WEBVTT 1 00:00:02.159 --> 00:00:05.279 - Heightened demand for behavioral health services isn't simply 2 00:00:05.279 --> 00:00:08.000 - a trend. It represents a structural shift in 3 00:00:08.000 --> 00:00:10.320 - what patients need and what health systems are 4 00:00:10.320 --> 00:00:13.039 - expected to deliver. And the space between that 5 00:00:13.039 --> 00:00:13.539 - expectation 6 00:00:14.015 --> 00:00:16.734 - and most organizations' current capacity is where the 7 00:00:16.734 --> 00:00:19.614 - hardest leadership questions live. How to recruit and 8 00:00:19.614 --> 00:00:22.435 - retain clinicians in a historically thin labor market, 9 00:00:22.574 --> 00:00:26.095 - how to build sustainable financial models around services 10 00:00:26.095 --> 00:00:28.320 - that have been chronically under funded and how 11 00:00:28.320 --> 00:00:30.720 - to integrate care in ways that actually improve 12 00:00:30.720 --> 00:00:33.140 - outcomes rather than just check a box. 13 00:00:33.520 --> 00:00:36.000 - Becker's Fall Behavioral Health Summit is where more 14 00:00:36.000 --> 00:00:38.100 - than 300 executive level attendees 15 00:00:38.479 --> 00:00:40.914 - and 30 plus speakers spend two days working 16 00:00:40.914 --> 00:00:43.475 - through exactly those questions with the kind of 17 00:00:43.475 --> 00:00:45.795 - candor that only happens when the right people 18 00:00:45.795 --> 00:00:48.034 - are in the room. Join us November fourth 19 00:00:48.034 --> 00:00:50.914 - and fifth at the Hyatt Regency Chicago. For 20 00:00:50.914 --> 00:00:53.714 - the agenda and event details, visit beggars hospital 21 00:00:53.714 --> 00:00:55.920 - review dot com and click on the events 22 00:00:55.920 --> 00:00:57.219 - tab in the upper right. 23 00:00:58.079 --> 00:01:00.799 - Welcome to the Becker's Behavioral Health Podcast. I'm 24 00:01:00.799 --> 00:01:03.520 - Ella Reuter, your host. Today, I'm joined by 25 00:01:03.520 --> 00:01:06.719 - Manish Sapra, system vice president of behavioral health 26 00:01:06.719 --> 00:01:10.004 - services at CommonSpirit Health. He recently joined the 27 00:01:10.004 --> 00:01:13.224 - system's national leadership team to help guide behavioral 28 00:01:13.284 --> 00:01:15.385 - health strategy across one of the largest 29 00:01:16.004 --> 00:01:17.545 - health systems in the country. 30 00:01:17.844 --> 00:01:19.685 - Doctor. Sapra, thank you so much for joining 31 00:01:19.685 --> 00:01:20.424 - us today. 32 00:01:21.060 --> 00:01:23.700 - Thank you for having me. It's really exciting 33 00:01:23.700 --> 00:01:25.700 - to be here, and, I hope you have 34 00:01:25.700 --> 00:01:26.519 - a good conversation. 35 00:01:27.140 --> 00:01:29.379 - Yes. I'm looking forward to it. Well, can 36 00:01:29.379 --> 00:01:31.060 - you start us off by telling us a 37 00:01:31.060 --> 00:01:33.959 - little bit more about yourself, your leadership background, 38 00:01:34.099 --> 00:01:35.719 - and how you ended up at CommonSpirit? 39 00:01:37.245 --> 00:01:39.505 - Sure. Yeah. I I joined CommonSpirit 40 00:01:39.885 --> 00:01:40.704 - last November, 41 00:01:41.245 --> 00:01:43.645 - and so it's been about eight months in 42 00:01:43.645 --> 00:01:44.305 - the organization. 43 00:01:45.965 --> 00:01:48.685 - I was hired to be the system vice 44 00:01:48.685 --> 00:01:51.185 - president for, behavioral health services 45 00:01:51.509 --> 00:01:53.909 - overseeing a new strategic service line in the 46 00:01:53.909 --> 00:01:54.409 - system, 47 00:01:55.590 --> 00:01:56.069 - which is, 48 00:01:56.629 --> 00:01:59.030 - remarkable for the system to actually invest in 49 00:01:59.030 --> 00:02:01.129 - a national behavioral health service line. 50 00:02:01.590 --> 00:02:03.049 - As far as my background, 51 00:02:03.349 --> 00:02:05.909 - I I was recently with another health system 52 00:02:05.909 --> 00:02:08.585 - in New York, called Northwell, where I ran 53 00:02:08.585 --> 00:02:10.365 - their behavioral health service line there 54 00:02:11.064 --> 00:02:12.525 - for several years. And, 55 00:02:13.705 --> 00:02:15.625 - part of that, I have had experience of 56 00:02:15.625 --> 00:02:16.425 - working in, 57 00:02:17.064 --> 00:02:17.965 - in in Pittsburgh, 58 00:02:18.425 --> 00:02:19.085 - at UPMC, 59 00:02:19.544 --> 00:02:20.205 - and then 60 00:02:20.580 --> 00:02:21.639 - in rural, 61 00:02:22.259 --> 00:02:23.959 - settings in Central Pennsylvania 62 00:02:24.419 --> 00:02:27.699 - and community settings within Connecticut. So lot of 63 00:02:27.699 --> 00:02:29.959 - experience of working community based organizations, 64 00:02:30.259 --> 00:02:33.139 - community hospitals, which is really relevant right now 65 00:02:33.139 --> 00:02:35.879 - in in this role, at Crown Spirit. 