WMH Season 4 Ep 5: Smarter Systems, Better Care Reimagining Behavioral Healthcare Treatment

This is a transcript of Watching Mental Health Season 4, Episode 5 which you can watch and listen to here:

Katie: Hi everyone. Welcome to another episode of Watching Mental Health. And I am so excited because today we're really diving into what I think can be the future of behavioral health and mental health treatment and some pretty exciting things. And my guest today is John Trimmer. With more than three decades of leading innovation at the intersection of healthcare and technology, he's built a career centered on improving lives through smarter systems of care. And so he's an accomplished healthcare and technology executive with leadership experience spanning behavioral health, digital health and venture development. And as the CEO and co-founder of Optima Care 360, he's pioneering evidence-based, tech enabled approaches to substance use treatment and behavioral health access.

And in this day and age, with AI and technology at our fingertips, it's important that we look at how we can integrate these. But John believes that healing isn't just clinical, it's human. And so technology should be bringing us together to that truth. And so we're going to dive into that a little bit and we're going to be talking about what it's going to take really to rebuild trust in the American health system, why quality in healthcare really means consistency and how to implement technology effectively in that way. Ultimately, what's missing in behavioral health integration because it's so important that we really start to make changes with our treatments. And so with that, I'm so excited to bring on John Trimmer to the show so we can talk about this really important conversation.

John: Well, hi Katie. It's so great for you to have me on here today and I'm looking forward to our discussion.

Katie: Yeah, thank you so much. I think, like I said, it's important and it's timely. We use AI and we use technology in so many aspects of our lives, but with all of this conversation around mental health and AI and technology, it seems like we're just more kind of confused and we're not really utilizing it and really effective ways while we're busy worrying about chat GPT. And so I'm just really excited. I know that you've been at the forefront of this kind of work for a long time. And so with that, before we get into any of it though, I always like to ask my guests, first and foremost is just to tell me who you are. Tell me a little bit about yourself in your own words and why this work matters to you. Why did you decide to go down this path?

John: Well, thanks, Katie. Well, first of all, I guess it started a long time ago when I was born into the family of a physician. So I have the son of a physician. And I guess for the time that I was little to growing up, I was always asked, are you going to be a doctor like your father? And it got to the point where I said, I guess so I guess that's the expectation. So entering college, I certainly transitioned over to the business side of things. And after college I went to one of the few graduate programs to get an MBA with a specialization in healthcare management and healthcare management administration. So I took that and went into consulting in the health and medical division of a large international consulting firm for a while and transitioned to a medical supply company, which was then the largest in the world and spent three years with them to one corporate and two in a manufacturing division.

And I wanted to then transition out to the west coast and go where startups prosper. And so I moved out to San Francisco and was fortunate enough to become first person into a fairly revolutionary behavioral health company called American Bodine. American Bodine was really the first carve out of any kind, not just in mental health, but carve out where we would go to insurance companies and we'd receive full clinical and financial responsibility for their population of subscribers. We built that based on some concepts that we'll talk about that really stayed with me to today and really provide a very fundamental impression that I have on the issues in the healthcare delivery system and in the behavioral health system as well. So following that, I did another startup in healthcare and got involved in technology and a voiceover IP company, a telecommunications company, and now I'm kind of doing a redux and back into the behavioral health world. And we're looking to make some very material changes in the industry through Optima Care 360.

Katie: Wow, that's so interesting to me because I feel like your experience is almost like a unicorn in some ways, and that makes you, I think probably have a different, be able to have maybe a different perspective on the American health system because you've seen it from these different angles and you've really seen, I think the forest through the trees with some of your past work. So I just find that so interesting. So tell me, because you do I think have a unique take on this. What do you see, what are these kind of major problems with the American health system? What's missing? Why are we continuing to struggle?

John: Well, I think I am going to give you a little analogy and ask you if you would feel comfortable in getting on an airplane that was designed by an individual aviation engineer. If you though very well trained and very well intentioned to build the best possible airplane which you trust getting on that in a life or death situation. And I say I wouldn't. And I think the healthcare industry is very analogous to that, where we have very well trained and compassionate group of providers in our country, but they're all operating in a silo. I would argue we have as many different healthcare delivery systems as we do doctors because every doctor really practices things differently. And it is probably fair to say that if you had the same presenting complaint, go to 10 different doctors, you get 10 different responses. And from my definition and my perspective, that translates into low quality because in virtually all other industries, quality is defined as the ability to produce a good or service that conforms with an APRI definition of what the specification of that particular product or service should look like.

