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

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

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