Together We Will Overcome Addiction

0:00:23 William Moyers
Hello and welcome again to Let's Talk, an award-winning series of podcasts produced and brought to you by the Hazelden Betty Ford Foundation. Each podcast focuses on an issue that matters to us and an issue that we know matters to you. From prevention and research to treatment, recovery management, and all things in between. I'm your host, William Moyers, and joining us today is the President and CEO of Hazelden Betty Ford, Mark Mishek. Welcome, Mark.

0:00:49 Mark Mishek
Thank you, William. I'm glad to be here.

0:00:50 William Moyers
Glad that you're with us again today, too. We've done podcasts with you in the past—

0:00:54 Mark Mishek
We have. Right.

0:00:54 William Moyers
—And here we are, it's another year. We wanna talk today about leadership, treatment trends, and advocacy.

0:01:02 Mark Mishek
Great.

0:01:02 William Moyers
You've now been with us for 12 years. Hard to believe.

0:01:05 Mark Mishek
I know. It—times goes quickly when you're having fun.

0:01:08 William Moyers
[laughs] Yeah. And we've had a lot of fun.

0:01:09 Mark Mishek
We have.

0:01:10 William Moyers
And it's been a remarkable time of growth for the organization.

0:01:12 Mark Mishek
It has.

0:01:12 William Moyers
What do you look back on this past 12 years—what do you see as one of the signature moments in Hazelden Betty Ford's history?

0:01:21 Mark Mishek
I think the biggest moment we have had over the last 12 years is our decision and then our ability to move from a high-end, self-pay model to being fully available to everyone across the country who has health insurance. We now participate in all the major health plans around the country. We are available to everyone to come to the Betty Ford Center, to Center City, to wherever they need care, at whatever level. And that's been a major change for the organization.

0:01:53 William Moyers
And why is that so important, that access issue?

0:01:56 Mark Mishek
Well, as you well know William, only 1 out of 10 people get the help they need that have a substance use disorder. So removing barriers to treatment is really important. And finances is a huge barrier to treatment. So, if people can access their health insurance for substance use disorders as they can for getting their gall bladder out or going to their primary care doctor, that's a big deal.

0:02:17 William Moyers
And how have we as an organization had to learn to adapt to the utilization of insurance? We have had to deliver our treatment in a different sort of way.

0:02:28 Mark Mishek
You know, I think the number one thing that's made us successful in this journey is one of attitude and approach. We don't view third-party payers, insurance companies, self-insured employers, as evil, as out to cut benefits—we view 'em as our partners. And we work with them to understand how to get their members well or how to get their employees well. And get 'em to the right level of care. Do we get less money than we did when we were self-pay? Sure we do. But can we still have a margin and still fulfill our mission? Absolutely we can. So that—that—

0:03:05 William Moyers
Yeah.

0:03:05 Mark Mishek
Having that attitude of partnership with our payers has made all the difference in the world.

0:03:10 William Moyers
Of course another area that has unfolded under your leadership was the actual merger with the Betty Ford Center—

0:03:16 Mark Mishek
Right.

0:03:17 William Moyers
Here in Rancho Mirage, California where we're recording this podcast. What did that mean to the industry in general and what did that mean to Hazelden to be able to come together with the Betty Ford Center?

0:03:27 Mark Mishek
Well we had three objectives when we merged. And this was six years ago. One was to serve more people. The second one was really to have the size and scale to participate in national health care. And the third was to be the leader.

0:03:41 William Moyers
Mmm.

0:03:42 Mark Mishek
And I have to say for all three of those, what my expectations were at the time have been far exceeded—

0:03:48 William Moyers
Huh.

0:03:48 Mark Mishek
—In terms of the benefits of what the merger has brought for the organization and for all the people we serve, we are serving so many more people today because we have a national system of care than we were before. Either as Betty Ford or as the Hazelden organization. We are so much more of a national leader today because of the size and scale we have and the fact that we're in so many communities around the country. And, you know what? We were able to weather what every health care organization has to weather and that's installing a new electronic health record—

0:04:17 William Moyers
Yes.

0:04:18 Mark Mishek
—Which has been our electronic backbone of this organization and make it through to the other side in a healthy financial, fiscally responsible way.

0:04:26 William Moyers
And of course the merger with the Betty Ford Center also enhanced the mission that Hazelden had because in that merger came the Children's Program, SIMS, and other dynamics that we didn't have on the Hazelden side.

0:04:39 Mark Mishek
No the Hazelden side had its strengths, the Betty Ford side had its strengths. We looked at it at the time and it may have sounded like rhetoric, you know, that we had things that we could complement, but that actually has been the case. And those two examples are really good examples of that.