66 00:02:36.395 --> 00:02:38.794 - And then, you know, over the years, I 67 00:02:38.794 --> 00:02:40.574 - would say I've had sort of the, 68 00:02:41.594 --> 00:02:43.935 - front row seat looking at health care consolidation 69 00:02:44.555 --> 00:02:47.275 - and as large health systems build, you know, 70 00:02:47.275 --> 00:02:48.415 - structures to 71 00:02:48.960 --> 00:02:51.199 - connect their programs and, 72 00:02:51.680 --> 00:02:54.560 - become more organized. I've had the pleasure of 73 00:02:54.560 --> 00:02:57.680 - of creating that service line strategy, which is 74 00:02:57.680 --> 00:02:59.599 - what brings me to common spirit as as 75 00:02:59.599 --> 00:03:01.540 - the system is looking to do the same. 76 00:03:02.245 --> 00:03:03.764 - Yes. Well, thank you so much for that 77 00:03:03.764 --> 00:03:04.985 - brief overview there, 78 00:03:05.364 --> 00:03:07.444 - especially with your leadership background. Again, thank you 79 00:03:07.444 --> 00:03:09.604 - for touching on everything and showing just your 80 00:03:09.604 --> 00:03:10.824 - breadth of work there. 81 00:03:11.125 --> 00:03:14.424 - We talked with you, Beckers did, last November 82 00:03:14.485 --> 00:03:15.944 - when you took on this position, 83 00:03:16.909 --> 00:03:18.510 - and you told us how you were spending 84 00:03:18.510 --> 00:03:20.430 - your first few months understanding the work that 85 00:03:20.430 --> 00:03:21.569 - was already happening 86 00:03:21.950 --> 00:03:22.849 - across CommonSpirit 87 00:03:23.150 --> 00:03:23.650 - before, 88 00:03:24.349 --> 00:03:25.969 - implementing any major changes. 89 00:03:26.670 --> 00:03:27.889 - When you look across 90 00:03:28.189 --> 00:03:28.849 - a system 91 00:03:29.150 --> 00:03:30.689 - of this size like CommonSpirit, 92 00:03:31.544 --> 00:03:34.844 - what opportunities do you see to standardize behavioral 93 00:03:34.905 --> 00:03:35.644 - health strategy, 94 00:03:35.944 --> 00:03:37.724 - and where do you believe standardization 95 00:03:38.344 --> 00:03:41.245 - can have the greatest impact on quality, 96 00:03:41.544 --> 00:03:44.044 - patient outcomes, and operational performance? 97 00:03:45.490 --> 00:03:47.750 - Yeah. You know, before making any big changes, 98 00:03:48.530 --> 00:03:50.790 - especially for a system this this big, 99 00:03:51.810 --> 00:03:53.889 - it's it's really crucial to take a step 100 00:03:53.889 --> 00:03:57.009 - back and get to know each market, each 101 00:03:57.009 --> 00:03:59.430 - clinical setting that we are working on. 102 00:03:59.784 --> 00:04:02.185 - And that's where I've invested my time. You 103 00:04:02.185 --> 00:04:04.425 - know, because of our size, every community has 104 00:04:04.425 --> 00:04:06.205 - such different needs, resources. 105 00:04:07.145 --> 00:04:09.485 - There are different regulations that affect care. 106 00:04:10.264 --> 00:04:12.264 - So I've spent the first few months just 107 00:04:12.264 --> 00:04:13.164 - mapping out, 108 00:04:13.625 --> 00:04:15.485 - what's already happening on the ground. 109 00:04:16.449 --> 00:04:18.689 - We want to find those bright spots, the 110 00:04:18.689 --> 00:04:21.750 - the practices that that are already working well 111 00:04:22.129 --> 00:04:24.129 - and figure out how to scale them up 112 00:04:24.129 --> 00:04:26.310 - so that the whole system can benefit. 113 00:04:27.089 --> 00:04:28.389 - Now regarding standardization, 114 00:04:28.930 --> 00:04:30.930 - you know, it's a huge opportunity for us 115 00:04:30.930 --> 00:04:31.430 - to 116 00:04:32.504 --> 00:04:35.705 - boost, both our quality and efficiency and and 117 00:04:35.705 --> 00:04:38.525 - bring the economies of scale to to those, 118 00:04:39.384 --> 00:04:39.884 - initiatives. 119 00:04:41.064 --> 00:04:43.165 - My vision is really that 120 00:04:44.025 --> 00:04:45.404 - we are able to 121 00:04:46.180 --> 00:04:46.680 - centrally 122 00:04:47.139 --> 00:04:50.279 - consult over what consistent guidelines should be, 123 00:04:51.139 --> 00:04:54.479 - you know, whether it is working with our 124 00:04:54.740 --> 00:04:57.399 - quality folks on building some peers, 125 00:04:57.860 --> 00:04:58.360 - scorecards, 126 00:04:59.620 --> 00:05:01.240 - to track our work, 127 00:05:02.714 --> 00:05:04.875 - or to really sharpen how we use our 128 00:05:04.875 --> 00:05:07.675 - electronic medical records. You know, we're we're doing 129 00:05:07.675 --> 00:05:09.295 - a lot of work right now on 130 00:05:09.675 --> 00:05:12.154 - admission auto sets and other auto sets and 131 00:05:12.154 --> 00:05:13.915 - and, you know, what kind of analytics we 132 00:05:13.915 --> 00:05:16.634 - can get from our from our electronic medical 133 00:05:16.634 --> 00:05:17.375 - records. So 134 00:05:17.810 --> 00:05:20.770 - those kind of initiatives give us an approach 135 00:05:20.770 --> 00:05:22.370 - and a and a hope that we can 136 00:05:22.370 --> 00:05:22.870 - actually, 137 00:05:23.810 --> 00:05:25.589 - deliver some consistent message, 138 00:05:26.610 --> 00:05:28.389 - centrally from the system 139 00:05:29.170 --> 00:05:31.250 - about what it means to get being get 140 00:05:31.330 --> 00:05:33.225 - getting better and how can we 141 00:05:33.625 --> 00:05:34.125 - measure 142 00:05:34.904 --> 00:05:37.145 - that success or or just keep an eye 143 00:05:37.145 --> 00:05:39.404 - on how our operations are going. 144 00:05:40.264 --> 00:05:42.764 - On top of that, if we standardize think, 145 00:05:42.824 --> 00:05:45.645 - we are looking at our acute care models. 146 00:05:45.779 --> 00:05:48.339 - Right? We're looking at EV throughput. We're looking 147 00:05:48.339 --> 00:05:51.699 - at, efficiency in our inpatient care model, our 148 00:05:51.699 --> 00:05:54.579 - crisis intervention model. We have set up some 149 00:05:54.579 --> 00:05:55.079 - crisis 150 00:05:55.379 --> 00:05:57.720 - stabilization units, in the system. 