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How FQHCs Can Extend the Reach of Behavioral Health and Substance Use Disorder Services for Vulnerable Populations · Becker's Healthcare Behavioral Health

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  - Hello, everyone. This is Erica Spicer Mason with
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  - Becker's Healthcare. Thank you so much for tuning
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  - into the Becker's Healthcare podcast series.
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  - So today, we're going to cover how FQHCs
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  - can extend the reach of behavioral health and
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  - substance use disorder services for vulnerable populations.
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  - And joining me for this important conversation,
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  - we have with us Robin Henry, the chief
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  - operating officer at Solvera Health.
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  - Robin, so glad to have you with us
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  - today. Thank you again for being here, and
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  - welcome to the podcast.
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  - Thank you so much. I'm happy and excited
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  - to be here and be a part of
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  - this conversation.
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  - Yeah. And I know it's an important one.
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  - And before we get into the nitty gritty
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  - here, Robin, I wanted to know if you
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  - could share just a little bit more about
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  - yourself, maybe a quick overview for our listeners
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  - of your background and your work at Silvera.
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  - Oh, absolutely.
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  - My background is rooted in health care. I
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  - am a registered nurse. I've
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  - done a lot of work at leadership around
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  - operations and clinical resources.
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  - I intentionally
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  - build care delivery models that improve access while
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  - maintaining quality and sustainability,
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  - being able to design and operationalize
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  - clinic workflows,
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  - whether by integrating behavioral health, leveraging telehealth, or
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  - even deploying alternative care models, all with that
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  - same goal of helping Solvera Health better serve
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  - our complex and our underserved populations.
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  - We do work closely with the communities we
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  - serve, we meet people where they are, and
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  - we assist our patients navigate the healthcare ecosystem.
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  - Within Solvera Health, our focus is that we
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  - deliver hospitality and healthcare.
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  - We look to expand access to primary and
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  - specialty care services that are often difficult to
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  - deliver at scale, including behavioral health and substance
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  - use disorder treatment.
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  - Additionally, as this federally qualified health care space,
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  - we are what is called a look alike
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  - In both of our clinic locations, Peoria, Illinois,
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  - Galesburg, Illinois,
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  - we have our in house pharmacy services.
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  - Great to learn more about you, Robin, and
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  - Silvera as well.
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  - Especially appreciate that note you mentioned about aiming
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  - to deliver hospitality and health care.
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  - What a great phrase to live by.
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  - But I wanna start high level here and
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  - set the scene for our listeners a bit.
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  - You know, FQHCs,
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  - for anyone who may not be aware in
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  - the audience,
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  - these organizations have always been on the front
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  - lines of serving vulnerable
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  - populations,
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  - but behavioral health and SUD services
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  - in those communities,
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  - the needs have really, intensified
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  - in recent years.
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  - So, Robin, I'd love to know from your
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  - vantage point,
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  - where are you seeing the gap between what
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  - FQHCs are being asked to deliver
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  - for behavioral health and what they're actually able
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  - to provide?
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  - Yes. Of course. The gap that I am
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  - witnessing, it is both structural and practical.
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  - On one hand, FQHCs are expected to serve
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  - as a comprehensive care hub, safety nets, for
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  - example.
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  - We address not only the physical health of
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  - our patients, but the increasingly complex behavioral health
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  - and substance use disorder needs.
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  - While on the other hand, our reimbursement
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  - models in our workforce availability and infrastructure have
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  - not kept pace with the expectation.
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  - A lot of what we see most often
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  - is the demand outstrips the capacity,
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  - especially for psychiatry,
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  - therapy services, and medication assisted recovery.
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  - The workforce shortages are more severe in our
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  - rural and our underserved communities.
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  - We also have fragmented funding streams that don't
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  - always support this integrated longitudinal
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  - care.
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  - And as a
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  - result, the FQHCs are being asked to deliver
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  - specialty level behavioral care with primary care level
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  - resources,
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  - which is not a sustainable equation without new
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  - approaches.
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  - Yeah. Robin, I think that phrase that you
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  - just used, you know, being asked to deliver
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  - specialty level care with primary care resources that
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  - that really encapsulates
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  - the message that I think you're driving home
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  - here. And I'm sure that it's challenging for
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  - FQHCs
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  - to try to close those gaps on their
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  - own.
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  - So to extend behavioral health and SUD services
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  - into the communities that need them most,
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  - what does an effective
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  - partnership model with an external solution provider really
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  - look like in practice for Silvera or maybe
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  - more broad?