0:04:56 William Moyers
Just sitting here talking to you it occurs to me how much has occurred under your leadership of course, parity with insurance and the utilization of insurance that our patients now can have. The merger. I think about the fact that you've been the President and CEO during this national epidemic with opioids. Talk to us a little bit about how the opioid epidemic has affected our organization and our mission.

0:05:20 Mark Mishek
Sure. Let me back up those 'cause you skipped over something I think is pretty important. And that is the parity law. The parity law passed just before I came to this organization.

0:05:30 William Moyers
Yes.

0:05:31 Mark Mishek
And the Affordable Care Act then passed shortly thereafter. [Moyers nods.] Those two laws, for the first time in decades, injected more money into the system.

0:05:39 William Moyers
Mmm-hmm.

0:05:42 Mark Mishek
Put more money into treatment. And that's a good thing. The problem is is that it also allowed unscrupulous operators to come in—

0:05:51 William Moyers
Yes.

0:05:52 Mark Mishek
—And take advantage of some of the things that were created to help more people get treatment.

0:05:54 William Moyers
Great point. [nods]

0:05:55 Mark Mishek
That's had a huge effect on our field. There's no question about it. Parity is specifically at the time we talked about the fact that it was gonna take years to enforce that law, that health plans may resist it at first, maybe not understand it—

0:06:09 William Moyers
Mmm-hmm.

0:06:09 Mark Mishek
And that has turned out to be the case. But I'd say here we are, 11, 12 years after Parity was passed, and we're in a pretty good place as a—as a country in terms of the large, sophisticated plans—

0:06:21 William Moyers
Mmm-hmm.

0:06:21 Mark Mishek
—Understanding what Parity is and making sure that they're enforcing it appropriately. The problem is is that these unscrupulous operators found a way to really what I call milk the parity law. By taking out of network benefits that now health plans had to offer for substance use disorders—

0:06:35 William Moyers
Mmm-hmm.

0:06:36 Mark Mishek
—As they offer it for Med Surge. And take that and just create this whole industry. This whole industry of treatment centers that rely upon out of network benefits. And maximizing those versus the care and treatment of the patient as their primary focus as an organization. And that has led to unscrupulous operators, it's going to lead and I'm not gonna talk about the future right now—

0:06:59 William Moyers
Mmm-hmm.

0:06:59 Mark Mishek
—But it's going to lead to I think bankruptcies and I think a real shaking out of the industry. Now let's go to the opioid crisis. It's had a huge effect on our organization. It required us to step back and evaluate what we considered the best clinical model in the world and we found out well, it wasn't working so well when it came to our opioid use disorder patients—

0:07:19 William Moyers
Right.

0:07:20 Mark Mishek
—It simply wasn't. And so it really required the organization to look at itself, to evaluate how we were doing, and really make the changes necessary both in the culture of the organization and our systems to be able to treat this type of patient. And we're getting there. We're not there yet, we're still learning as we go forward about how to best deliver treatment for opioid use disorder patients on an outpatient basis. 'Cause it's not easy to do.

0:07:46 William Moyers
And of course, some of the critics out there, some of whom have thrown darts at us and said well you're—you're getting away from that abstinence-based Twelve Steps that have been so integral to recovery and integral to the first 70 years of Hazelden Betty Ford's existence. What's your response to that?

0:08:04 Mark Mishek
Well we're an abstinence-based organization and we'll continue to be one. It really gets down to this and it gets down to one specific medication that maybe ten percent of our patients use—

0:08:13 William Moyers
Right.

0:08:14 Mark Mishek
—And that's Buprenorphine which is—which is an opioid in terms of its molecular and chemical structure. And it is an FDA-approved medication that we are using for its intended purpose and that's to reduce craving. And we are saving lives by using Suboxone is the trade name for it.

0:08:33 William Moyers
Right.

0:08:33 Mark Mishek
We are saving lives because when you have an alcohol use disorder and you relapse, typically, I mean bad things can happen but typically you've got a really bad hangover and you're really remorseful.

0:08:44 William Moyers
Yes. [nods]

0:08:45 Mark Mishek
When you are an opioid use disorder, opioid addict, and you relapse, there's a good chance you're gonna die.

0:08:51 William Moyers
Right.

0:08:51 Mark Mishek
Because you don't know what you're taking, you don't know what the dose is, it's now being cut with Fentanyl or Carfentanyl—

0:08:56 William Moyers
Mmm-hmm.

