2015 Behavioral Healthcare Champions
Today's behavioral health executives know that passion is nice, but personal attributes alone cannot sustain a business. Instead, they invest in the hard work of managing budgets, hiring the best clinical staff, capturing outcomes and integrating with the industry at large.
The 2015 Behavioral Healthcare Champions are the industry's premier examples of leaders who have done the hard work and have the success stories to show for it. They are advocates who understand how business expertise leads to greater fulfillment of the mission. They embody innovation within the changing, challenging healthcare landscape.
Our Champions come from all over the country, representing urban and rural locations. Each was selected from among dozens of outstanding nominees who have raised the bar of success for the industry as well as for individual patients and clients. With their professionalism, courage and inspiration, these professionals each have a story to tell and lessons to share.
In addition to the snapshots provided here, we look forward to recognizing the Champions personally at the
See you in
Chief Operating Officer,
When
Dammeyer says at the time, there wasn't enough volume to support the ongoing operation, and the services were in danger of crumbling altogether. The behavioral unit in the not-for-profit hospital-hours away from any other acute-care facility-could only afford to treat SUD patients with insurance coverage.
"I argued that they needed to abandon that way of thinking," he says. "I wanted the facility to be attractive to a person who could choose to fly somewhere to get their treatment or somebody who had zero economic resources. If you hold the bar up high enough, you can attract everyone."
Outcomes focus
With
In the relaunch, what was different was the improved way of thinking, which was not focused on the aesthetics or the location, but on the necessity of positive outcomes. Every dime had to be invested in the ultimate goal of the patients' long term recovery.
"Society is more than willing to pay to help people with substance abuse problems, but they have to see empirical evidence that it works," Dammeyer says. "The money will come if you produce outcomes."
Early on, he spent 95 percent of his time seeing patients to help keep the unit lean, and he often worried that every patient he saw might be the last. He made sure everyone knew good outcomes were the ultimate key to financial stability. In fact, during intake, he would candidly tell the patients themselves how earnestly the care teams expected positive outcomes.
"We tell people 'all you need is to be able to pay for services or give us a good clinical outcomeone or preferably both of those things,'" he says.
And he is quite serious about the reinforcement of that focus on patients. They know the care teams will do whatever it takes, but there is mutual agreement that the patients need to work just as hard.
"It was very successful for us, but after awhile the word gets out, and the clients start coming to you," Dammeyer says. "People are so hungry for real outcomes, they are willing to back up what they say with intensity."
New day
By 2010,
Dammeyer recommends that behavioral health professionals shift their focus to outcomes-not anecdotal stories but empirical clinical outcomes- to determine whether their programs are successful. By chasing outcgjBS -T i exclusively, programs will change the conversation from asking for more money and resources to demonstrating scientific proof of value. It's a more honest point of reference.
"I hear anguish rather than innovation," he says. "If you could guarantee eight out of 10 people with addiction positive outcomes-not just the easy cases but across the board-people will come flying in with all kinds of funding mechanisms to support that. And the burden is on us to get those clinical outcomes and admit to ourselves when we are not capable of it and then find ways to improve and build a model to reflect that."
He believes more support can be gained in the industry as a whole if leaders would talk in terms of numbers and dollars as they relate to effectiveness and efficiency. Play for keeps, and be honest about what you can or can't deliver.
Dammeyer is now the chief operating officer at Central Peninsula, yet he still sees patients a few hours a week. He says he planned that and expects to see patients his entire career because he considersihat on-the-ground experience to be invaluable.
Chief Executive Officer, Thresholds
In 2011,
Ishaug saw the potential of the two trends, believing there was opportunity to improve not just points of care for individuals with behavioral conditions, but the system itself.
"I've spent the vast majority of my working life building partnerships, using evidence-based practices, trying to create value and outcomes programs, and engaging in advocacy at the highest level," Ishaug says.
Managed care
Cenpatico, the behavioral health arm of the state
"We call our services 'in vivo,"' he says. "We're not a traditional community mental health center or federally qualified health center where the people come to us. We engage people where they are because that is what the evidence says works."
In the year-long Cenpatico pilot ending in
"This pilot project has grown into a full-fledged case-rate arrangement," Ishaug says. "It's a new way of doing business and partnering with managed care organizations to collectively achieve the outcomes we want."
He also says new payment arrangements such as case rate models provide some latitude to deliver comprehensive services, unlike the fee-for-service model that limits what is reimbursed to specific medical interventions. For example, a community team seeking to engage a homeless member who has repeatedly visited the emergency room might not be able to bill a payer under a fee-forservice model, but their engagement services could be funded in a case rate model.
Thresholds manages care for about 400 Cenpatico enrollees right now, representing about 10 percent of Thresholds' total membership population. In another managed care initiative, the organization has plans to begin a project with the local
Housing
In the future, Ishaug envisions managed care companies investing beyond the health services and looking into housing for their enrollees because a person's housing situation has a direct and dramatic effect on overall health. He says some discussion has begun over the last year about the right mechanism to fund managed care investment in housing, but it's still at a conceptual loans.