151 00:05:58.555 --> 00:06:00.314 - How are those things working out? Whether we 152 00:06:00.314 --> 00:06:03.615 - wanna enhance, expand that, that is, something 153 00:06:04.235 --> 00:06:06.495 - the the service line, looks to 154 00:06:07.115 --> 00:06:09.034 - advise the rest of the system on how 155 00:06:09.034 --> 00:06:10.414 - to to build that. 156 00:06:11.149 --> 00:06:14.189 - We're talking about expanding access to care, so 157 00:06:14.189 --> 00:06:16.910 - cutting down on redundant processes. And this is 158 00:06:16.910 --> 00:06:19.470 - a big one, like reducing those frustrating wait 159 00:06:19.470 --> 00:06:21.250 - times for patients in the ER. 160 00:06:21.790 --> 00:06:24.509 - So we're working on looking at ways to 161 00:06:24.509 --> 00:06:25.009 - enhance 162 00:06:25.985 --> 00:06:26.805 - our assessment 163 00:06:27.185 --> 00:06:29.904 - in the emergency departments. We have several pockets 164 00:06:29.904 --> 00:06:32.225 - of really good work that's going on in 165 00:06:32.225 --> 00:06:34.085 - the system, and we're looking to 166 00:06:34.625 --> 00:06:36.545 - to learn from that and bring it to 167 00:06:36.545 --> 00:06:38.960 - the rest of the system. So this means 168 00:06:39.100 --> 00:06:39.600 - giving, 169 00:06:40.379 --> 00:06:41.120 - more comprehensive, 170 00:06:41.980 --> 00:06:42.480 - evaluations 171 00:06:42.939 --> 00:06:43.680 - and then, 172 00:06:44.300 --> 00:06:46.860 - helping out with behavioral health transfers. We're starting 173 00:06:46.860 --> 00:06:49.680 - to use some technology, some inbuilt, and some 174 00:06:49.819 --> 00:06:51.199 - with our external partners 175 00:06:51.740 --> 00:06:53.360 - on helping with those referrals, 176 00:06:54.115 --> 00:06:55.654 - both internally and externally. 177 00:06:56.754 --> 00:06:58.675 - So that's that's some work that we are 178 00:06:58.675 --> 00:06:59.654 - focusing on. 179 00:07:00.034 --> 00:07:01.814 - We're also looking to identify 180 00:07:03.074 --> 00:07:03.574 - proactively, 181 00:07:04.354 --> 00:07:05.094 - and preemptively 182 00:07:05.474 --> 00:07:05.954 - using, 183 00:07:06.274 --> 00:07:08.854 - you know, technology, analytics, even AI 184 00:07:09.250 --> 00:07:09.750 - within 185 00:07:10.209 --> 00:07:12.850 - our emergency departments as soon as patient, is 186 00:07:12.850 --> 00:07:13.669 - showing up 187 00:07:14.050 --> 00:07:15.589 - or within our broader, 188 00:07:15.970 --> 00:07:18.149 - you know, patient population using, 189 00:07:18.850 --> 00:07:20.949 - concepts like registries and 190 00:07:21.834 --> 00:07:23.754 - identifying patients who are at risk so that 191 00:07:23.754 --> 00:07:26.555 - we can have a more proactive approach in 192 00:07:26.555 --> 00:07:27.615 - in reaching out 193 00:07:27.995 --> 00:07:29.995 - and a timely approach in reaching out to 194 00:07:29.995 --> 00:07:30.735 - those patients. 195 00:07:31.595 --> 00:07:34.014 - See, ultimately, the goal is to balance everything. 196 00:07:34.154 --> 00:07:36.334 - So we wanna maintain those high quality 197 00:07:36.899 --> 00:07:39.939 - standards across the entire ministry, but we have 198 00:07:39.939 --> 00:07:41.800 - to make sure that every region 199 00:07:42.339 --> 00:07:43.639 - still gets that flexibility. 200 00:07:44.420 --> 00:07:45.639 - You know, every market 201 00:07:46.019 --> 00:07:47.720 - can develop a tailored toolkit 202 00:07:48.100 --> 00:07:50.339 - that actually fits their unique patients and the 203 00:07:50.339 --> 00:07:52.360 - resources they have on the hand. So 204 00:07:52.875 --> 00:07:53.375 - it's, 205 00:07:54.555 --> 00:07:56.475 - it's kind of work that that can start 206 00:07:56.475 --> 00:07:58.574 - centrally, but it really is delivered, 207 00:07:59.835 --> 00:08:02.154 - at a market or a site level, within 208 00:08:02.154 --> 00:08:02.814 - our organization. 209 00:08:04.395 --> 00:08:06.459 - Can you talk more about how you're thinking 210 00:08:06.459 --> 00:08:09.899 - about balancing system wide behavioral health priorities and 211 00:08:09.899 --> 00:08:10.959 - quality standards 212 00:08:11.339 --> 00:08:13.819 - while still giving individual markets, you know, the 213 00:08:13.819 --> 00:08:14.319 - flexibility 214 00:08:14.620 --> 00:08:16.639 - to address unique patient populations 215 00:08:17.419 --> 00:08:18.719 - and workforce realities 216 00:08:19.754 --> 00:08:21.855 - and community partnerships as well? 217 00:08:22.555 --> 00:08:24.555 - Yeah. That is such a perfect question. Right? 218 00:08:24.555 --> 00:08:27.035 - It especially for an organization of this size, 219 00:08:27.035 --> 00:08:27.535 - it 220 00:08:27.835 --> 00:08:29.694 - really gets to the heart of the challenge. 221 00:08:30.634 --> 00:08:33.615 - Honestly, the work always has to start locally, 222 00:08:33.995 --> 00:08:35.375 - right at the site level. 223 00:08:36.209 --> 00:08:39.250 - We are incredibly fortunate to have such great 224 00:08:39.250 --> 00:08:39.750 - leaders, 225 00:08:40.370 --> 00:08:41.589 - across the system, 226 00:08:41.970 --> 00:08:43.509 - you know, behavioral health leaders. 