Latest / Becker's Healthcare Behavioral Health / Behavioral Health Innovation and Expanding Access Across Communities with Dr. Manish Sapra
Transcript
- 0:02- Heightened demand for behavioral health services isn't simply
- 0:05- a trend. It represents a structural shift in
- 0:08- what patients need and what health systems are
- 0:10- expected to deliver. And the space between that
- 0:13- expectation
- 0:14- and most organizations' current capacity is where the
- 0:16- hardest leadership questions live. How to recruit and
- 0:19- retain clinicians in a historically thin labor market,
- 0:22- how to build sustainable financial models around services
- 0:26- that have been chronically under funded and how
- 0:28- to integrate care in ways that actually improve
- 0:30- outcomes rather than just check a box.
- 0:33- Becker's Fall Behavioral Health Summit is where more
- 0:36- than 300 executive level attendees
- 0:38- and 30 plus speakers spend two days working
- 0:40- through exactly those questions with the kind of
- 0:43- candor that only happens when the right people
- 0:45- are in the room. Join us November fourth
- 0:48- and fifth at the Hyatt Regency Chicago. For
- 0:50- the agenda and event details, visit beggars hospital
- 0:53- review dot com and click on the events
- 0:55- tab in the upper right.
- 0:58- Welcome to the Becker's Behavioral Health Podcast. I'm
- 1:00- Ella Reuter, your host. Today, I'm joined by
- 1:03- Manish Sapra, system vice president of behavioral health
- 1:06- services at CommonSpirit Health. He recently joined the
- 1:10- system's national leadership team to help guide behavioral
- 1:13- health strategy across one of the largest
- 1:16- health systems in the country.
- 1:17- Doctor. Sapra, thank you so much for joining
- 1:19- us today.
- 1:21- Thank you for having me. It's really exciting
- 1:23- to be here, and, I hope you have
- 1:25- a good conversation.
- 1:27- Yes. I'm looking forward to it. Well, can
- 1:29- you start us off by telling us a
- 1:31- little bit more about yourself, your leadership background,
- 1:34- and how you ended up at CommonSpirit?
- 1:37- Sure. Yeah. I I joined CommonSpirit
- 1:39- last November,
- 1:41- and so it's been about eight months in
- 1:43- the organization.
- 1:45- I was hired to be the system vice
- 1:48- president for, behavioral health services
- 1:51- overseeing a new strategic service line in the
- 1:53- system,
- 1:55- which is,
- 1:56- remarkable for the system to actually invest in
- 1:59- a national behavioral health service line.
- 2:01- As far as my background,
- 2:03- I I was recently with another health system
- 2:05- in New York, called Northwell, where I ran
- 2:08- their behavioral health service line there
- 2:11- for several years. And,
- 2:13- part of that, I have had experience of
- 2:15- working in,
- 2:17- in in Pittsburgh,
- 2:18- at UPMC,
- 2:19- and then
- 2:20- in rural,
- 2:22- settings in Central Pennsylvania
- 2:24- and community settings within Connecticut. So lot of
- 2:27- experience of working community based organizations,
- 2:30- community hospitals, which is really relevant right now
- 2:33- in in this role, at Crown Spirit.
- 2:36- And then, you know, over the years, I
- 2:38- would say I've had sort of the,
- 2:41- front row seat looking at health care consolidation
- 2:44- and as large health systems build, you know,
- 2:47- structures to
- 2:48- connect their programs and,
- 2:51- become more organized. I've had the pleasure of
- 2:54- of creating that service line strategy, which is
- 2:57- what brings me to common spirit as as
- 2:59- the system is looking to do the same.
- 3:02- Yes. Well, thank you so much for that
- 3:03- brief overview there,
- 3:05- especially with your leadership background. Again, thank you
- 3:07- for touching on everything and showing just your
- 3:09- breadth of work there.
- 3:11- We talked with you, Beckers did, last November
- 3:14- when you took on this position,
- 3:16- and you told us how you were spending
- 3:18- your first few months understanding the work that
- 3:20- was already happening
- 3:21- across CommonSpirit
- 3:23- before,
- 3:24- implementing any major changes.