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  - Oh, sure. I know from my own
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  - personal and professional lens,
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  - what makes the most effective partnerships, they are
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  - not bolt on solutions.
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  - We look for partnerships that are as deeply
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  - integrated as an extension of our FQHC care
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  - model.
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  - While in our practice, this means our clinical
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  - alignment,
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  - our providers are operating within our FQHC care
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  - protocols,
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  - the documentation standards, as well as the quality
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  - goals.
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  - We bring our workflow integration, which is the
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  - services that are embedded in the patient journey.
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  - They're not siloed. We're not referred out referring
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  - out patients to intentionally create the barriers. Like
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  - I said earlier, we're really here to navigate
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  - for our patients.
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  - The data interoperability,
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  - this is the shared access to patient information,
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  - so
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  - all of the care teams, internal and external,
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  - can still function as one cohesive unit.
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  - We have our flexible delivery models. This is
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  - combining in person, virtual, or even hybrid care
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  - to meet patients where they are.
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  - We look for the aligned incentives.
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  - FQHC organizations
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  - are focused on outcomes, access, and patient engagement,
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  - not just the volume. For FQHCs,
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  - the most meaningful metrics go beyond our simple
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  - visit counts.
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  - Our metrics to make them meaningful and impactful
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  - are also demonstrating access engagement outcomes and sustainability.
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  - These partnerships that we are orchestrating
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  - for the patients are meant to feel invisible.
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  - Our goal
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  - is from the patient's perspective that we are
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  - one care team all participating in every avenue
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  - of their care.
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  - Thanks, Robin. And I can tell the the
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  - deep focus that your organization has on patients
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  - when you're saying that these partnerships that you're
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  - coordinating and orchestrating are really meant to feel
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  - behind the scenes and unseen to the patients,
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  - but rather help their care journey just feel
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  - smoother
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  - and more seamless.
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  - And I noticed earlier, Robin, you had mentioned
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  - this trend of demand for behavioral health and
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  - SUD services really outpacing
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  - capacity and what FQHCs are able to deliver.
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  - So I wanted to go a little bit
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  - deeper on the workforce piece.
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  - Shortages in behavioral health in terms of the
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  - workforce are, of course, very well documented at
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  - this point. And for FQHCs
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  - operating in underserved areas, that challenge can be
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  - even more acute.
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  - So from your perspective, how can organizations
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  - get creative about extending their clinical reach, you
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  - know, whether that's through tech,
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  - alternative staffing models, or redesigning care delivery
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  - without compromising quality and continuity of care?
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  - This is
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  - a question very near and dear to me
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  - because I feel as an operational leader,
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  - whether being a nurse or clinically sound or,
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  - you know, just by having presence, the thinking
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  - out of the box is essential.
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  - You have to be
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  - not afraid to be a disruptive innovator. It
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  - is essential.
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  - Our organizations that are succeeding because we're rethinking
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  - not only how we deliver the care
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  - by who, but also by how it's delivered.
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  - So it's very strategic.
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  - We look at the team based care model.
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  - We're leveraging care coordinators, our peer support specialists,
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  - we call them patient advocates,
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  - and our behavioral health coaches alongside our licensed
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  - clinicians.
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  - We have our telebehavioral
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  - health,
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  - which allows us to expand access to
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  - more scarcity specialties like psychiatry without having the
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  - geographic constraints in Illinois
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  - speaking to the rural demographics.
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  - We have a tiered care delivery where we're
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  - matching our patient acuity to the appropriate level
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  - per provider. So our specialists,
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  - internal and external, also focus on the highest
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  - need cases.
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  - We've built many of our collaborative care models
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  - to embed behavioral health into primary care workflows
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  - supported by our in house psychiatrist.
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  - Measurement based care, we use standardized tools to
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  - track the outcomes and adjust care in real
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  - time. Fortunately, we're able to do that with
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  - our EHR.
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  - Whereas the key to maintaining the clinical oversight
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  - and continuity,
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  - technology and alternative staffing is here to extend
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  - clinicians reach, not replace
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  - the relationship
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  - based
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  - core of that patient care.
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  - Yeah. Robin, thanks for elaborating there, and it's
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  - been really insightful to learn how your organization
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  - is approaching.
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  - You know, when we're talking about the workforce
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  - here, you've deployed anything from patient advocates to
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  - care navigators, telebehavioral health to changing, you know,
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  - how you're meeting patients by acuity level, but
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  - then also more broadly
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  - I I I love that sentiment about not
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  - being afraid to be a disruptive innovator, and
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  - it sounds like there's quite a bit of
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  - that going on at Silvera, which is fantastic.
