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Becker’s Healthcare Podcast
Building Integrated, Measurement Based Behavioral Health at Scale with Shannon Werb of Array Behavioral Care
00:22:14
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- [00:00]
A
Hello everyone, this is Jacob Emerson with the Beckers Behavioral Health Podcast. Thrilled today to be joined by Shannon Werb, who's the ARRAY Behavioral Care CEO. Shannon, thank you so much for taking the time to be with me on the podcast today.
- [00:14]
B
Hi Jacob, thank you for making the time. I'm really looking forward to it.
- [00:17]
A
Likewise. And before we dive into everything, we want to talk with you about, Shannon, can you first tell us a little bit more about yourself, your background in healthcare and what it is that you do today at array?
- [00:28]
B
Yes, I'd be happy to Jacob. Thank you. I've spent my career really focused on scaling tech enabled health care services organizations. Early on that was in the radiology space. I've spent a number of years also in the acute care space and most recently I joined array in 2023 in the mental health space. Most of the time this focus has been on telehealth or virtual care, but sometimes also leveraging hybrid models where we might have some virtual capabilities along with on premise capabilities. Really I view ARRAY and the behavioral health industry at this inflection point. This opportunity I think for us to start thinking about an integrated set of capabilities where I think historically organizations have attempted to address behavioral health through point solutions. There's many organizations out there that deliver great products and services, unfortunately oftentimes not well integrated. And that puts the patients in a position where they have to figure out how to navigate that inconsistent system. I really think there's this unique opportunity for us to try to figure out how to begin really bringing together clinical services for behavioral health or in our world focused on mental health patients. I think about that really as this need for truly integrated service capabilities. When you think about ARRAY behavioral care, we're a national all virtual behavioral health provider. Again in the mental health space. We deliver care across the full continuum. So we deliver acute services. Think about patients that enter the hospital, usually through the ED in crisis. We deliver care virtually in an outpatient environment. Oftentimes those are outpatient services associated with the hospitals and health systems we deliver acute services to. But they might also be independent community health clinics, FQHCs, tribal communities, correctional facilities. We also deliver care virtually to patients in their home. We do this today now all on an interoperable EPIC based clinical platform. So our electronic health record is epic. We believe that that patients oftentimes originate or usually end up back within a health system. Making sure we have an interoperable advanced platform is really important to how we enable our clinicians to practice, but also the experience that our patients receive when you add all this up. We really view our mission at Array to transform behavioral healthcare, the landscape of BH in a way that we're continually innovating these care models to define new standards, standards of excellence for patients that are in need and pulling together the various capabilities that ARRAY has to offer in an integrated fashion on an epic based platform for patients where they are, meeting them where they are.
- [03:42]
A
Absolutely. No, I appreciate that. Breakdown Shannon, about the company and one thing that I think is really great about Array is your direct employment model of your clinicians rather than a contracting network. And I know we've heard you all describe that as really being critical to the consistency and to the high health outcomes that you achieve on behalf of the patients that you serve. So getting to the heart of your career expertise, which you detailed for us at the start of this conversation, I wonder what you would say in terms of what you've learned about building a tech enabled clinical workforce in the behavioral space at national scale. Given, like I said, the background, the career you've had, and then looking at that through the context of leading Array, what do you think are some of the key lessons you've learned there?
- [04:34]
B
Yeah, Jacob, great question. You know, we approach this intentionally using words to describe our practice model as a practice, I'm air quoting there versus a network of clinicians. We are really trying to create this environment that embraces the fact that we think behavioral. Behavioral health is a relationship driven field and therefore consistency and accountability really matter in the clinicians that show up every day to take great care of patients. But to your point, over decades and working in multiple clinical service areas, this is an opportunity for an organization to invest in an employed model. W2 based employees, those employees, when they practice with us full time, which most of them do receive benefits as well, allows us to think about things like building culture and standardizing the practice that our clinicians deliver their services around. Training our clinicians on our care pathways, I know we'll talk about those here later. And really making sure that we're delivering consistent quality across every single patient interaction. I think these contracted marketplaces really struggle with turnover. Variable training models, inconsistent practice patterns, don't get me wrong, they're trying to do a great job. But I really think an employed model where the clinicians can call Array their home, where we invest in them more broadly than the income they earn from any given patient encounter, creates an environment where we can have clinicians practicing at the top of their license and really ensuring that these patients are getting the best possible outcome and the Best possible services. That's why we think about this as a practice versus a network model. That that means we offer W2 employment contracts with our clinicians, we offer benefits to our clinicians when they join our practice. Today, about 90% of the clinicians that are with ARRAY are W2 employed, and about 80% of them are actually full time, which means they practice with us for greater than 30 hours per week.
