Latest / Becker's Healthcare Behavioral Health / Thomas Otten, Vice President of Avera Behavioral Health Services

Transcript

Thomas Otten, Vice President of Avera Behavioral Health Services · Becker's Healthcare Behavioral Health

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  Thomas Otten, vice president for Avera McKinnon in
• 0:07
  charge of behavioral health services. Thomas, it's a
• 0:10
  pleasure to have you on the podcast today.
• 0:12
  Thank you. Very excited to be here today.
• 0:15
  Absolutely. We're excited to have you as well.
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  I know there's so much happening in the
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  behavioral health space and certainly,
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  a really, really unique community you have there
• 0:22
  in South Dakota. And and,
• 0:24
  so I'm excited to learn more about how
• 0:26
  you're thinking about things and where the health
• 0:28
  system is headed. But before we dive in,
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  can you tell us a little bit more
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  about yourself and your background?
• 0:34
  Yeah. So my background,
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  as as you noted, I'm the vice president
• 0:39
  at Avara McKinnon, and I oversee all of
• 0:41
  the behavioral health inpatient and outpatient operations. So
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  from, my way of training, I have a
• 0:46
  master's in educational psychology and a master's in
• 0:49
  counseling.
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  And I have been with, Avera McKinnon for
• 0:53
  the past
• 0:55
  twenty eight years, in a variety of different
• 0:57
  roles. I actually started,
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  as a temporary hire, as an assessment counselor
• 1:02
  working a week of nights and then a
• 1:04
  week of evenings and back and forth. Eventually,
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  at six months, they decided to keep me.
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  And,
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  I've been in a variety of different jobs,
• 1:11
  since that time. So currently at at behavioral
• 1:14
  health, here at Avera, we I oversee a
• 1:17
  variety of different things. So we have eight
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  inpatient units, based on ages and acuity of
• 1:22
  the patients. We have a 20 fourseven,
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  urgent care program.
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  We have partial program, intensive outpatient, five different
• 1:30
  outpatient behavioral health clinics.
• 1:32
  And then in the addiction space, we have
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  residential
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  programs for both adults,
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  and adolescents, as well as outpatient,
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  addiction programs as well. So last couple pieces
• 1:43
  of in our continuum, we do have an
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  EAP program,
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  that we do employee assistance,
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  not only for a Vera McKinnon, but we've
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  got contracts with about 1,100 other businesses,
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  around the region.
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  And we have a small little family visitation
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  center. So a lot of pieces keep me
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  busy at a Vera McKinnon. And then I
• 2:00
  also oversee the admin I'm the administrator for
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  the behavioral health service line. So at Avera,
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  we break them down by, 17 different service
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  lines, behavioral health being one of them,
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  throughout the whole Avera print. So it'd be,
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  big parts of South Dakota, Iowa, Minnesota,
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  Nebraska, and a little bit of of North
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  Dakota.
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  So all of the inpatient facilities in that
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  region, we have inpatient in Marshall, Minnesota, Inpatient
• 2:27
  in,
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  Aberdeen, South Dakota, and a wide variety of
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  outpatient programs throughout,
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  that footprint,
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  that I help oversee those as well. So
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  plenty of things that kinda keep me out
• 2:38
  of trouble.
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  Absolutely. And it's really impressive to hear the
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  huge area that you serve as well as
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  all the different
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  services provided, especially in the behavioral health space,
• 2:48
  which is increasingly important across the country.
• 2:51
  And and really cool to hear your origin
• 2:54
  story with Avera as well starting off as
• 2:55
  a temporary worker.
• 2:58
  Did you think that your career would grow
• 2:59
  into what it's been today? Or,
• 3:02
  you know, what was your plan when you
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  started and and joined Avera?
• 3:05
  Yeah.
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  I would say I dreamed that it would
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  grow in the way it has today, and,
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  and it has become a very, very
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  neat part. My wife actually found the ad
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  in the, local newspaper,
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  that started that journey,
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  twenty eight years ago. So very, very
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  cool thing. Avera is a a very mission
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  centered,
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  organization, which which fits very well with me
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  personally. And so,
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  everything begins and ends with mission.
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  I love that, and what a great way
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  to kind of frame this discussion. Now
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  in thinking about,
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  Vera, what are some of the opportunities and
• 3:42
  headwinds that you have your eye on right
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  now?