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  - And before I let you go, I'd love
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  - to just get kind of your,
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  - what you're looking at for the future.
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  - For an executive at an FQHC who knows
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  - that they need to expand access
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  - to behavioral health and SUD services
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  - but is working within those familiar constrained resources
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  - and competing priorities,
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  - what is your honest advice on where they
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  - could start, and what does success really look
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  - like on the other side of an investment
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  - like that?
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  - My advice to anybody in this space is
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  - to start, focus, and build the momentum upon
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  - that focus drive.
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  - Identifying the highest impact of a gap. Where
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  - is the patient population and data? Where are
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  - the longest wait times for the highest unmet
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  - needs?
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  - Starting there rather than trying to solve everything
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  - at once,
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  - the long wait times that so many people
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  - experience in the poor access are often the
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  - biggest barriers even in our FQHC settings.
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  - I would want someone to pick a scalable
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  - model, not just a one off solution. So
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  - whether it is at telepsychiatry,
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  - whether it is medication assisted recovery treatment expansion
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  - or integrated behavioral health, choose something that will
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  - grow with your organization because you're gonna need
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  - that that reach and those touch points and,
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  - you know, word-of-mouth goes a long way.
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  - Leverage partnerships intentionally.
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  - Don't try I for myself speaking, I do
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  - not try to build everything internally. The right
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  - partner that we have selected has been able
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  - to accelerate access while reducing the operational burden.
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  - We look to align workflows and our metrics.
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  - This integration is what determines success, not just
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  - access.
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  - Measuring the patient engagement, what their follow-up is
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  - to the visits, and what any of these
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  - clinical outcomes look like from day one of
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  - a patient attribution.
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  - Then if you flip the script a little
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  - bit, have the other side of investment, that
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  - success now is gonna bring in shorter wait
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  - times for these
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  - specialty needed services such as behavioral health and
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  - substance use.
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  - Our behavioral health outcomes
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  - really
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  - depend on continuity of care. We need to
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  - see what the visit frequency to the adherence
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  - to the treatment plan is and what the
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  - retention looks like of a thirty, sixty, ninety
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  - day.
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  - What our medication assisted recovery retention rate looks
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  - like for substance use patients.
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  - And if there any drop off between a
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  - first and second visit or what the follow-up
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  - rate looks like after
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  - a crisis event or an emergency room presentation,
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  - knowing that
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  - our patients that are here in front of
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  - us, those that have a higher patient engagement
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  - and retention and treatment are what's gonna have
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  - us to produce these better outcomes because we're
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  - doing it in that fluid approach. We're doing
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  - it with the person who is the expert
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  - in their own health, Really looking for the
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  - clinical outcomes for our high risk.
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  - You know, we're looking at how to reduce
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  - the burden on primary care providers because so
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  - many of them are often carrying these cases.
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  - Really looking at what a sustainable care model
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  - is where our staff also feels
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  - confident to delivering.
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  - Robin, it it's fantastic advice. I appreciate some
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  - of those overarching
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  - points about starting with the highest unmet needs
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  - rather than solving everything at once, but then
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  - going down to those more granular strategies that
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  - you're using at Solferra to measure those improvements
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  - and and measure the return on investment.
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  - It's been great speak speaking with you today,
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  - and I just wanna thank you again for
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  - making the time. Anything else, Robin, before we
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  - close today?
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  - Thank you for for taking the time to,
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  - you know, to meet me and to hear
• 12:28
  - about our services. You know, none of us
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  - in this health care spectrum are alone. We're
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  - all fighting the good fight. You know, we're
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  - all here for the reasons whether it's personal
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  - or professional, but at the end of the
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  - day, it is these patients that are what
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  - matter. It's these outcomes that are bringing the
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  - sustainability, you know,
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  - and knowing that you can be that problem
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  - solver and having somebody come in your front
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  - door and you're producing that care that keeps
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  - them coming back and then now striving for
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  - their health.
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  - That's really what makes all this worth it.
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  - Nicely said. Robin, thank you again for sharing
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  - your time and and your passion for your
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  - work and what you do. And, of course,
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  - we'd also like to thank our podcast sponsor
• 13:05
  - for today, Precise Behavioral Health.
• 13:08
  - Listeners, be sure to tune in to more
• 13:10
  - podcasts from Becker's by visiting our podcast page
• 13:13
  - at beckershospitalreview.com.