"All evidence suggests that homeless folks with mental health and substance use disorders are often frequent users of healthcare and are costing the system a fortune," he says. "Getting people into affordable housing, while it may cost
Ishaug says Thresholds is one of
Housing includes:
* Supervised group homes;
* Supportive housing in a singleroom occupancy setting; and
* Independent apartment settings.
"Housing is healthcare," he says. "The fact that we separate them is like separating the mind from the body or mental health from physical health."
Thresholds is looking for ways to increase the inventory of available supportive housing in the future, whether through Section 8 or unique organizational partnerships. Creating more housing options is core to the organizatbri's missionr-he says,
Chief Executive Officer and Clinical Director,
fhen
"Integrated health to me is people on the front lines working together for a common cause, and that common cause is to improve the health and wellness of our clients," Trentacoste says.
Today, the 43,000 square-foot building in
"Over the past eight years, the goal has been to build on the model and become even more tightly woven into the fabric of social support, of which, healthcare is primary," Trentacoste says. "We are one component, and we are obligated to stitch ourselves together with other providers of healthcare and social supports."
Where to start
When the integration plan emerged, Treotaæste ïïïadp ari extra effort to train for the new model and earned a certificate in primary care behavioral health from the University of
"For me, it was about the perspective of learning that larger treatment system and culture so we can present ourselves as an aspect of it that is being underutilized," he says. "We are a specialty aspect of care."
And there are differences. For example, primary care charts contain more numerical measures, such as blood pressure, and fewer clinician notes, while behavioral charts contain more notes and fewer data points.
To begin an integration effort, Trentacoste recommends centers start with conversations and informal connections with local primary care practices so behavioral health isn't a "black hole" in the care continuum. Family doctors often bemoan the way patients fail to follow doctor's advice, and behavioral health can offer a quick win with its clinical expertise in motivating change and inspiring patients to take care of themselves and their families.
In an even bigger context, Trentacoste is also collaborating through the local healthcare council, which is working on pilot projects in population health to reduce utilization among frequent users of the ER and to reduce réadmissions for patients with chronic obstructive pulmonary disorder.
"Our decision to physically relocate and join together with the health center-in a more attractive way than is usually expected in our service system- sparked a lot of interest in exploring the relationships further," he says., ; ^
Trentacoste recommends that as part of integration, providers should examine ways to measure outcomes and leverage evidence-based treatment protocols.
But even more so, he says, a publicly funded entity should be expected to show results.
"It doesn't sound like a big deal, but the act of measuring the progress we're making and the outcomes we're delivering has created an environment where we can generate resources we never could before," he says.
For example,
"We were able to show them results, not just stories of client success, but numbers and data that was meaningful to them and their donors who want to see those results," Trentacoste says.
He believes the extra layer of work that comes from tracking and aggregating outcomes is more than offset by the benefit of proving value and effectiveness, which leads to new __ resources. He sees it as;i§sS'w5rkf not more. The tools are there, he says, bghavicfiSf healthcare leaders just need to use them.
Chief Executive Officer,
On a sunny Thursday morning in rural
"It's 10 o'clock," Weston-Hall says to a young man listening to rock music piped through the speakers of the empty lecture hall. "You're on your way to group now?"
He scrambles away with a bounce In his step.
"Because I have a clinical background, I'm really connected to everything that goes on," she says. "I go to clinical staff meetings every day, and I have an open-door policy. Patients can stop in for whatever reason."
Weston-Hall herself is in recovery and reached the 40 year milestone recently. As CEO, she knows clinical science and the recovery business continue to change over time. Long-term, the best strategy is to always remain focused on the patient experience as a way to stay true to the mission, she says.
Responsive strategy
"We play music before and after lectures, and we have music therapy groups," she says. "We've also added art therapy and more exercise classes."
The center has also recruited specialized staff who are trained to care for 18 to 25 year-olds and can help monitor their activities. As a group, they tend to be a bit more disruptive than their older counterparts because of a different maturity level, she says. In many cases, the patients are arriving in treatment with ultimatums from their parents and might have those additional conflicts to work through as well.
"Initially they were two steps ahead of us," Weston-Hall says. "We were used to the average age of a patient being late 30s, but now we might have 50 patients between the ages of 18 and 25."
She says many of them arrive addicted to heroin, and the unrelenting epidemic is truly concerning to her. She's seen various trends peak over the years, but heroin use is an ongoing issue that has far reaching impact on families and communities.
Outcomes measures
"One of the challenges with outcomes is that a lot of people leaving the program aren't going back to the same living situation or change their phone numberin some cases we advise that because of past drug use," she says. "So it is challenging sometimes to follow up in this field. It's important to contact family as well as the patient."
She says other aspects of recovery are also measurable such as lifestyle changes, reconnecting with loved ones, improved quality of life and avoiding trouble with law enforcement. The industry as a whole needs to do a better job of collecting that information, too, even though it's a huge job, she says.
Alumni activities can also provide some data on outcomes. For example,
The future
"Our salary structure is attractive here at
Enhanced tuition reimbursement packages, comparable benefits and wages and more advancement opportunities will help future professionals consider addiction treatment a lifetime career choice, she says. Her own recovery experience influenced her decision to work in the field, and Weston^-,Hall believes supporting thoseirfrecovery with funding and opportunities to move towarcter Clinical career can only enhance what treatment centers have to offer.
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