In healthcare, we have part of that. We do have specifications of best practice and evidence-based care, but adherence to those principles is largely voluntary by the doctor. And so the result is as I would argue, that we have as many different healthcare systems as we do physicians in this country. And so what we need to do in terms of definition of quality is really to build a system that relies on foundational evidence-based care, best practices, and then as importantly an organized delivery system that encourages the physicians and other providers to adhere to those basic principles and deliver care in a way that comports with that.

And so, that's one of the principles by which we founded American iodine years ago. The second component of the concepts behind American iodine was a concept of optimal care, which is bringing the patient back to health in the shortest time possible and the least intrusive, most conservative way. And that translates in by doing the right things clinically, you eliminate concepts such as iatrogenesis, which is medically induced malady. You eliminate variability of care and you provide a way in which we are resorting to risk introducing techniques only as a last resort and not as a first. So in the event, in the situations that are non-emergent, why shouldn't we exhaust all of the non-intrusive, more conservative interventions before we resort to the types of interventions that in fact could introduce risk malady and other things? We know for a fact that studies have indicated that the third leading cause of death in the United States is physician error, and that is really a malady or a travesty if in fact it's a situation that it's a procedure that wasn't even necessary or indicated if there are other opportunities to introduce a more conservative methodology. So this is really an important concept that I have in terms of healthcare, that what we have to do is eliminate the variability of delivery, which is among physicians and in the behavioral health world, clinicians are all trained differently and they provide different kinds of services at varying degrees of skill and expertise. And there's really no mechanism to really provide a more consistent therapeutic journey for patients even within a center that has multiple clinicians involved.

Katie: Yeah, wow. I had no idea that physician error led to that many. I mean deaths really. So it is a life or death thing. It is a big deal. I had no idea. That's very interesting. So you mentioned a few things that are interesting here. First, you'd mentioned silos, and you don't see that. You see that across healthcare and you see that in behavioral health. You see that really everywhere. And it is so challenging because even here in Las Vegas, we're operating in silos, we can't get out of it. But really what you're saying is we need to get out of that to have that collaboration. At the beginning of the show, I mentioned that you mentioned that healthcare to improve healthcare, it means consistency, not complexity. And when you have all these doctors operating in different silos, that is complexity. We're adding in all these extra layers and variables that ultimately can lead to really, really bad situations if they're not making the right decisions. So that's a really big deal, I think,

John: And it is a significant challenge because from a philosophy, we believe that a professional license is really sanc the sake, and it's something that we respect. And I'm the doctor and I know what's best for you. And in many cases you're a patient and you trust.

Katie: I'm trusting that.

John: And even our legislation is really oriented toward that. The patient bill of rights and legislation was passed in the nineties and corporate practice of medicine, these evil business people are going to get involved in interfering between the patient and the doctor relationship. And in fact, what we need is suggested is organization and the delivery so that we can indeed make sure that our delivery system follows best practices and evidence-based care, not only in general health, but obviously in behavioral health as well.

Katie: And so that's interesting that you picked behavioral health to continue on this journey because I find behavioral health to be, in some ways even worse if I have cancer, they're like, okay, chemo, whatever. But if I have a mental health problem, first off, like you said, I go to 10 different behavioral health doctors and they're going to give me maybe 10 different diagnoses. I'll be bipolar with one and depressed with another. It just depends on how they see it. And I know that we have our forms and we have these systems in place, but it seems like the variability amongst behavioral health treatment is so extreme, and it seems like sometimes it's because of the patient, we're all different people, and so maybe we do need a slightly different approach, but then other times it feels like it's the system and it's like the DSM is adding more diagnoses every day. And so it feels a little bit of both. So talk to me more about behavioral health and your approach in this aspect because the variability in this area is intense, I think.

John: Yeah, and when you get right down to it, again, there are a number of studies that show that actual training, which does vary among different schools of psychology and behavioral health education. It varies quite a bit, but studies show that one of the primary determinants of effective outcomes has nothing to do with training. It has everything to do with the compassion and connection with the patient and empowering the patient.

And so these are skills that and part are inherent, but they can be learned in terms of making sure that patient care is approached with a basic humility that I am a catalyst for you, I'm a support for you, I'm a guide for you, but it's your life and we need to empower you the best we can. And that's felt by the patient in terms of whether or not somebody is just there to see you once a week and have an annuity coming in the office every week or somebody that truly cares about them and is participating in their journey with them. And so you mentioned the diagnosis, and in our system it's what we say, it's not what's wrong with you, it's what happened to you. So trying to follow through on the pathway with the patient to understand how you got there and who's to say that any of us on that same pathway with the same kind of trauma in their life might end up in the same place as that patient and the dysfunctional behavior, be it substance use disorder or any other, is really in many respects a solution to the problem that we experience through our development.

