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Becker’s Healthcare Podcast
Expanding Access and Sustainability in Behavioral Health with Stephen Merz
00:18:45
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Steven Mertz, Vice president and Chief Operating Officer at Shepherd Pratt Solutions. Stephen, it's a pleasure to have you on the podcast today.
- [00:42]
C
Thank you for having me.
- [00:44]
B
Now I'm excited for our conversation because I know it's such a dynamic time in healthcare. You know, we truly interesting to dig into some of the things you're doing at Shepherd Pratt and how you're thinking about the future. But before we dive in, can you tell us a little bit more about yourself and the organization? Sure.
- [00:59]
C
Thanks so much for having me on the podcast. So my name is Steve Merz. My role is chief Operating Officer at Shepherd Pratt Solutions. I'll first tell you a little bit about Shepherd Pratt. It may be a place you have heard of or perhaps not, but Shepherd Pratt is one of the oldest and largest nonprofit behavioral healthcare systems in the country. We started more than 170 years ago under the premise of trying to create a supportive and caring environment for people experiencing mental health care or or substance use disorder treatment needs. And we are based in Maryland and we have two primary campuses in Towson, Maryland and in Baltimore. And we've been around for a very long time. I run the division of Shepherd Pratt that provides services of Shepherd Pratt, like services outside of Maryland. So if you are a health system or a community agency or you're an existing provider of service and you want to try to make your services run better or you want to provide a level of care that doesn't exist, Shepherd Pratt Solutions goes out and works with nonprofit health systems to help them improve access to care. And our lens on behavioral health care is that behavioral healthcare is an important, vital part of the healthcare system. So we really want to try to get the word out so more people can try to take a crack at delivering those services and meeting those needs.
- [02:24]
B
Absolutely. That makes a lot of sense. You know, such a needed service all the time. But especially in the last few years, that need for behavioral health has just skyrocketed in so many communities so, you know, when you think about the last year or so, could you tell us about the most important initiative that you led? What did you do and what were the results?
- [02:42]
C
Yeah, thanks for the question. So I think from my perspective, the most important work we did was to help a commute, help communities that we worked with that didn't have a formalized behavioral health care program and access and really help them grow those programs or make them more sustainable or in some cases start them. So I'll just give you a couple examples. So we've worked with a couple of major health care systems that are in our national kind of ecosystem of health care. And they sometimes have struggled with trying to make the behavioral health care service line work. So we've worked with them to try to look at, instead of closing or consolidating programs of try to make the program work more sustainably by having it see more patients, have it provide a continuum of care where patients can move from setting A to setting B and have less readmissions and generate more continuity of care. And that generates more continuity of services and then the revenues associated with that. So just as one example, one of the things we worked last year we're very proud of is we worked with a very large health system of about 15 hospitals in this major system with more than half a billion dollars of behavioral healthcare service line revenue. Yet they were losing money. So they were considering should they keep the services, should they sell them, should they reorganize them. And we identified that this service line could save up to 90% or eliminate 90% of their losses by simply making the system that they had work much better. So that's kind of an example. Another access example would be we worked with a health system. We were working with University of Michigan. They have a campus that they operate in Lansing called Sparrow Health System. This is part of mid Michigan. There is generally a need for access of care. And working with our colleagues there, they identified the opportunity to build more behavioral healthcare. So we're working with them directly to add beds in their community and add levels of care. Like for the first time ever, there'll be kids care for child and adolescent patients, which is great. I mean, we know that 80% of mental health care conditions start in youth. And so getting that care in that community makes us really excited. Lastly, our big project that we did last year, we celebrated in November the groundbreaking of a new hospital we're working on with WakeMed Health in Raleigh, North Carolina to build a new behavioral healthcare hospital called a mental health and well being Campus and that's in Garner, North Carolina. So just really active year for us. Very excited about that.
- [05:31]
B
That's amazing to hear. And you know, it's really cool to have that opportunity to find ways to expand access to care in bringing into new services and communities. And especially as you mentioned, ensuring that sort of services aren't closing or consolidating. Because you know, funding in healthcare right now is a challenge and every dollar is precious. And so, you know, when you're looking across the landscape, what do you do when you're working with systems to try to make sure they can first start thinking about their strategy differently so they can keep those behavioral health service lines open?