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  Yeah. So a couple things in the behavioral
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  health space that we're looking at. One, very
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  near,
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  is is we're looking at an esketamine clinic.
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  It's something that as we have, as you're
• 3:56
  probably well aware in treating
• 3:58
  suicidality,
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  it's it's a complex thing with medications. Medications,
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  psychotropic medications don't act as quickly as maybe
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  we would like them to. And so it
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  takes a little bit of time. Esketamine gives
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  us a different opportunity,
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  a
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  opportunity, new opportunity to treat it in a
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  much,
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  faster way. And so we're hoping within the
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  next thirty days, we'll have, that clinic open
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  here,
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  at, Avera. So that would be, an exciting
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  undertaking for us.
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  The other thing we're looking at a little
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  bit longer term, but, just starting kind of
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  in the process,
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  is looking at another piece of that continuum,
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  a psychiatric residential treatment facility,
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  for adolescents. So a place,
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  maybe a little bit longer stay between three
• 4:41
  and twelve months
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  stays, as opposed to our inpatient acute care,
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  where they're staying just a week or so.
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  That is a very large undertaking, obviously. And
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  we're just beginning kind of the early stages
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  of a capital campaign to say, you know,
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  what would this look like?
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  What would it we put together the business
• 4:59
  plan. How much philanthropy
• 5:01
  would need to be a part of that,
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  and and how would we go about, doing
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  that? Because it's an important piece of the
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  continuum.
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  A lot of times, in our state, there's
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  there's kids that are placed out of state
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  because there is no place for them, in
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  our,
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  local state because of a shortage of of
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  those kinds of beds.
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  That's you know, it makes a lot of
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  sense and,
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  truly, truly interesting to see how these programs
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  have evolved. And as you mentioned, being able
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  to,
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  have the funding,
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  to get where you need to be,
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  and provide services for all as much as
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  possible. When you look at the philanthropy piece
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  of it,
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  is there anything that you've done that, you
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  know, has been successful in in growing that
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  piece, or how are you going about it
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  this year that might have been differently in
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  the past?
• 5:46
  Yeah. Great question. So we recently in 02/2022,
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  we built on, so we started with a
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  a 10 bed facility, and now it's a
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  60 bed.
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  And we built on a four story building
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  here in 2022.
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  It was a $28,000,000
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  build,
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  and our goal was,
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  to raise,
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  $18,000,000
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  and and put in $10,000,000
• 6:09
  of our own capital. So we created a
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  philanthropy team,
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  and and had a amazing team, with a
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  couple of co chairs that were very
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  active in the community.
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  We we raised the $18,000,000,
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  and this is back, we started the the
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  campaign back in 2020.
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  In ninety three days, we had raised,
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  the $18,000,000
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  that was was needed. And once we raised
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  the 18,000,000, we decided we didn't wanna stop
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  there because it was a three year campaign,
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  and we were only three months in.
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  And we continued on that path.
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  We set a couple different goals and and
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  surpassed each of them raising. By the end
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  time, it was over $32,000,000
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  for a $28,000,000
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  building, which gave us a lot of dollars
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  to
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  reinvest back into programming and other things that
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  really make, behavioral health,
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  you know, important,
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  work. We really can invest in things that
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  sometimes maybe wouldn't make sense otherwise.
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  That's really impressive to hear. I mean, the
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  the things that you've met your goal in
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  three months that was supposed to be a
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  three year goal, is huge, and then to
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  continue that on. And,
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  it just really, speaks volumes, it sounds like,
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  to the community and the leaders that you
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  had in charge of, putting together the philanthropy
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  efforts.
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  That was really a fun project.
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  Janan Braborovich, who's the chief philanthropy officer for
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  us, really has a passion around behavioral health,
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  and we had,
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  chair, committee chairs that were co chairs that
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  were really passionate about behavioral health. And it's,
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  you know, in that first probably 40 asks
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  we made, we had zero people tell us
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  no. It's really if you think about behavioral
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  health, it is something that touches just about
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  everybody's life, either in their own personal life,
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  someone in their family, someone that's, their friend.
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  And so,
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  it really is, an area where, philanthropy can
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  be an important component of the growth projects.
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  That's amazing,
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  and truly, truly helpful. Thank you for talking
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  through that with us a bit. Now,
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  and looking ahead, how are you thinking about
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  growth and adding value to the organization overall?