- 3:26- When you look across
- 3:28- a system
- 3:29- of this size like CommonSpirit,
- 3:31- what opportunities do you see to standardize behavioral
- 3:34- health strategy,
- 3:35- and where do you believe standardization
- 3:38- can have the greatest impact on quality,
- 3:41- patient outcomes, and operational performance?
- 3:45- Yeah. You know, before making any big changes,
- 3:48- especially for a system this this big,
- 3:51- it's it's really crucial to take a step
- 3:53- back and get to know each market, each
- 3:57- clinical setting that we are working on.
- 3:59- And that's where I've invested my time. You
- 4:02- know, because of our size, every community has
- 4:04- such different needs, resources.
- 4:07- There are different regulations that affect care.
- 4:10- So I've spent the first few months just
- 4:12- mapping out,
- 4:13- what's already happening on the ground.
- 4:16- We want to find those bright spots, the
- 4:18- the practices that that are already working well
- 4:22- and figure out how to scale them up
- 4:24- so that the whole system can benefit.
- 4:27- Now regarding standardization,
- 4:28- you know, it's a huge opportunity for us
- 4:30- to
- 4:32- boost, both our quality and efficiency and and
- 4:35- bring the economies of scale to to those,
- 4:39- initiatives.
- 4:41- My vision is really that
- 4:44- we are able to
- 4:46- centrally
- 4:47- consult over what consistent guidelines should be,
- 4:51- you know, whether it is working with our
- 4:54- quality folks on building some peers,
- 4:57- scorecards,
- 4:59- to track our work,
- 5:02- or to really sharpen how we use our
- 5:04- electronic medical records. You know, we're we're doing
- 5:07- a lot of work right now on
- 5:09- admission auto sets and other auto sets and
- 5:12- and, you know, what kind of analytics we
- 5:13- can get from our from our electronic medical
- 5:16- records. So
- 5:17- those kind of initiatives give us an approach
- 5:20- and a and a hope that we can
- 5:22- actually,
- 5:23- deliver some consistent message,
- 5:26- centrally from the system
- 5:29- about what it means to get being get
- 5:31- getting better and how can we
- 5:33- measure
- 5:34- that success or or just keep an eye
- 5:37- on how our operations are going.
- 5:40- On top of that, if we standardize think,
- 5:42- we are looking at our acute care models.
- 5:45- Right? We're looking at EV throughput. We're looking
- 5:48- at, efficiency in our inpatient care model, our
- 5:51- crisis intervention model. We have set up some
- 5:54- crisis
- 5:55- stabilization units, in the system.
- 5:58- How are those things working out? Whether we
- 6:00- wanna enhance, expand that, that is, something
- 6:04- the the service line, looks to
- 6:07- advise the rest of the system on how
- 6:09- to to build that.
- 6:11- We're talking about expanding access to care, so
- 6:14- cutting down on redundant processes. And this is
- 6:16- a big one, like reducing those frustrating wait
- 6:19- times for patients in the ER.
- 6:21- So we're working on looking at ways to
- 6:24- enhance
- 6:25- our assessment
- 6:27- in the emergency departments. We have several pockets
- 6:29- of really good work that's going on in
- 6:32- the system, and we're looking to
- 6:34- to learn from that and bring it to
- 6:36- the rest of the system. So this means
- 6:39- giving,
- 6:40- more comprehensive,
- 6:41- evaluations
- 6:42- and then,
- 6:44- helping out with behavioral health transfers. We're starting
- 6:46- to use some technology, some inbuilt, and some
- 6:49- with our external partners
- 6:51- on helping with those referrals,
- 6:54- both internally and externally.
- 6:56- So that's that's some work that we are
- 6:58- focusing on.
- 7:00- We're also looking to identify
- 7:03- proactively,
- 7:04- and preemptively
- 7:05- using,
- 7:06- you know, technology, analytics, even AI
- 7:09- within
- 7:10- our emergency departments as soon as patient, is
- 7:12- showing up
- 7:14- or within our broader,
- 7:15- you know, patient population using,
- 7:18- concepts like registries and
- 7:21- identifying patients who are at risk so that
- 7:23- we can have a more proactive approach in
- 7:26- in reaching out
- 7:27- and a timely approach in reaching out to
- 7:29- those patients.
- 7:31- See, ultimately, the goal is to balance everything.
