Marti Taylor is the president and CEO of OneFifteen and the Executive Director of Behavioral Health at Verily. She started her career in nursing, Prior to joining Verily and OneFifteen, she spent many years working in hospital administration.
Most recently, she served as CEO of the University Hospital and the Ross Heart Hospital at the Ohio State University, Wexner Medical Center.
On the name of her company
[6:32] OneFifteen is a sobering acknowledgement that more than 115 people were dying every day in the United States in 2017, 2018 from an opioid overdose. And it was really to show our quest to reverse this course. People that are living with substance use disorder are our sisters and our brothers, and our parents and our friends and our neighbors, and their lives are worth fighting for.
On the intersection between mental health and substance use disorders
[8:12] Often, substance use and mental health issues contribute to the expression of one another. People with mental health disorders might use substances to self-medicate, and often people with substance use disorders develop mental health issues as a result of changes to their brain. And the conditions can often exacerbate one another when people experience those simultaneously.
So there’s not only an intersection between the two, but also a heightened risk of people living with both disorders.
[16:41] Today, most people are comfortable if others know that they have a cancer diagnosis or a cardiovascular diagnosis, and that prompts others to have a sense of ‘how can I help this individual?’
And whether that’s bringing a casserole over to their home or whether that’s saying, ‘How can I help you at your job?’ We don’t have that yet in mental health where not everyone is comfortable with others knowing that they have some sort of a mental health or a substance use disorder diagnosis. And nor do others know what to do if they do open up to them and say, ‘I have a mental health diagnosis.’
On the role of virtual care
[22:45] It is virtual first, but it is very much partnered with a human touch. And I think, especially in substance use disorder and behavioral health more broadly, we have to think about that human touch component as well. So in the last four years that I’ve been working at Verily, I Absolutely see the advantages that technology can do to supplement care and to complement care.
But it’s not going to completely take over for care.
(Transcripts may contain a few typographical errors due to audio quality during the podcast recording.)
[00:05] Britt: Welcome to the John E. Martin Mental Healthcare Podcast, created in partnership with Google and U.C. Berkeley Haas School of Business. I’m Britt Jensen.
[00:12] Michael: And I’m Michael Martin.
[00:14] Britt: And we are your hosts for today.
[00:21] Michael: I’m thrilled today to welcome Marti Taylor to the podcast. We’ve been working to make this happen for quite some time. Marti is the president and CEO of OneFifteen, and is also the executive director of behavioral health at Verily. She’s started a career in nursing. Prior to joining Verily and OneFifteen, she spent many years working in hospital administration. Most recently, she served as CEO of the university hospital and the Ross Heart Hospital at The Ohio State University Wexner Medical Center. Marti, welcome to the podcast.
[00:50] Marti: Thanks so much, Michael. Great to be here.
[00:52] Britt: Yes, Marti, we are so excited to talk to you today. It seems like you’re one of those rare people who has worn many different hats in the healthcare space. You’ve been in clinical and administrative, corporate and nonprofit roles. But before we jump into our many questions about your background and your current work, I was wondering if you could share something that you’re grateful for today that helped provide you a little grounding, maybe some perspective or maybe even a smile.
[01:15] Marti: Yeah. Thanks so much, Michael and Britt. It’s great to be here this morning. Great way to start my day. So, first of all, I’m thankful that you all are doing this podcast. It’s really another way that I think we need to be opening up the conversations, allowing these conversations to happen about behavioral health, and make it comfortable for folks to share their experiences. So, thank you for that. And then, secondly, I would say the team that I work with, I have an amazing team that I work with who really are, not only here in Ohio, but are all over the country, waking up every day passionate about substance use disorder and how we really start to reverse the course. And so, I have subject matter experts. I have folks who have been in the field for long periods of time. I have folks with lived experience. And it’s just an amazing team. So, I am so grateful for them and so happy that I get to work with them every day.
