AHLA's Speaking of Health Law
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AHLA's Speaking of Health Law
Mental Health Care Is Health Care: Integrating Behavioral Health into Health Care Delivery Systems
Physical health providers, health systems, and hospitals often struggle with how to handle behavioral health issues as they arise. Anna Whites, Attorney, Anna Whites Law Office, and Matthew W. Wolfe, Shareholder, Baker Donelson Bearman Caldwell & Berkowitz PC, discuss strategies for integrating physical and mental health care. They share their respective journeys into behavioral health law, how providers can add behavioral health care to their practices, legal and compliance challenges, and the future of integrated care. Anna and Matthew spoke about this topic at AHLA’s 2025 Annual Meeting in San Diego, CA.
Watch this episode: https://www.youtube.com/watch?v=wcDbdn6mD-4
Learn more about the AHLA 2025 Annual Meeting that took place in San Diego, CA: https://www.americanhealthlaw.org/annualmeeting
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SPEAKER_02:Hello, this is Anna White. I'm an attorney in Frankfort, Kentucky, our tiny state capital, and I have a solo practice that focuses mostly on behavioral health. I'm a healthcare attorney, and I really got roped into behavioral health. I went to college to be a doctor and was very serious in my pre-med classes, and then I hit genetics, and it turns out genetics is not my forte. And so I started looking around and couldn't find what I wanted to. And I took my MCAT, this admissions test, got a terrible score, could not get into med school. And I was driving through a McDonald's, this is a story anyone who knows me knows, and crying, but a Diet Coke fixes everything. And so the car in front of me had a Scales of Justice on the license plate and lots of Long before Elle Woods, I thought, well, I can do that. How hard can law school be? And so I take in my healthcare practice that pre-med focus, that having worked in an emergency room for all four years of college, 12-hour shifts every weekend, having hung around with doctors and med students, and really my respect for the medical, nursing, counseling field, and I bring that to my law practice. And I tell my clients... What sounds really good in my head, your policies or procedures or what I tell you to do, you know, it sounds great to me, doesn't always work in practice. And so I try and remember to really honor the providers and the other attorneys who work in this space and realize we're really all in it together. So I was excited to present at the AHLA annual meeting in San Diego this year on mental health is physical health, behavioral health is physical health. It's all part of the holistic well-being of an individual. And I was the luckiest woman on earth because my co-presenter was Matt Wolfe. And Matt, tell us a little bit about yourself.
SPEAKER_01:Sure. Thank you, Anna. I didn't realize that we were going to be making a movie today. Anna White's The Prequel to Legally Blonde. So Matt Wolfe with the law firm Baker Donaldson and I manage our Raleigh office and also have the pleasure of of co-chairing Baker Donaldson's Behavioral Health Initiative. Anna and I actually got to know each other through, at the time, the Behavioral Health Task Force, now the Behavioral Health Practice Group of AHLA. And we're really excited to be a part of that movement and effort to put behavioral health on the same footing as so many of the other practice groups that are more focused on sort of traditional physical health care. In terms of why I became interested in behavioral health as part of my practice, I think it really goes back to my childhood. I'm not going to bore you with the full story, but my mom was a special education teacher. And so I worked a lot with her students on a volunteer basis and got to learn through her eyes how challenging it can be to navigate the education system for her students and how much the various systems that impact their lives, healthcare, education, social services, vocational rehab. And I had then the opportunity after I graduated college to teach and became a special education teacher myself. And through that, got to see even more clearly what happens and what the adverse consequences are when you have systems and silos that don't always work well together. So went to law school, had no idea what I was going to practice. I certainly didn't even think that health care or health law was going to be a part of my practice. But I'm glad it did. And then behavioral health sort of fell into my lap. And here I am a couple of decades later.
