Latest / Becker’s Healthcare Podcast / Scaling Behavioral Health While Preserving Clinical Autonomy with Ben Johnson

Transcript

Scaling Behavioral Health While Preserving Clinical Autonomy with Ben Johnson · Becker’s Healthcare Podcast

• 0:00
  Welcome to Becker's Behavioral Health Podcast. I'm Ella
• 0:03
  Reuter, your host, and I'm thrilled to be
• 0:04
  introducing our guest today, Ben Johnson,
• 0:07
  director of behavioral health provider practices and operations
• 0:11
  at Lakeland Regional Health in Florida.
• 0:14
  Ben, thank you for joining us today. For
• 0:16
  those in our audience who may not be
• 0:17
  familiar with you and the work that you
• 0:19
  do, could you please introduce yourself and tell
• 0:21
  us a little bit more about Lakeland Regional
• 0:24
  Health?
• 0:25
  Sure. Thanks, Ella. Thanks, for having me on
• 0:27
  today. I'm glad to to be here to
• 0:29
  talk a little bit more about what we
• 0:31
  do at Lakeland Regional.
• 0:33
  My name is Ben Johnson. I have the
• 0:35
  privilege to serve as the director of behavioral
• 0:37
  health providers and practice operations at Lakeland Regional
• 0:40
  Health. Lakeland Regional Health is we're based here
• 0:43
  in Lakeland, Florida. We have the privilege to
• 0:46
  serve the Central Florida community over the last
• 0:48
  a hundred and ten years.
• 0:50
  We started out as a small community hospital
• 0:52
  called Morrell Hospital in 1916,
• 0:55
  and now we're one of the largest hospitals
• 0:57
  in Florida with a physician group of over
• 0:59
  400 providers,
• 1:01
  40 specialties, and 35 locations.
• 1:04
  Over the last five to six years, the
• 1:06
  footprint of behavioral health at Lakeland Regional has
• 1:09
  grown significantly.
• 1:11
  We have a state of the art facility
• 1:12
  of a 96 bed inpatient behavioral health unit.
• 1:16
  We have a thriving outpatient practice with multiple,
• 1:19
  locations.
• 1:21
  Our behavioral health provider group is now over
• 1:23
  50,
• 1:24
  amazing clinicians from psychiatrists,
• 1:26
  child, adolescent psychiatrists,
• 1:29
  psychiatric nurse practitioners,
• 1:31
  addiction medicine physicians,
• 1:33
  psychologists,
• 1:34
  therapists, clinical social workers, and now,
• 1:37
  psychiatry physician residents.
• 1:39
  Besides inpatient outpatient behavioral health, we offer IOP,
• 1:43
  interventional psychiatry services like ECT,
• 1:46
  TMS, ketamine.
• 1:48
  We also have a robust consult liaison
• 1:51
  psychiatry service at our 910
• 1:54
  bed hospital.
• 1:55
  We have a psychiatrist embedded right within our
• 1:58
  emergency department,
• 2:00
  and integrated behavioral health and our primary care
• 2:02
  practices.
• 2:03
  This year, we've also added a walk in
• 2:06
  clinic for psychiatric med management.
• 2:08
  Just a little bit about myself. I've been
• 2:10
  in behavioral health, leadership for over a decade
• 2:13
  and between behavioral health and consulting practices,
• 2:17
  across multiple states.
• 2:19
  I started out as a therapist.
• 2:22
  Marriage and family therapy,
• 2:23
  is my background,
• 2:24
  but I quickly wanted to move into administration,
• 2:28
  which has led me here today.
• 2:31
  Well, wonderful. Thank you so much for that
• 2:33
  brief overview and introduction.
• 2:35
  I'd love to kick us off with our
• 2:37
  first question.
• 2:38
  As Lakeland Regional scales its behavioral health services,
• 2:42
  where have you seen the most operational variation,
• 2:45
  and how are you standardizing
• 2:46
  workflows without losing clinical flexibility?
