Latest / Becker's Healthcare Behavioral Health / Dr. Manish Sapra, Executive Director of the Behavioral Health Service Line at Northwell Health

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Dr. Manish Sapra, Executive Director of the Behavioral Health Service Line at Northwell Health · Becker's Healthcare Behavioral Health

0:00
This is Riley Wilson with the Becker's Healthcare
0:02
podcast. I'm thrilled to be joined today by
0:04
doctor Manish Sapra, executive director of the behavioral
0:07
health service line at Northwell Health. Doctor Sapra,
0:10
thanks so much for being here today.
0:12
Oh, thanks for having me. Thank you.
0:14
K. Before we jump in, can you tell
0:16
us a little bit more about your background
0:17
and about your role at Northwell Health?
0:20
Sure, Riley. It's a pleasure to be here
0:22
with you, and hello to all the listeners.
0:24
I'm a psychiatrist,
0:25
with background in community psychiatry,
0:28
population health,
0:30
and,
0:31
guess all things,
0:33
related to psychiatric administration.
0:35
I started my career, working out in rural
0:38
communities and community based organizations and then worked
0:42
at a community hospital.
0:43
I I got interested in,
0:46
administrative,
0:47
aspects of behavioral health and how,
0:49
mental health care is delivered,
0:52
and
0:54
and and really saw my place as being,
0:56
someone who could,
0:58
take and tweak with the system.
1:01
I,
1:02
then, worked in,
1:04
larger health systems since and worked on, service
1:07
line strategies. I will describe myself as a
1:10
physician leader who is
1:12
passionate about, building new programs or processes that
1:15
improve quality
1:16
and efficiency of mental health care delivery.
1:19
In my current role, I'm executive director of
1:22
behavioral health service line at Northwell.
1:24
Little bit about Northwell, it's a large,
1:27
it's the largest,
1:28
private,
1:29
employer health care provider in New York,
1:32
with 21 hospitals and over 900 outpatient facilities,
1:36
within our health system. Behavioral health has a
1:39
large footprint.
1:40
We have over 600 inpatient psychiatric beds.
1:44
These are at,
1:45
at several of our hospitals, but we also
1:47
have two freestanding,
1:49
inpatient psychiatric facilities.
1:52
We have multiple outpatient behavioral health, programs.
1:56
We have programs,
1:57
linked to our hospital based services, but also,
2:00
several practices that we have set up in
2:02
the community.
2:04
Together in our ambulatory programs, we provide over
2:07
600,000
2:08
visits annually.
2:10
And we have a strong academic footprint in
2:12
in training and research.
2:15
We're very excited about a new residency program
2:18
coming online, this year. We already had three,
2:21
so we're not going to full residency programs.
2:24
And soon, we'll be adding a fifth program
2:26
next year.
2:27
So it's a large complex integrated health system,
2:30
and behavioral health is a big piece of
2:32
clinical services provided within Northwell. And I'm really
2:36
honored to be part of this health system
2:38
where
2:38
we have not only continued to support behavioral
2:41
health, but,
2:42
actually focused on expanding services,
2:46
as we take on the challenge of mental
2:47
health crisis.
2:49
So, love. Thanks for having me today, and
2:51
I love to have this conversation with you.
2:54
Great. Yeah. Well, thank you again so much
2:56
for being here. Like you said, you know,
2:58
you're working on expanding behavioral health. Can you
3:01
tell us a little bit more about what
3:02
you're doing to improve
3:04
access to behavioral health at Northwell?
3:07
Sure. Yeah. So, you know, we just had
3:09
the five year anniversary of start of the
3:11
pandemic, which, as you know,
3:13
changed a lot,
3:14
for all of us.
3:17
We already had a crisis brewing in mental
3:19
health related to poor access to services.
3:22
And since the pandemic, we have just seen
3:24
an increase in demand, which continues
3:27
to sustain itself.
3:29
When you add to that the issue of
3:31
limited workforce,
3:33
the health care disparities,
3:35
which were highlighted so much during the pandemic,
3:38
you know, we've had a perfect storm here.
