Whole Person Care by Array Architects

Whole Person Care By Neil Carpenter, Jillian Barbaro, Isabelle Moratti, Alexandra Laramee

INTRODUCTION Array wanted to break out of the incremental nature of most health care evolution white papers and focus on long term trends that might not be felt strongly for a decade or more. Just as a major pandemic was eminently predictable but rarely addressed because it was never a likely near-term event—so are the structural forces we describe in our papers. We interviewed 16 leading healthcare executives across the industry, including representatives from the provider side, payor organizations, technology innovators, and academia and asked them to visualize health care delivery in 2040. The study documents and expands upon the perspectives of these leading thinkers and the four major trends that emerged from these interviews. Each installment unpacks one of the four trends: • Deterioration of trust: following the societal trend, patients will no longer simply listen to what the provider says. As the care delivery process becomes more participative, what are the implications? • Segmentation of healthcare: the big sort is coming to healthcare practices and different demographics will demand different focuses. • Whole person care: an integrated vision of health will mean a much broader definition of physical and mental wellbeing, with less traditional providers and methods of care. • Evolution of healthcare settings and employment: a major shift in how health care dollars are spent coming. Discover how care settings and the workforce will be the key drivers. Not only do we provide research behind why we believe healthcare is heading this way, but we also provide implications for how different players within the industry can prepare themselves to be successful for what is to come. New installments of the study will be issued every week. The first follows. To contact the authors with questions, comments or strategic planning support, see p 11 for their information or contact us. This paper will be a four-part series with a new emergent trend to be released each week.

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INTERVIEWEES Shahid Shah Co-Founder of Citrus Health (technology at home), Founder of Netspective Communications (technology strategy & sale), Health Sciences & Technology Advisor at Larta Institute.

Rasu Shrestha, MD, MBA Chief Strategy & Transformation Officer, Atrium Health

Robert Kramer Marcy Carty, MD, MPH EVP of Strategy at Ready Responders

Paul Keckley The Keckley Group, Healthcare Industry Research and Policy Analysis

Trenor Williams, MD

Founder and Fellow at Nexus Insights; Co-Founder and Strategic Advisor National Investment Center for Seniors Housing & Care

Sara Vaezy Chief of Digital and Growth Strategy at Providence Health, Health Evolution Forum Fellow

Dan Durand, MD

CEO & Co-Founder Socially Determined

Chief Clinical Officer & Chair of Radiology at LifeBridge Health

Tom Cassels

Braden Lambros

President at Rock Health

Executive Vice President at Olive

Michael Tangrea, Ph.D. Endowed Professor in Biology, Former Scientific Director of Innovation & Research

Sunny Ramchandani, MD President and CEO, Stream Health Group, Former Payor Executive

Peter O’Neill

Susan Mani, MD

Executive Director of Cleveland Clinic Innovations & Innovation Consultant

Payor Executive, Former Chief of Population Health at LifeBridge Health

Mark F Victor, MD

Alan Pitt, MD

CEO, Cardiology Consultants of Philadelphia

Neuroradiologist with Dignity Health and Co-Founder of Vitalchat Telehealth

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Whole person care will not only change how health care is delivered, but how it is defined. Based on interviews and research, whole person care will be defined using two overlapping venns: holistic health and personalization of care. In other words, whole person care is not just about mental health, nontraditional, or overlooked health care issues but also recognition that every person is an N of 1. While voice has been given to the clinical application of an N of 1 in the form of patient-centered care and the beginning of genetic discovery, today’s healthcare model is still “episodic” with doctors’ culture and the organization’s business dominating the conversation over patients’ unique needs. The future, however, calls for the transformation of healthcare into a model that is much broader and “ubiquitous” while being deeply personal to the patient. As put by one panel member, “Health is more than diagnosis and the doctor’s office.” This clinical shift will be supported by the movement towards an N of 1 culturally as discussed in the segmentation section. For example, data taken from “Google Books” reported that the use of “I”, “me”, and “mine” had increased and the use of pronouns such as “we” and “us” decreased.i Today, most media consumption is customized (i.e., Facebook, Spotify, Netflix) and the average American spends two hours on highly customized social media each day.ii People prefer the platforms that provide personal experiences and respond to them—or at least appear to respond to them—as an individual rather than mass generated answers. An Adweek/IBM Watson Advertising report found that 44% of U.S. internet users would leave a brand that did not personalize content These preferences will have implications for healthcare providers ranging from understanding a patient by integrating their health and non-health records to personalized communication plans to reach him/her/they. The idea of the N of 1 implies that cultural shifts will prompt clinical changes which will demand a new type of provider who will deliver care for the whole person. For a health care system based on long cycles of research on physical and measurable traits and protocols for care, this will be a difficult pivot.

