In this episode we hear part 2 of the conversation between, Josh Vire and JP Sharp, where they discuss the current and future state of value-based care including primary and specialty care and the recently released making care primary payment model.

You've recently in your career focused on integration of behavioral health with primary care. Can you speak to a little bit how critical important that is in on this path of transformation and alternative payment models and those challenges with access to behavioral health and the finances of behavioral health care?

Glad you bring that up. It is a trend and for a reason is that our thinking, I think it's caught on in this kind of evolution of behavioral health being much more central to healthcare not this silent thing and that's just a vestige of history is that we as a people in healthcare and in America just drew a line there and said here's physical healthcare over here and there is behavioral healthcare over there and they were siloed off and behavioral health care was often more stigmatized and so it got the short end of the stick when it came to attention and funding and innovation. And so, it it's only through a snowballing of research and public momentum and acceptance of this where stigma of behavioral health and treatment associated with it is being reduced.

It's absolutely still there, but just better understanding of it. And it's incorporation into physical health is twofold. It's both from just an evidentiary standpoint and clinical is that they are linked. So the behavioral health impact, if you have say depression, your physical health if you have say diabetes, those are related you know if not like directly in a physiological mechanism but rather if you're depression goes unchecked you're less likely to take care of your diabetes and your physical health, take your meds, see your doctor what have you, and those things it's a compounding exacerbating effect. And so, the thought now is that hey these are these things are so intertwined that evidence suggests treating behavioral health issues first and alongside primary care issues is going to result in better care.

And then kind of the other is just purely logical and from a patient perspective like you know, you had a human level like we don't separate these things. If you ask me how I'm doing, I'm not going to there just say Oh my knee hurts and like stop there. If you ask me how I'm doing I'm going to be like well, you know I'm a bit stressed out right now. I've got a lot of things going and you know maybe feeling a bit down from x, y, or z reason. And you know what like my knee hurts and I wish I could run a little bit further than I did last weekend. And so, you know it's like that's like what you know our life experience is, it's not siloed like we've kind of set up the healthcare system to do. So how can we kind of design the system to better appreciate all of these things at a you know patient experience level as well.

Right yeah, that's the question and an important one particularly. I appreciate you talking about the stigma and the importance of behavioral health, I know it's important area for you and I think an important one that we get right as we think about this transformation. It's critically important. So, I'm going to ask you to look into your crystal ball here a little bit. Where do you think in the next five years let's say, 5 to 10 years, where will the focus in value based care be in your opinion? Will it still be in the primary care space primarily or do you think it'll shift to, specialty is obviously one that's already beginning to talk about, but just your thoughts on where you think this transformation will be in the next few years?

Absolutely. So primary care is not going to go away. I think it's caught on enough people have realized that and that's going to be more about incorporating it into more and more...