[02:08] Britt: Awesome. Well, first, I’d love to ask you a little bit more about your background. So, as I alluded to, you spent many years working on the clinical and administrative side of healthcare and you switched to focus on behavioral health at both Verily and OneFifteen in 2018. And I was curious what prompted the switch.
[02:25] Marti: It really was an unexpected call from Dr. Rob Califf, who you know is now our FDA commissioner. And Rob has been a mentor of mine for many years. We worked together at Duke for many, many years when he was a young faculty member and I was a young nurse back in the day. But at the time, in 2018, Rob was advising Verily and reached out to me to share their intention and their vision to build a learning healthcare system for substance use disorder. And as I talked to Rob and I started to better understand his vision and the vision that Andy Conrad, our CEO, were creating, I remember thinking, wow, this is pretty cool how they’re thinking about this, but it’s really not in my wheelhouse. But I said, “I’d like to have this conversation continue a bit more.” And so, over the following months, we talked a few more times.
And I remember one night talking with my husband and saying, “You know what? This is really pretty incredible, what they’re trying to create.” And wanting to do it in Ohio, my home state, even though I’ve lived many years in North Carolina, but knowing that my home state was really struggling with addiction issues and the opioid crisis, I thought, how can I not do this? It’s really a unique opportunity to impact the lives of so many.
And while I had been in more traditional healthcare for so many years, really, the culture of traditional healthcare wasn’t prioritizing mental and behavioral health in a way that I knew we really could be impacting so many lives. So, I took a chance on what Rob and Andy were envisioning and said, “Yes, I want to be part of this and try to create something very unique.”
[04:15] Britt: That’s amazing. It sounds like the perfect confluence of some personal roots in Ohio and all of your professional background. And actually, you said something that I think is a good segue into the next question, which is that traditional healthcare was not quite meeting the bar on what we needed to be doing to address addiction and behavioral health issues. And so, since we’ve worked in so many different capacities, what do you see as the biggest barrier for these different kinds of organizations collaborating to really solve the mental health crisis? I know that’s a pretty big question.
[04:45] Marti: It is. But I will say, I think, first and foremost, it comes down to parity, parity, and parity. It’s parity in care. It’s parity in access to care. It’s parity in payment of care. And the list goes on and on. As you know, the Mental Health Parity Act of 1996 and then following in 2008 and then, of course, the ACA, have all been good building blocks, as it relates to payment of parity. But legislation alone is not going to be enough. The supply and the availability of mental health providers certainly needs more attention. We need to make it attractive and something that people say, gosh, I really want to be a part of this as well, like I did, where I wasn’t planning on my career in my 50s, moving more into the mental health space. We need to make it something that feels good for people to say, “I want to be in this space.” As you know, a lot of our providers are concentrated in high-population high-income areas. And certainly, during the pandemic, we recognized that the lack of mental health providers in rural America, and especially in the pediatric and adolescent space, was very much missing. So, we have to address the workforce issues as well.
And then I think overarching these issues of parity is the ongoing stigma associated with behavioral health. The light is shining brightly now on behavioral health, thankfully. And so, we need to seize the opportunity to do something about that and to continue to create innovative solutions for those that are struggling with some mental health issues.
[06:26] Michael: Marti, taking a step back, I’m interested to go and understand the origin behind the name, OneFifteen, and what the significance of that name is.
[06:36] Marti: OneFifteen is a sobering acknowledgement that more than 115 people were dying every day in the United States in 2017, 2018 from an opioid overdose. And it was really to show our quest to reverse this course. People that are living with substance use disorders are our sisters and our brothers and our parents and our friends and our neighbors. And their lives are worth fighting for. And within the OneFifteen ecosystem, we hope to give all of them the best opportunity to, not only manage their condition, but also to thrive. And our goal is to build and optimize a recovery-based learning health system that really becomes a national blueprint to serve a lifetime of treatment needs for patients and to generate quality data to advance the field of addiction and behavioral health.