227 00:08:44.690 --> 00:08:47.089 - Many of them who have been deeply embedded 228 00:08:47.089 --> 00:08:49.990 - in their communities and, and within our ministry 229 00:08:50.049 --> 00:08:50.870 - for years, 230 00:08:51.355 --> 00:08:53.774 - their firsthand knowledge is invaluable. 231 00:08:54.315 --> 00:08:56.315 - So we lean heavily on their insight and 232 00:08:56.315 --> 00:08:58.815 - judgment. And and how we get them 233 00:08:59.514 --> 00:09:03.595 - engaged is, through building an extensive collaborative network. 234 00:09:03.595 --> 00:09:04.955 - So we we have we have had a 235 00:09:04.955 --> 00:09:07.620 - behavioral health collaborative for several years within the 236 00:09:07.620 --> 00:09:09.879 - system, which has led to the right foundation 237 00:09:09.940 --> 00:09:10.600 - to develop 238 00:09:11.139 --> 00:09:11.940 - a a more, 239 00:09:12.899 --> 00:09:15.559 - a robust behavioral service line structure. 240 00:09:16.420 --> 00:09:19.779 - So this collaborative invites active participation from every 241 00:09:19.779 --> 00:09:22.455 - single site. From there, we move up to 242 00:09:22.455 --> 00:09:24.455 - the market level in the system, and the 243 00:09:24.455 --> 00:09:26.455 - markets then report up to the region. So 244 00:09:26.455 --> 00:09:28.134 - it's so so we move up to the 245 00:09:28.134 --> 00:09:30.295 - market level where it's crucial to have our 246 00:09:30.295 --> 00:09:33.595 - clinical operations and strategy leaders at the table, 247 00:09:34.139 --> 00:09:37.899 - along with input from regulatory compliance, patient experience 248 00:09:37.899 --> 00:09:39.200 - teams, and other stakeholders, 249 00:09:40.139 --> 00:09:41.820 - that we have to work on, especially in 250 00:09:41.820 --> 00:09:44.080 - behavioral health. There's advocacy, there's, 251 00:09:45.420 --> 00:09:45.920 - philanthropy. 252 00:09:46.894 --> 00:09:47.715 - And this process helps us, 253 00:09:48.975 --> 00:09:51.774 - find that common ground across markets and regions 254 00:09:51.774 --> 00:09:52.914 - as we look to develop, 255 00:09:53.294 --> 00:09:54.274 - you know, strategic, 256 00:09:54.894 --> 00:09:55.394 - plans. 257 00:09:56.335 --> 00:09:57.154 - We've also, 258 00:09:58.575 --> 00:09:59.075 - established, 259 00:09:59.779 --> 00:10:03.799 - operational work groups focusing on everything from ambulatory 260 00:10:04.019 --> 00:10:07.539 - care and inpatient services to patient experiences to 261 00:10:07.539 --> 00:10:08.039 - work, 262 00:10:08.899 --> 00:10:11.139 - in developing policies. So these work groups are 263 00:10:11.139 --> 00:10:13.079 - within the behavioral health service line, 264 00:10:14.235 --> 00:10:16.715 - and they also have participation from each of 265 00:10:16.715 --> 00:10:19.535 - the local sites where this work is relevant. 266 00:10:20.235 --> 00:10:21.934 - So once any of the initiatives 267 00:10:22.554 --> 00:10:24.735 - are worked on within these groups, 268 00:10:25.035 --> 00:10:25.934 - we bring it 269 00:10:26.330 --> 00:10:26.990 - for feedback, 270 00:10:27.850 --> 00:10:30.750 - to all our sites before anything is finalized, 271 00:10:30.970 --> 00:10:31.929 - but let it be, 272 00:10:33.129 --> 00:10:35.389 - you know, a a decision for 273 00:10:36.090 --> 00:10:37.929 - developing a new program or if it's a 274 00:10:37.929 --> 00:10:39.769 - new policy or if it's maybe a new 275 00:10:39.769 --> 00:10:42.985 - order sets within our electronic medical record. 276 00:10:43.684 --> 00:10:46.164 - One area that I'm really passionate about supporting 277 00:10:46.164 --> 00:10:46.664 - in 278 00:10:47.044 --> 00:10:49.365 - a in a more system wide strategy is 279 00:10:49.365 --> 00:10:50.904 - for community partnerships. 280 00:10:51.605 --> 00:10:53.625 - Right now, that's working well, 281 00:10:54.179 --> 00:10:56.899 - in patches, but perhaps it's not that uniform 282 00:10:56.899 --> 00:10:58.600 - or perhaps we've not had 283 00:10:59.540 --> 00:11:01.720 - the the resources to work on it. So 284 00:11:02.259 --> 00:11:04.580 - I was actually speaking with, one of our, 285 00:11:04.899 --> 00:11:07.535 - rural hospitals recently, and they had done such 286 00:11:07.535 --> 00:11:10.995 - a fantastic work collaborating with local psychiatric facilities 287 00:11:12.175 --> 00:11:13.774 - that, you know, when we sat down with 288 00:11:13.774 --> 00:11:15.615 - them to discuss how we could provide some 289 00:11:15.615 --> 00:11:18.095 - national support, it became clear that they only 290 00:11:18.095 --> 00:11:20.415 - had the right approach. They just needed the 291 00:11:20.415 --> 00:11:20.915 - validation. 292 00:11:21.779 --> 00:11:22.679 - That's exactly 293 00:11:23.059 --> 00:11:24.980 - the kind of practices that I'll lift up 294 00:11:24.980 --> 00:11:27.079 - and share across the rest of the organization 295 00:11:27.459 --> 00:11:29.299 - so that, you know, as we're building our 296 00:11:29.299 --> 00:11:32.339 - community partnerships, there's also focus on behavioral health, 297 00:11:32.339 --> 00:11:33.879 - which is so much 298 00:11:34.579 --> 00:11:36.769 - needed, especially when it comes to, you know, 299 00:11:37.595 --> 00:11:40.095 - know, any strategy to enhance access to care. 300 00:11:40.475 --> 00:11:40.975 - Mhmm. 301 00:11:41.434 --> 00:11:43.355 - And is there anything that you look for 302 00:11:43.355 --> 00:11:45.695 - specifically within these community partnerships? 