- 7:34- So we wanna maintain those high quality
- 7:36- standards across the entire ministry, but we have
- 7:39- to make sure that every region
- 7:42- still gets that flexibility.
- 7:44- You know, every market
- 7:46- can develop a tailored toolkit
- 7:48- that actually fits their unique patients and the
- 7:50- resources they have on the hand. So
- 7:52- it's,
- 7:54- it's kind of work that that can start
- 7:56- centrally, but it really is delivered,
- 7:59- at a market or a site level, within
- 8:02- our organization.
- 8:04- Can you talk more about how you're thinking
- 8:06- about balancing system wide behavioral health priorities and
- 8:09- quality standards
- 8:11- while still giving individual markets, you know, the
- 8:13- flexibility
- 8:14- to address unique patient populations
- 8:17- and workforce realities
- 8:19- and community partnerships as well?
- 8:22- Yeah. That is such a perfect question. Right?
- 8:24- It especially for an organization of this size,
- 8:27- it
- 8:27- really gets to the heart of the challenge.
- 8:30- Honestly, the work always has to start locally,
- 8:33- right at the site level.
- 8:36- We are incredibly fortunate to have such great
- 8:39- leaders,
- 8:40- across the system,
- 8:41- you know, behavioral health leaders.
- 8:44- Many of them who have been deeply embedded
- 8:47- in their communities and, and within our ministry
- 8:50- for years,
- 8:51- their firsthand knowledge is invaluable.
- 8:54- So we lean heavily on their insight and
- 8:56- judgment. And and how we get them
- 8:59- engaged is, through building an extensive collaborative network.
- 9:03- So we we have we have had a
- 9:04- behavioral health collaborative for several years within the
- 9:07- system, which has led to the right foundation
- 9:09- to develop
- 9:11- a a more,
- 9:12- a robust behavioral service line structure.
- 9:16- So this collaborative invites active participation from every
- 9:19- single site. From there, we move up to
- 9:22- the market level in the system, and the
- 9:24- markets then report up to the region. So
- 9:26- it's so so we move up to the
- 9:28- market level where it's crucial to have our
- 9:30- clinical operations and strategy leaders at the table,
- 9:34- along with input from regulatory compliance, patient experience
- 9:37- teams, and other stakeholders,
- 9:40- that we have to work on, especially in
- 9:41- behavioral health. There's advocacy, there's,
- 9:45- philanthropy.
- 9:46- And this process helps us,
- 9:48- find that common ground across markets and regions
- 9:51- as we look to develop,
- 9:53- you know, strategic,
- 9:54- plans.
- 9:56- We've also,
- 9:58- established,
- 9:59- operational work groups focusing on everything from ambulatory
- 10:04- care and inpatient services to patient experiences to
- 10:07- work,
- 10:08- in developing policies. So these work groups are
- 10:11- within the behavioral health service line,
- 10:14- and they also have participation from each of
- 10:16- the local sites where this work is relevant.
- 10:20- So once any of the initiatives
- 10:22- are worked on within these groups,
- 10:25- we bring it
- 10:26- for feedback,
- 10:27- to all our sites before anything is finalized,
- 10:30- but let it be,
- 10:33- you know, a a decision for
- 10:36- developing a new program or if it's a
- 10:37- new policy or if it's maybe a new
- 10:39- order sets within our electronic medical record.
- 10:43- One area that I'm really passionate about supporting
- 10:46- in a in a more system wide strategy
- 10:48- is for community partnerships.
- 10:51- Right now, that's working well,
- 10:54- in patches, but perhaps it's not that uniform
- 10:56- or perhaps we've not had
- 10:59- the the resources to work on it. So
- 11:02- I was actually speaking with, one of our,
- 11:04- rural hospitals recently, and they had done such
- 11:07- a fantastic work collaborating with local psychiatric facilities
- 11:12- that, you know, when we sat down with
- 11:13- them to discuss how we could provide some
- 11:15- national support, it became clear that they only
- 11:18- had the right approach. They just needed the
- 11:20- validation.
- 11:21- That's exactly
- 11:23- the kind of practices that I'll lift up
- 11:24- and share across the rest of the organization
- 11:27- so that, you know, as we're building our
- 11:29- community partnerships, there's also focus on behavioral health,
- 11:32- which is so much
- 11:34- needed, especially when it comes to, you know,
- 11:37- know, any strategy to enhance access to care.