Rise of China and Alternative Medicine The recognition of the N of 1 will call for more customized ways to treat the whole person, including increased offerings of nontraditional health care remedies like acupuncture. In 2018, there were about 38,000 licensed acupuncturistsiii, about eight times the number of cardiac surgeons in the US.iv While the latter get more visibility the former clearly have the raw numbers. Over the past 20 years, the research of acupuncture as a medical treatment has been growing at twice the rate of the research into biomedicine.v This trend demonstrates the energy around testing new approaches. The growing insurance coverage for acupuncture, chiropractic, massage, and naturopathy demonstrate the market is demanding it. We see China’s growing global role impacting medical delivery around the world. Much like American power helped export American movies and blue jeans, it is likely that Chinese soft power will help promote eastern medicine. Eastern medicine, more specifically Traditional Chinese Medicine (TCM), dates back almost 3,000 years making it the oldest system of medicine in the world. Practitioners of TCM use a variety of herbal medicines, acupuncture, and physical exercise (Yoga, Tai Chi, Qigong) to focus on energy flow throughout the body. As of 2020, there were approximately 4,000 hospitals

Distribution of Utilization of Traditional Medicine

and 40,000 clinics in China that treat patients using TCM. In an effort to increase participation in TCM, the Chinese government implemented a new law in July of 2020 that gives TCM practitioners an opportunity to qualify as licensed physicians. China’s government is promoting this spread of TCM since it is believed to have economic benefits due to the significantly lower cost than Western medicine. Nearby Australia has over 5,000 medical clinics that practice TCM and hold a very progressive approach in implementing it into their medical education as well. Currently, 183 countries and regions in the world practice Traditional Chinese Medicine.vi Some of these countries and regions have established laws around TCM and others Segmentation: The Coming Healthcare Divide | PAGE 4

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Growth of DOs in the US, 1990—2019

have incorporated some of TCM’s practices, namely acupuncture, as part of the medical insurance system. In the United States, Johns Hopkins Hospital (Baltimore, MD) has created a department to specifically focus on alternative medicine including TCM. The growing cultural acceptance of traditional medicine and the broader view of treating the whole person will shift the relative balance of influence within the medical community as well. As of 2016, the U.S. had almost 130,000 medical students of Osteopathic Medicine and the number of DO’s was almost 65% more than a decade before.vii Additionally, one in four medical students are choosing to attend osteopathic medical school, which is representative of the growing influence of holistic medicine in the United States. With younger generations being the driving force in the cultural influence of Eastern medicine within the healthcare system, it is significant that almost 70% of the DOs practicing in the United States are younger than 45.viii This signals that going forward, the influence of Eastern medicine will only continue to grow, led by this next generation of practitioners.

Personalized Care (Genetics)/ Precision Medicine For all practical purposes, we are an N of 1 genetically. Right now, the big

