A New Kind of Center of Excellence

Physician Dan Matthews has offered life-long services, pro-bono, to a youngster and his family he helped last year to figure out the real cause of his behavior. The kid, Aaron, was a 2nd grader and was on an IEP, was diagnosed with an unspecified spectrum disorder and had been taking antipsychotic medications to address outbursts in class and home. Matthews, who heads up NeuroBehavioral Health Systems in Texas, righted the ship – spending about 1 week with Aaron and his mom, doing testing and eventually adjusting the diagnosis and medication. Aaron wasn’t on the spectrum, and the medicine had had been taking that led to 35 pounds of weight gain was completely wrong. His condition was primarily a frontal lobe issue related to Aaron’s development. His new medicine is easier to manage and those 35 pounds he gained are gone. He’s calmer, more engaged, and the stigma that followed him in the halls has been lifted. The diagnosis that Dr. Mathews practice made is an example of the real opportunity the healthcare system has in making better use of regional experts who understand the science of behaviors and can maneuver through confusing conditions like depression, anxiety and autism. While Aaron’s family still can use Dr. Matthews, the beauty of this model is the center is primarily steps away after creating the protocol. But for all these benefits, there are risks, like how to pay for these services to ensure access to them and to ensure the right protocols are established. What’s more, autism and psych practice providers today will likely need to make sure they are linked in with these regional diagnostic centers of excellence. An open question exists in terms of how the health system ought to value these centers. With cancer back in 2008, I recall that Wellpoint at the time was keen on paying for these so-called diagnostic weeks, where the family could go to an MD Anderson or City of Hope to get the right protocol in place. ‘We ought to just pay for the flight and trip to get it right the first time, avoid a lot of re-diagnosing and tumors that move from stage 2 to 3 just because the local oncologists lack the resources, the expertise,’ Dave Tofanelli, former VP of enterprise contracting told me. Tofanelli’s idea was ahead of its time in some respects. These models are now beginning to be discussed more across services, not just behavioral and cancer, but orthopedics and neurology and likely other fields.