• 2:50
  A great question.
• 2:52
  The most significant variation in behavioral health is
• 2:55
  usually not the therapeutic work itself.
• 2:58
  It's in the operational
• 2:59
  infrastructure
• 3:00
  infrastructure
• 3:01
  surrounding care,
• 3:03
  including access, intake, pathways,
• 3:06
  referral management, handoffs, documentation, expectations, and scheduling workflows.
• 3:12
  My philosophy,
• 3:13
  is really that behavioral health leaders need to
• 3:15
  be very careful not to over insert themselves
• 3:18
  into
• 3:19
  the the clinical encounters.
• 3:21
  I've seen way too many organizations
• 3:25
  policy themselves into a corner and create
• 3:27
  operational rules that unintentionally
• 3:30
  compromise,
• 3:31
  patient care.
• 3:32
  Behavioral health is,
• 3:34
  difficult to fully manualize.
• 3:37
  It's not a commodity service line, and
• 3:40
  it doesn't respond well to,
• 3:43
  rigid, one size fits all operational models.
• 3:46
  Because of that, I I do not believe
• 3:49
  the the
• 3:50
  goal is to standardize the clinical encounter. The
• 3:53
  goal is actually to
• 3:55
  standardize the infrastructure
• 3:56
  around the encounter.
• 3:58
  At Lakeland Regional, we try to to to
• 4:01
  create an environment where providers can operate as
• 4:05
  closely
• 4:06
  to a private practice model as possible,
• 4:09
  while still benefiting from the strength of an
• 4:12
  integrated health system.
• 4:14
  That means,
• 4:15
  myself, my leadership team, and our support departments
• 4:18
  at Lakeland Regional Health are are really here
• 4:20
  to absorb as much of the administrative burden
• 4:23
  as possible
• 4:24
  so that providers can can stay focused on
• 4:28
  on patient care.
• 4:29
  We're here to solve the operational headaches, not
• 4:32
  to micromanage
• 4:33
  the art of the medicine or the psychotherapy
• 4:36
  itself.
• 4:37
  The way I think about standardizing
• 4:39
  is through guiding principles, not excessive rules.
• 4:44
  You know, we defined
• 4:45
  the the minimum standards necessary for access, for
• 4:49
  safety, coordination,
• 4:52
  and team function, but
• 4:54
  we leave the room for the provider judgment
• 4:57
  and the patient specific nuance.
• 5:00
  That's a is is, especially important in behavioral
• 5:03
  health where
• 5:05
  trust, the therapeutic alliance, with the patient,
• 5:09
  and the individualized care planning,
• 5:13
  are central to outcomes.
• 5:15
  So the balance is is really this, the
• 5:18
  standardized what protects
• 5:20
  the patient
• 5:21
  and supports the team, but
• 5:23
  do not,
• 5:24
  overstandardize
• 5:25
  in ways that intrude on clinical judgment.
• 5:29
  Yeah. That's really incredible.
• 5:31
  Thank you so much for for giving that
• 5:33
  overview there. And I'm really curious about how
• 5:36
  technology is playing a role in this.
• 5:39
  If you could kind of dive into
• 5:41
  where it's driven consistency
• 5:43
  versus where it's kind of fallen short.
• 5:46
  Great question.
• 5:47
  Technology has played an an important role in
• 5:50
  helping us create consistency
• 5:53
  in the administrative and operational aspects of care.
• 5:57
  It can support
• 5:59
  the the standard referral pathways, documentation,
• 6:02
  templates, the order sets,
• 6:05
  the communication workflows,
• 6:06
  the tracking tools, and
• 6:09
  performance visibility across our practices. It's especially helpful
• 6:13
  in creating a a shared infrastructure
• 6:16
  so that teams are are are not solely
• 6:18
  relying on their memory,
• 6:21
  their tribal knowledge, or even, like, the the
• 6:24
  local workarounds. That said,
• 6:27
  technology has its clear limits in behavioral health.