Applying Cross Percentages to the Population

research findings for genetics apply to small percentages of the population: APOE4 already Alzheimer risk—2%, BRACA—0.25 %, ALS gene A—0.00002%. This is true of phenotype combinations as well as genetic ones. One study calculated there were 270 million unique combinations of symptoms that meet DSM-5 criteria for PTSD and major depressive disorder.ix As we learn more about genetics and gain new phenotype data, even narrower slices of findings will emerge, and once cross percentages are applied to population sets, e.g., the 2% of the .1% of the .05%, you can get very close to an N of 1 for any patient you ever treat. The body of knowledge around genomics and precision medicine more broadly will grow rapidly as both their markets are expected to explode. Currently, the global genomics market size is valued at $20 billion USD and is expected to increase at a compound annual growth rate (CAGR) of 15% from 2021 to 2028.x Market Research Future reported that the Precision Medicine Market in the United States is going to be valued at $126 billion USD by 2025 with a CAGR of 13%.xi The US government has helped facilitate this growth. In 2015, President Obama launched The Precision Medicine Initiative (PMI) to accelerate understanding of people’s individual variability and the effect that it has on disease onset, progression, treatment, and prevention. The amount proposed was $215 million with $130 million going to PMI research. The idea is to promote both long-term and short-term goals with study and research on individual’s genetic makeup, environment, and lifestyle.xii For example, this type of research could lead to a more personal understanding of what approach is best to prevent a disease or what medication responds best to a person’s genetic makeup. In 2018, $28.6 million from All of Us Research program—a historic effort by the NIH to study millions of people to advance precision medicine—funded three genome centers around the country.xiii Where the US invests millions, China often invests billions. Synthetic biology or personalized medicine was one of China’s 2025 targeted industries (though it got less press than its push into AI or EVs). Part of China’s 2025 initiatives included making biotechnology 4% of their GDP (about 15 trillion dollars) by 2020.xiv Part of this biotechnology was launched through $20.9 billion dollars into military technology. Foreign investors have shown increased interest in Chinese biotechnology which has led to $8 billion dollars in funding in 2020xv and, like other forms of FDI in China, is expected to strongly increase in the coming years.

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Explosion of Behavioral Health While genetics reveals more about each of us physically, COVID has revealed and exacerbated the prevalence of behavioral health issues in the United States. Even before the pandemic, it was estimated that 20% of the entire U.S. population suffered from a mental health or substance use condition.xvi In the initial months of the pandemic the number of individuals reporting negative mental health status jumped from 32% to 53%.xvii Since the mental impacts of traumatic events last far longer than physical impacts, the U.S. could see anywhere from 66 to 108 million Americans suffering from a behavioral health issue for years to come. By 2040, the U.S. population will reach 380 million. Without any change, this would mean that 76 million individuals could suffer from a behavioral health condition. Since today only 40% (26 million) of people receive treatment for their conditionxviii, the United States would have to triple the amount of mental health services provided to treat every person. The demand for these services has been growing for some time due to population growth, cultural shifts, and increasing coverage by insurance companies (especially after the U.S. Mental Health Parity and Addiction Equity Act went into full effect in 2014). However, the effects of the COVID-19 pandemic may catapult this growth to levels previously unseen. While demand rises, supply has not been able to keep pace. 22% of all adults with a mental illness reported that they were not able to receive the treatment they needed—a number that has not declined since 2011.xix All categories of mental health providers, from social workers to psychiatrists are expected to have shortages by 2025 according to SAMHSA.xx Digital health solutions are beginning to address some of the issues and

Mental Health Workforce Availability

disparities in mental health delivery. For example, the rapid adoption of tele-mental health has helped to ameliorate the mental health professional shortage discrepancy between regions. However, since incentives aren’t aligned to increase the supply of mental health providers (i.e., psychiatry is the lowest paid of any medical specialty), behavioral health models of the future will need to incorporate ever more innovative methods, like taking advantage of AI and other technologies. One of our panelists highlighted the option of making the first four sessions of one’s therapy journey automated. After these sessions, therapy becomes a form of self-care, so if we can streamline the process into quick diagnosis/discussion/help then more and more people can utilize these technologies for their mental health needs. There is evidence to support that both patients and practitioners are already open to these models. A recent survey from Workplace Intelligence and Oracle reported that 82% of all those who were surveyed picked an AI robot over humans to talk to about their mental health since these robots had 24-7 accessibility and no perceived ability to judge the individual (as compared to mental health professionals). For multiple years now, robots have been used in psychology and psychiatry to treat a wide range of mental health states, such as socially assistive robots who help children with autism spectrum disorder,xxi robots powered by AI that provide companionship for the elderly, and voice-activated robots that provide cognitive behavioral therapy and relay data to medical professionals.xxii These technologies and others are already being used to help with the mental health epidemic left in the wake of the COVID-19 pandemic. In the future, the strongest behavioral health practices will leverage these innovative models of clinical automation to serve more patients and create better economics.