3:40
And many in the field know,
3:42
but it's not,
3:44
known very well, outside that more than half
3:47
of the people who have, any mental illness,
3:51
or any behavioral health diagnosis actually do not
3:53
receive any treatment.
3:55
Less than half of the treatment
3:57
that is actually even provided
3:59
is evidence based treatment.
4:02
So
4:03
there is this huge crisis, right, that there's
4:05
a large segment of our population
4:07
that needs to help,
4:10
but is not either getting,
4:12
but but is either getting no treatment
4:15
or not getting the most effective treatment that
4:18
they can.
4:19
So at Northwell, you know, we looked at
4:21
this,
4:23
and,
4:25
you know, I've been in in my current
4:26
role for five years. We've been working on
4:29
developing a strategy to rapidly expand outpatient access.
4:34
And,
4:35
again,
4:36
really
4:38
grateful for the support that we got from
4:40
senior leadership to develop
4:42
a a full track plan,
4:44
to increasing access for our community. So the
4:47
first,
4:48
pillar of this strategy is really supporting individuals
4:52
suffering from milder stress, anxiety, sadness, perhaps insomnia
4:56
through self care. Right? I mean, these people
4:58
perhaps do not need to see
5:00
a a psychiatrist or or or even a
5:03
therapist, but do need some support. And how
5:05
can we provide,
5:07
that support,
5:08
to our patients, and how can we leverage
5:10
technology.
5:11
So we believe that,
5:13
this is best delivered by digital tools where
5:16
it it could be a digital therapeutic. It
5:18
could be a mental health app or a
5:20
tech space support or a curated list of
5:23
low cost, no cost options that are vetted
5:25
by us but can be suggested to the
5:27
patients to get that
5:28
to get that wellness support, to get the
5:30
support in in,
5:32
for for really mild illness.
5:35
The second pillar of our strategy is integration,
5:39
which, you know, I'm happy to talk more
5:41
about if we have time because that has
5:43
been a core,
5:44
core strategy for us to grow.
5:47
We have been in this journey for seven
5:49
years now. We cover several of our primary
5:51
care practices, but we have also,
5:55
integrated services in,
5:57
subspecialty,
5:59
medical programs such as bariatric,
6:01
oncology,
6:02
transplant programs.
6:04
And, we have also embarked on a robust
6:07
community integration programs that covers
6:10
schools, colleges, and even, recently faith based programs.
6:14
So,
6:15
integration of behavioral health outside the traditional settings
6:19
is really
6:21
a great way in a population health approach
6:24
to bringing,
6:26
services
6:27
to the patients where they are,
6:30
and at at a very large scale with
6:32
limited resources,
6:34
with utilization of limited resources.
6:37
Then we're focusing on our specialty care, which
6:39
is in you should think about as the
6:41
traditional outpatient programs.
6:44
We have, been on this journey of continuing
6:47
to expand,
6:48
outpatient programs.
6:50
We do that, both, as I said earlier,
6:52
through our hospital based,
6:55
centers which
6:58
have, care for,
7:00
you know, in in general psychiatry practices, but
7:02
also in specialty subspecialty
7:04
programs. We have, robust programming in our bipolar
7:08
disorder center, OCD center,
7:10
you know, perinatal programs, and several other, specialty
7:14
programs.
7:15
We have been,
7:16
also now growing our,
7:18
college mental health program in our outpatient department
7:22
and building new practices. So one thing I'll
7:24
say about Northwell, we have really focused on
7:26
getting out of the hospitals and putting actually
7:28
practices in in suburban areas or other places
7:32
within the communities.
7:34
And these are not
7:36
private practices, but feel like that patient get
7:39
that,
7:40
welcoming ex
7:42
experience. We accept insurances
7:45
and, have, developed a robust evidence based programs.
7:50
We have developed practice
7:51
practices and,
7:53
that focus on cognitive behavior therapy. We developed
7:56
a center for traumatic stress recovery and resilience.
7:59
We developed a special program to treat medical
8:01
students at Pfizer Medical School. So there are
8:04
some many, such
8:07
examples of developing outpatient,
8:10
programs. We are,
8:11
actually
8:13
building,
8:13
new new three practices this year, and then
8:16
we have plans for for the build next
8:18
year. So that has been a very exciting
8:20
journey. And the final pillar is really complex
8:22
care, which is looking at,
8:25
our,
8:27
inpatient services and,
8:30
our partial hospital out IOP services.