SPEAKER_02:So you can tell that we are both very excited about what we do and came from slightly non-traditional ways into the practice of law. And I think we see that across the healthcare attorney field. I don't know that I've ever met anyone, and maybe you kids today who are going to law school do this, but I don't know that I've ever met anyone who said, I'm going to be a healthcare lawyer when I grow up. I think we all come to it because we have a great fascination for how bodies work and how we keep the people who take care of those bodies and minds legally compliant. And as I tell my clients, out of the orange jumpsuits. That's my goal for every client. No orange jumpsuits for anybody. So... When I was younger, my mom was a hippie, and so behavioral health, mental health was really part of what we did. And she was a midwife, so she also delivered babies. But the focus was really more on spirit. And so my rebellion against that was, no, I'm going to be a surgeon. I'm going to just focus on the body. But then in law school and in practice in the early days, I really saw that there was a huge divide between mental health and behavioral health to the extent that each side almost called the others fake you know you're not you're not a real provider you're a psychiatrist or you're not really treating people you're just a surgeon you just cut and walk on and I'm glad to see over particularly the last 10 years how physical and mental health are weaving together that we finally understand that we're we're not silos there's not your body and your mind it's all one package and so So providers are now recognizing, and it's even being taught in schools, that we need both sides to work together, which suddenly, as my clients, hospitals and clinics and so providers started figuring out, really opened up the world to them as to what they could do, but also created a lot of new risks and ideas and concerns they hadn't seen before. So to me, it's important to weave the two together and to be real Thank you so much. Or here's a physical health practice, let's weave in the mental health. And so what we say pretty much works both ways, but it's important to consider the safest way to integrate mental and behavioral health with physical health. What are you seeing in your practice? How did you start putting the two together?
SPEAKER_01:Yeah, I mean, I think it was largely a product of there being a need that my clients were seeing in their communities that they serve where they were treating. And I work with providers of all different stripes and across the continuum of care. So I was working with predominantly behavioral health clients who were seeing their patients not able to access physical health care. And then I was working with sort of more traditional physician practices and hospitals and health systems that were seeing unmet behavioral health needs in their communities. And so just working to try to translate not only the two different areas clinically, but also from a compliance perspective, from an operational perspective, certainly from a reimbursement and privacy and security licensure perspective, and trying to find ways to make the two different languages speak together. And that's not always possible. And sometimes that's one of the more challenging things is to talk with a client and explain why you could do it in the physical health context, but you can't do it in the behavioral health context or vice versa.
SPEAKER_02:And so we'll get down to a little more nuts and bolts. What I'm seeing and what you're seeing as we talk providers through this, there's some good initial steps. It's great to think I am going to expand my practice to include the other area of law, but there are some very practical steps we have to go through first. And I tell people, first of all, think about what your end goal is and look around your space, not just your office or your clinic or your hospital, but your space as in who else is doing the type of work you want to add in your community. Are you adding a practice that is going to take every patient from the primary care office next to yours? That's going to make you really unpopular. Are you adding a practice that is going to have a lot of patient intensive time like primary care is often added to behavioral health clinics because that's a big need in that population. Well, if you have a one-person office for your counseling with a couch, where are you going to put the 25,000 children and parents who are coming in needing their earaches looked at? And so for me, the first thing is look at where you are, your office, your community, your provider group, and think about how that's going to work for you. What are you starting, Matt, with your folks?
SPEAKER_01:Yeah, no, I think it's the same thing. I mean, you're really looking at what the market is or where the where the gaps are in the community or communities that you're operating in. And then, you know, trying to determine if there are models or sometimes partnerships or JVs that you can work with, because the answer isn't always, let's, you know, there's a need, let's go ahead and create a de novo program or clinic or program to be able to address it. But sometimes it's, okay, there's somebody else that are does this well, but they just may not be able to do it the same scale or they may not have the same resources or access to capital to make further investments or expansion. So how can we work together to be able to address that need? And I think there can be incredible value, again, in both directions to having some humility and realizing that, okay, this is not a space that I have operated in for the past X number of years. And it may be beneficial to bring people in that have done that and that can offer that expertise. But I think that's really important. And then I think sort of understanding what your goals are as far as integration. That was something I think that you touched on already, Anna. I think sometimes because integrated care or whole person care is in vogue, or at least it has been for the past decade or so, sometimes people just do it because everyone else is doing it or they're told that's what they need to do. And, you know, I don't find those those goals to be particularly focusing and they certainly don't help you when you invariably are going to run into challenges or setbacks, whether it be with payors or staffing or with oversight bodies. And so having a clear vision of why it is that your organization is doing it, I think can help you to get through those challenging times.