Where’s the baseline data for behavioral or whole health? As of today, the phrase “garbage in... garbage out” applies to some big data analysis because we haven’t started with the right inputs to paraphrase one panelist. One thought leader in the health-tech space suggested we will need a whole new starting point on health data in many areas. In particular, mental health has few areas of baseline data to compare patients’ current behaviors with (i.e., is the patient fidgeting more? Sleeping less? Less socially engaged?). This data is not hard to capture and is sometimes already available on other platforms (e.g. FITBIT, Facebook, phone, etc.). However, it is almost completely absent in today’s billing focused medical records. Moreover, as one panelist noted, “All chronic disease management is mental health management,” you can see how interconnected and robust the data set will need to be over time to treat the whole person.

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In the future, the EMR will need to have additional information related to a person’s social determinants of health to make risk predictions more accurately. This may mean incorporating personal financial data (like Mission Health Partners and Lumeris are already doing) or patient information like transportation or housing status.xxiii The medical record will also need to expand to include not just physical health baselines, but mental health baselines. Some options to include may be depression screens (PHQ-9), anxiety screens (GAD-7), adverse childhood experiences baseline (ACE), a trauma screen, and loneliness or social isolation scores.xxiv These last two ailments have long been known to be highly correlated with negative health impacts but have traditionally been associated with the elderly. However, the digital age has caused feelings of isolation and loneliness to impact all age-groups with surprising frequency—60% of college students say that they have felt lonely in the past yearxxv—making this a relevant item to track across the age spectrum. By including multiple levels of mental health baselines, the EMR may also help surface mental health intersectionality, allowing providers to better see the layers of issues that their patient may be facing. Finally, information on how a patient interacts with the medical system should be included to help inform treatment plans. For example, including a measure of a patient’s health literacy can cue a provider to how they need to present treatment plans (i.e., written instructions, pictographs, follow up from front-office staff, etc.). Likewise, medication compliance can be tracked using claims data that feeds into the EMRxxvi which may then indicate to a provider treating a patient with high cholesterol that a biannual intramuscular injection, like inclisiran, may be a more effective treatment than a daily oral medication.xxvii There will be tough privacy issues associated with aggregating and integrating all this information, but both patients and payors will want to use the data to improve outcomes.

Physician Education – AI and EQ As one health care leader interviewed pointed out, “The medical education system is broken.” The WHO reported that nonadherence in the physician patient relationship is a cause for 50% of treatment failures, 125,000 deaths, and up to 25% of hospitalizations per year in the U.S. The panelist noted even provider language around patients is disheartening and destructive “noncompliance, “orders”. Nothing cries out more for evolution than provider—patient communication given this immense problem. Recently there has been a large push to change the curriculum of medical education to increase the effectiveness of the workplace and keep up with the changing healthcare world. As a result, medical schools are beginning to look different than before. The Zucker School of Medicine at Hofstra (now Northwell) was established in 2008 and led several initiatives for changing the medical education system, establishing their new curriculum as “emphasizing early clinical experiences, self-directed learning, and a case-based curriculum” in order to increase effectiveness. Additionally, their curriculum emphasizes a team-based approach, focuses on training in patient care, and the ability to problem-solve.xxviii In 2011, The American Medical Association donated $1 million to 11 different schools to modernize their programs with the larger health system in mind. In 2018, Wake Forest University made public their own curriculum changes. Students will go through 18 months of basic sciences and clinical studies before the normal clinical curriculum. Additionally, they are integrating more methods to develop professionalism, problem solving, and active learning skills.xxix With Wake Forest’s integration with Atrium health, more evolutionary changes are anticipated. However, these changes are slow compared to the dramatic nature of the problem. Another panelist expressed great hope that the AI revolution will speed up the evolution of who goes to medical school, how they are trained and how they progress in their career. The panelist noted that MCAT’s are all about memorization and that AI can drive a lot of rules-based analysis for providers in the future, so their “role as communicators” will be much greater. As a result, the selection focus should shift from predominantly analytics in the cognitive specialties to “Emotional Intelligence”. Several studies have documented the correlation

