Latest / Becker's Healthcare Behavioral Health / Expanding Access and Sustainability in Behavioral Health with Stephen Merz

Transcript

Expanding Access and Sustainability in Behavioral Health with Stephen Merz · Becker's Healthcare Behavioral Health

• 0:01
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
• 0:07
  hospital and health system executives and nearly 800
• 0:10
  speakers to Chicago
• 0:12
  April.
• 0:14
  This year's event includes keynote conversations with Dallas
• 0:17
  Cowboys legend Troy Aikman and former president George
• 0:20
  w Bush. For the agenda and event details,
• 0:22
  visit beckershospitalreview.com
• 0:25
  and click on the events tab in the
• 0:26
  upper right. We're looking forward to hosting you
• 0:29
  in Chicago.
• 0:31
  This is Laura Dirdo with the Becker's Healthcare
• 0:33
  podcast. I'm thrilled today to be joined by
• 0:36
  Steven Mertz, vice president and chief operating officer
• 0:38
  at Shepherd Pratt Solutions. Steven, it's a pleasure
• 0:40
  to have you on the podcast today. Thank
• 0:42
  you for having me. Now I'm excited for
• 0:44
  our conversation because I know it's such a
• 0:46
  dynamic time in health care. You know, we
• 0:48
  truly,
• 0:49
  interesting to dig into some of the things
• 0:51
  you're doing at Shepherd Pratt and how you're
• 0:53
  thinking about the future. But before we dive
• 0:54
  in, can you tell us a little bit
• 0:56
  more about yourself and the organization?
• 0:58
  Sure. Thanks so much for having me on
• 1:00
  the podcast. So my name is Steve Mers.
• 1:03
  My role is chief operating officer at Shepherd
• 1:05
  Pratt Solutions.
• 1:06
  I'll first tell you a little bit about
• 1:08
  Shepherd Pratt. It may be a place you
• 1:10
  have heard of or perhaps not,
• 1:13
  but Shepherd Pratt is one of the oldest
• 1:15
  and, largest
• 1:16
  nonprofit behavioral health care systems in the country.
• 1:19
  We started more than a hundred and seventy
• 1:21
  years ago
• 1:22
  under the premise of trying to create a
• 1:24
  supportive and caring environment for people experiencing mental
• 1:28
  health care or substance use disorder treatment needs.
• 1:31
  And we are based in, Maryland, and we
• 1:34
  have two primary campuses in Towson, Maryland and
• 1:37
  in Baltimore,
• 1:39
  and we've been around for a very long
• 1:40
  time.
• 1:42
  I run the division of Shepherd Pratt that
• 1:44
  provides services of Shepherd Pratt like, services outside
• 1:49
  of Maryland.
• 1:50
  So if you are a health system or
• 1:52
  a community agency
• 1:53
  or you're an existing provider of service and
• 1:56
  you wanna try to make your services run
• 1:58
  better or you wanna provide a level of
• 2:00
  care that doesn't exist, Shepherd Pratt Solutions goes
• 2:03
  out and works with nonprofit health systems to
• 2:05
  help them improve,
• 2:07
  access to care. And,
• 2:09
  our lens on behavioral health care is that
• 2:12
  behavioral health care is an important vital part
• 2:14
  of the health care system, so we really
• 2:15
  wanna try to get the word out so
• 2:17
  more people can try to take a crack
• 2:20
  at delivering those services and meeting those needs.
• 2:24
  Absolutely. That makes a lot of sense. You
• 2:25
  know, such a needed service all the time,
• 2:28
  but especially in the last few years that
• 2:30
  need for behavioral health,
• 2:32
  has just skyrocketed in in so many communities.
• 2:34
  So, you know, when you think about the
• 2:36
  last year or so, could you tell us
• 2:37
  about the most important initiative that you led?
• 2:39
  What did you do, and what were the
• 2:40
  results?
