Beyond the staggering number of cases and deaths, the coronavirus pandemic is exacerbating a crisis in mental health, with millions of Americans reporting that they are anxious, depressed or feeling isolated, according to multiple national surveys. But increased awareness of mental health issues may result in better care in the long run, according to Mark Ganz, CEO of Cambia Health Solutions. Ganz, who is stepping down as head of the Portland, Ore.-based company at the end of the year, talked with Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You’ve been focused on building an innovative portfolio since you joined Cambia in 2003. How can organizations sustain that drive in the midst of the pandemic?
Ganz: We have had little difficulty in doing so and I attribute it to two main things. We have a clarity about our vision and what we are trying to accomplish as a company and that’s something that I’m proud to say … we put in place in 2003 when I became CEO.
The second element has been culture. You know, the old aphorism that culture will eat strategy any day of the week is very true. One of the things I have focused on in my leadership has been making sure that we attend to and transform the culture inside the company so that it went from what I would call a well-running bureaucracy, very much about enforcing and following (rules) to one that transformed into an innovation culture.
When you have a culture and you have the clarity of vision, things like even a global pandemic don’t stop you. You just simply think, “OK, how can we innovate through this?” Because this is a huge issue for the people we serve and how can we make sure we’re there for them and that we see the opportunity to move the entire industry in ways that you probably couldn’t do in a steady-state environment.
MH: Are there specific things you were able to do over the past nine months because of your culture?
Ganz: We made more decisions in the first couple of months of the pandemic than probably we would normally make in a year to two years. We were able to make decisions that were consumer-focused, that were about the people that we serve. What is going to be most important to them at a time like this? What are the fears they’re dealing with?
I had a personal issue where I think I had COVID back in late February, early March. I think I contracted it at a meeting of hospital executives in San Diego. The disease was pretty rampant in Southern California, probably all the way through January and February and nobody knew it. There was no testing capacity in Oregon at the time. I guess I’ll never know for sure, but it was certainly an unusual illness that I’d never experienced. I dealt with some anxiety myself. It gave me at least a personal sense of, “OK, we’ve really got to get at this.”
Then, for example, we came to the early conclusion— before it was really being widely talked about—that not only do we have a pandemic upon us, we have an epidemic in the mental health world coming upon us from all of the isolation, the loneliness, just the anxiety that people were dealing with. We saw that as an important area to focus on right here, right now, and try to do what we could to help people understand what was going on inside them and get help when they needed it and how to manage it.
We also see this as a huge strategic opportunity for healthcare. I’ve always been struck by when I became CEO that healthcare was primarily about the physicality. It was the physical medicine. It was when you got sick, how can we cure you? Too often, the issues of the mind and the issues of the spirit were not attended to.
We didn’t intend to be a pioneer, but I guess we’ve been called a pioneer in the work that we’ve done in palliative care. It’s not about end of life. It’s about dealing with a person’s spirit and their family during the course of an illness or in the wake of an injury. It should happen side by side with the curative physical care they’re getting. We also know that even as they’re going through physical challenges, there are mental challenges that come with that—depression and, again, isolation.
My dream and my belief is that 10, 15 years from now, healthcare will finally get it right in understanding that you have to deal with the physical, the mental and the spiritual all at the same time and with the same level of respect and investment and care. I see this as a huge opportunity coming out of this pandemic.
MH: Part of the challenge though is mental health parity, isn’t it? Are insurers providing the right level of coverage?
Ganz: I would disagree with that premise. The lesson from mental health parity and the fact that mental healthcare is very difficult to obtain is the fundamental mistake we make in this country that saying that if we pay for it, then people will have access. That’s just not true. I don’t know why we have to keep learning that lesson over and over again, and why it’s not better understood that what we need to focus on is the competency of the care and the availability of the providers to do it.
It is not a sufficient way to deal with mental health to go to your primary-care doctor and be given a pill. So often, the issues are complicated. You need real professionals who understand and can counsel people and work with them and talk with them and listen to them and then maybe a drug can be augmentative.
It’s the same thing with palliative care. It’s why when we invest in palliative care, we make direct investments into the palliative-care community, into workforce development. I think we have the same opportunity with mental health to get it in the right sequence.
MH: Are there investments you did in palliative care that you’re looking to do in mental health?
Ganz: We’re already doing it in the (Cambia Health Foundation). That’s where we started with palliative care. We’re trying to develop the same kind of network of expertise so that our investments are well-placed, that we’re actually providing it where it’s most needed and how it’s most needed. We’re in that quick learning mode and experimentation mode to do it right. I know that (President and Chief Operating Officer) Jared Short, who will succeed me … is on fire about this.
MH: You said this is a 10- to 15-year horizon. Can we shorten that time frame?
Ganz: I go back to culture. Culture changes slowly because people have to change their beliefs and then they have to change their habits to go with their beliefs.
I do think that the availability and workforce issues may come a little bit sooner, but again, I think you have to change culture in medical schools and residency programs so that those who may be attracted to serving in the mental health environment don’t feel like second-class citizens; that they feel like that’s a great undertaking to take on, and that it attracts more people to that.