Average Physician’s Score on EQ-I 2.0 Scale

between physician emotional intelligence and patient’s

(according to Assessment of Emotional Intelligence in Pediatric and

clinical outcomes. For example, one study conducted at

Med-Peds Residents)

Jefferson Medical College found that of 29 physicians

Average Physician

treating patients with diabetes, those with the highest empathy scores also had the best patient outcomes, as measured by levels of hemoglobin in the blood. xxx

Despite this well-researched concept, physicians in

general barely score higher than the average person on emotional intelligencexxxi, and their emotional intelligence is jeopardized throughout their education and career. The demands of medical training—from Segmentation: The Coming Healthcare Divide | PAGE 7

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long hours and high-performance expectations to limited social support networks—have been shown to erode the trainee’s emotional intelligencexxxii. In one study, empathy scores dropped by around 5 points during medical training alone.xxxiii The decrements in medical students’ emotional intelligence may be partially attributable to burnout, which is experienced by 4571% of medical students.xxxiv Unfortunately, this trend continues into the physician’s career, where the overall rate of burnout is 42% among all medical specialties.xxxv With one of the three key components of burnout being depersonalization, or the “replacement of empathy with cynicism, negativity, and feeling emotionally numb”xxxvi, EQ continues to drop (ironically, lower EQ scores also make physicians more susceptible to burnout). While aspiring physicians may start with decent emotional intelligence, the demands of the profession—both in training and in practice—drop these scores. Fortunately, unlike IQ, emotional intelligence can be taught. Selecting for individuals that already have a heightened emotional intelligence as well as incorporating EQ skills into the medical education curriculum can protect doctors’ health and job satisfaction as well as increase patient outcomes.

Implications for Providers: Given many patients will see their health through the lens of nontraditional treatments and their mental health (among other aspects) providers with greater clinical breath and EQ will win in the marketplace while some providers who may have strong reputations for other reasons will be shocked at how the hierarchy of health care is changing. It also means that almost all practices today are not staffed to meet patient needs. Practices will need to grow either directly or through some other alignment to meet patient’s needs. Those needs could be driven by capitation/cost concerns or patient’s own redefinition of good care, either way there is no escaping the massive redefinition of health. The graphic below illustrates how this new team may deliver care. Important to note while patient A (depression) my only present once a week in clinic, Patient B (anxiety) may present every day. PCP kept up to date through EMR and can help take over care management once condition is stabilized.

PCP kept up to date through EMR and can monitor for improvement or need for referall to higher level of care.

PCP equipped with behavioral health expertise

Enters information into EMR

Diagnosed and treated by PCP on the spot

Two patients present with BH issues

Referred to psychiatrist for diagnosis and treatment

PATIENT A: Bipolar I in Depressive State

App interconnected with EMR for updating progress

PATIENT B: Mild Anxiety Prescribed regular sessions on appbased therapy

Implications for Health Systems: BH as MVP (Most Valuable Player). Over the long term, many patients in the community will have a relationship with a behavioral health (BH) tool/team before they ever develop a relationship with a PCP, and the relationship with the BH tool/team may be much stronger than with a PCP. Therefore, over the long run tens of millions of Americas most important health care relationship (from their perspective) will be with a BH provider. Almost no health system in the country is prepared for this reset of relationships with their patients. It is not just processes, staffing and business models are not ready for this work, even the culture of health system is not. As of today, very few board members, CEOs, CMOs have any sort of background in mental health—that must change. All those parties need to get smarter on BH to even think through the process, business model and staffing issues.