• 6:30
  It can support a workflow,
• 6:32
  but it really shouldn't define the entirety of
• 6:34
  of the of the care model.
• 6:37
  Where technology really falls short is when organizations
• 6:40
  try to force behavioral health
• 6:43
  into a rigid system
• 6:46
  that doesn't always reflect the nuance of the
• 6:48
  work.
• 6:50
  An EHR
• 6:51
  can
• 6:52
  standardize
• 6:53
  the the fields and the steps, but it
• 6:55
  really can't replace the clinical judgment,
• 6:57
  the therapeutic align alliance,
• 7:00
  or the reality that behavioral health is often
• 7:03
  nonlinear.
• 7:04
  Technology,
• 7:06
  it it can fall short when it becomes
• 7:09
  another layer of an administrative burden rather than
• 7:12
  a tool that actually removes the burden.
• 7:16
  In behavioral health,
• 7:18
  that is a real risk if the system
• 7:20
  creates more clicks, more duplicative
• 7:23
  documentation,
• 7:25
  or,
• 7:26
  more operational policying
• 7:29
  than
• 7:30
  of the actual clinical encounter.
• 7:32
  Clinicians will will feel it immediately.
• 7:35
  So I view, technology as more of a
• 7:38
  enabler,
• 7:38
  not the solution itself.
• 7:41
  It should support support,
• 7:43
  consistency
• 7:44
  in the administrative scaffolding
• 7:46
  around care,
• 7:47
  but it should never become,
• 7:49
  yeah, a mechanism
• 7:51
  through which,
• 7:53
  administration
• 7:54
  overreaches
• 7:55
  into the into the clinical encounter.
• 7:58
  When technology is
• 8:00
  is well designed,
• 8:03
  it creates
• 8:04
  clarity,
• 8:05
  it reduces friction.
• 8:07
  But then
• 8:08
  on the opposite side, when it's poorly designed,
• 8:11
  it it amplifies both frustration
• 8:13
  and fragmentation
• 8:15
  in the system.
• 8:17
  One of our big wins for our team
• 8:18
  this past year has been adding AI,
• 8:21
  to help our providers
• 8:23
  document their sessions.
• 8:24
  It's been a huge patient satisfier,
• 8:27
  or a huge provider satisfier rather
• 8:30
  that they can spend more patient facing time
• 8:33
  and not have to worry about getting to
• 8:34
  the the next session. And it also helps
• 8:37
  our providers get home quicker to their families
• 8:40
  and move on, so they're not having all
• 8:43
  of that, extra documentation at the end of
• 8:45
  the day.
• 8:46
  Yeah. That's really incredible. I know I've talked
• 8:48
  to a lot of leaders about kind of
• 8:49
  that workforce strategy there with
• 8:52
  the AI,
• 8:53
  listening tools and documentation tools. So thank you
• 8:56
  so much for for talking more about how
• 8:58
  AI is is, you know, affecting,
• 9:02
  Lakeland Regional Health. I'd also love to dive
• 9:05
  more into I know you mentioned standardizing versus
• 9:08
  clinician autonomy.
• 9:10
  And I was kind of wondering if you
• 9:11
  could dive more into the challenges there and
• 9:14
  kind of how
• 9:15
  you're navigating that so that you are balancing
• 9:18
  the two in the in your system?
• 9:22
  First,
• 9:23
  I I do assume that a a more
• 9:25
  standardized process is automatically
• 9:28
  a better one.
• 9:29
  In behavioral health,
• 9:31
  a a process can look more efficient
• 9:34
  on,
• 9:35
  on paper
• 9:36
  and still create friction,
• 9:39
  that damages patient care or clinician and, engagement.