303 00:11:46.075 --> 00:11:48.014 - How do you approach these conversations 304 00:11:48.875 --> 00:11:50.495 - and find that mutual understanding? 305 00:11:51.730 --> 00:11:52.529 - Well, I think, 306 00:11:53.090 --> 00:11:54.309 - if the 307 00:11:54.690 --> 00:11:57.090 - community partners are also looking to solve the 308 00:11:57.090 --> 00:11:58.790 - same problems that we are, 309 00:11:59.570 --> 00:12:00.870 - and if they have, 310 00:12:01.889 --> 00:12:04.470 - programs and services that fill the gaps, 311 00:12:04.835 --> 00:12:05.735 - then those conversations 312 00:12:06.115 --> 00:12:07.815 - become really easy. 313 00:12:08.835 --> 00:12:11.254 - Then it's really about a set of values, 314 00:12:11.554 --> 00:12:13.875 - you know, if if those align or not 315 00:12:13.875 --> 00:12:15.794 - and on where where does that count ground 316 00:12:15.794 --> 00:12:16.855 - where we can meet? 317 00:12:17.235 --> 00:12:17.735 - So 318 00:12:18.200 --> 00:12:20.460 - it's it's really about keeping the patient 319 00:12:21.159 --> 00:12:21.980 - in the center 320 00:12:22.600 --> 00:12:25.500 - and seeing what part of that patient's journey 321 00:12:25.639 --> 00:12:27.019 - can be enhanced 322 00:12:27.399 --> 00:12:29.720 - by that community partnership. That's at least what 323 00:12:29.720 --> 00:12:31.419 - I, look for the most. 324 00:12:32.345 --> 00:12:33.964 - Thank you so much. And 325 00:12:34.904 --> 00:12:37.144 - a huge focus in behavioral health and especially 326 00:12:37.144 --> 00:12:40.264 - for leaders has been behavioral health integration, and 327 00:12:40.264 --> 00:12:42.664 - it just remains a major priority across health 328 00:12:42.664 --> 00:12:44.605 - care in general. But operationalizing 329 00:12:45.065 --> 00:12:46.444 - it across inpatient, 330 00:12:47.190 --> 00:12:48.410 - outpatient, ambulatory 331 00:12:48.790 --> 00:12:51.290 - settings is often easier said than done. 332 00:12:51.750 --> 00:12:55.610 - How is CommonSphere approaching behavioral health integration today, 333 00:12:55.990 --> 00:12:57.049 - and what opportunities 334 00:12:57.350 --> 00:12:58.649 - do you see to strengthen 335 00:12:59.110 --> 00:13:03.154 - those connections between behavioral health, primary care, specialty 336 00:13:03.215 --> 00:13:07.154 - care, emergency departments, and acute care settings? 337 00:13:08.174 --> 00:13:09.934 - Yeah. I mean, I think this is going 338 00:13:09.934 --> 00:13:10.835 - to be a very 339 00:13:11.455 --> 00:13:11.955 - significant, 340 00:13:12.815 --> 00:13:13.315 - approach 341 00:13:13.695 --> 00:13:15.855 - for us, and it has been, in the 342 00:13:15.855 --> 00:13:16.355 - organization. 343 00:13:17.629 --> 00:13:19.009 - So I'll start with 344 00:13:19.389 --> 00:13:21.389 - perhaps go through clinical settings, and I can 345 00:13:21.389 --> 00:13:23.549 - start with when patients show up in our 346 00:13:23.549 --> 00:13:24.370 - our hospitals. 347 00:13:24.909 --> 00:13:26.690 - First, in the emergency departments, 348 00:13:27.470 --> 00:13:28.610 - several of our markets, 349 00:13:29.230 --> 00:13:29.970 - have done 350 00:13:30.674 --> 00:13:32.375 - really great work in building, 351 00:13:34.434 --> 00:13:37.414 - peer recovery coaches or substance use disorder navigators, 352 00:13:38.434 --> 00:13:40.054 - or community health workers, 353 00:13:40.674 --> 00:13:42.134 - embedded within the emergency 354 00:13:42.914 --> 00:13:43.414 - departments 355 00:13:44.129 --> 00:13:46.549 - to, you know, do the screening, 356 00:13:47.250 --> 00:13:48.070 - some interventions, 357 00:13:49.250 --> 00:13:52.070 - and, referral to treatment. We have, 358 00:13:53.009 --> 00:13:55.250 - also, in many of our markets, work with 359 00:13:55.250 --> 00:13:57.934 - our emergency medicine colleagues in 360 00:13:58.554 --> 00:14:00.014 - initiating, bridging treatment, 361 00:14:00.394 --> 00:14:02.495 - for substance use disorders, MAT, 362 00:14:03.115 --> 00:14:06.335 - and and other strategies. So that has been 363 00:14:06.475 --> 00:14:07.934 - a a focus of, 364 00:14:08.634 --> 00:14:10.715 - our system in many markets, and I certainly 365 00:14:10.715 --> 00:14:11.455 - want to, 366 00:14:12.049 --> 00:14:12.950 - enhance that. 367 00:14:13.970 --> 00:14:16.529 - Almost all hospitals have some kind of a 368 00:14:16.529 --> 00:14:17.029 - psychiatric 369 00:14:18.610 --> 00:14:19.110 - support, 370 00:14:19.730 --> 00:14:21.750 - whether it's in person or 371 00:14:22.370 --> 00:14:22.690 - or, 372 00:14:23.409 --> 00:14:24.629 - where our teleservices 373 00:14:25.089 --> 00:14:27.384 - or with our with our external partners in 374 00:14:27.384 --> 00:14:28.365 - bringing the psychiatry 375 00:14:29.865 --> 00:14:30.664 - into the, 376 00:14:31.144 --> 00:14:33.625 - physical health settings, whether it's ED or med 377 00:14:33.625 --> 00:14:35.485 - surg floors. And this is something 378 00:14:36.184 --> 00:14:38.365 - that I'm