[07:37] Michael: Building upon that and thinking about the model, can you go and share with us what your current thinking is and, perhaps, what the academic thinking is around how addiction and behavioral health issues interact and intersect with one another?
[07:53] Marti: Mental health and substance use disorder share common risk factors, such as trauma and stress. Nine and a half million adults have co-occurring substance use disorder and mental health issues. That’s data from 2019. So, I would imagine that number is probably even higher today. And often, substance use and mental health issues contribute to the expression of one another. People with mental health disorders might use substances to self-medicate. And often, people with substance use disorders develop mental health issues as a result of changes to their brain. And the conditions can often exacerbate one another when people experience those simultaneously. So, there’s not only an intersection between the two, but also a heightened risk of people living with both disorders.
[08:47] Michael: When you think about that intersection, how does it inform the approach that OneFifteen is taking in terms of promoting recovery amongst those that are suffering from addiction and mental health-related issues?
[09:01] Marti: Surprisingly, addiction and mental health treatment often remains siloed. And so, at OneFifteen, one of the things we’re doing is to really take a whole-person approach to deal with these co-occurring conditions. Untreated mental health and substance use can trigger relapse of one another. And so, it’s critical to address these issues at some point during one’s recovery.
[09:24] Michael: One of the things that is so interesting about business, and particularly, as you noted at Verily, being focused on data is key metrics. And the reason why we have these is, in a sense, we’re trying to go and quantify success, or a lack thereof. I’m wondering, with regards to addiction treatment, with regards to mental health, with regards to that intersection, what are some of those metrics that you see on the journey for a patient? And are those standardized across the industry?
[10:00] Marti: Recovery is difficult to measure because addiction is not simply becoming free of biological dependence on a substance. SAMHSA, as you may know, defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. So, just think about how that national organization is describing it. And as this definition suggests, one of the reasons that there’s a lack of standardization in recovery metrics is that recovery is a really personal experience, and it’s defined differently by each individual.
So, at OneFifteen, we take a very patient-centered approach to treating addiction, which means that all patients define their unique pathway to recovery. And for some people, that means prioritizing family reunification. For others, it’s achieving employment and financial stability. So, therefore, we measure success through multiple domains that influence recovery and according to their preferences and the goals of our patients. We monitor these changes over time, like employment and housing and purpose in one’s life. So, in fact, our goal is to move from process to outcomes, like recovery science. Like I mentioned previously, our data-driven approach to recovery is really quite, I think, unique in this space. And we want to help move the field forward in its adoption of valid recovery measures.
[11:40] Britt: So, when you talk about that data-driven approach, I’m just curious, asking for other people working in the space or other companies, how would you suggest developing a more data-driven approach in this space, given that just looking at it through traditional KPIs and metrics is not a possibility?
[11:58] Marti: I think we have to recognize, like I was mentioning, it’s a very personal journey for individuals. So, for some individuals, they may be very highly functioning and in a job but are suffering from addiction. And so, it may be how do they get back, though, to what else is important in their life around quality of life indicators? For others, it is what many of us take for granted as having things like safe housing, having food, those social determinants that we very much take for granted. And so, it really becomes a very personal journey that I think we need to recognize that we can’t just say it’s a 30-day inpatient stay for individuals to move into recovery. In fact, that 30 days is really just driven by payment. And so, there’s nothing magical to say 30 days is the right amount of time for someone to move into a sustained recovery. You really have to think about what’s bringing them into treatment and how do we really impact those things that matter most to them.
[13:16] Britt: I just wanted to drill into the urban versus rural divide, since that is such a focus for our challenge this year. Is that something that you are conscious of in your work in OneFifteen at this point? Or, are you still focused mostly on the urban context?
[13:30] Marti: No, we really are thinking a lot about that as well. To date, most of our patients have been from Dayton, which, as you may know, is a mid-size city in Southwestern Ohio where we have our five-acre campus. But in rural communities, as we all know, it’s very difficult oftentimes to access treatment services, both because of structural barriers like distance and commute times, but there are a few providers. As I’ve already mentioned as well, we just don’t have enough providers there.