• 9:44
  I look at whether the the process
• 9:47
  is actually helping patients,
• 9:49
  enter care more smoothly or move through the
• 9:51
  continuum more effectively
• 9:54
  and connect with the right provider with less
• 9:56
  confusion and less duplication.
• 10:00
  I also look at,
• 10:02
  at whether it is protecting clinicians,
• 10:05
  from unnecessary administrative burden.
• 10:08
  One of my core leadership principles is that
• 10:11
  providers should be doing
• 10:13
  the,
• 10:14
  provider work and not spending
• 10:16
  their day fighting avoidable
• 10:19
  operational barriers.
• 10:21
  If a process
• 10:22
  improve,
• 10:23
  improves throughput by pushing,
• 10:26
  work back onto clinicians
• 10:29
  or
• 10:30
  by creating,
• 10:32
  an impersonal patient experience. I I really don't
• 10:35
  consider those to be a successful design.
• 10:38
  We try to build systems that reduce administrative
• 10:40
  drag,
• 10:41
  and create real clarity,
• 10:43
  for the entire support around the provider.
• 10:46
  That means having schedulers,
• 10:49
  MAs, operational leaders,
• 10:51
  and support teams really carry that administrative load,
• 10:55
  that they're meant to carry. So
• 10:57
  the provider can,
• 10:59
  remain focused on care delivery. You may hear
• 11:02
  me say that, multiple times because, it's it's
• 11:04
  really important to me. It also means being
• 11:07
  honest that,
• 11:08
  not every access metric tells the full story.
• 11:12
  I'm very cautious about those workflows that technically
• 11:14
  satisfy
• 11:15
  payer timeline standards so that,
• 11:18
  that in a way, it fragments the patient
• 11:21
  experience.
• 11:22
  For me, true access is not just about
• 11:25
  getting a patient seen quickly.
• 11:27
  It's about getting them meaningfully connected to the
• 11:31
  right
• 11:32
  level of care, ideally,
• 11:34
  with the right long term provider
• 11:37
  relationship too. So
• 11:38
  so we evaluate,
• 11:40
  the process design
• 11:42
  through both an operational lens and a care
• 11:44
  experience lens.
• 11:46
  If it improves
• 11:47
  throughput but weakens trust,
• 11:49
  continuity or the provider sustainability,
• 11:53
  then it's truly not optimized.
• 11:56
  Yes. And I'm really curious too about
• 11:59
  how you're connecting with providers to making to
• 12:02
  make sure there isn't an added friction.
• 12:04
  I was kinda curious about how you're receiving
• 12:06
  that feedback and maybe closing those loops.
• 12:10
  So I really think it's important that
• 12:12
  you have an open line of communication
• 12:16
  between your provider group, your support teams,
• 12:20
  and your leaders,
• 12:21
  and that really does require
• 12:23
  open door policies
• 12:25
  and frequent meetings,
• 12:27
  particularly within within our department. We
• 12:30
  have
• 12:31
  one large department meeting, and then we have,
• 12:34
  smaller meetings within, behavioral health. Like, our outpatient
• 12:37
  team, we meet, once a month
• 12:39
  where we,
• 12:41
  discuss those,
• 12:43
  friction points. And,
• 12:45
  what I ask of my team is that,
• 12:47
  if they've identified,
• 12:49
  a friction point, that they're also, you know,
• 12:52
  helping us try to find solutions as well
• 12:55
  because, we're we're a team here. And,
• 12:58
  on my team, they know that,
• 13:00
  I like to volunteer us for lots of
• 13:02
  different pilot opportunities. So it's not turning away
• 13:07
  turning down a an idea just because we
• 13:10
  want to continue. Well, this is this is
• 13:12
  the way we've always done it. You know,
• 13:14
  if there's some if there's a different way
• 13:15
  for us to
• 13:17
  find a find a solution for a problem,
• 13:19
  then let's try it and then,
• 13:22
  monitor and adjust from there. So it's having
• 13:25
  those open discussions about those friction points
• 13:28
  and,
• 13:30
  being willing to to trial things to,
• 13:33
  to make it better.