actively looking at at 379 00:14:38.904 --> 00:14:40.345 - at both the, 380 00:14:41.450 --> 00:14:43.929 - the strength of the work that is already 381 00:14:43.929 --> 00:14:45.790 - there and what needs to be enhanced, 382 00:14:46.649 --> 00:14:48.490 - and and how's the quality and and how 383 00:14:48.490 --> 00:14:50.970 - we are working on that. So this is, 384 00:14:51.370 --> 00:14:51.870 - something 385 00:14:52.170 --> 00:14:54.110 - that, the service line can really 386 00:14:54.730 --> 00:14:55.710 - deliver on. 387 00:14:56.595 --> 00:14:57.315 - There are, 388 00:14:58.754 --> 00:15:02.115 - many approaches on behavioral health integration beyond the, 389 00:15:03.315 --> 00:15:05.334 - acute care side as as you know 390 00:15:05.794 --> 00:15:07.735 - and and many of the listeners would know. 391 00:15:08.034 --> 00:15:10.134 - And we have, across the system, 392 00:15:10.960 --> 00:15:13.759 - use varying approaches depending on and this goes 393 00:15:13.759 --> 00:15:15.840 - back to, you know, what is centralized and 394 00:15:15.840 --> 00:15:17.679 - what is what can be standardized and what 395 00:15:17.679 --> 00:15:18.659 - needs to be local. 396 00:15:19.519 --> 00:15:21.860 - So there have been multiple approaches on behavioral 397 00:15:21.919 --> 00:15:22.740 - health integration 398 00:15:23.120 --> 00:15:24.179 - across the system. 399 00:15:25.235 --> 00:15:27.394 - Some of the pockets where we have medical 400 00:15:27.394 --> 00:15:27.894 - groups, 401 00:15:28.995 --> 00:15:30.534 - that have, you know, strong 402 00:15:30.995 --> 00:15:31.495 - outpatient 403 00:15:31.875 --> 00:15:33.095 - behavioral health presence, 404 00:15:33.955 --> 00:15:35.894 - and we do that in Pacific Northwest, 405 00:15:36.274 --> 00:15:36.934 - in California, 406 00:15:37.750 --> 00:15:40.149 - especially in Northern California markets. We are looking 407 00:15:40.149 --> 00:15:40.649 - to 408 00:15:41.590 --> 00:15:44.730 - use those resources to embed services 409 00:15:45.110 --> 00:15:47.930 - in our, medical practices and our subspecialty 410 00:15:48.309 --> 00:15:48.809 - practices. 411 00:15:50.024 --> 00:15:53.304 - In Arizona, we've built a collaborative care model, 412 00:15:53.544 --> 00:15:55.144 - by the book, and and, you know, we 413 00:15:55.144 --> 00:15:57.084 - use collaborative care billing. And, 414 00:15:57.464 --> 00:16:00.105 - and and that model is being expanded to 415 00:16:00.105 --> 00:16:00.985 - other, re 416 00:16:01.704 --> 00:16:03.324 - markets within that region. 417 00:16:04.024 --> 00:16:06.960 - Similarly, we built behavioral health embedded care model 418 00:16:06.960 --> 00:16:09.460 - virtually in Nebraska and Iowa markets. 419 00:16:09.840 --> 00:16:12.799 - So there have been different approaches and, all 420 00:16:12.799 --> 00:16:15.279 - good and all working, and we're looking to 421 00:16:15.279 --> 00:16:17.519 - to work on how to enhance that. We've 422 00:16:17.519 --> 00:16:19.220 - also worked with external partners 423 00:16:19.934 --> 00:16:20.674 - in building, 424 00:16:21.215 --> 00:16:23.554 - behavioral health integration, whether it is 425 00:16:24.014 --> 00:16:27.394 - just, you know, collaborative care or even specialty 426 00:16:27.535 --> 00:16:29.794 - care, like in eating disorders and other programs, 427 00:16:30.575 --> 00:16:32.674 - where we bring in behavioral health resources 428 00:16:33.240 --> 00:16:35.480 - with our external vendors into our, 429 00:16:36.360 --> 00:16:37.500 - primary care site. 430 00:16:38.039 --> 00:16:39.960 - So it's a long winded answer, but it 431 00:16:39.960 --> 00:16:40.360 - is, 432 00:16:40.919 --> 00:16:42.940 - basically an all of the above approach. 433 00:16:43.799 --> 00:16:45.340 - But an important approach, 434 00:16:45.960 --> 00:16:47.899 - of improving access, improving, 435 00:16:48.745 --> 00:16:49.565 - behavioral health 436 00:16:50.024 --> 00:16:51.945 - care, and and one that will be central 437 00:16:51.945 --> 00:16:53.325 - to our service line strategy. 438 00:16:54.184 --> 00:16:56.105 - Yes. Well, thank you. I know integration is 439 00:16:56.105 --> 00:16:57.004 - a very complex, 440 00:16:58.024 --> 00:17:01.144 - question to answer and navigating, so I appreciate 441 00:17:01.144 --> 00:17:03.325 - you taking that question on. And 442 00:17:03.959 --> 00:17:05.019 - speaking of integration, 443 00:17:05.559 --> 00:17:08.059 - I'd love to know more about how Commisphere 444 00:17:08.200 --> 00:17:08.940 - is approaching 445 00:17:09.480 --> 00:17:11.179 - substance use disorder care 446 00:17:11.720 --> 00:17:12.859 - across the nation. 447 00:17:13.960 --> 00:17:14.440 - Yeah. 448 00:17:14.839 --> 00:17:15.480 - So I, 449 00:17:16.795 --> 00:17:19.355 - spoke about I work with peer recovery coaches 450 00:17:19.355 --> 00:17:23.115 - and SUD navigators, which primarily, you know, was 451 00:17:23.115 --> 00:17:24.734 - done in California where we 452 00:17:25.035 --> 00:17:26.095 - all of our hospitals, 453 00:17:26.555 --> 00:17:28.315 - almost in California, and I believe we have 454 00:17:28.315 --> 00:17:30.414 - 27, 28 hospitals in California, 455 00:17:30.929 --> 00:17:33.990 - where we, brought in substance use disorder navigators. 