In 2020, a study done by Shatterproof found that 39% of U.S. counties had no providers able to prescribe buprenorphine, which we know is a lifesaving treatment for opioid use disorder. So, that is something that we are constantly thinking about how can we open up access. So, we are now focusing some of our efforts to address this problem by extending access to services through telemedicine in order to effectively access our services throughout that geographic reach where we have a shortage of workforce. We’re currently in conversations with FQHCs (federally qualified health centers) to build collaborative care models where they are seeing patients in their community but may not have the expertise around substance use disorder. So, we’re starting to build some of those collaborative care models with federally qualified health centers.
[14:57] Britt: Wow, that’s wonderful. Yeah, it’s really hard to get the specific expertise, I would assume, for something like substance abuse in rural areas, not just a general mental health practitioner.
[15:07] Marti: That’s right.
[15:08] Britt: Yeah.
[15:10] Michael: One of the things that I think is an issue at the same time in this domain is that sense of stigma. And I think there’s this philosophical question that needs to go and be thought about in terms of privacy and stigmatization, such that how do we actually go and honor one’s privacy and celebrate that without people feeling like, oh, the reason why this actually needs to go and be kept private is because, if people were to go and find out, it would sully their reputation. And I’m wondering, Marti, how do you think through this in terms of trying to go and be very thoughtful in terms of how this idea of privacy is actually presented and honored so that it actually doesn’t go and actually unintentionally aid in the stigmatization of this issue that, quite frankly, so many people are going and dealing with?
[16:12] Marti: I think it is pretty simply just saying we need to be having more conversations about it. And yet, at the same time, it’s very much an individual’s comfort with that. And so, while today most people are comfortable if others know that they have a cancer diagnosis or a cardiovascular diagnosis, and that prompts others to have a sense of, how can I help this individual? And whether that’s bringing a casserole over to their home or whether that’s saying, “how can I help you at your job,” we don’t have that yet in mental health, where not everyone is comfortable with others knowing that they have some sort of a mental health or a substance use disorder diagnosis. And nor do others know what to do if they do open up to them and say, “I have a mental health diagnosis.” And so, I think so much of it comes down to us allowing and feeling comfortable starting to talk about it.
But I think the other piece of that is, but what is being done about it? Where is the research happening? What are the investments that are being made to really understand this better? Think about cardiovascular disease and where we were with cardiovascular disease in the 1960s and ’70s. We didn’t know what caused a heart attack. We didn’t know how to prevent a heart attack. We didn’t know what to do after one had a heart attack. And now, not only has the mortality rate from cardiovascular disease come down strikingly, but there is so much more that we know about it. We need to be in that same space in the behavioral health domain and, certainly, with substance use disorder. And so, there has to be more public, private investment in this space, and there has to be more of a willingness to start to talk about where we have gaps in treatment today and how we need to forge ahead for those innovative solutions.
[18:23] Michael: One of the things that I think is interesting here in terms of figuring out mental health in a way that’s comparable to the cardiovascular space is, what are some of the leading indicators of issues? When do we need to go and address this? And Brit, I was wondering if you wanted to go chat about some of the thoughts that we’re having around adolescents, in particular.
[18:44] Britt: Yeah, definitely. So, as we mentioned, the prompt this year is focused on youth mental health. And so, we’re trying to understand more about that space. And we’re wondering how you think about that at Verily or at OneFifteen. Is there a different approach when you’re thinking about people who are in the 10 to 18 age range?
[19:05] Marti: So, at OneFifteen, because we had to start somewhere, we treat individuals that are 18 and older. So, we’re not currently treating adolescents. I can tell you again, because of the lack of providers and just not having enough people in the adolescent and pediatric space, we get asked all the time, when will you start treating adolescents? But currently, we are 18 and above.