• 2:42
  Yeah. Thanks for the question. So I think
• 2:44
  from my perspective, the most important work we
• 2:46
  did was to help a commute help communities
• 2:49
  that we worked with that didn't have a
• 2:51
  formalized behavioral health care program and access
• 2:55
  and really help them,
• 2:57
  grow those programs or make them more sustainable
• 3:00
  or, in some cases, start them.
• 3:02
  So I'll just give you a couple examples.
• 3:04
  So we've worked with a couple of
• 3:07
  major health care systems that are in our
• 3:09
  national kinda ecosystem of health care, and they,
• 3:13
  sometimes have struggled with trying to make the
• 3:16
  behavioral health care service line work.
• 3:19
  So we've worked with them to try to
• 3:21
  look at, instead of closing or consolidating programs
• 3:24
  of try to make the program
• 3:27
  work more sustainably
• 3:28
  by having it
• 3:30
  see more patients,
• 3:31
  have it provide a continuum of care where
• 3:33
  patients can move from setting a to set
• 3:36
  setting b
• 3:37
  and have less readmissions
• 3:39
  and generate more,
• 3:40
  continuity of care, and that generates more continuity
• 3:43
  of services and then the revenues associated with
• 3:46
  that. So, just as one example, one of
• 3:49
  the things we worked last year we're very
• 3:51
  proud of is we worked with a very
• 3:52
  large health system of about 15
• 3:55
  hospitals in this major system
• 3:57
  with more than half $1,000,000,000
• 3:59
  of behavioral health care service line revenue,
• 4:02
  yet they were losing money. So they were
• 4:05
  considering, you know, should they keep the services?
• 4:07
  Should they sell them? Should they reorganize them?
• 4:09
  And we identified that this service line could,
• 4:12
  you know, save up to 90% or eliminate
• 4:15
  90% of their losses
• 4:17
  by simply making the system that they had
• 4:20
  work much better.
• 4:22
  So that's kind of an example. Another access
• 4:24
  example would be we worked with a a
• 4:27
  a health system. We will be working with
• 4:28
  University of Michigan.
• 4:30
  They have a campus that they operate in
• 4:32
  Lansing called Sparrow,
• 4:34
  health system,
• 4:35
  and this is, this is part of Mid
• 4:37
  Michigan. There,
• 4:38
  is,
• 4:39
  generally a need for access of care. And
• 4:42
  working with our colleagues there, they identified the
• 4:44
  opportunity to build more behavioral health care. So
• 4:47
  we're working with them directly to add beds
• 4:49
  in their community
• 4:51
  and add levels of care. Like, for the
• 4:53
  first time ever, there'll be kids, the care
• 4:55
  for child and adolescent patients,
• 4:57
  which is great. I mean, we know that
• 4:59
  eighty percent of mental health care conditions start
• 5:02
  in youth,
• 5:03
  and so getting that care in that community
• 5:06
  makes us really excited.
• 5:08
  Lastly, we our big project that we did
• 5:10
  last year, we celebrated in November the groundbreaking
• 5:14
  of a new hospital we're working on with
• 5:16
  WakeMed
• 5:17
  Health in Raleigh, North Carolina
• 5:19
  to, build a new behavioral health care hospital
• 5:22
  called a mental health and well-being campus,
• 5:24
  and that's in Garner, North Carolina. So just
• 5:27
  really active year for us. Very excited about
• 5:30
  that.
• 5:31
  That's amazing to hear. And, you know, it's
• 5:33
  really cool to have that opportunity to find
• 5:36
  ways to expand access to care and and
• 5:39
  bringing into new services of communities and especially
• 5:41
  as you mentioned, ensuring that services aren't closing
• 5:45
  or consolidating because,
• 5:47
  you know, funding in health care right now
• 5:49
  is a challenge, and and every dollar is
• 5:51
  precious. And so, you know, when you're looking
• 5:53
  across the landscape,
• 5:54
  what do you do when you're working with
• 5:56
  systems to try to make sure they can,
• 5:57
  you know, first start thinking about their strategy
• 6:00
  differently so they can keep those, you know,
• 6:02
  behavioral health service lines open?