456 00:17:34.049 --> 00:17:35.669 - And we've had a really, 457 00:17:37.409 --> 00:17:38.309 - strong champion 458 00:17:38.609 --> 00:17:39.250 - in that, 459 00:17:39.889 --> 00:17:40.389 - region, 460 00:17:40.849 --> 00:17:42.710 - from our emergency medicine services. 461 00:17:44.085 --> 00:17:45.125 - And that physician, 462 00:17:45.525 --> 00:17:47.384 - has, worked a lot in 463 00:17:47.845 --> 00:17:48.825 - bridging care, 464 00:17:49.365 --> 00:17:52.005 - to these, patients. That program has been going 465 00:17:52.005 --> 00:17:53.785 - on more than five years now. 466 00:17:54.244 --> 00:17:56.644 - We've also done other work in our mountain 467 00:17:56.644 --> 00:17:57.144 - region 468 00:17:57.889 --> 00:18:01.429 - in, which is, you know, primarily Colorado, Utah, 469 00:18:02.130 --> 00:18:04.069 - and Kansas markets where we have, 470 00:18:04.450 --> 00:18:05.990 - worked on enhancing 471 00:18:06.369 --> 00:18:06.869 - MAT, 472 00:18:07.809 --> 00:18:10.289 - in acute care settings. So we're really proud 473 00:18:10.289 --> 00:18:12.470 - of that work, and we're looking to expand 474 00:18:12.529 --> 00:18:13.269 - that further. 475 00:18:14.345 --> 00:18:16.345 - We do not do a lot of substance 476 00:18:16.345 --> 00:18:19.065 - use disorder on the acute care side as 477 00:18:19.065 --> 00:18:19.565 - such, 478 00:18:19.945 --> 00:18:21.404 - except for in couple 479 00:18:21.945 --> 00:18:23.164 - of couple of our markets. 480 00:18:24.025 --> 00:18:24.424 - But, 481 00:18:24.984 --> 00:18:26.904 - there is a lot of substance use disorder 482 00:18:26.904 --> 00:18:28.924 - that we see obviously across the system 483 00:18:29.759 --> 00:18:32.559 - as as comorbid conditions in our acute care 484 00:18:32.559 --> 00:18:33.059 - facilities. 485 00:18:34.000 --> 00:18:35.039 - You know, one of the things that I'm 486 00:18:35.039 --> 00:18:37.359 - really proud of, that the system has done 487 00:18:37.359 --> 00:18:40.180 - is, working on an anti stigma campaign. 488 00:18:41.965 --> 00:18:42.684 - We have done, 489 00:18:43.404 --> 00:18:45.164 - and it's not been a one approach. There 490 00:18:45.164 --> 00:18:47.164 - have been several approaches. We've done a lot 491 00:18:47.164 --> 00:18:49.265 - of educational work. We've done 492 00:18:50.205 --> 00:18:50.705 - awareness 493 00:18:52.285 --> 00:18:55.025 - campaigns, including, you know, some short form videos, 494 00:18:55.485 --> 00:18:55.985 - some 495 00:18:56.909 --> 00:18:57.409 - CME, 496 00:18:58.349 --> 00:18:59.569 - grade, trainings, 497 00:19:00.029 --> 00:19:00.929 - that are available 498 00:19:01.549 --> 00:19:02.049 - for, 499 00:19:02.589 --> 00:19:03.730 - folks who are interested. 500 00:19:04.509 --> 00:19:06.929 - And we've also collaborated with, 501 00:19:07.789 --> 00:19:08.289 - EHA, 502 00:19:08.829 --> 00:19:11.924 - on their anti stigma campaign for broader mental 503 00:19:11.924 --> 00:19:12.825 - health issues. 504 00:19:13.525 --> 00:19:14.244 - And and, 505 00:19:14.804 --> 00:19:17.365 - so those those things have really been very 506 00:19:17.365 --> 00:19:20.025 - helpful working just internally within the organization 507 00:19:20.484 --> 00:19:20.984 - to 508 00:19:21.605 --> 00:19:22.664 - to attack, 509 00:19:23.125 --> 00:19:25.625 - you know, stigma related to substance use disorders. 510 00:19:27.259 --> 00:19:29.359 - I think this will be a significant, 511 00:19:30.220 --> 00:19:32.700 - strategy again for for our service line to 512 00:19:32.700 --> 00:19:33.419 - work and, 513 00:19:33.819 --> 00:19:35.200 - you know, to support 514 00:19:35.579 --> 00:19:37.339 - the good work that has gone on in 515 00:19:37.339 --> 00:19:39.819 - some several of our markets and bringing that 516 00:19:39.819 --> 00:19:41.200 - to the rest of the system. 517 00:19:42.075 --> 00:19:44.075 - So a lot to be still done, but 518 00:19:44.075 --> 00:19:46.154 - I'm very happy with what I've seen, has 519 00:19:46.154 --> 00:19:47.214 - been done so far. 520 00:19:48.075 --> 00:19:50.154 - Wonderful. And I think that's a perfect transition 521 00:19:50.154 --> 00:19:52.634 - into our next question of where are the 522 00:19:52.634 --> 00:19:55.595 - biggest growth opportunities that you're seeing in behavioral 523 00:19:55.595 --> 00:19:57.774 - health services over the next several years? 524 00:19:58.930 --> 00:20:01.090 - Yeah. I mean, well, the biggest opportunity for 525 00:20:01.090 --> 00:20:03.009 - growth are really in filling the gaps that 526 00:20:03.009 --> 00:20:04.870 - exist in our continuum of care. 527 00:20:05.570 --> 00:20:08.230 - You know, whether that's expanding access to comprehensive 528 00:20:08.450 --> 00:20:10.549 - care in the EDs like we talked about, 529 00:20:10.769 --> 00:20:11.750 - building care navigation 530 00:20:12.164 --> 00:20:14.725 - transfers at at Southern markets. The other places 531 00:20:14.725 --> 00:20:17.545 - might be, you know, building integrated care, 532 00:20:18.725 --> 00:20:22.664 - and, expanding integrated care, if it already exists, 533 00:20:24.620 --> 00:20:26.160 - improving the quality of services, 534 00:20:27.180 --> 00:20:28.559 - that we are able to provide, 535 00:20:28.940 --> 00:20:30.960 - on our, med surge floors. 