- 11:40- Mhmm.
- 11:41- And is there anything that you look for
- 11:43- specifically within these community partnerships?
- 11:46- How do you approach these conversations
- 11:48- and find that mutual understanding?
- 11:51- Well, I think,
- 11:53- if the
- 11:54- community partners are also looking to solve the
- 11:57- same problems that we are,
- 11:59- and if they have,
- 12:01- programs and services that fill the gaps,
- 12:04- then those conversations
- 12:06- become really easy.
- 12:08- Then it's really about a set of values,
- 12:11- you know, if if those align or not
- 12:13- and on where where does that count ground
- 12:15- where we can meet?
- 12:17- So
- 12:18- it's it's really about keeping the patient
- 12:21- in the center
- 12:22- and seeing what part of that patient's journey
- 12:25- can be enhanced
- 12:27- by that community partnership. That's at least what
- 12:29- I, look for the most.
- 12:32- Thank you so much. And
- 12:34- a huge focus in behavioral health and especially
- 12:37- for leaders has been behavioral health integration, and
- 12:40- it just remains a major priority across health
- 12:42- care in general. But operationalizing
- 12:45- it across inpatient,
- 12:47- outpatient, ambulatory
- 12:48- settings is often easier said than done.
- 12:51- How is CommonSphere approaching behavioral health integration today,
- 12:55- and what opportunities
- 12:57- do you see to strengthen
- 12:59- those connections between behavioral health, primary care, specialty
- 13:03- care, emergency departments, and acute care settings?
- 13:08- Yeah. I mean, I think this is going
- 13:09- to be a very
- 13:11- significant,
- 13:12- approach
- 13:13- for us, and it has been, in the
- 13:15- organization.
- 13:17- So I'll start with
- 13:19- perhaps go through clinical settings, and I can
- 13:21- start with when patients show up in our
- 13:23- our hospitals.
- 13:24- First, in the emergency departments,
- 13:27- several of our markets,
- 13:29- have done
- 13:30- really great work in building,
- 13:34- peer recovery coaches or substance use disorder navigators,
- 13:38- or community health workers,
- 13:40- embedded within the emergency
- 13:42- departments
- 13:44- to, you know, do the screening,
- 13:47- some interventions,
- 13:49- and, referral to treatment. We have,
- 13:53- also, in many of our markets, work with
- 13:55- our emergency medicine colleagues in
- 13:58- initiating, bridging treatment,
- 14:00- for substance use disorders, MAT,
- 14:03- and and other strategies. So that has been
- 14:06- a a focus of,
- 14:08- our system in many markets, and I certainly
- 14:10- want to,
- 14:12- enhance that.
- 14:13- Almost all hospitals have some kind of a
- 14:16- psychiatric
- 14:18- support,
- 14:19- whether it's in person or
- 14:22- or,
- 14:23- where our teleservices
- 14:25- or with our with our external partners in
- 14:27- bringing the psychiatry
- 14:29- into the,
- 14:31- physical health settings, whether it's ED or med
- 14:33- surg floors. And this is something
- 14:36- that I'm actively looking at at
- 14:38- at both the,
- 14:41- the strength of the work that is already
- 14:43- there and what needs to be enhanced,
- 14:46- and and how's the quality and and how
- 14:48- we are working on that. So this is,
- 14:51- something
- 14:52- that, the service line can really
- 14:54- deliver on.
- 14:56- There are,
- 14:58- many approaches on behavioral health integration beyond the,
- 15:03- acute care side as as you know
- 15:05- and and many of the listeners would know.
- 15:08- And we have, across the system,
- 15:10- use varying approaches depending on and this goes
- 15:13- back to, you know, what is centralized and
- 15:15- what is what can be standardized and what
- 15:17- needs to be local.
- 15:19- So there have been multiple approaches on behavioral
- 15:21- health integration
- 15:23- across the system.
- 15:25- Some of the pockets where we have medical
- 15:27- groups,
- 15:28- that have, you know, strong
- 15:30- outpatient
- 15:31- behavioral health presence,
- 15:33- and we do that in Pacific Northwest,
- 15:36- in California,
- 15:37- especially in Northern California markets. We are looking
- 15:40- to
- 15:41- use those resources to embed services
- 15:45- in our, medical practices and our subspecialty
- 15:48- practices.