• 6:05
  Yeah. It's a great question. So, you know,
• 6:07
  a lot of leaders are
• 6:09
  I I think I've been doing the behavioral
• 6:11
  thing for a long time, and I'll say
• 6:13
  there has been a real shift that's been
• 6:15
  great that's happened nationally.
• 6:17
  Many health care executives, you know, they get
• 6:19
  it. They understand that behavioral health care is
• 6:21
  an important vital part of health care.
• 6:24
  They're often challenged, however, with trying to make
• 6:26
  it work. They're trying to do the right
• 6:28
  thing, but it's hard to be an executive
• 6:30
  of a health system and have part of
• 6:32
  your portfolio that makes a lot of money
• 6:35
  and another part of your portfolio that loses
• 6:37
  a lot of money in trying to make
• 6:39
  health care work rationally for the way people
• 6:41
  experience it. You know, it's not like you
• 6:44
  you you just have one health care condition
• 6:46
  in in exclusivity.
• 6:48
  You often have co occurring conditions.
• 6:51
  So one of the things that we found
• 6:53
  is that where we're focusing on in this
• 6:55
  coming year is trying to bring together mental
• 6:58
  health care and physical health care in health
• 7:02
  care systems so that the leaders
• 7:04
  can feel that they can continue their investments
• 7:06
  in behavioral health care and not feel like
• 7:09
  they're constantly under the risk of program closure
• 7:13
  or changes in the reimbursement and the financing.
• 7:15
  So the things that we work on, for
• 7:17
  example, is that we lean into, you
• 7:20
  know, patients with that are highly acute.
• 7:22
  You know, some health care systems might say,
• 7:24
  well, the best behavioral health care is the
• 7:26
  one we don't serve. We let our other
• 7:28
  partner in the community do it. Our lens
• 7:31
  on it's a little bit different. We might
• 7:32
  say, you know, that patient with behavioral health
• 7:35
  care is also the,
• 7:37
  OB patient, your surgical patient, your oncology patient,
• 7:41
  your heart and vascular patient. And if you
• 7:44
  have behavioral, that patient is gonna be more
• 7:46
  complex and have more needs.
• 7:48
  So we really try to make the case
• 7:50
  that leaning into
• 7:52
  the higher higher acuity patient
• 7:55
  is serving their community in need. And we
• 7:58
  can usually make a case that by managing
• 8:00
  that need better,
• 8:02
  it improves the overall outcomes of care and
• 8:05
  ultimately reduces the cost of care. And I
• 8:07
  think we've made some really good paces, cases
• 8:09
  of that nationally.
• 8:11
  So that that that's really, focused. Some of
• 8:13
  the techniques we use are, you know, access
• 8:16
  to care. So the idea of no wrong
• 8:18
  door,
• 8:19
  every patient that comes into the system, you
• 8:21
  know, we know at least one in four
• 8:23
  people have a behavioral health care condition. So
• 8:25
  are you screening for that? Once you get
• 8:27
  screened, is there an access system in place
• 8:29
  that the patient can get access to care
• 8:31
  quickly? Once they get that access level of
• 8:34
  care, how do we reduce barriers so they're
• 8:36
  not limited by their insurance coverage or their
• 8:39
  medical acuity or other condition? So we make
• 8:42
  sure we get them into the treatment system,
• 8:44
  and we know once they get in the
• 8:46
  treatment system, their outcomes are way better. So,
• 8:49
  and we can get paid for it. You
• 8:50
  know, behavioral health care doesn't have to be
• 8:52
  scary. It's something that you can run at
• 8:54
  scale and not lose money.
• 8:57
  Oh, that's incredible,
• 8:58
  incredible way to look at it and think
• 9:00
  about it. And, you know, I imagine makes
• 9:02
  a big difference,
• 9:03
  when you're talking to executive leadership and, you
• 9:05
  know, especially when we're looking into the next
• 9:07
  year. So what are some of the big
• 9:08
  priorities and headwinds that you're focused on?