• 13:35
  Yeah. That's great to have that feedback from
• 13:37
  your team,
• 13:38
  and really be in in, close communication there.
• 13:42
  And for our last question, I'm really curious.
• 13:44
  If you could standardize one thing across behavioral
• 13:47
  health programs in the country, what would it
• 13:49
  be,
• 13:50
  if any, and what kind of impact would
• 13:52
  it have?
• 13:54
  That's another great question.
• 13:56
  You know, I I've thought about this,
• 13:58
  a lot, and it just it's just what
• 14:00
  kind of one of those things that
• 14:03
  I think
• 14:03
  we as, behavioral health operators, we've,
• 14:06
  would love to have across
• 14:09
  the nation. And that is one thing that,
• 14:12
  you know, if we could standardize one thing
• 14:14
  nationally, it would be,
• 14:16
  a true health information exchange across
• 14:20
  community agencies, behavioral health providers, addiction treatment centers,
• 14:23
  hospitals,
• 14:25
  other care settings.
• 14:26
  One of the biggest barriers in behavioral health
• 14:29
  today, is fragmentation.
• 14:31
  Many of the patients that we serve have
• 14:34
  interacted with multiple systems over time across different
• 14:37
  organizations,
• 14:38
  different levels of care, and sometimes different states.
• 14:41
  Particularly, you know, in in our location in
• 14:43
  Florida, we hit quite transient. We have people
• 14:45
  that,
• 14:46
  you know, snowbirds that'll come down.
• 14:50
  But yet, providers are still often,
• 14:53
  forced to
• 14:54
  piece together the story,
• 14:56
  from incomplete
• 14:58
  records and patient recollection.
• 15:01
  This is a major problem, especially in behavioral
• 15:03
  health,
• 15:04
  where patients
• 15:06
  may have, you know, complex treatment histories,
• 15:09
  multiple diagnoses,
• 15:11
  prior medication trials, prior hospitalizations,
• 15:14
  substance use treatment episodes,
• 15:16
  and, you know, and trauma histories that are
• 15:19
  are
• 15:20
  are are highly relevant to the current care,
• 15:23
  it would be enormously
• 15:26
  valuable
• 15:26
  if our providers could see the full picture
• 15:30
  and pick up where the last provider left
• 15:33
  off rather than having to start over from
• 15:35
  scratch. That would really improve continuity, reduce duplication,
• 15:41
  reduce reliance on,
• 15:43
  on patients perfect you know, being perfect,
• 15:46
  historians
• 15:48
  and help clinicians
• 15:49
  avoid repeating interventions that have already failed.
• 15:53
  For a large hospital system like ours, that
• 15:56
  would that would be particularly important because,
• 15:59
  we serve patients from across the state. We
• 16:02
  also
• 16:03
  care for seasonal residents that that may only
• 16:06
  be here for part of the year.
• 16:08
  A robust a robust
• 16:10
  information exchange would create
• 16:13
  a better coordination across a full continuum
• 16:16
  and across geographies.
• 16:18
  The impact would
• 16:20
  be improved safety,
• 16:22
  better treatment planning,
• 16:24
  more efficient care transitions,
• 16:27
  less fragmented care,
• 16:29
  and much more intelligent use of the system
• 16:32
  as a whole. If behavior health is ever
• 16:35
  going to function truly,
• 16:37
  like a truly integrated continuum, then the information
• 16:41
  has to move with the patient.
• 16:44
  Well, wonderful. Thank you so much, Ben, for
• 16:46
  sharing more about Lakeland Regional Health and your
• 16:49
  perspective as, director of behavioral health provider practices
• 16:53
  and operations.
• 16:54
  Thanks to our listeners for tuning in to
• 16:56
  Becker's Behavioral Health Podcast, and we'll see you
• 16:58
  next time. Thank you. Thank you very much.