Pediatric behavioral health provider Embark Behavioral Health has its sights set on growing its outpatient treatment footprint. But along the way, it refuses to put quantity over quality in its pursuits.
This comes as demand for pediatric behavioral health services is at an all-time high, with rates of depression and anxiety among children and teens skyrocketing. The CDC reports that 57% of teen girls and 29% of teen boys reported feeling persistently sad or hopeless in 2021, for instance.
According to Embark’s CEO, Alex Stavros, the company plans to combat the crisis with a combination of data-driven care and a community-based approach.
Chandler, Arizona-based Embark provides a network of outpatient centers and residential programs for mental health treatment for preteens, teens and young adults. Its services include virtual counseling, intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), short-term residential treatment, wilderness therapy and long-term residential treatment. Earlier this year, private equity firm Consonance Capital Partners invested in the provider, giving it a controlling stake in the company.
Behavioral Health Business sat down with Stavros to discuss measurement-based care, growth and building community at Embark.
This interview has been edited for clarity and length.
BHB: How are you looking at measurement-based care? And how are you implementing that?
Stavros: We like to call it feedback-informed treatment. We’ve been doing that for over 15 years. During treatment, once a week or every two weeks, in our programs, we send all sorts of questionnaires to the client themselves and each of the parents. These typically include evidence-based instruments like the PHQ9 to measure depression, the GAD-7, which measures anxiety, and the Y-OQ, a youth outcome questionnaire. So all these are internationally validated.
We also do the FHQ, which relates to family dysfunction.
The interesting thing is, often, you’re going to get different results from the different person who’s filling it out.
When we have treatment-team meetings to go over the treatment plan, we always require the lead clinician to pull up the dashboard to see the outcome measurements. They see where the parents think things are and where the client thinks things are, as well as the treatment team.
That data tells us what’s working, what’s not working, and what’s working for one person versus another because we’re focused on that system – the family system.
We also collect those outcomes during treatment. And that helps us determine levels of care. So when do we step down from residential treatment care (RTC) to PHP, or when should we step down from PHP to IOP? The big drivers are the data, and it has to be the whole family system.
Being able to show outcomes is linked to value-based care. How are you looking at value-based care?
One of the biggest challenges is this idea of utilization management, which is a battle between the provider and the payer. If the payer says, “Hey, the client no longer needs to be in the hospital or this residential treatment center.” And the provider says “Yes, they do.” It’s just this back-and-forth.
Collecting data, asking the payer if they agree with what the data shows and having a conversation, instead, starts to build trust in that relationship. It helps us make decisions together. The payer and the provider both want the same thing, and we want a good outcome. The problem is trust – and you build that with time and evidence.
That provides a foundation for moving toward value-based care because as soon as we create that relationship and it starts to work, the payer starts to trust that we’re making decisions based on data and outcomes. The payer will say, ”All right, now you take the whole thing. And we’re just going to pay you one rate for this whole period. You do whatever level of care you want.”
Where is Embark you on that value-based care journey?
We don’t have any value-based contracts with the payers yet. We’re on the journey of sharing our data and outcomes with payers. Whenever we talk about moving a client to a certain level of care, step down or step up, we always use data in ways they haven’t seen before.
Because a lot of times, data is collected after treatment, whereas we’re collecting it weekly, every two weeks, to inform treatment and the levels of care. And payers like that because it’s not like, “Here’s an anecdote or story about why they need this level of care.” There’s data with internationally validated instruments to make those decisions.
What are you thinking about regarding growth in the next five years?
We don’t believe in growth for growth’s sake. We also believe that we’re not growing fast enough. Nobody’s really growing fast enough because the problem is getting worse every single year.
The issue becomes that you can’t grow faster than the quality you can establish. If you do, you’re just shooting yourself in the foot.
We need to grow in a quality way to address the awareness and stigma issues – with a foundation of quality, good people, good systems and good culture.
The second thing I would say is our group is really focused on outpatient treatment. Outpatient – IOP, PHP – is the window into treatment. It’s often the first step into the continuum of care and the last step out. And those outpatient centers, unlike residential treatment centers, for example, are right in a community. It’s a 10-minute drive from your house.
And also, at that lower level of care, the more we can intervene to prevent residential treatment and hospitalizations and higher levels of care, the better. That’s one of the biggest gaps in the market.
And will that growth be through M&A or de novo? A combination of both?
Pretty much all de novo. De novo is important for us because it gets back to the quality aspect. You can grow really fast by acquiring a bunch of stuff. But then the question is, why are you growing really fast? And just acquiring a bunch of stuff?
When we do de novos, we can make sure that every space is designed the same, that we hire the people to fit our culture and our core values, that the systems and processes are consistent. And that’s going to create reliability and consistency in the service in the product, which will create trust with the payers and will create awareness.
You’ve talked a lot about building a community to promote mental well-being. How do you do that at Embark?
I think a good example would be our outpatient clinics. When you go into one of our outpatient clinics, they’re designed in a purposeful way that gives you an experience of belonging. It’s the colors, it’s the furniture, it’s the bright natural light coming in. All of those design aspects are intentional. They align with our culture, with our core values, with our Embark treatment approach, and they create an environment that can lead to healing – and an environment where you feel accepted.
We had a dad recently at one of our outpatient clinics in the D.C. area drop off his daughter for the first day of PHP. He shows up, and he’s like, “This isn’t like a hospital.” I was like, “No, it’s not a therapeutic day treatment program.” And he’s like, “This is awesome. Can I stay here and work?” So he wanted to stay there and work, and pull out his laptop.
What that ends up doing is that it creates community because then you have other teens from the area who come to the center and they say that this is where they start to feel safe. They feel heard, and they feel understood.
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