• 9:11
  Yeah. Like, I think that more more of
• 9:13
  a leaning into the the complex care, working
• 9:17
  on patients that have medical and behavioral comorbidities,
• 9:21
  that population is really important. So the big
• 9:24
  thing that we're working on is trying to
• 9:26
  get the word out more to health systems
• 9:29
  that they know that
• 9:31
  that they don't have to give up on
• 9:33
  behavioral health care is kind of our biggest
• 9:35
  priority. Like, we spend a lot of our
• 9:37
  time trying to be,
• 9:39
  national thought leaders in in getting out and,
• 9:42
  frankly, making Shepherd Pratt because we're one of
• 9:45
  these oldest and and the biggest.
• 9:48
  We don't wanna be alone. You know, like,
• 9:50
  it's part of our CEO has a very,
• 9:53
  you know, grand vision, which is that the
• 9:55
  world should not suffer and our country should
• 9:57
  not suffer with the lack of access to
• 9:59
  behavioral health care. In a very pure form,
• 10:02
  our mission is to improve
• 10:04
  access to behavioral health care resources. So we
• 10:07
  think our our goal for this year really
• 10:09
  is to continue to let acute care systems
• 10:12
  out there know that we are out there
• 10:15
  to be able to serve as a resource.
• 10:17
  If it's they need if health systems need
• 10:19
  support with knowing how to make it work,
• 10:22
  if they're having troubles with, you know, the
• 10:24
  the system not performing well either from a
• 10:27
  quality or access or financial perspective,
• 10:30
  before you close the program, please give us
• 10:33
  a call because we really are passionate about
• 10:35
  ensuring that there's access available in every community.
• 10:39
  Absolutely. That's so helpful to understand. And, you
• 10:41
  know, I I know access can be challenged
• 10:43
  by a good number of things, whether it's,
• 10:45
  you know, resources,
• 10:47
  personnel, or or just even
• 10:50
  lack of,
• 10:51
  leadership in some of these spaces, and needing
• 10:53
  to focus resources elsewhere. So, you know, I
• 10:56
  think especially when you're looking across the entire
• 10:58
  landscape, what are some of the, things that
• 11:01
  you're hearing most from the health systems that
• 11:03
  you're working with or some of the biggest
• 11:05
  challenges that they're running up against today?
• 11:07
  Yeah.
• 11:09
  We are hearing a lot of headwinds about
• 11:12
  the,
• 11:13
  the financial performance. There's, you know, there's always
• 11:16
  been this challenge of,
• 11:18
  you know, that behavioral health doesn't, you know,
• 11:20
  make a bottom line. And it's a good
• 11:22
  thing to have, but it might be like
• 11:24
  other some specialties, primary care, pediatrics, you know,
• 11:27
  some specialties that are really hard to generate
• 11:29
  a bottom line.
• 11:31
  It's just become more
• 11:33
  acute, that need.
• 11:34
  The and it's really driven by
• 11:37
  I don't I think the fundamentals are still
• 11:39
  there. There's a lot of patients that have
• 11:40
  needs. The care
• 11:42
  the, interventions make sense. The outcomes you can
• 11:45
  track. None of that has changed. What has
• 11:47
  really changed is that there's a lack of
• 11:49
  certainty
• 11:50
  and stability regarding the funding sources for behavioral
• 11:53
  health care. So either,
• 11:55
  you know, some some we're hearing from health
• 11:57
  systems that are really concerned about the $3.40
• 12:00
  b payments
• 12:01
  and this the how strong they would be,
• 12:03
  and then they do the math and they
• 12:05
  say, well, if we adjust our psychiatry service,
• 12:08
  we will decrease
• 12:10
  our likelihood that we'll get three forty b,
• 12:12
  and that ends up being a really big
• 12:14
  program,
• 12:15
  implication for them. So that's been a huge
• 12:18
  change is not understanding the the stability of
• 12:21
  that funding. The other one that's out there
• 12:23
  is we hear from a lot of health
• 12:25
  systems that are challenged with access for youth
• 12:28
  mental health care.