• 8:12
  Yeah. So couple things that we think about,
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  you know, growth, from a psychiatry standpoint. And
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  I'd say, you know,
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  you mentioned, one of the headwinds we've had.
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  Headwinds would certainly be on the staffing front.
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  I don't think we're alone in that. I
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  think there's been shortages in staffing. The one
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  area where we've generally done pretty well,
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  is in psychiatry. We have about 30 psychiatrists.
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  We have our own,
• 8:36
  residency, USD school of residency is here with,
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  eight students graduating every year plus, two child
• 8:41
  fellows in each of the year. So we
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  end up with,
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  about 36 residents, at all times. And so
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  we're able to recruit from our own pretty
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  well,
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  in a psychiatry standpoint. But no matter how
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  many psychiatrists we turn out,
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  there's never going to be enough
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  psychiatrists to meet the entire,
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  need of of what is out there. And
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  so one of the things we've looked at
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  growth recently, we actually just
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  received a grant that will be for collaborative
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  care to partner with family practice physicians,
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  and creating a collaborative care,
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  team, and essentially,
• 9:16
  working with case management and a variety of
• 9:19
  different pieces that go along with that really
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  doing measurement based, care or measurement informed care,
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  to make sure that we're tracking, in the
• 9:28
  family practice with a lot of depression, anxiety,
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  ADHD, some of those,
• 9:33
  diseases that, you know, family practice physician can
• 9:35
  do very well. And then we have a
• 9:37
  psychiatrist come in behind and collaborate with them
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  to make sure that,
• 9:41
  we're we're doing it, correctly. So we've we've
• 9:44
  learned a lot across the the country, and
• 9:46
  and we're just stepping our foot into this
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  here over the next sixty days or so.
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  We're gonna, really open that collaborative care,
• 9:53
  program.
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  The other way we look at growth, as
• 9:56
  I said, psychiatry never,
• 9:58
  probably enough,
• 10:00
  psychiatrist.
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  But as we looked at the extenders and
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  and advanced practice providers,
• 10:05
  psychiatric mental health nurse practitioners in particular,
• 10:09
  and and PAs, how can we use them
• 10:11
  differently? And, we have them partnered with our
• 10:14
  medical director, doctor David Ermer,
• 10:16
  to do very close supervision with them, both
• 10:19
  weekly group supervision and then also individual supervision
• 10:23
  with them to really,
• 10:24
  use everybody at kind of the top of
• 10:26
  their license. And so that's been a couple
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  of,
• 10:29
  exciting opportunities for us to to look at
• 10:31
  growth in the future.
• 10:34
  Absolutely. That's amazing to hear. And as you
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  mentioned, I know that workforce element of it
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  too. So many organizations are are trying to
• 10:40
  figure out how to strengthen their pipeline or
• 10:43
  still continue offering services, whether it's, you know,
• 10:46
  using technology or or figuring out other ways,
• 10:48
  to leverage their workforce differently than they had
• 10:50
  in the past. And so,
• 10:52
  I appreciate, you know, how much goes into
• 10:54
  trying to revamp the the, those processes,
• 10:58
  in a way that is meaningful and makes
• 11:00
  sense even as as staffing shortages continue to,
• 11:04
  be a challenge.
• 11:05
  Absolutely.
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  So I think, you know, talking about a
• 11:09
  lot of different opportunities,
• 11:11
  that are round and available, I know for
• 11:13
  lots of hospitals and health systems, margins are
• 11:15
  are tight right now. And so, you know,
• 11:17
  for those, there might be a lot of
• 11:18
  different programs they're looking at. But how do
• 11:20
  you identify or what do you see as
• 11:21
  still being a risk that's worth taking even
• 11:24
  if you are under some, financial challenges?
• 11:27
  Yeah. So I'll talk about one of the
• 11:29
  things that we found very beneficial for us.
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  In that 02/2022
• 11:33
  expansion, one of the things we have on
• 11:35
  the Ground Floor there is a
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  twenty four hours a day, seven days a
• 11:40
  week, three hundred and sixty five days a
• 11:41
  year, behavioral health urgent care. And and I
• 11:45
  would think of it almost like an emergency
• 11:47
  room. We don't call it emergency because it
• 11:49
  doesn't meet that trauma standard, but essentially it's
• 11:51
  staffed by behavioral health technicians, psychiatric nurses, assessment
• 11:55
  counselors,
• 11:57
  and then advanced practice providers kinda playing that
• 12:00
  role of of the physician. So a patient
• 12:02
  will come in. They'll be triaged by one
• 12:03
  of the nurses.