- [06:05]
C
Yeah, it's a great question. So, you know, a lot of leaders are, I think I've been doing the behavioral thing for a long time and I'll say there has been a real shift that's been great that's happened nationally. Many healthcare executives, you know, they get it, they understand that behavioral healthcare is an important, vital part of healthcare. They're often challenged, however, with trying to make it work. They're trying to do the right thing. But it's hard to be an executive of a health system and have part of your portfolio that makes a lot of money and another part of your portfolio that loses a lot of money. And trying to make healthcare work rationally for the way people experience it. It's not like you just have one healthcare condition in exclusivity. You often have co occurring conditions. So one of the things that we found is that where we're focusing on in this coming year is trying to bring together mental health care and physical healthcare in healthcare systems so that the leaders can feel that they can continue their investments in behavioral healthcare and not feel like they're constantly under the risk of program closure or changes in the reimbursement and the financing. So the things that we work on, for example, is that we lean into, you know, patients that are highly acute. You know, some healthcare systems might say, well, the best behavioral healthcare is the one we don't serve. We let our other partner in the community do it. Our lens on it's a little bit different. We might say, you know, that patient with behavioral healthcare is also the OB patient, your surgical patient, your oncology patient, your heart and vascular patient. And if you have behavioral, that patient is going to be more complex and have more needs. So we really try to make the case that leaning into the higher acuity patient is serving their community in need. And we can usually make a case that by managing that need better. It improves the overall outcomes of care and ultimately reduces the cost of care. And I think we've made some really good cases of that nationally, so that's really focused. Some of the techniques we use are access to care. So the idea of no wrong door. Every patient that comes into the system, we know at least one in four people have a behavioral healthcare condition. So are you screening for that? Once you get screened, is there an access system in place that the patient can get access to care quickly Once they get that access level of care? How do we reduce barriers so they're not limited by their insurance coverage or their medical acuity or other condition? So we make sure we get them into the treatment system, and we know once they get in the treatment system, their outcomes are way better. So. And we can get paid for it. You know, behavioral health care doesn't have to be scary. It's something that you can run at scale and not lose money.
- [08:57]
B
Oh, that's incredible. Incredible way to look at it and think about it. And, you know, I can imagine makes a big difference when you're talking to executive leadership and, you know, especially when we're looking into the next year or so, what are some of the big priorities and headwinds that you're focused on?
- [09:12]
C
Yeah, like, I think that morning more of leaning into the complex care, Working on patients that have medical and behavioral comorbidities. That population is really important. So the big thing that we're working on is trying to get the word out more to health systems that they know that they don't have to give up on. Behavioral health care is kind of our biggest priority. We spend a lot of our time trying to be national thought leaders and getting out and frankly, making Shepherd Pratt, because we're one of these oldest in the biggest. We don't want to be alone, you know, like, it's part of. Our CEO has a very, you know, grand vision, which is that the world should not suffer and our country should not suffer with the lack of access to behavioral health care in a very pure form. Our mission is to improve access to behavioral health care resources. So we think our. Our goal for this year really is to continue to let acute care systems out there know that we are out there to be able to serve as a resource if it's. They need. If health systems need support with knowing how to make it work, if they're having troubles with, you know, the system not performing well, either from a quality or access or financial perspective. Before you close the program, please give us a call because we really are passionate about ensuring that there's access available in every community.
- [10:39]
B
Absolutely. That's so helpful to understand. And, you know, I know access can be challenged by a good number of things, whether it's, you know, resources, personnel, or just even lack of leadership in some of these spaces and needing to focus resources elsewhere. So, you know, I think, especially when you're looking across the entire landscape, what are some of the things that you're hearing most from the systems that you're working with or some of the biggest challenges that they're running up against today?
- [11:08]
C
Yeah, we are hearing a lot of headwinds about the. The financial performance. There's, you know, there's always been this challenge of, you know, that behavioral health doesn't, you know, make a bottom line and it's a good thing to have. But it might be like other. Some specialties, primary care, pediatrics, you know, some specialties that are really hard to generate a bottom line. It's just become more acute that need the. And it's really driven by. I don't. I think the fundamentals are still there. There's a lot of patients that have needs, the care imp. The interventions make sense and the outcomes you can track. None of that has changed. What has really changed is that there's a lack of certainty and stability regarding the funding sources for behavioral health care. So either, you know, some. We're hearing from health systems that are really concerned about the 340B payments and how strong they would be. And then they do the math and they say, well, if we adjust our psychiatry service, we will decrease our likelihood that we'll get 340B and that ends up being a really big program implication for them. So that's been a huge change is not understanding the stability of that funding. The other one that's out there is we hear from a lot of health systems that are challenged with access for youth mental health care, basically adolescents and kids, that they're not served well in the treatment system. General acute pediatric hospitals are not equipped with behavioral services. And general psychiatric hospitals don't have the kids services. So unfortunately, a lot of these youth are left in the lurch. They don't have any opportunity of where to go. And they unfortunately get stuck in emergency departments, have to wait a long time. And, you know, that's just a miserable experience for a family. So we do hear that as a really a big concern how to. A lot of community health needs assessments show that there's an ongoing need for. For kids mental health, but people don't even know where to start. And so there's, there's been a lot of interest we've seen there that's helpful to understand.