• 12:30
  Basically,
• 12:31
  adolescents and kids that, they they're not served
• 12:34
  well in the treatment system. General acute pediatric
• 12:37
  hospitals are not equipped with behavioral services,
• 12:41
  and general psychiatric hospitals don't have the kids
• 12:44
  services.
• 12:45
  So, unfortunately, a lot of these youth are
• 12:48
  left in the lurch. They don't have any
• 12:50
  opportunity of where to go, and they unfortunately
• 12:53
  get stuck in emergency departments, have to wait
• 12:55
  a long time, and, you know, that's just
• 12:56
  a miserable experience for a family. So,
• 12:59
  we do hear that as a really a
• 13:02
  big concern.
• 13:03
  How to a lot of community health needs
• 13:05
  assessments show that there's an ongoing need for
• 13:08
  kids' mental health, but people don't even know
• 13:10
  where to start. And so there's there's been
• 13:12
  a lot of interest we've seen there.
• 13:15
  That's helpful to understand. I I appreciate you
• 13:18
  kind of going through that with us. Now
• 13:19
  what do you think the hardest thing you're
• 13:21
  gonna have to do in the coming year
• 13:22
  will be?
• 13:24
  For us, the for the organization that I
• 13:27
  and my colleagues that I work with is
• 13:28
  basically
• 13:29
  how to,
• 13:31
  translate what we know as a huge demand
• 13:33
  out there
• 13:34
  for services with health systems needing the support
• 13:37
  and then connecting them with the resources we
• 13:40
  have. So it's really a scaling thing.
• 13:43
  I go to I go to enough meetings
• 13:45
  and I talk to colleagues across the country
• 13:47
  that their stories are very similar. The financial
• 13:50
  changes I mentioned, the, you know, youth access,
• 13:54
  managing complex care with with, very sick and
• 13:57
  acute patients. They're all experiencing the same challenges.
• 14:01
  They just there's not a good ecosystem out
• 14:03
  there for people to know
• 14:05
  how they can solve them.
• 14:07
  And,
• 14:08
  the hardest thing I have to do, I
• 14:11
  think, and that we have to do this
• 14:12
  year is how to scale
• 14:14
  the knowledge of these interventions
• 14:17
  to other health systems. So it's sometimes it's
• 14:20
  coming from the CFOs.
• 14:22
  Sometimes it's from the chief medical officers or
• 14:24
  the CEOs where they're struggling with trying to
• 14:27
  make these
• 14:28
  needs get met.
• 14:30
  And our biggest struggle is to let people
• 14:32
  know that there's places like us out there.
• 14:35
  Shepherd Pratt is can be a real place
• 14:37
  that people can go to. They can go
• 14:39
  see a thing that's been around for nearly
• 14:41
  two centuries.
• 14:42
  They can see how care is delivered at
• 14:44
  scale in the most patient centered way,
• 14:47
  entirely on a behavioral health care revenue stream.
• 14:50
  And when typically, I'll tell you, it's really
• 14:53
  not a not a fib. When people visit
• 14:55
  our campus, they they almost always say, this
• 14:59
  is amazing. I never knew it could be
• 15:01
  like this.
• 15:03
  And it's almost,
• 15:04
  Laura, the way I would say people might
• 15:07
  say that seeing is believing,
• 15:09
  that it that when did they see this,
• 15:11
  they know that it's possible, and that's inspiring.
• 15:14
  So, you know, we're only one campus in
• 15:17
  a huge sea of need. So my biggest
• 15:20
  challenge is trying to get out there and
• 15:21
  let people know that you can do it
• 15:23
  and reach out and ask, and there are
• 15:25
  people out there that are willing to help.
