Trent Iden Talks Behavioral Health and Why He’s Returning to ECG

When Trent Iden left ECG in 2019, he couldn’t have imagined how dramatically the world was about to change. Barely a year after he became the chief clinical transformation officer at a behavioral health organization in Northern California, COVID-19 upended life as we knew it.

And while hospitals grappled with overcrowded emergency departments, staffing shortages, and rising case counts, another surge was playing out. The virus that to date has killed more than 900,000 Americans has also had widespread negative effects on people’s mental health. The percentage of adults reporting symptoms of anxiety or depression jumped from 11.0% in 2019 to 41.1% in 2021. That’s not to say that mental health disorders are limited to adults—in October 2021, several major pediatric associations declared a national emergency in child and adolescent mental health.

Behavioral health has historically been an underserved need in the US. Access challenges, inadequate reimbursement, and market fragmentation in the mental health space were issues that preceded the pandemic; the events of the past two-plus years only exposed the flaws in the system.

A desire to change all of that led Trent to accept an executive role with a behavioral health provider network. “I felt compelled to dedicate myself full time to the opportunity of creating access within behavioral health in Northern California,” Trent explains.

He returns to ECG with a similar sense of urgency. Trent rejoins ECG this month as a principal in our Managed Care Division, with a specific focus on expanding the firm’s behavioral health service line. Here he talks about the path the led him back to ECG and why he’s optimistic about change in one of the most intractable areas of healthcare.

There and Back Again

The decision to leave the consulting world in 2019 was made with, in Trent’s words, “a heavy heart,” but also a sense of determination. Over the course of five-plus years, he’d been helping a client develop a behavioral health program. The work was compelling, and when the engagement neared its conclusion, Trent wasn’t ready to move on. “We were introducing things like value-based care and thinking about quality differently and what that would mean to our patients and payer partners,” he says. “We were working with the provider network we had created and figuring out how we needed to support those stakeholders differently to grow this service line. And that has been incredibly interesting.”

Gratifying as the work has been, Trent realized that returning to ECG would give him the opportunity to bring valuable lessons learned to a broader audience. “I think we’ve grown and evolved very rapidly here in Northern California. Part of the advancement here in California is due to the progressive legislative and regulatory environment, which has accelerated change. I anticipate similar trends developing in other parts of the country, some of which are already forming. We’ve done some wonderful things that I think we can share with our clients and continue this work on a more national landscape. I look forward to being part of that.”

An Evolving Landscape

The three years Trent spent away from ECG have been eventful ones, to say the least. The national conversation around mental health has changed against the backdrop of the pandemic. Pre-pandemic challenges in the behavioral health space persist, but Trent sees a growing emphasis on mental health and an evolving approach among payers and providers. “So much has changed and so much has happened in that time period, and I think we’re really in the early innings where that evolution, that growth, that work is going to continue at a very high pace,” he says.

Trent points to several key shifts in behavioral health, the first concerning the way payers perceive the service line. “If I reflect back to 2019, the conversation was still hyper-focused on access to care, he explains. “Access is still paramount, but from the payer perspective, there’s been far more emphasis on defining what quality means within the behavioral health service line and how to establish the right protocols and standards. Behavioral health has grown in expense for many of the payer partners I work with, and making sure that payers understand the value proposition within that service line” has become critical, he says. “It’s been difficult to align on consistent quality protocols throughout the industry, and I think a lot more work needs to be done to achieve that.”

Another major change is the way behavioral health services are being provided. “Telehealth has become a much bigger aspect of the behavioral health footprint, and I think that’s a very positive evolution,” Trent says. “It allows organizations to scale resources differently, think about their business models differently, and stay connected with families in ways that they may not have been able to.”

He expects telehealth to keep growing, and points to increasing amounts of investment in behavioral health services as another encouraging development. “I’m seeing a lot more investment and thought around technology and capabilities within the space, which I think is tremendously positive.”

The Road Ahead

What’s evident in listening to Trent talk is that there are no quick or easy solutions for improving the way mental health care is delivered and reimbursed. For any organization, and for the industry as a whole, meaningful change takes time, money, and creativity. Provider shortages make it difficult to maintain and grow capacity, there’s resistance to tinkering with traditional care models, and the economics around behavioral health constantly force organizations to learn how to do more with less.

But as he talks about the approaches his organization has taken to address those issues, a common theme stands out—focusing on the people involved. Listening to patients, providers, and the community at large, and understanding their needs, is central to making a difference.

“We’ve been investing a lot of time and resources in exciting, energizing career paths and supporting the growth of our staff,” Trent says as he talks about mitigating the provider shortage and the effects of the Great Resignation. “We’ve also been really thoughtful about aligning with other providers within the region and thinking about what access to care truly means. It’s not just having access to services, but making sure that we understand the demographics and the needs within that patient population. And we’ve invested a lot in research and evolving the care models. How do we scale our resources differently? How do we think about these service needs differently? We’ve been very consumer focused in those approaches.”

Daunting as it all sounds, Trent is hopeful that change is happening. “I think this pace of innovation and evolution is going to continue, and it’s going to be rapid and exciting. I look forward to ECG being right in the center of it, supporting our clients thoughtfully and continuing to be part of that solution.”