SPEAKER_02:Right. And as you're looking across the playing field and think, wow, my friend who owns a lab is doing this really well. Maybe I should just work with them or partner with them. It's always good to, at that point, tell your clients, you know, Stark and anti-kickback and even ECRA in the addiction space still apply Just because you know your patients need something and somebody close to you could partner with you for it, you still have to go through those legal steps and assure yourself that you're being compliant in the way you're doing this. So often I get a very excited clinic owner, and often these are people who are somewhat new to the space. They popped up a clinic, it's working well, and they say, I'm spending a ton of money on labs and I'm spending a ton of money on billing companies. why don't I just partner with those people and tell them you send me all yours I'll send you all mine it'll be great and thus we see the classic stark and anti-kickback issue arise very innocently I may be just really lucky but in my practice I have never yet had someone come through the door who said man I want to commit some crimes for money it's always people who have a good idea and jump in without talking to an attorney to say, hey, can I do this legally? And that's also, for those of you out there looking for new clients, super good advertising. Talk to your behavioral health groups in your town. Talk to your nurse practitioner groups and sort of explain these concerns so that when they're working for someone or they themselves have these brilliant ideas, they know, wait a minute, Ms. Anna said I should talk to a lawyer first. And what are you seeing as some of the other stumbling blocks that people inadvertently run across?
SPEAKER_01:Yeah, I think there's a number of them. Certainly fraud and abuse and compliance concerns is a big one. I think not knowing who the players are in the other space. So by way of example, in some states, the entities that license mental health providers is completely different and separate apart from the sort of more traditional healthcare entities. Sometimes you have different funding systems. Sometimes you have different Medicaid managed care models, depending on what population or what services that you are providing. I know that behavioral health providers often don't think about corporate practice doctrine issues, or at least not historically thought about those. And so if you are a behavioral health practice, and you're thinking about getting into physical health care, and you're in a state where you have a robust practice of medicine doctrine in a state medical board that enforces it, you could find yourself in a very uncomfortable position really quickly having to explain to the physicians that you were seeking to employ or contract with why you may not be able to do that. I think we want these models to be sustainable. So we started talking about the need, but we also have to have funding mechanism or mechanisms to be able to to sustainably meet that need. So reimbursement is another really, really big area. And to think about in advance about not only is this a billable activity, but how can you capture the value of it? And I think there was a variety of things that we're seeing, Medicare, private insurers, Medicaid, that are attempting to encourage integrated care. But I still think that we are at the very early stages really trying to capture the value that an integrated care model can provide. What about you, Anna? Where do you sort of see the direction of integrated care if you were to stare into your
SPEAKER_02:crystal ball? I think definitely integrated care is where we're headed. I think that having providers work together across the types and specialties is definitely the way of the future. That doesn't mean jump into it and just start practicing and referring to your friends. But I know even in Kentucky and Tennessee and surrounding states, a lot of our Medicaid organizations are offering providers contracts to do per diem care or here's a set fee. Let's do not soup to nuts for a patient, but let's do everything that we expect to see in this patient's need. Let's be their medical home and here's the fee we pay you for that. A glitch that got a client just the other day was those contracts are wonderful. If you know what you can do and should do for a patient and you look at the codes with your billing team and you know you're providing these services, that's awesome. There's always a small sentence at the bottom of these integrated care contracts that says everything else is payable at one penny per service. And I had a client who did not read the small print and provided an awful lot of wonderful primary and family care that was payable at one penny a day to about 200 patients. So props to them. They did a lot of free medical and we love them for it. But it's important to move towards integrated care, thinking about how you're going to do it and how you're going to be paid. And another issue that we talked about in annual meeting is if you're in one area of care, you may not be thinking about what staff and licensure or you need for another. It's pretty easy to find a peer counselor in most states. So you can grow a behavioral health or addiction treatment practice pretty easily. In some states, it's very, very hard to find a PA or an APRN or a psychiatrist who's going to be able to offer required medical or mental health care. And so before you say, I am offering this, look around and think, is this even going to be possible for me to integrate more care into my practice. And I know you had some points to make on that as well, Matt, at annual meeting.