• 15:27
  I love that. That's an amazing, kind of
• 15:29
  mindset to have and and truly,
• 15:31
  being able to be proactive there. You know,
• 15:34
  I I know it's difficult to get the
• 15:36
  word out, but to have that kind of
• 15:37
  infrastructure in place and that example for other
• 15:40
  systems and organizations is critical. Now before we
• 15:42
  wrap up, I wanted to ask, where do
• 15:44
  you see some of the best opportunities for
• 15:45
  organizational growth?
• 15:47
  Well, I think that, you know I mean,
• 15:49
  the math is super easy here. There's, like
• 15:51
  I think the database shows that we have
• 15:54
  about 4,800
• 15:55
  or 5,000 hospitals nationally.
• 15:58
  And when you look at the database, maybe
• 16:00
  it's just over a thousand, roughly, I think,
• 16:02
  1,200 hospitals that have some formalized behavioral health
• 16:06
  care service in their portfolio.
• 16:09
  And I mean, you just contrast that with
• 16:11
  where we see behavioral health care, which is
• 16:14
  it's on every inpatient unit
• 16:17
  in every outpatient program,
• 16:19
  every clinic.
• 16:21
  You know, it doesn't discriminate by
• 16:23
  age, geography,
• 16:25
  race,
• 16:26
  setting, insurance status. We just know it is
• 16:29
  always out there. So for me, the biggest
• 16:32
  growth area I focus on is where most
• 16:35
  people get their health care. It's in their
• 16:37
  community hospital or community health system. It's in
• 16:40
  their local doctor's office.
• 16:41
  It's in their clinic.
• 16:44
  The biggest opportunity is to lean in
• 16:48
  and recognize that
• 16:49
  patient care, health care involves the entire patient,
• 16:53
  and well-being is a big part of that.
• 16:55
  And the mental health care space has got
• 16:56
  to be with the physical
• 16:58
  health. So if we can do more
• 17:00
  to, to lean in on that, that's that's
• 17:02
  to me the biggest opportunity.
• 17:04
  We have at Shepherd Pratt, I'll tell you,
• 17:07
  there are so many experts of so many
• 17:10
  different conditions
• 17:11
  all in one place.
• 17:12
  And I work with an amazing team of
• 17:14
  people who are really super smart
• 17:17
  and have literally decades of experience. I don't
• 17:19
  think anybody in my team has less than,
• 17:21
  two decades of experience in behavioral health care.
• 17:24
  So,
• 17:26
  I'm really honored to be working with them
• 17:28
  and just to try to find a way
• 17:30
  to connect with other health systems is kind
• 17:32
  of our major message.
• 17:34
  I love that. Steve, thank you so much
• 17:36
  for joining us on the podcast today. This
• 17:38
  has been a really informative conversation,
• 17:40
  and a lot of fun to learn about
• 17:42
  what you're doing and how you're thinking about
• 17:44
  the future. And, you know, I'm excited as
• 17:46
  well to see you in April. I know
• 17:47
  you'll be speaking,
• 17:49
  at our hospital review, conference coming up as
• 17:52
  well as behavioral health summit. So it'll be
• 17:54
  great to see you there and catch up
• 17:55
  and dig deeper on some of these things
• 17:57
  that we've been talking about today.
• 17:59
  Absolutely. And I cannot end this this discussion
• 18:02
  without paying a big thanks to Becker's because
• 18:05
  Becker's, for the last six or seven years
• 18:07
  has been very active and explicit about raising
• 18:10
  behavioral health care awareness at its national meetings,
• 18:13
  be it at the annual hospital review or
• 18:15
  if at the annual CEO and CFO conference
• 18:18
  in your various summits. And then last year,
• 18:20
  having the inaugural behavioral health care summit just
• 18:23
  speaks to the passion with which, you know,
• 18:26
  from the leadership on down from Scott Becker
• 18:28
  and the whole organization,
• 18:29
  really just appreciate you so much getting the
• 18:32
  word out about behavioral health care and letting
• 18:34
  other other,
• 18:35
  organizations in the health care ecosystem know that
• 18:38
  this is important. So thank you so much
• 18:40
  for for doing this.