And so we really try to focus on that and understand that and try to work with the patient to be able to come to grips with that and then to find less destructive ways of dealing with those things than whatever kind of behavioral abuse it could be or substance use disorder.

Katie: Sure. I love that you brought that up because it's patient integration. And so it's not just taking technology and forcing us into a box. It's taking technology and integrating it into a system to make it more organized, less complex, and then giving that patient the ability to be a part of the process almost, which a lot of patients walk in and don't feel like they are. And so I just really liked that you brought that up and at the top of the hour. I also mentioned that you've talked about what's missing in behavioral healthcare integration, and you've talked about it's how a lot of times it's the patient, but they need to be as involved. And so I just find that so interesting. I'm really glad that you brought that up because people will see the system like this and assume, oh, we're just going to fit everything into a box and it's just going to be based on technology, but it needs to be a collaborative effort, is what I'm hearing, and that having the patient involved in the tech piece will actually help that patient integration. Is that what I'm hearing? Is that how I'm understanding it?

John: Yeah, there's no doubt about that, that everybody has unique experiences in their life and we can't put people into boxes. It really is a matter of really trying to understand all the various dimensions of their being so that we can not make judgements about them, but to really understand them and have compassion for those journeys. And that does emanate to the patient and promotes better outcomes for certain. And you will be addressing, I guess, the technology aspect of this in short order, but technology can be used to be able to ensure that there's a better understanding on the part of the clinician to be able to work better with the patient once they understand the full dynamics of that person's being.

Katie: Yeah, absolutely. And that was my next question is let's talk about the technology piece of it. I think that what you're doing is really innovative. So explain a little bit more about this technology about what Optima Care 360 really is and is trying to bring to the system.

John: Well, our mantra is to normalize clinical excellence. And let me explain what that is. We would argue that the law of large numbers says you put any hundred clinicians in a room, and by definition they are going to gravitate on balance on to average performance. And half of the services by half the clinicians will be below average, and half will be above. And so that's if we leave it to chance, that's what we're going to get. We're going to get average and we want better than average. So what we believe the purpose of organization is to provide the tools, the training and the management discipline to cause ordinary people to do superior work. So with Optima, what we are doing is providing tools that fall into two basic categories. One is educational foundation and the other is technology. So from the educational foundation, we provide extensive foundational clinical education in the form of clinical modules that are really into four general areas designed for clinicians. The first is fundamental DSM reference library in video format. And again, even though we don't really focus on DSM as the factors that determine care, it does help to have a reference in terms of what medications might be indicated, what type modalities might be best.

Katie: It's a starting point. Yeah,

John: We have a library of those and we have a library on the values that I indicated collaboration and empowerment and formulation, and being able to work with the patient to do the things that the patient will need to adopt as their own, to be able to come up with a treatment program, motivational interviewing, other kinds of things like that that can assist in getting the patient on track, supporting them make coming to the decision of what they need to do. And then there are the values that we talked about, which are the types of things that we talked about in terms of humility and compassion and those kinds of things, and also the various modalities like CBT and other kinds of things, and then some administrative modules to working within an organization. So that's one category. Clinical education, we also have patient education.

So recognizing that the patient journey to get to the point where they have behavioral dysfunction is unique. We provide the opportunity to assign through our clinical process various modules that can take a patient on their own individualized pathway. Some patients may be dealing with relationship issues, some may be dealing with vocational issues, some may be dealing with homelessness, single parenting, toxic, toxic relations, whatever they might be. So we can provide foundational education for the patient to support the therapeutic process. And also we can use these modules to support a consistent I-O-P-P-H-P or general behavioral health curriculum that provides all of our patients consistent evidence-based psychoeducation and facilitation for group interaction through reflection, skill development, and some other resources that provides a normalized pathway toward excellent patient care. And we wrap that around finally with clinical management structures and systems to provide the administration or clinical management supervision, clinical case conferences, development plans to cause clinicians to continue to pursue excellence in their own skill level.