• 12:05
  They'll be placed into one of the rooms,
• 12:07
  then the counselor will come in and see
• 12:09
  them and do a biopsychosocial
• 12:11
  to try to try to stand kinda what
• 12:13
  the precipitating
• 12:14
  events are. And then, the final piece is
• 12:17
  the advanced practice provider. Again, kind of playing
• 12:19
  that role of the ED physician comes in,
• 12:22
  and does kinda that medical component and clearance
• 12:25
  of all of that. Between those three disciplines,
• 12:27
  counselor, the nurse,
• 12:28
  and the advanced practice provider, we make a
• 12:30
  level of care determination. What's the best place,
• 12:34
  for this patient to be fit in kind
• 12:35
  of our continuum, whether that's inpatient or
• 12:39
  intensive outpatient or partial program, or maybe they
• 12:41
  need a counselor or maybe they need a
• 12:42
  psychiatrist. We can kinda plug them into whatever
• 12:45
  the right level of care is. So
• 12:47
  for those people who have an inpatient, it
• 12:49
  has been,
• 12:51
  an absolute,
• 12:53
  jewel for us. Now if you looked at
• 12:55
  that cost center unto its own, it it's,
• 12:58
  not a moneymaker.
• 12:59
  It it almost breaks even, just a a
• 13:01
  hair below break even. But, if you look
• 13:04
  at what it is as far as from
• 13:05
  the community standpoint, it's the absolute easy button.
• 13:08
  Twenty four hours a day, seven days a
• 13:10
  week. I don't have to wonder where to
• 13:11
  go or what to do. There's one phone
• 13:14
  number people can call or they can come
• 13:15
  directly into the urgent care, and we're waiting
• 13:18
  and and ready to serve them. And then
• 13:20
  we can get them into the right level
• 13:22
  of of care for them. So obviously for
• 13:24
  us, if that ends up being services that
• 13:26
  they need here at Avera,
• 13:28
  it's it's got a lot of downstream revenue
• 13:31
  for us that that's very advantageous. If if
• 13:33
  it's,
• 13:34
  some service outside of Era that they might
• 13:36
  need, we can refer them on to those
• 13:38
  services as well and and, have great partnerships
• 13:40
  with with people in our community.
• 13:43
  That's amazing to hear. I love that idea,
• 13:44
  and it seems like it would, you know,
• 13:47
  have,
• 13:48
  help you meet the goals in in so
• 13:49
  many different ways, for the the organization
• 13:52
  not to have to necessarily have those folks,
• 13:55
  you know, be in the general ER, but
• 13:57
  but really truly triaging them quickly into the
• 13:59
  right spaces.
• 14:00
  Yeah.
• 14:01
  It's a much
• 14:02
  kinder and gentler feel to a behavioral health.
• 14:04
  You know, I think most ERs will tell
• 14:06
  you,
• 14:07
  the staff would say behavioral health patients are
• 14:10
  probably one of the populations they're least comfortable
• 14:12
  with. I think the patients,
• 14:14
  that have to go to an ER would
• 14:16
  often say that's not a good fit. So
• 14:17
  this is really designed around behavioral health. So
• 14:20
  it really is a very different feel,
• 14:23
  and certainly has raised the, the quality, you
• 14:27
  know, having all of that screened, by an
• 14:29
  advanced practice provider right here,
• 14:32
  prior to their admission, has really helped us
• 14:34
  in in a variety of different ways as
• 14:36
  well.
• 14:37
  I love that. You know, really, really cool.
• 14:40
  For setting up a program like this,
• 14:43
  you know, that is it pretty, I guess,
• 14:45
  what does it take to stand up a
• 14:47
  program like this and really dedicate the time
• 14:49
  and effort, from, you know, having the idea
• 14:51
  to then being able to open it up
• 14:53
  and, have the right specialist working with the
• 14:56
  behavioral health patients coming in?
• 14:58
  Yeah. It was definitely a a large undertaking
• 15:00
  at the time. But, you know, if if,
• 15:03
  it's it's a a matter of getting the
• 15:05
  right staff, it means from a advanced practice
• 15:07
  provider, we're typically using FMPs there,
• 15:12
  who have kind of that medical knowledge.