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Staffing: Everyone is part of BH. Beyond establishing more psychiatry residency programs (which we believe will become more popular for a variety of reasons from compensation to status)—providing incentivized BH educational opportunities for clinical staff outside of psychiatry is a model of interest. By leveraging the skills of talent already within the health system, you decompress BH volume demand and create a more balanced physician. With scarcity in BH resources, primary care and subspecialty physicians will have an even larger role in managing BH disease towards favorable medical outcomes for their patients. Organizations like The Reach Institute are recommended to provide intensive training to non-BH physicians to increase their comfort diagnosing and treating psychiatric conditions. In the ideal scenario, medical school curriculum and residency training would provide enhanced mental health education to primary care and specialties with significant mental health overlap in their patient populations.xxxvii In the future, not only will this behavioral health skill set be clinically necessary, but it will also be highly marketable for physicians who have an interest in niching and branding their services as focused on “whole health.” Systems will also need to think about BH in all parts of care delivery from hospital room design and facility layout to capturing BH needs at all points of the physical care continuum (urgent care to local SNFs). Process: better triage and acuity sorting. Equipping non-behavioral health physicians and other clinical staff with behavioral health expertise relieves some of the demand on the scarcest resource (psychiatry). With this expanded treatment capacity, how will the system determine who receives psychiatry versus services with another provider? Since mental health disease, much like medical disease, occurs across an acuity spectrum, we recommend use of triage tools at point of entry. Much like an Emergency Department triage model, an effective triage will sort the “right” patients to the “right” type of provider. Lower acuity patients could be sorted to psych-equipped PCPs, therapy interventions with a psychology team or an ancillary staff guided psycho-education CBT program. Measures of symptomatology and quality of life impairment would be collected at baseline and midpoint to determine if the patient is seeing benefit or if a higher level of intervention is needed. The most successful programs in this endeavor will not only expand tele capacity during program creation, they will show a doggedness about aligning new tele-systems with existing EMR, scheduling and billing systems so that patient information and progress flow without redundancy snags for patients or providers. Precision medicine will be just medicine. Depending on your market, the migration of precision making as a nice to have marketing feature to a core part of care delivery will occur. The most upscale, health literate markets will push for this first as they read more every day about scientific advancements and topics like microbiome become common knowledge. Thus, community hospitals will not be able to cede to AMCs precision medicine and those costs, without also ceding significant amounts of elective market share. Even alliances with Academics might suggest to patients ‘for real medicine go to the mother ship.’ This will take scale for community hospitals to invest in genomics labs etc., but we strongly suggest avoiding complete outsourcing where possible. It’s important that patients feel like the hard work is done within your health system even if a white label partner is doing the work inside your hospital. For one recent Array client we recommended redoing the lobby of their main campus and putting the genetics lab there—with big windows. Let every patient literally sees the future of medicine at work. Like BH this again will represent a cultural hierarchy shift where the lab experts have more visibility and influence than the past. In other words, don’t hide the science show the science.

Implications for Payors: Align offerings with the consumer’s evolving definition of health. Historically, payors have assumed a narrow definition of healthcare to determine what medical services will be covered. Medicare Advantage offerings are slowly evolving to offer non-medical benefits that address social determinants of health (I.e., air conditioners for asthmatics, transportation for those without, and home-meals for the immunocompromised). Going forward, assuming a more holistic view of health and offering insurance products that have behavioral health, alternative medicine, and/or non-medical SDH benefits may be a way to gain commercial members.

Implications for All Stakeholders: Time to reimagine data collection. For new entrants there may be plenty of market room for whatever successor to the EMR there is. Interoperability won’t just be about traditional health care data. Today, phones, watches, social media are all full of data that could be foundational to 21st century medicine like vital signs were foundational to 20th century medicine. If you are a provider and get that data in a trusted fashion, “you are in”, if not you are feeling in the dark.

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In our next paper we will discuss how an integrated vision of health will mean a much broader definition of physical and mental wellbeing, with less traditional providers and methods of care.