But I think, as we think about solutions, they really need to be aimed at the individuals, as well as the social context in which they exist, which means bringing families on board early and in a very meaningful way—again, being willing to talk about it. My son is struggling with depression at the age of 12 or 14. We need to recognize that we need to be looking for treatment options to help my son at 12 or 14 years old, just like we would be looking for treatment options for him if he had something going on in the orthopedic arena and not denying that or thinking that there’s something wrong. So, again, we need to be doing that in a very meaningful way.
And ensuring that, in parallel, that there are efforts to keep them on track in school, keep them on track with really… starting to think about purpose in life. They don’t have to have a career defined when they’re an adolescent and what they’re going to be doing. But really, starting to think about longer term and keeping kids on some track and path, and being a little bit more prescriptive with them and certainly always very supportive of their emotional and mental health needs.
We were recently awarded a grant in Montgomery County, which is the county that Dayton is in. We were recently awarded a grant through the Montgomery County Juvenile Court. And what that is that we are going to be working with the parents of juveniles who are struggling with substance use disorder. So, we’re coming at it at both angles to say we really have to be supporting the parents who are trying to support these adolescents. So, while we’re not treating adolescents today on our campus, we have a lot of other, I would say, wraparound types of work happening in this space. So, those are the efforts that we have today.
[21:31] Britt: I liked what you were saying about getting parents involved, thinking about schools. I think no one should feel alone in this journey, and especially, not kids and adolescents. They need that support community. That brings up a philosophical question that I think I struggle with in the mental health care space, which is, how much of a role technology can play and at what point technology reaches its limits. I’m curious if you have a perspective on the limits of technology in this space.
[21:56] Marti: I do. I do. And I don’t know if it’s somewhat rooted in my nursing early on in my career that I still carry with me today. And as we’re thinking today about scaling the approach in Dayton, we’re moving towards this virtual first approach. And it’s not virtual only. It is virtual first, but it is very much partnered with a human touch. And I think, especially in substance use disorder and behavioral health, more broadly, we have to think about that human touch component as well.
So, in the last four years that I’ve been working at Verily, I absolutely see the advantages that technology can do to supplement care and to complement care, but it’s not going to completely take over for care. Again, I think I know I’ve said this a lot, but we really do believe this. It’s very personal. We saw during the pandemic, when we, in nine days, pivoted to be able to provide more virtual care because, like all of us, we went into stay-at-home orders. We saw that there was a population that really benefited from that virtual care. And that may have been because we took away some of those barriers to getting treatment, which was, “I don’t have a ride to get to my appointment today,” or, “I’m homeschooling my children. How am I going to get to my appointment?” But there were other people who were losing that human connection and being part of whether it was individual treatment or group therapy treatment said, “I am really needing to be back with individuals.”
So, we’ve put together this hybrid approach, if you will. And we’re moving forward with a virtual first approach that will be complemented with a human touch, which we call a care advocate. And that care advocate will be local and living in a community, knowing the community resources that we can help our patients get connected to, but having that technology to also be a part of their care journey.
[24:04] Britt: I love that it keeps coming back to that personalization, whether it’s how they’re accessing care or how you’re measuring their success. I think that seems like a big theme from today’s conversation.
[24:13] Marti: Yeah, for sure.
[24:15] Britt: It brings to mind a question that I think is really prevalent in this space. And I think you’ve touched on this earlier, but receiving care from people that look like you, who’ve had the similar lived experience, I know where we have a crisis of caregivers in the mental health space. They’re not enough and they’re not enough who come from different kinds of backgrounds. So, it sounds like you guys have some system that is trying to get around that a little bit by bringing other people with lived experience, and even if they’re not psychiatrists and psychologists. Could you talk a little bit more about that?