SPEAKER_01:Yeah, I think that, you know, we were often talking about expanding the scope of what you do. And often we're also talking about changing staffing models. So if you have sort of a traditional physician practice, right, and that's, you know, office-based care, you have, you know, clinical staff, you have your office staff, and you're not really typically managing a large swath of people. But if you decide, hey, I really want to get into community-based mental health, suddenly you may be growing your payroll tenfold. And then the way that you operate your business is very different. The kinds of headaches, the kinds of not just health law compliance concerns, but just Employment compliance concerns can very radically change overnight. So again, I think going into these kinds of models or these kinds of approaches or expansions with eyes wide open can be really helpful to avoiding headaches down the road.
SPEAKER_02:And I think as I talk about this with clients, I try and stay in touch with what the payers, particularly, you know, your big, your BCBS, but also your Medicaid payers are talking about. What kind of contracts or proposals are they sending out to clinics? And if you ask them, they'll tell you what kind of pilots they're getting into. A few years ago, one of the payers in the state was saying, we really want to look at home-based detox, home-based residential treatment. And they issued a couple pilots and they went pretty well. And then nobody heard anything for a year and people forgot about it. And suddenly they have resurfaced saying we are going to pay for detox, but it has to be home-based. So only those of you who are paying attention and have figured out how you can do that in a way that's cost-effective and also safe for the patient are going to get those contracts. So kind of staying in touch with what the fields are the different fields of medicine are doing and what the payers are doing, make it easier to see what's coming in the future. I think we all know we're going to be moving to a lot more integrated care. We're going to be moving to a lot more lump sum payments, or I guess I think we are. And I think we're also going to be really pushed to prove the value of our services and not, I know everyone says value-based care. And while there's how do you even measure that? But I think we're going to have to create providers and frameworks that providers can use to prove how is this working? Why is this the right way to go? It's no longer we're going to fund every autism treatment center in the whole state. It is which ones are moving the needle in terms of what teachers think, what parents think, what persons with autism think, who is effective, and how do we measure that? So I think that's also something I'm seeing in the future and trying to stay in touch with.
SPEAKER_01:Yeah. I mean, I think that value-based care and integrated care go hand in hand. I don't see how you do one without the other. I think that... Where I see the industry going is actually even more involved than just taking physical health and the mental health and behavioral health side and combining them under one roof or moving away from fee-for-service and more for pay-for-performance or subcapitation. I think one of the most exciting things that's happened, and I think probably one of the greatest contributors to destabilizing stigmatizing mental health care in this country and around the globe. It is still very much stigmatized, but I think one of the greatest helpful factors was the advancement in telehealth and the ability for people to be able to access mental health treatment from the privacy of their own home, frankly, wherever they had an internet connection and could do live audio video. And so we saw overnight the development of these platforms that exist that allow people to be able to access mental health care without having to call all around. Finding people that are on your insurance still challenges, obviously, with being able to get coverage for some of those platforms. But the costs have gone way down. The access, the convenience has gone way up. And so I think what that is likely going to lead to is we're going to continue to see more and more of telehealth. But I think even beyond that, you're going to see more digital health, right? We now have with our wearables and our phones and all the various apps, we have an incredible treasure trove of data that providers can use on the physical health and the mental health side, and that, you know, that the patient or client can use to be able to self-direct their care. So I think we're at a really exciting crossroads for behavioral health, for physical health, for healthcare more broadly, and for valuation care. It's just that we still have a lot of old models. We have a lot of sort of outdated legal structures and regulatory overlays that are going to complicate how we take some of these opportunities and technology and advancements and we get to this bright future. So it's going to be fun to be on the sidelines and maybe sometimes even in the arena trying to help guide providers And