- [13:17]
B
I appreciate you kind of going through that with us now. What do you think the hardest thing you're going to have to do in the coming year will be for us?
- [13:25]
C
The, for the organization that I and my colleagues that I work with is basically how to translate what we know is a huge demand out there for services with health systems needing the support and then connecting them with the resources we have. So it's really a scaling thing. I go to enough meetings and I talk to colleagues across the country that their stories are very similar. The financial changes I mentioned, the youth access, managing complex care with very sick and acute patients, they're all experiencing the same challenges. They just. There's not a good ecosystem out there for people to know how they can solve them. And the hardest thing I have to do, I think that we have to do this year is how to scale the knowledge of these interventions to other health systems. So it's sometimes it's coming from the CFOs, sometimes it's from the chief medical officers or the CEOs where they're struggling with trying to make these needs get met. And our biggest struggle is to let people know that there's places like us out there. Shepherd Pratt is, can be a real place that people can go to. They can go see a thing that's been around for nearly two centuries. They can see how care is delivered at scale in the most patient centered way, entirely on a behavioral healthcare revenue stream. And when typically, I'll tell you, it's really not a fib. When people visit our campus, they almost always say, this is amazing. I never knew it could be like this. And it's almost Laura the way I would say people might say that seeing is believing that when they see this, they know that it's possible. And that's inspiring. So we're only one campus in a huge sea of need. So my biggest challenge is trying to get out there and let people know that you can do it and reach out and ask. And there are people out there that are willing to help.
- [15:27]
B
I love that. That's an amazing kind of mindset to have and truly being able to be proactive there. You know, I know it's difficult to get the word out, but to have that kind of infrastructure in place and that example for other systems and organizations is critical. Now, before we wrap up, I wanted to ask, where do you see some of the Best opportunities for organizational growth.
- [15:47]
C
Well, I think that, you know, I mean, the math is super easy here. There's like, I think the AHA database shows that we have about 4,800 or 5,000 hospitals nationally. And when you look at the database, maybe it's just over a thousand, Roughly, I think 1200 hospitals that have some formalized behavioral health care service in their portfolio. And I mean, you just contrast that with where we see behavioral healthcare, which is it's on every inpatient unit, in every outpatient program, every clinic. It doesn't discriminate by age, geography, race, setting, insurance status. We just know it is always out there. So for me, the biggest growth area I focus on is where most people get their health care. It's in their community hospital or community health system. It's in their local doctor's office, it's in their clinic. The biggest opportunity is to lean in and recognize that patient care healthcare involves the entire patient and well being is a big part of that. And the mental health care space has got to be with the physical health. So if we can do more to lean in on that, that's, to me, the biggest opportunity we have at Shepherd Pratt. I'll tell you, there are so many experts of so many different conditions all in one place. And I work with an amazing team of people who are really super smart and have literally decades of experience. I don't think anybody in my team has less than two decades of experience in behavioral healthcare. So I'm really honored to be working with them. And just to try to find a way to connect with other health systems is kind of our major message.
- [17:35]
B
I love that. Steve, thank you so much for joining us on the podcast today. This has been a really informative conversation, a lot of fun to learn about what you're doing and how you're thinking about the future. And I'm excited as well to see see you in April. I know you'll be speaking at our Hospital Review conference coming up as well as Behavioral Health Summit. So it'll be great to see you there and catch up and dig deeper on some of these things that we've been talking about today.
- [17:59]
C
Absolutely. And I cannot end this discussion without paying a big thanks to Beckers, because Beckers for the last six or seven years has been very active and explicit about raising behavioral healthcare awareness at its national meetings, be it at the annual Hospital Review or if at the annual CEO and CFO Conference and your various summits. And then last year, having the inaugural Behavioral Healthcare Summit just speaks to the passion with which, you know, from the leadership on down, from Scott Becker and the whole organization, really just appreciate you so much getting the word out about behavioral healthcare and letting other, other organizations in the health care ecosystem know that this is important. So thank you so much for, for doing this.