So that's the content side. And then on the technology side, we kind of look at the overall industry and things that I've done in the past, I call it uberizing things. So when you start a company, you can either look to create incremental change or material change. And I look at Uber as a great example as we're all familiar with Uber. And they could have looked at the taxi cab industry and said, my gosh, we just need a better dispatch system, so let's build a software to make cab companies better. But they didn't do that. They said, we're going to blow up that whole industry and we're going to design something completely different. And I call that starting on a blank sheet of paper. So you look at all the various deficiencies in the industry and you say, what do we want to do to really build a solution to that? That addresses all of it. It's ambitious to do that, but you're not encumbered by the things that are wrong with it today. You step forward and say, let's try to go from here to there, and recognizing that there's a little bit of evangelism that's involved in that because you're trying to change the world, but to do things correctly in much more of an idealistic sense, you don't want to accept the deficiencies in the system and kind of incrementalize change. You want to make a transformational change. So technology world, there are a couple things that we're trying to do. The first and most important to recognize that technology needs to be used as a means to enhance the clinical experience. It's not an end in of itself. It's not just to be more efficient or more effective, it's to really enhance the patient experience. And so the first thing that we've built is a way of recognition of the fact that therapy cannot be discreet. It has to be continuous.

So even if you're in a nine hour per week IOP session, for example, there's another 259 hours in the week that you're not in treatment. And that's where dysfunction happens. That's where life happens. That's where all these pressures come on. So it's very clear that we need to be able to create a mechanism to be able to have a constant touch with the patient, have a constant understanding of where they are, where their stress factors are, where their triggers might be, and to be able to provide work plans to be able to provide some ability to provide the necessary interaction with the patient to be able to resolve some of those issues that

Katie: Keep that support going.

John: Absolutely. And so that's the feedback to the clinical team, connection with peers, connection with sponsors, providing some of worksheets and video content to be able to address some of the immediate needs that they have, and using AI to be able to understand what the patient is saying and be able to respond with that action plan that can deal with the patient immediately even though they're not in the room getting therapy.

Katie: Wow. Wow. That's such a different approach.

John: And then there's clearly all of the functional from the perspective of the facility, from the perspective of the clinician in terms of trying to make the life easier and to be able to establish the ability to look at the critical KPIs on a real-time basis and do some things that will enhance patient care and also to alleviate administrative burden on the therapists, be able to allow free up time to do the things that they do best and they should be spending all their time on not just 80% and 20% administration. So we're really building technologies around all of that to solve all the problems. And as I said, it's quite ambitious, but with today's world, and we kind of mentioned where we're moving, this is a brave new world with AI and a lot of things. It's almost like every week you look at new advancements and new ways to apply AI in the whole delivery of services here. So we're running really hard to keep up with that and stay ahead of it, stay

Katie: Ahead of it. Yeah,

John: It's kind of cool to be a part of this right now because the world is changing every day.

Katie: Exactly. It's an exciting time to be in this field. It's scary for some people, and I get that, but it's not going away. And so I want to ask about the future, what you envision for the future, but before I get to that, I want to ask a little bit more about any safeguards or kind of guardrail that you have thought about with utilizing AI integration with your system, because that seems to be something that's really missing in our more general AI tools that the majority of the public is using as these safeguards are not really in place in an effective way. Is that something that you've been thinking about as you've developed this tool?

John: Yes. I mean, there's no doubt in my opinion, technology advances far faster than our ethical ability to manage it. And you can take a lot of different technologies that we can do and apply in the human race, and we just don't know how to deal with this handle it. And I have no clue as to how this is going to evolve over time, but it's exciting, but provides a little trepidation at the same time because we don't know what this is going to turn into and we see some applications that are really, really positive. And we can also see some misapplications already and some adverse complications of the use of ai. Apparently, I'm not directly understanding of this, but I did hear that in one case the AI was instructing a suicidal patient of actually how to commit suicide, and that's obviously a misapplication of it. And that's where we need to be very, very careful in how this tool is used because it can be misused in many, many ways. And so we just have to be very sensitive to the fact that there are ethical considerations to everything that we do, not only here at Optima Care 360, but as a society as we enter this brave new world.

Katie: Yeah, yeah, absolutely. And you're right, we have to take it and utilize it the best we can, but be careful and recognize that. So with that in mind, you mentioned you want to help the world, you want to take it as far as it can go. So tell us, what are you envisioning for Optima Care 360 for this technology? It's a totally different framework, and I think that that's interesting and people don't like change, but I'm imagining that you're imagining this being everywhere, this kind of being integrated into the American healthcare system.

John: Well, one of the things that I would suggest, and it was one of the big things that some of the foundational principles of American iodine and carries through with us today, that everybody, at least on an episodic basis have mental health challenges. We all go through periods of we're down, we're blue, we're elated. Some people become dysfunctional, the defense mechanisms become dysfunctional for them and others. And we would also argue that every medical problem has a psychology component to it. If we're diagnosed with cancer, you mentioned chemotherapy, I mean, we're going to kind of be depressed about it. And there is a connection with your competency as it relates to your mental status.