0:08:57 Mark Mishek
—You don't know what's in it. And so, it is critically important to keep people alive. While they're with us and Suboxone helps us do that

0:09:05 William Moyers
Talk a little bit about the partnerships and the collaborations that have really proliferated particularly during your tenure. Whether it's with the Mayo Clinic and the study that we're doing we have a podcast with Dr. Seppala talking about that. Whether it's the patient care network, some of these other endeavors that require us to partner and collaborate with others out in the field.

0:09:28 Mark Mishek
Sure. We can't do it alone. We are a national organization but there's so many people we don't reach. Millions and millions of people we don't reach. And to be as effective as we can be, we have to have these partnerships. But they can't just be any partnership, we have to affiliate with other organizations that are approaching substance use disorder as a disease, that are comfortable using the FDA-approved medications as part of their treatment arsenal—

0:09:54 William Moyers
Mmm-hmm.

0:09:55 Mark Mishek
Their armamentarium, what they're gonna be using here. And so our patient care network does that. It sorts out the people, the organizations that understand what we're trying to do, have a really robust modern clinical model and then we affiliate with 'em so we can refer our patients to Peoria, refer our patients to Columbus, Ohio, wherever they may be going back to home and know that there's an excellent treatment provider in that community. That's what we're trying to do.

0:10:20 William Moyers
I wanna go back for a second and talk more about reforms in our field actually. Because we—I did get a little bit ahead of myself, but Hazelden Betty Ford has been at the forefront of these reforms. You've testified in Congress, we have our advocacy in policy efforts under Nick Motu, driving health reforms in our field. Why is that important? Why is it important that Hazelden Betty Ford be a leader when it comes to reforms and standards?

0:10:51 Mark Mishek
Well, it's really important because there's not a lot of leadership in our field. We've got a really now well-organized, much better national professional association in the National Association of Addiction Treatment Providers—

0:11:02 William Moyers
Mmm-hmm. Yes.

0:11:04 Mark Mishek
NAATP. Great organization under great leadership. With them and us, and perhaps a few others, we can provide the leadership that's needed. But, it's a field that does not have a lot of size and scale to it and someone has to step up to the plate and take the leadership. And it needs to be us. We say in our strategic plan if not us, who?

0:11:23 William Moyers
Right.

0:11:24 Mark Mishek
And this is a perfect example—if not us, who?

0:11:25 William Moyers
Yeah. Yeah. If not us, who? I wanna end in just a minute here with a topic that we know in our personal journeys, but one that we know our patients have experienced. And one that we know has been a cornerstone of our mission for so long. And that's attacking the stigma. We know the stigma of addiction in our own lives, we know the stigma in our patients, we know the stigma that's out there. Talk a little bit about what you've seen positively or negatively, if you will, during the course of your tenure since 2008 when it comes to stigma.

0:11:59 Mark Mishek
Well it's an interesting journey. When you work in the field like we do, you're surrounded by people who understand stigma and you don't on a day-to-day basis because of who we're working with see the stigma. But when you run up—run into it—out in the big world, it smacks you right in the face—

0:12:16 William Moyers
[chuckles] Yeah.

0:12:15 Mark Mishek
Like wow, there it is! And it's still there. We had a landlord at one of our sites who basically kicked us out of the building 'cause he believed we were the ones, our patients, were the ones that were defacing bathrooms on another floor far away from where we were. And of course they weren't our patients. But the stigma there was that we were apparently bussing in convicts who were IV heroin users, I mean it went on and on. And so stigma's alive and well out there. And the efforts that we have to do—we have to continue to find those people in recovery who are comfortable talking about the disease, who are out working, paying taxes, in the communities, and talking about—I respect people's anonymity—

0:12:55 William Moyers
Mmm-hmm.

0:12:56 Mark Mishek
—It's up to them to decide whether they wanna do it. If somebody's ready to talk about their journey, we need to help them and promote them and get it out there so that others can get hope.

0:13:06 William Moyers
Mark Mishek, I know it takes a team and we've got a huge team here at Hazelden Betty Ford but it also takes a leader and you've been an extraordinary leader for us now for 12 years. And we are glad that you're leading us and we're glad that you've taken time out of your busy schedule to be here for another one of our podcasts. Thank you, Mark Mishek.

0:13:21 Mark Mishek
Yeah. Thank you, William.

0:13:22 William Moyers
[turns to camera]And thanks to all of you for tuning in to another edition of Let's Talk. The series of podcasts that covers all the issues that Mark and I have just talked about. We hope that you will tune in again for another edition of Let's Talk. Thank you.