8:33
And are we delivering the best evidence based
8:36
care? What are some opportunities for growth? So
8:39
we have invested a lot on on college
8:41
mental health. We've developed a college mental health
8:43
unit, which, by the way, was featured,
8:46
on a documentary by HBO called, One South,
8:49
a great documentary if anybody wants to check
8:51
out on multiple,
8:53
college mental health programs or generally,
8:56
experiences of an inpatient psychiatry unit, available on,
9:01
HBO
9:02
Max.
9:03
So,
9:04
we we have been, looking at developing these
9:07
programs, not just at Sucker Hillside, which is
9:10
our academic freestanding psychiatry center, but also
9:13
outside there. So we're,
9:15
building a new college unit at South Oaks
9:17
Hospital, which is our other freestanding hospital in
9:20
in in Long Island.
9:22
So, a lot of effort to develop
9:25
the the right access, you know, scaling growth,
9:28
but also maintaining quality, which is, you know,
9:31
the toughest part of doing all this.
9:34
Great. Thank you so much for laying out,
9:36
all those different dimensions you're working on. I
9:38
want to zoom in, on integrated care because
9:41
that's such a big focus for so many
9:42
behavioral health leaders right now. Can you tell
9:45
us a little bit more about what specifically,
9:47
integrated care means to you and how you
9:49
implement that at Northwell?
9:51
Right. So as I said, like, integrated care
9:54
has been
9:56
a significant area for focus for us, and
9:59
and and we believe in it a lot
10:01
because, as I said, it is really a
10:02
population health approach. You can use the limited
10:06
workforce that is available within behavioral health, but
10:08
then actually really
10:11
reach out to a vast,
10:14
majority of our
10:16
population,
10:17
in the community.
10:19
So,
10:20
across Northwell,
10:22
I'm so proud to say we have we
10:23
have been working on our depression screening initiative
10:26
now,
10:27
for two years,
10:29
where we are screening patients for,
10:31
and,
10:32
coming into our primary care practices or any
10:34
specialty practices for for depression.
10:38
And that's just
10:39
a a that's just an example of how
10:42
we wanna reach these patients early, which is
10:44
so important in,
10:46
in behavioral treatment to get to the patients
10:48
earlier in the treatment course.
10:51
But prior to that, we've been in this
10:53
journey for, like, six or seven years now
10:56
of integrating behavioral health in primary care spaces.
11:00
So we chose to adopt the collaborative care
11:02
model, which came out of University of Washington
11:05
and has had,
11:06
over 80 over 80,
11:10
articles,
11:11
published trials,
11:12
which show the evidence of the, and the,
11:15
effectiveness of the program.
11:17
And, basically, the collaborative care model is,
11:20
integrating a behavioral health resource such as social
11:22
worker or a nurse in a primary care
11:25
setting,
11:26
but, also providing the supervision with the psychiatrist
11:29
and backup.
11:31
And but we are really up scaling our
11:33
primary care colleagues,
11:36
in taking on mild to moderate depression and
11:39
anxiety and and helping us,
11:41
provide treatment,
11:43
to within our primary care settings.
11:46
So we've scaled that program over the last,
11:49
six, seven years and now to, more than
11:52
80 practices across the system. We cover almost
11:55
all of our pediatric practices.
11:58
We cover a big, chunk of our medicine
12:00
service line practices, and our goal is to
12:03
cover all of our,
12:04
medicine service line practices by next year.
12:08
We have recently,
12:11
also implement,
12:12
implemented this program in OB GYN practices and
12:16
and working with our OB colleagues to to,
12:20
you know, expand services for women within the
12:23
health system.
12:24
So
12:26
that's the work of integration in primary care
12:29
spaces, which has been, you know,
12:31
a a great journey that we've been on.