536 00:20:31.420 --> 00:20:33.440 - And I'm also working with other other 537 00:20:33.820 --> 00:20:34.720 - service lines. 538 00:20:36.230 --> 00:20:38.875 - Wisconsin Spirit has a great, women's and infant 539 00:20:38.875 --> 00:20:40.975 - service line. We're working a lot on perinatal 540 00:20:41.115 --> 00:20:43.275 - mental health and how, we know we're doing 541 00:20:43.275 --> 00:20:44.414 - great work in screening 542 00:20:45.115 --> 00:20:48.394 - now for perinatal care, but also now working 543 00:20:48.394 --> 00:20:48.894 - on, 544 00:20:49.440 --> 00:20:51.059 - with our OB GYN colleagues, 545 00:20:51.599 --> 00:20:53.460 - to build integrated care. 546 00:20:54.480 --> 00:20:55.940 - So that'll be a new initiative, 547 00:20:56.319 --> 00:20:58.000 - that we'll work on, but that's a great 548 00:20:58.000 --> 00:20:58.500 - area 549 00:20:59.279 --> 00:20:59.940 - of opportunity 550 00:21:00.240 --> 00:21:01.619 - just to give you an example. 551 00:21:02.480 --> 00:21:03.139 - And then, 552 00:21:04.404 --> 00:21:06.825 - you know, we're not above the financial realities 553 00:21:06.964 --> 00:21:08.265 - and regulatory environment. 554 00:21:08.644 --> 00:21:10.825 - So, you know, things that that are, 555 00:21:11.204 --> 00:21:13.924 - just anyways barriers to grow behavioral health. But 556 00:21:13.924 --> 00:21:15.845 - I think the our approach will have to 557 00:21:15.845 --> 00:21:16.585 - be innovative. 558 00:21:17.220 --> 00:21:20.599 - We'll focus on, you know, disseminating the psychiatric, 559 00:21:20.819 --> 00:21:22.119 - the behavioral health expertise, 560 00:21:23.220 --> 00:21:24.900 - any way we can. We talked a lot 561 00:21:24.900 --> 00:21:26.200 - about, you know, for example, 562 00:21:27.619 --> 00:21:28.119 - integration, 563 00:21:28.500 --> 00:21:30.440 - which is a great way of doing that. 564 00:21:31.154 --> 00:21:33.075 - And where there'll be a lot of focus 565 00:21:33.075 --> 00:21:35.015 - on really on efficiency and improving, 566 00:21:36.115 --> 00:21:37.575 - quality of care. And, 567 00:21:39.234 --> 00:21:39.734 - these, 568 00:21:40.515 --> 00:21:41.015 - approaches 569 00:21:41.795 --> 00:21:44.035 - are are, you know, all an opportunity to 570 00:21:44.035 --> 00:21:46.295 - build a better behavioral health care 571 00:21:47.190 --> 00:21:47.690 - culture. 572 00:21:48.549 --> 00:21:49.529 - We're also looking, 573 00:21:49.909 --> 00:21:52.630 - to create that internal infrastructure so that, 574 00:21:53.109 --> 00:21:55.669 - various parts of the organization can get quick 575 00:21:55.669 --> 00:21:56.169 - consultation 576 00:21:56.630 --> 00:21:59.509 - on, you know, any strategic program they wanna 577 00:21:59.509 --> 00:22:02.295 - grow or any quality improvement efforts they wanna 578 00:22:02.295 --> 00:22:05.174 - take on or any technology related to behavioral 579 00:22:05.174 --> 00:22:06.634 - health that they wanna bring on. 580 00:22:07.095 --> 00:22:09.914 - So I that will be another area 581 00:22:10.295 --> 00:22:12.394 - for the service line to work on. 582 00:22:13.000 --> 00:22:15.980 - We're looking at our payer strategy and opportunities 583 00:22:16.279 --> 00:22:18.519 - there. I'm working closely with our, you know, 584 00:22:18.519 --> 00:22:21.259 - population health, organization to seeing opportunities 585 00:22:21.640 --> 00:22:23.179 - where value based care, 586 00:22:23.799 --> 00:22:24.779 - which could be, 587 00:22:25.400 --> 00:22:25.900 - especially, 588 00:22:26.279 --> 00:22:26.859 - you know, 589 00:22:27.734 --> 00:22:30.214 - a great opportunity for behavioral health to grow, 590 00:22:30.214 --> 00:22:31.654 - especially in areas of care, 591 00:22:32.134 --> 00:22:33.595 - coordination, care management, 592 00:22:34.055 --> 00:22:35.674 - and treating patients with, 593 00:22:36.775 --> 00:22:37.974 - severe mental illness, 594 00:22:38.615 --> 00:22:40.795 - also in primary care and 595 00:22:41.174 --> 00:22:43.769 - integrated care. So I think pop health will 596 00:22:43.769 --> 00:22:44.909 - be a significant, 597 00:22:45.609 --> 00:22:48.089 - area of, focus for the behavioral health service 598 00:22:48.089 --> 00:22:48.589 - line. 599 00:22:49.289 --> 00:22:50.269 - So, yeah, I hope, 600 00:22:50.889 --> 00:22:52.569 - it's given you a good good view of, 601 00:22:52.569 --> 00:22:55.069 - like, where there are some of those opportunities 602 00:22:55.210 --> 00:22:57.515 - exist. But, yeah, I mean, if the central 603 00:22:57.515 --> 00:22:59.835 - thing is to be innovative and and look 604 00:22:59.835 --> 00:23:02.494 - at areas which really improve our efficiency. 605 00:23:03.914 --> 00:23:04.734 - Well, wonderful. 606 00:23:05.275 --> 00:23:07.194 - Doctor Sopra, thank you so much for joining 607 00:23:07.194 --> 00:23:09.694 - us and sharing your insights on common spirit 608 00:23:09.914 --> 00:23:13.019 - health, behavioral health strategy and transformation efforts. 609 00:23:13.319 --> 00:23:15.000 - And thank you to our listeners for tuning 610 00:23:15.000 --> 00:23:17.480 - into Becker's Behavioral Health Podcast. We'll see you 611 00:23:17.480 --> 00:23:18.299 - next time. 612 00:23:19.159 --> 00:23:20.220 - Great. Thank you.