[24:44] Marti: Work to do, still. We really do, because it does matter. People want to be treated by individuals that they know understand them and oftentimes look like them, talk like them. And so, we need to be mindful of that. Our staff is pretty diverse, and we are. We pay more and more attention to that, to try to attract folks from all different backgrounds and diversity. But we still have more work to do in that space. And I think this is where, from the standpoint of folks that have gone through our ecosystem of care, we now have many of them who have come back and are now employees of ours. And so, that is something that we, really, it’s an area that we focus on to say not everybody is going to have the right degree or the right skill set for that. But oftentimes, having gone through it, and a year later when they come back and say, “This is what I learned. And here’s how I can contribute to, really, the success of many others,” we need to welcome them in and we need to find the right opportunities for them. So, it may be that they’re our registration folks, that they are the first point of entry on that bricks-and-mortar campus that somebody sees. That can make a real difference at the point of registration. So, we do think about that. But we have more work to do. I wouldn’t say we’re exactly where I want to be just yet.
[26:05] Britt: Yeah, that’s really powerful to bring people back in and keep them as part of that community.
[26:10] Michael: Marti, how do you not bring the work home?
[26:14] Marti: Now that I’ve been in healthcare for 30 years or so, I can remember early on in my nursing career, one of my dear friends who’s still a dear friend today, who worked in cancer nursing, and I worked in cardiovascular nursing, and she would say, “I don’t know how you work with people who come in and have just suffered from a heart attack and may die the next day.” And I would say, “I don’t know how you work with cancer that is, oftentimes, more of a chronic disease and watching these folks slowly decline.”
And I think you get to a point where I don’t know that I’ve ever completely blocked off my professional life and my personal life. I try to, certainly, balance both. But I also learn from both. And so, I think there are things that I learn in my home life, my personal life, my community, that I share in the healthcare space, and vice versa. There are things that we all see everyday that families or individuals are struggling with that we can learn from. But if you allow the work to be something that is all-consuming and you can’t have that balance in your life, you really have to make sure you’re thinking about how you’re going to partition things off a bit.
[27:37] Britt: Yeah, definitely. Thank you so much, Marti. It’s been such a pleasure chatting with you today. And before we let you go, we were wondering if you could offer our listeners, many of whom are students like myself from around the country, any words of wisdom as it relates to championing their mental health and wellbeing and that of their loved ones.
[27:56] Marti: Yeah, sure. Well, thanks so much for having me. Again, it’s been a great way to start off my day. And what I would say to your listeners in thinking about championing their own mental health is, first, it’s okay to talk about it. I know it can be scary, and I know it can be uncomfortable at times, but it’s okay to talk about it. Advocate for your mental health, like you do your own physical health. You don’t ignore your own physical health needs, so don’t ignore your mental health needs. Secondly, there are resources that are available to help. And so, know where those resources are, and reach out to those resources. And then I would say be part of the innovation. Help us think about how we can be more innovative in this space. And so, you all are some of the brightest minds in the world today in helping us say, what is it that I need for my own mental health? So, bring forward those innovative ideas, and inspire those of us that are a little bit older in the healthcare space and need some of that creative thinking.
I think podcasts like this are really helping us to get the right messages out there. So, Michael and Britt, thanks so much for doing that. And we need to be perfectly comfortable talking about mental health and the associated challenges, but also the associated solutions. And lastly, I’ll just say our team at OneFifteen and at Verily is always happy to talk to folks. So, feel free to reach out to us. And we’d love to be a resource, but we’ll also tap into you to help us think about how we can do better in this space.
[29:35] Britt: Thank you so much. It’s been so inspiring to talk to you. And as someone who is hoping to pursue a career in this space, it’s great to see all the ebbs and flows of your own career and how you’re thinking about impact and thinking about innovation today.
[29:48] Marti: Thank you.
[29:52] Britt: Thank you so much for joining us today, as we learn about how to improve the access to and quality of mental healthcare. We would like to send a special thanks to our partners, Google and U.C. Berkeley Haas School of Business. And we would, of course, like to thank Ventures FM for making this podcast come to life. Until next time, take care of yourselves and each other.