12:33
Apart from that, we're also looking at,
12:37
practice integration
12:38
or or co located behavioral health. So the
12:40
difference being collaborative care and co located is
12:43
then collocated, we actually bring services,
12:46
of a psychiatrist and a therapist right at
12:49
the practice where the patient is. So the
12:52
services delivered
12:54
in a destigmatized,
12:56
medical setting,
12:57
but also an active collaboration
12:59
with the,
13:01
primary providers. It may not be that a
13:04
primary care physician, but it is the primary
13:06
provider for that for patient
13:09
in in that,
13:11
you know, health journey that they are in,
13:14
whether it is oncology,
13:16
or
13:18
or cardiology or
13:20
or or GI.
13:21
So we have developed these services within our
13:23
psycho oncology,
13:25
insit within our oncology institute,
13:29
with psychologists and embedded in oncology practices. Another
13:33
example is,
13:34
work being done by a, bariatrics
13:38
psychologist.
13:39
We've developed a transplant
13:41
psychiatry program. So there are examples of working
13:43
with other
13:44
service lines within the health system where we're
13:46
integrating services
13:48
in their institutes
13:50
to help
13:51
patients of our health system,
13:54
who are going through medical, treatment. And by
13:57
the way, this is just a great way
13:59
of piggybacking behavioral health growth with the general
14:02
growth of the
14:04
of the health system as this is something
14:06
behavioral leaders,
14:08
really struggle with, in in, you know, in
14:11
non behavioral health settings.
14:13
But, you know, integration doesn't stop, like, just
14:16
integrating within medical
14:18
settings. We have also
14:20
gone beyond medical settings
14:22
into,
14:24
our communities. So we have a very robust
14:27
school mental health program. We have contracts with
14:30
over 50 school districts,
14:32
in, in that sense of a county in
14:34
Long Island. And we're now moving to Westchester
14:37
County, which is, you know, north of, of
14:39
the city here in New York.
14:41
We,
14:42
cover about 200,000,
14:44
kids within various school districts.
14:47
And this program really provides,
14:49
collocated services either within the school
14:52
or same day or next day access in
14:54
these dedicated behavioral health centers that we have
14:56
built for these school districts.
14:59
We also have similar programs with college,
15:02
students,
15:03
providing, services to them where they are.
15:07
And then the last thing I would wanna
15:08
mention here is the our integration really out
15:12
in the community,
15:14
with, faith based leaders.
15:16
So, you know, around the pandemic, we,
15:19
we started working a lot with our faith
15:21
based leaders on issues like vaccination
15:24
and,
15:25
food drives
15:27
and other matters, but also
15:29
found a big, huge need for mental health
15:31
needs. We,
15:33
we have trained several of our faith based
15:34
leaders in mental health first aid and stress
15:37
first aid,
15:38
and then, organized these mental health forums with
15:40
them, which led to
15:42
our,
15:44
embedding behavioral health providers
15:46
in actually faith based settings. So last year,
15:49
we embedded,
15:50
three providers, two in churches and one in
15:52
a mosque in, in our communities.
15:55
And that's a great program, and we're looking
15:57
to further expand it by,
16:00
you know, further training
16:02
the faith based leaders and their colleagues in
16:04
lay
16:05
through lay counselor academy and,
16:08
as lay counselors in the communities.
16:10
So, really, the idea of bringing this
16:13
to the patients in the community
16:16
and meeting them where they are is really
16:18
so important to engage all these patients. As
16:21
I mentioned, I never actually even,
16:24
getting the treatment that they need.
16:26
Great. Well, thank you so much for laying
16:28
out all those different ways that you're approaching
16:30
integration.
16:31
For our last question here, I wanna turn
16:32
to technology.
16:34
I'm curious to hear from your perspective, doctor
16:36
Sabra, what technologies will we say reshape behavioral
16:39
health in the next few years, and are
16:40
you looking at implementing any of these at
16:42
North?
16:44
Yeah. We're really excited about,
16:46
you know, the trend of digital transformation of
16:49
psychiatry.
16:51
I I feel like, you know, this may
16:53
be something that finally breaks multiple barriers for
16:57
us,
16:58
such as,
16:59
you know,
17:00
mental health stigma,
17:03
workforce issues,
17:04
but we still have to figure out how,
17:07
our digital,
17:09
colleagues
17:11
breakthrough,
17:12
barriers such as, you know, regulations and the
17:14
reimbursement,
17:16
models.
