding mentorship.

Bill Frist:                       A Second Opinion broadcast from Nashville, Tennessee, the nation’s Silicon Valley of health services, where we engage at the intersection of policy, medicine, and innovation.