• 15:14
  We do have a a PA or two
• 15:16
  in there as well. So,
• 15:18
  and they each work, a set number of
• 15:20
  shifts. They work 12 shifts a month. They
• 15:22
  work twelve hour shifts. And so
• 15:24
  it's it's a matter of getting the right,
• 15:27
  FTE. Pretty much always have one APP at
• 15:29
  all times, and then it's, you know, getting
• 15:31
  the counselors. And we have to kinda study
• 15:33
  the trends of how often wins it busy,
• 15:36
  wins it slow. You know, we've, identified that
• 15:39
  basically from about one in the afternoon until
• 15:41
  nine in the afternoon
• 15:43
  or early evening is is the real busy
• 15:45
  time. So we have to have our kind
• 15:47
  of maximum number of counselors. We start with
• 15:49
  just two counselors in the morning, but we
• 15:50
  get to six counselors when we get to
• 15:52
  that really the busiest time.
• 15:55
  And so it's it's kind of mapping all
• 15:57
  of those out.
• 15:58
  And again, from a nursing standpoint, we have,
• 16:01
  just a couple of nurses there. They can
• 16:02
  help us do all the nursing admission history
• 16:05
  on the patients that actually get admitted. We
• 16:07
  also have inside of that urgent care, we
• 16:10
  have an observation area. So we have four
• 16:12
  kind
• 16:13
  of over engineered La Z Boy chairs that
• 16:15
  can be for patients who need twenty three
• 16:17
  hour observation. If they maybe don't need inpatient,
• 16:19
  but they need something more than, you know,
• 16:21
  let's see your counselor next week.
• 16:24
  We can really, have them stay in our
• 16:26
  observation area and work on an outpatient plan
• 16:28
  and a safety plan and,
• 16:30
  have conversations around, means.
• 16:33
  And so there's a lot of different pieces
• 16:35
  that we can fit inside that. So
• 16:37
  a big component of that is certainly staffing,
• 16:40
  and then the second component is really kind
• 16:42
  of figuring, okay, what does that programming look
• 16:44
  like, for all of those components to work
• 16:46
  together?
• 16:47
  Got it. That's amazing. Thank you for digging
• 16:49
  in there. Now,
• 16:51
  right before we wrap up here, I'm curious,
• 16:54
  where do you see some of the best
• 16:55
  growth opportunities,
• 16:56
  in the future for yourself and and for
• 16:58
  your team overall?
• 17:00
  I think for for Rivera, it's a it's
• 17:02
  an exciting time in behavioral health for sure.
• 17:05
  You know, again, we've got a 60 inpatient
• 17:08
  beds now.
• 17:09
  We just recently,
• 17:11
  in 2024,
• 17:13
  just opened here a couple months ago, our
• 17:16
  most recent,
• 17:18
  unit. And so,
• 17:20
  there's a lot of,
• 17:22
  exciting things ahead of us as we look
• 17:24
  at, like, what other pieces of the continuum
• 17:26
  might be possibilities.
• 17:28
  I mean, certainly,
• 17:29
  we've looked at eating disorders. Eating disorders is
• 17:32
  a scourge that has really troubled a lot
• 17:35
  of our youth and and young adults over
• 17:37
  the course, particularly over the last five years.
• 17:40
  And so we've explored that a little bit
• 17:43
  to say, what would that look like?
• 17:45
  You know, certainly, as we look at,
• 17:48
  partnerships,
• 17:49
  I think, you know, joint ventures with other
• 17:52
  businesses make a lot of sense to us.
• 17:54
  We love to partner wherever we can. You
• 17:55
  know, again, as I said at the beginning,
• 17:57
  it really starts and ends with mission for
• 17:59
  us. So we try to identify from a
• 18:01
  community
• 18:02
  needs assessment, like, what are the areas where
• 18:05
  we really have needs and then see if
• 18:07
  we can fill any any of those gaps
• 18:09
  either by ourselves or in partnership with somebody
• 18:11
  else.
• 18:13
  Got it. That's so helpful to hear. Thomas,
• 18:16
  thank you so much for joining us on
• 18:17
  the podcast today. This has been an extremely
• 18:19
  fun and interesting conversation, and I look forward
• 18:21
  to connecting with you again soon. Absolutely. My
• 18:23
  pleasure. Thanks much, Laura.