17:18
So, you know, the
17:19
I I'll I'll mention a few things about
17:22
technology and just break it out into
17:24
a a few
17:26
different categories. So first, maybe let's start with
17:29
virtual
17:30
care.
17:31
You know, the pandemic made us all virtual
17:33
providers overnight. And in behavioral health, the the
17:36
trend has just sustained. It's not gone back
17:39
to so much in person care.
17:41
And I see that telehealth and behavioral health
17:43
is here to stay.
17:45
We're perhaps,
17:46
settling into a hybrid model in most of
17:48
our practices.
17:49
Some patients,
17:51
really prefer a virtual care model,
17:54
you
17:55
know, folks with busy lives or who,
17:57
have the means to engage in tele,
18:00
and with technology.
18:02
Well, there are other populations that are still
18:04
preferring in person approach, and this could be
18:06
our families, our our family with children.
18:09
And then some of our hospital based centers,
18:11
which, tend to treat,
18:14
folks with, with specialty care or focus on
18:16
moderate to severe stage of illness, people do
18:19
like to come into the offices,
18:21
like they always did. So I overall see
18:24
various
18:25
approaches,
18:27
depending on the setting of either completely virtual
18:30
care or hybrid models settling in. And we
18:33
have been really
18:35
hoping that our teles
18:37
health regulations,
18:39
you know, the relief that we got from
18:40
the regulations continues.
18:44
And, yeah, telehealth, you know,
18:46
behavioral health has been the whole field has
18:48
been very excited about,
18:50
use of technology
18:51
through digital interventions.
18:54
So as you know, we have thousands of
18:56
apps available for our patients,
18:58
on the App Store.
19:00
And,
19:01
I would say that most of these applications
19:03
are what I call in the wellness space,
19:05
where they focus on awareness,
19:07
education,
19:09
and common techniques for, like, stress reduction,
19:12
thinking,
19:13
mindfulness,
19:14
or or teaching meditation.
19:16
And these are generally helpful, though I would
19:18
say it would be good to see more
19:20
research,
19:21
effectiveness of these apps.
19:24
But then there are other applications that we
19:26
are calling
19:27
digital therapeutics
19:29
that have a bit more science behind them,
19:31
you know, including FDA approvals.
19:34
Though those approvals are not as, they don't
19:36
go through as stringent,
19:38
evaluations as our medications do. But still the
19:41
digital therapeutics
19:43
are now increasingly coming to the market, and
19:45
there is excitement about use of these products
19:48
as adjuvant
19:50
to our current treatments. And we're certainly
19:52
excited about implementing them,
19:55
and hopefully,
19:58
you know, reimbursement models will develop that we
20:00
can get
20:02
paid for these digital therapeutics.
20:04
Apart from Digital Hold and Telia,
20:07
there's a lot of excitement for,
20:09
AI.
20:11
One of the clear examples is just using
20:13
ambient scribes,
20:15
which is being used across all specialties, which
20:17
is particularly very helpful in behavioral health. So
20:20
where we have these copious notes.
20:23
I'm particularly excited about, some novel applications of
20:27
AI in remote monitoring and passive data collection,
20:30
especially in between visits.
20:32
So,
20:33
that is something
20:34
that we're looking forward to. One of the
20:37
use cases of AI that we are implementing
20:39
is exploring,
20:41
ways where our care navigators can match the
20:43
right patient with the right provider in the
20:46
community.
20:47
We also you see the use of AI
20:49
in training of workforce,
20:51
and monitoring quality of work.
20:54
So, overall, you know, I feel digital transformation
20:56
of psychiatry
20:57
is the near near future and and long
20:59
term future
21:01
and and will certainly help us scale good
21:03
evidence based care, you know, which is the
21:05
real challenge,
21:07
and hopefully help us also personalize care so
21:09
that,
21:10
we're meeting,
21:12
you know, we are best treating each individual.
21:16
Great. Well, there's certainly a lot to look
21:18
out for on the horizon. Doctor Sapper, thank
21:20
you so much for being here today and
21:22
for sharing your expertise, and we hope to
21:24
have you join us again soon.
21:26
Thank you for having me.