Footnotes: i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii.

xiii. xiv. xv. xvi. xvii. xviii. xix. xx. xxi. xxii. xxiii. xxiv. xxv. xxvi. xxvii. xxviii. xxix. xxx. xxxi. xxxii. xxxiii. xxxiv. xxxv. xxxvi. xxxvii.

https://www.apa.org/research/action/speaking-of-psychology/unlocking-millennials https://famemass.com/time-spent-on-social-media/ https://pubmed.ncbi.nlm.nih.gov/30477857/ https://www.annalsthoracicsurgery.org/article/S0003-4975(18)31477-2/pdf https://www.evidencebasedacupuncture.org/acupuncture-scientific-evidence/ https://daxueconsulting.com/healthcare-market-china/ https://www.aacom.org/news-and-events/press-releases-and-statements/ press-release-archives-detail/2017/01/19/2016-omp-report-profession-reaches-all-time-high https://osteopathic.org/about/aoa-statistics/ Reading our Minds, the rise of Big Psychiatry, Daniel Baron https://www.grandviewresearch.com/industry-analysis/genomics-market https://www.marketresearchfuture.com/reports/precision-medicine-market-925 https://obamawhitehouse.archives.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precisionmedicine-initiative#:~:text=Launched%20with%20a%20%24215%20million,treatments%20will%20work%20 best%20for https://allofus.nih.gov/news-events-and-media/announcements/nih-funded-genome-centers-accelerate-precision-medicinediscoveries http://english.cas.cn/newsroom/archive/china_archive/cn2017/201705/t20170503_176612.shtml https://www.nature.com/articles/s41587-021-00973-w?utm_source=other&utm_medium=other&utm_content=null&utm_ campaign=JRCN_1_DD01_CN_NatureRJ_article_paid_XMOL https://www.insynchcs.com/blog/rising-shortage-mental-health-providers https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ https://www.insynchcs.com/blog/rising-shortage-mental-health-providers https://mhanational.org/issues/2020/mental-health-america-access-care-data#two https://www.goodtherapy.org/for-professionals/personal-development/become-a-therapist/ is-there-shortage-of-mental-health-professionals-in-america https://www.apa.org/monitor/2015/06/robo-therapy https://www.psychiatryadvisor.com/home/practice-management/the-robot-will-see-you-now-the-increasing-role-of-robotics-inpsychiatric-care/ https://www.healthleadersmedia.com/innovation/using-personal-financial-data-improve-healthcare?page=0%2C2 https://www.nationalacademies.org/news/2020/02/health-care-system-underused-in-addressing-social-isolation-lonelinessamong-seniors-says-new-report Left to their Own Devices, Julie Albright. 2019. https://ehrintelligence.com/news/medication-data-in-ehr-provides-basis-for-tracking-adherence https://www.everydayhealth.com/high-cholesterol/twice-yearly-injections-halve-bad-cholesterol-in-patients-with-clogged-arteriesstudy-shows/ https://medicine.hofstra.edu/education/md/ https://school.wakehealth.edu/Education-and-Training/MD-Program/Curriculum-Overview https://www.6seconds.org/2019/05/28/case-study-eq-declines-during-medical-school/ https://www.mdlinx.com/article/emotional-intelligence-can-help-make-better-doctors/lfc-772 https://www.6seconds.org/2019/05/28/case-study-eq-declines-during-medical-school/ https://www.mdlinx.com/article/emotional-intelligence-can-help-make-better-doctors/lfc-772 https://www.medicalnewstoday.com/articles/318037#Is-physician-burnout-an-epidemic? https://www.medicalnewstoday.com/articles/318037#Is-physician-burnout-an-epidemic? https://www.medicalnewstoday.com/articles/318037 https://www.thereachinstitute.org/services/for-primary-care-practitioners/adult-behavioral-health-in-primary-care

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About Array Advisors Array Advisors is a healthcare strategy consulting and operations optimization firm dedicated to both improving the way healthcare is delivered and helping clients overcome their business challenges. The team can help clients with strategic plan development including market analysis, ambulatory and service line planning, provider strategies and integrated capital and facility planning as well as operational analysis including scenario modeling, benchmarking, and lean design.

Author Contacts

NEIL CARPENTER, MBA

JILLIAN BARBARO, MHA

Vice President Strategic Planning

Strategic Planner

d: 202-795-3707

d: 202-788-5631

m: 917-576-9980

jbarbaro@array-advisors.com

ncarpenter@array-advisors.com

ISABELLE MORATTI

ALEXANDRA LARAMEE, LCSW

Array Advisors Intern

Behavioral Health Clinical Operations

imoratti@array-advisors.com

alaramee@array-advisors.com

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