- [06:53]
A
Wow. Understood. So it makes a lot of sense why you do that in that way. I wonder, Shannon, if you were talking directly to a lot of the health system leaders that are listening in, these are the individuals who oversee the behavioral piece of large health systems across the country. If you're talking directly to them, what's some of the advice that you would give in terms of that, this battle that they're constantly trying to decide between building, buying, or partnering to build out behavioral health capacity. It's obviously, it's a key topic for this, for this, for this audience right now. And it's something we hear about constantly across the country. Country of systems working to continue to build out this, these services to meet the high demand for them. So what would be your advice to them on how to, how to figure out what the best path is to go down?
- [07:45]
B
Yeah, Jacob, let's start first with what do I think this means? What do we think a practice model means for a hospital partner? And I think about that along the lines of a handful of pillars. One, reliability. I think this enables hospitals to get access to a more stable team, maybe not an environment where there's a revolving door of clinicians coming in and out of the practice. Alignment, I think, is really important. When we work with hospitals and health systems, we need to make sure that we train our clinicians on partner workflows, documentation, standards, escalation expectations, the quality programs of the systems that we are working with. And I think a stable workforce allows us to do that. Continuity. Our clinicians are practicing our care pathways again, I know we'll talk about those here in a little bit, but that means that each of our clinicians will deliver consistently like the others that are in the practice. I also think, finally, that gives you a much more scalable approach in ensuring that we can appropriately offer a competitive solution to these clinicians so we can recruit them, credential them, manage them, supervise that workforce. We do that on behalf of our hospital health system partners. And I think that works better in this employed model. And so then when I think about that question of buy versus build, I covered this, I think, on a Becker's webinar we did earlier in the year. I'm not sure I would look at it necessarily black and white where you have to choose one versus the other. I think the recruiting psychiatrists and therapists is harder than ever. Internal models in health systems often make it difficult or more difficult than an organization like ours who really we're experts in recruiting, employing ramping and engaging clinicians long term, in a telehealth model, I think that enables us to augment the health system more than just a clinician that fills a shift. As an example, we can bring clinical leadership, we can bring workflows, we can bring technology to the table. So in some sense the health system is building the things that are important to them and in another sense they're partnering or buying the things that a partner like Array might be able to bring to the table. So again, I'm not sure I would call that necessarily a black and white decision. I think it's a little bit of both, deciding what pieces of it you really want to own and then partnering with someone who can integrate directly and bring the capabilities that augment the services you're trying to build on your own.
- [10:40]
A
Sure. I appreciate you reframing that, Shannon, because it's a great point. This isn't a black and white decision. It should really be a multifactored strategy. It sounds like when making these kinds of decisions. You mentioned care pathways and I did want to dig into that a little bit because as you know, of course Array launched that this year with a focus on measurement based care, which of course, you know, we've heard across the industry for a long time that it's been about for years. It's something a lot of companies and health systems are chasing, but they've struggled to implement it at scale. And so what do you think is actually making it possible now for you all? And what do you think, what does it take for hospitals and for payers to move from treating this more of as a, as a nice to have to do an operational standard?
- [11:32]
B
Well, you obviously could tell Jacob, I was looking forward to talking about this, bringing it up in the previous two questions. But you know, we think of care pathways as making measurement based care and behavioral health real or capable. We think of epic, our electronic health record, as making it scalable. And so let me talk a little bit about what we think care pathways are, how we're using them, how they deliver against measurement based care goals, and why we think EPIC is such a key part of enabling this to occur and maybe part of the reason why the industry in general has struggled with it, because a lot of these infrastructures just don't exist in many other places. So for us, care pathways are a structured, evidence based clinical pathway that guides how we match patients to the right level and intensity of care. We do this based on risk, acuity and clinical presentation. And so every new patient receives an assessment as part of their intake process that allows our clinician, facilitated through epic, to match the patient to the right level and right intensity of care. We have a phrase we call the right care at the right time. And the right dose and dose isn't meant to be medication, it's really meant to be intensity of care. How frequent and what type of care does patient actually need to receive. We really think this matters because it reduces unwarranted variation in care. I think that's one of the biggest drivers of poor outcomes. It also allows us to ensure that we're avoiding unnecessary cost. In the behavioral health space. These care pathways connect to measurement based care. It's really not just about us collecting data. We are using the data we collect on top of the data that's produced as part of the care episodes to inform the paths that a patient follows. Those paths can change over time. And so therefore the adjustments to care that the patient might need to receive at one point or another, they allow us to evaluate things like dosage or intensity, whether a patient needs higher level care or lower level care. And we have those, they're just a different path. And so that ultimately means we're really tracking the impact of the care or the outcomes of the care and adjusting along the way as we need to. And so the final point I'll make about care pathways is really why is EPIC or a mature modern electronic health record so important in this environment? Because we run on epic. This really enables us to have real time data, shared documentation, automatic templates, decision support for our clinicians. And then of course, we have epic's care everywhere and every exchange and every interaction we have with patients essentially have a custom built solution from EPIC for behavioral health through a partnership we have with an organization called KeyCare. So EPIC gives our clinicians the information, workflows they need to consistently apply pathways at scale. We have a high 90 percentile adherence rate to patients that are assigned to the right path. This allows us to collaborate with our partners. We can support transitions across the paths and then across settings. So think a patient in the ER is discharged safely and transitioned to care in the home, ultimately allowing us to make sure we're closing the fragmentation gap by enabling this cross setting visibility, which I think back to my original opening, it's something that point solutions or other telehealth platforms really have a hard time offering is making sure that as a patient's setting of care or levels of acuity changes, how do we make sure we integrate that capability across the environment? So we are very excited about care pathways. We're excited to announce them this year. We've had patients on the paths now for about 13 months and we're beginning the process of publishing some of the data we're learning around care pathways. So watch out for more to come in that area.