- 15:50- In Arizona, we've built a collaborative care model,
- 15:53- by the book, and and, you know, we
- 15:55- use collaborative care billing. And,
- 15:57- and and that model is being expanded to
- 16:00- other, re
- 16:01- markets within that region.
- 16:04- Similarly, we built behavioral health embedded care model
- 16:06- virtually in Nebraska and Iowa markets.
- 16:09- So there have been different approaches and, all
- 16:12- good and all working, and we're looking to
- 16:15- to work on how to enhance that. We've
- 16:17- also worked with external partners
- 16:19- in building,
- 16:21- behavioral health integration, whether it is
- 16:24- just, you know, collaborative care or even specialty
- 16:27- care, like in eating disorders and other programs,
- 16:30- where we bring in behavioral health resources
- 16:33- with our external vendors into our,
- 16:36- primary care site.
- 16:38- So it's a long winded answer, but it
- 16:39- is,
- 16:40- basically an all of the above approach.
- 16:43- But an important approach,
- 16:45- of improving access, improving,
- 16:48- behavioral health
- 16:50- care, and and one that will be central
- 16:51- to our service line strategy.
- 16:54- Yes. Well, thank you. I know integration is
- 16:56- a very complex,
- 16:58- question to answer and navigating, so I appreciate
- 17:01- you taking that question on. And
- 17:03- speaking of integration,
- 17:05- I'd love to know more about how Commisphere
- 17:08- is approaching
- 17:09- substance use disorder care
- 17:11- across the nation.
- 17:13- Yeah.
- 17:14- So I,
- 17:16- spoke about I work with peer recovery coaches
- 17:19- and SUD navigators, which primarily, you know, was
- 17:23- done in California where we
- 17:25- all of our hospitals,
- 17:26- almost in California, and I believe we have
- 17:28- 27, 28 hospitals in California,
- 17:30- where we, brought in substance use disorder navigators.
- 17:34- And we've had a really,
- 17:37- strong champion
- 17:38- in that,
- 17:39- region,
- 17:40- from our emergency medicine services.
- 17:44- And that physician,
- 17:45- has, worked a lot in
- 17:47- bridging care,
- 17:49- to these, patients. That program has been going
- 17:52- on more than five years now.
- 17:54- We've also done other work in our mountain
- 17:56- region
- 17:57- in, which is, you know, primarily Colorado, Utah,
- 18:02- and Kansas markets where we have,
- 18:04- worked on enhancing
- 18:06- MAT,
- 18:07- in acute care settings. So we're really proud
- 18:10- of that work, and we're looking to expand
- 18:12- that further.
- 18:14- We do not do a lot of substance
- 18:16- use disorder on the acute care side as
- 18:19- such,
- 18:19- except for in couple
- 18:21- of couple of our markets.
- 18:24- But,
- 18:24- there is a lot of substance use disorder
- 18:26- that we see obviously across the system
- 18:29- as as comorbid conditions in our acute care
- 18:32- facilities.
- 18:34- You know, one of the things that I'm
- 18:35- really proud of, that the system has done
- 18:37- is, working on an anti stigma campaign.
- 18:41- We have done,
- 18:43- and it's not been a one approach. There
- 18:45- have been several approaches. We've done a lot
- 18:47- of educational work. We've done
- 18:50- awareness
- 18:52- campaigns, including, you know, some short form videos,
- 18:55- some
- 18:56- CME,
- 18:58- grade, trainings,
- 19:00- that are available
- 19:01- for,
- 19:02- folks who are interested.
- 19:04- And we've also collaborated with,
- 19:07- EHA,
- 19:08- on their anti stigma campaign for broader mental
- 19:11- health issues.
- 19:13- And and,
- 19:14- so those those things have really been very
- 19:17- helpful working just internally within the organization
- 19:20- to
- 19:21- to attack,
- 19:23- you know, stigma related to substance use disorders.
- 19:27- I think this will be a significant,
- 19:30- strategy again for for our service line to
- 19:32- work and,
- 19:33- you know, to support
- 19:35- the good work that has gone on in
- 19:37- some several of our markets and bringing that
- 19:39- to the rest of the system.