SPEAKER_02:I think the consumers, the clients or patients are probably a little more advanced than we are in the legal field because we see even Amazon, but we see lots of private businesses. And every time you turn on your TV, if you're watching the ads, companies advertising, hey, you can get this kind of care. Just come and type in your name and number and your symptoms. We can treat you. You don't have to see anyone. So it's digital. It's telehealth, but it's digital. given the patients the expectation. And as a patient myself, I think I deserve to be able to get my earache treated or my strep throat treated or my other issues treated immediately. I shouldn't have to wait two weeks till my doctor has an opening. But I think the patients are driving what is happening and providers are sort of scrambling to keep up. And that's why it's very important as a lawyer to tell all your clients, no matter how big or small, all the time, don't jump before you make sure we've looked to see if there are sharks in the water you're jumping into. Because in healthcare, there's always going to be a shark. And this is particularly so with people who come from the business world to the healthcare space, because what makes sense in business, if you're marketing your gas station or your boutique, it's very different than marketing your family care practice. And so there are things that we would do and do in the marketing space that even lawyers can do, but a healthcare provider cannot. And so it's this push-pull, the tension between the patients who want the newest and the greatest and the shiniest, and most importantly, the most convenient, and the providers who want to keep up and still make a living, and ultimately also want to do what's best for the patients. And so integrating is wonderful, but also exposes you to new risks. If you are only used to one aspect of care, you may not even be looking out for the things that impact patients. If you're a physical health provider and you've never really thought about, you know, you're a dermatologist and you've never thought about what goes on in the mind, it may really stress you to get your first suicidal patient. And so people need to also think about not, I want to expand, this is what my patients want, this is a good revenue stream, but is this a field I have any any knowledge of or actual interest in. You can't these days practice healthcare just for the money because it is so hard to provide the services correctly, build them correctly, be licensed correctly, and get paid for what you do. It is not a field for the faint at heart. But it's certainly not a field that's going away and with as quickly as things are changing. I think I'm going to be doing this till I die, Matt. My goal is to be a have the judges say to my grandchildren, you've got to keep grandma out of the courtroom no more. I love it. It's just fascinating to me.
SPEAKER_01:Well, Anna, I'm going to try to retire early. So I'll be cheering from the sidelines as you're continuing to practice. Now, as always, Anna, it's really a pleasure to connect with you. And I know that we probably need to wrap up. I know we probably could talk for hours about this, but any sort of closing thoughts or comments before we bid our audience adieu?
SPEAKER_02:I want to encourage anyone, any attorney in the healthcare space to really sit down and think about are they telling their clients what is out there, what is coming, integrated care, value-based, weaving together physical and mental health. Don't get so used to doing what you do that you don't think of these exciting new opportunities for your clients. And for attorneys who are brave enough to listen to us and not be in the health care space, Some of my most successful behavioral health practice owners owned gas stations just a short time ago or even still do. One of my favorite clients had a minute mart in a very sketchy part of his town and he bought up all the distressed properties around him, made them sober living homes and then thought, well, my people can't even, the residents can't get jobs. So he started hiring them and the residents can't get care. And so he bought a clinic and installed some counselors and now everyone in the neighborhood has access to care a safe place to live and a job so if you're not in the healthcare space now encourage your clients to think about should they diversify into healthcare and big plug for behavioral health particularly into behavioral health I think it's changing so fast and I'm loving seeing what's happening so stay excited about what you do and really think about are there new things that you and your clients could be doing.
SPEAKER_01:I would echo all of that advice. And the only thing I would add is that if you are a practitioner or provider that is listening to this podcast episode, I would sort of end where I began talking about humility and trying to learn more about the fields that maybe you did not have as much exposure to in med school or grad school or whatever your formal training was. Attend conferences, be curious, network or engage with people in your community so that you can better understand what they do and how they do it. And those are oftentimes the best ways to find opportunities to move towards an integrated care approach. So with that, Anna, hopefully we will see each other before then. But if not, I look forward to seeing you at next year's annual meeting in New York City, the Big Apple.
SPEAKER_02:Oh, cannot wait. Very exciting. Thank you so much for spending time talking to me. And thank you, Jillette, for the opportunity.
SPEAKER_00:If you enjoyed this episode, be sure to subscribe to AHLA's Speaking of Health Law wherever you get your podcasts. For more information about AHLA and the educational resources available to the health law community, visit AmericanHealthLaw.org. And stay updated on breaking healthcare industry news from the major media outlets with AHLA's Health Law Daily Podcast, exclusively for AHLA Comprehensive members. To subscribe and add this private podcast feed to your podcast app, go to AmericanHealthLaw.org slash Daily Podcast.
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