- [15:58]
A
Jacob yeah, you left us with a cliffhanger at the end there, Shannon. You'll have to keep us posted on the data here because I know our team on the behavioral side of things would certainly love, love to to cover that in terms of what you're, what you're seeing, what you're achieving there over these last 13 months. I did want to ask you more of a, an open faced question about the year that just occurred for the behavioral health industry because it's been, it's been massive and it's been incredibly impactful, especially in terms of what comes next. I think we saw the telehealth policy cliff come and go. HR1 was signed into law and I know pretty much every healthC organization around the country right now is preparing for the effects of that. There's obviously the continued workforce shortage across the industry. Nothing new there. And then there's the growing pressure on hospital systems all over the country to keep integrating behavioral services across the care continuum. Shameless plug. But it certainly led us to hosting our first behavioral health executive conferences this year because of just the demand brand we've been hearing about from around the country. So I wonder for you Shannon, as you look back on this year, what, what maybe surprised you about how the industry evolved and what do you think are some of the biggest gaps or some of the biggest needs you still see out there that need to be addressed heading into next year?
- [17:26]
B
Yeah, Jacob, great, great question and I will compliment Becker's. I think you all did a great job. And the Behavioral Health Focus conferences, I know there's going to be more than coming and ensuring that the right content is there and the right speakers are there. You know, when I look back on 2025, there's a handful of like, you know, things that we hear about regularly and maybe a handful of themes as well. Growing ed volumes and higher acuity presentations. We've worked really hard to continue to staff up to ensure consistent service delivery to our partners. And interestingly enough, the customers that were with us at the beginning of the year, those same customers for the same hours at the same site are sending us nearly 15 or 16% more volume. They're seeing more volume, they're sharing more of that volume with us. I think that contributes this pressure around improving patient flow but not compromising safety. Really this desire for system wide integrated capabilities rather than point solutions as I mentioned earlier and ensuring that health systems are talking to us now about a real reliable integrated partner. Again, not the black or white buy versus build, but how do we do something in the middle. So we're just not another telesyc service. We're really somebody that can bring yes, staffing, but clinical models, technology and data to the table. So I think the themes there are really integration is no longer optional. We need to make sure that these services are data enabled. They they cross multiple settings. This really is becoming the expectation. I think accountability is becoming much more of a differentiator. Their systems, health systems are looking for clinically accountable organizations with employed clinicians, quality programs, real pathways, real measurement, again more than staffing. And you know, in 2026, as we move forward, I really think you're going to see many of the organizations that have focused their services on to consumer to be those organizations that are now thinking about the hospital space a whole lot more and recognizing the need and opportunity that it is for them to really partner with hospitals and health systems to try to get upstream, solve some of these challenges that they may see in a direct to consumer model. So we're really excited about 2026. We think we're really well positioned around a number of our capabilities. We, we've been in hospitals and health systems for years. We really started there. It was really our origin. Acute care is what we do really, really well. We also have care pathways for lower acuity patients, oftentimes caring for them in their home. And so therefore we think we're really built for some of this hospital level care and where the puck is going. We think we're there and we're ready. We think we have a really great option around integrating our platform, technology and data. Again back to the fact that we're deployed on epic. And so we really think that we're a clinically accountable partner that can help hospitals and health systems think about that buy versus build equation and bring the right resources to the table as they continue to invest in behavioral health programs.
- [20:51]
A
Fantastic. Well Shannon, what else are we missing? You've got the years of a lot of those health system leaders from all over the country right now. Any other wrap up thoughts, final bits of advice you want to offer them?
- [21:03]
B
Well Jacob, again thank you very much for the time. Really appreciate the partnership with Beckers. Really have appreciated the conferences and the educational material and the opportunity to come together and interact with partners as well as we can through the Beckers experience. As I mentioned earlier, we're really excited about the innovation that we're working hard to bring bring to the table. We really think about the fact that we have this opportunity to take care of patients across multiple levels of acuity, multiple settings of care. We do that leveraging measurement based care pathways and we do that on a modern electronic health record that ensures patients don't fall through the cracks and we can communicate our work safely and correctly back to the health systems that we partner with. So we're really looking forward to next year. And Jacob, again I think thank you very much for your time.
- [21:56]
A
Thank you Shannon for taking the time to be here with us on the podcast and for sharing your expertise with our audience. We really appreciate it and to our audience. If you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview. Com.