So, to the extent that we remain in a state of distress in some form, it's going to create an environment for more medical issues. So it's a very, very important consideration that we were able to deal with this on a real-time basis. So I would love to see more integration into the medical arena, triaging people out of the medical arena into the behavioral arena for the psychosomatic complaints that people have where there's no underlying organic issue. And so to be able to really integrate behavioral health and have it much more of an accepted issue that we all deal with from time to time and eliminate the stigma of it, and as suggested when we look at the pathway to social dysfunction or any kind of behavioral dysfunction, it is something that we need to, as a society understand that it's tragic that people have experienced that kind of trauma in their life or influence in their life that has led them to that particular solution that affects everybody around them and affects their life in particular. So I'd love to see much more integration and acceptance of behavioral health and see much greater integration.

Katie: Yeah, I'm glad that you brought that up. I think that that is so true, and these are all important points that you're mentioning. Stigma, the fact that, yeah, physical conditions often have a mental health component and even vice versa. I could be coming into a doctor with something with rashes, and we have no idea how much of a mental component that has, and we really do need to be integrating our systems, especially with the rates of suicide, and it's just people are continuing to struggle. And so I am open to these new ideas and new approaches, and that's what we need, I think, to really help improve the system because we've been, I feel the behavioral health care system has been stagnant for 20 years, at least since the nineties. There really hasn't been a whole lot of progression made with some of our treatments except for maybe these more experimental treatments. But it's hard to know what's right and what's wrong. And so just having a system like this I think is really good because like you said, going back to the beginning of our conversation is that this makes this collaborative, it makes it so we're not in silos. It makes it so when I go to see a doctor, I feel assured that they're not going to be on the lower half of that scale, the other side.

On the other half. And I think we all deserve that. We deserve that as an American people. So I think that it's really ingenious and we need people like you at the helm kind of doing this work. And so I think it's really, really, I'm excited to see where it goes.

John: Well, appreciate it, Katie, and we would love to make a difference, and that's our objective and our mission, and we're here for the long term to make that happen.

Katie: Absolutely. That's so exciting. Well, so I'm going to end it, but before I do, I always ask this question to my professionals, and the question is, as somebody who maybe, and especially somebody in your position who's maybe seen, I think the forest or the trees a little bit more, you've kind of seen the broader perspective of things. Do you think that it's possible for someone with a mental health challenge or a mental health condition or an illness to overcome that, to move past it? And what does that look like?

John: Well, first of all, it does begin with an understanding of the pathway and to be aware of the circumstances and aware that there's often a manifestation of that in the form of dysfunction can be abuse. And we used to call it garlic. So

You taste the garlic, you don't taste the garlic, but everyone around you knows smell the garlic. So you can really affect people by acting out your own dysfunction. So it's understanding that situation and then trying to develop the tools with guidance and direction, the tools to be able to deal with that less destructively either personally or for those around you. And there are tools and there are ways to deal with it, and I think that's what needs to be done. Now that being said, there are some organic issues, bipolar, for example, that are organic and can't necessarily be treated and some others, but for the majority of behavioral disorders that we are dealing with, yes. I think there is a way that with proper guidance that patients can progress upon a pathway to really deal with those in again, less destructive ways. In very productive ways.

Katie: Sure. Yeah, absolutely. Tools, providing them the tools and just that support system, like we were saying, patient integration I think is key and it misses, it's missing, and it leads to a lot of patient non-compliance when we don't really give them that power. So yeah, thank you so much. I really appreciate that. For anyone who's interested in learning more about Optima Care 360, who maybe there's a clinic out there who wants to maybe integrate this system, is that possible? What does that look like? How can they reach out?

John: Well, our website is www.optimacare360.com. We are introducing our first product today, and we have a series of other products that are on the drawing board for 2026. Again, blending the technology and the clinical assets that we've developed in different ways to address different audiences. And you had kind of touched upon that it is difficult to narrow it down because there's a vast array of targets that we can have from clearly the behavioral health centers to individuals, to wellness programs, to senior living programs. There's just a whole host of ways we can go. So we would love to hear from you if there's any interest. So it's www.optimacare360.com.

Katie: Wonderful. Thank you again for your time. This was a really enlightening conversation. I think that it shows the future, and I think that we need to be keeping an eye on the future, and we need to be keeping an eye on technology because if we don't learn how to integrate it and use it effectively, then it'll use us, right? Somebody else is going to come along, and as long as we have good people working on it, I think we're going to keep being okay. So I again, appreciate your time. Thank you so much for being here, John, and to everyone who's tuning in, please join us every first and third Wednesday of the month here on Watching Mental Health and see all of our podcasts on Spotify, apple, YouTube, and my website, katie rose wecter.com. Have a great one. Thank you everyone.

John: Bye-bye!