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