- 19:42- So a lot to be still done, but
- 19:44- I'm very happy with what I've seen, has
- 19:46- been done so far.
- 19:48- Wonderful. And I think that's a perfect transition
- 19:50- into our next question of where are the
- 19:52- biggest growth opportunities that you're seeing in behavioral
- 19:55- health services over the next several years?
- 19:58- Yeah. I mean, well, the biggest opportunity for
- 20:01- growth are really in filling the gaps that
- 20:03- exist in our continuum of care.
- 20:05- You know, whether that's expanding access to comprehensive
- 20:08- care in the EDs like we talked about,
- 20:10- building care navigation
- 20:12- transfers at at Southern markets. The other places
- 20:14- might be, you know, building integrated care,
- 20:18- and, expanding integrated care, if it already exists,
- 20:24- improving the quality of services,
- 20:27- that we are able to provide,
- 20:28- on our, med surge floors.
- 20:31- And I'm also working with other other
- 20:33- service lines.
- 20:36- Wisconsin Spirit has a great, women's and infant
- 20:38- service line. We're working a lot on perinatal
- 20:41- mental health and how, we know we're doing
- 20:43- great work in screening
- 20:45- now for perinatal care, but also now working
- 20:48- on,
- 20:49- with our OB GYN colleagues,
- 20:51- to build integrated care.
- 20:54- So that'll be a new initiative,
- 20:56- that we'll work on, but that's a great
- 20:58- area
- 20:59- of opportunity
- 21:00- just to give you an example.
- 21:02- And then,
- 21:04- you know, we're not above the financial realities
- 21:06- and regulatory environment.
- 21:08- So, you know, things that that are,
- 21:11- just anyways barriers to grow behavioral health. But
- 21:13- I think the our approach will have to
- 21:15- be innovative.
- 21:17- We'll focus on, you know, disseminating the psychiatry,
- 21:20- the behavioral health expertise,
- 21:23- any way we can. We talked a lot
- 21:24- about, you know, for example,
- 21:27- integration,
- 21:28- which is a great way of doing that.
- 21:31- And where there'll be a lot of focus
- 21:33- on really on efficiency and improving,
- 21:36- quality of care. And,
- 21:39- these,
- 21:40- approaches
- 21:41- are are, you know, all an opportunity to
- 21:44- build a better behavioral health care
- 21:47- culture.
- 21:48- We're also looking,
- 21:49- to create that internal infrastructure so that,
- 21:53- various parts of the organization can get quick
- 21:55- consultation
- 21:56- on, you know, any strategic program they wanna
- 21:59- grow or any quality improvement efforts they wanna
- 22:02- take on or any technology related to behavioral
- 22:05- health that they wanna bring on.
- 22:07- So I that will be another area
- 22:10- for the service line to work on.
- 22:13- We're looking at our payer strategy and opportunities
- 22:16- there. I'm working closely with our, you know,
- 22:18- population health, organization to seeing opportunities
- 22:21- where value based care,
- 22:23- which could be,
- 22:25- especially,
- 22:26- you know,
- 22:27- a great opportunity for behavioral health to grow,
- 22:30- especially in areas of care,
- 22:32- coordination, care management,
- 22:34- and treating patients with,
- 22:36- severe mental illness,
- 22:38- also in primary care and
- 22:41- integrated care. So I think pop health will
- 22:43- be a significant,
- 22:45- area of, focus for the behavioral health service
- 22:48- line.
- 22:49- So, yeah, I hope,
- 22:50- it's given you a good good view of,
- 22:52- like, where there are some of those opportunities
- 22:55- exist. But, yeah, I mean, if the central
- 22:57- thing is to be innovative and and look
- 22:59- at areas which really improve our efficiency.
- 23:03- Well, wonderful.
- 23:05- Doctor Sopra, thank you so much for joining
- 23:07- us and sharing your insights on common spirit
- 23:09- health, behavioral health strategy and transformation efforts.
- 23:13- And thank you to our listeners for tuning
- 23:15- into Becker's Behavioral Health Podcast. We'll see you
- 23:17- next time.
- 23:19- Great. Thank you.