Value-based care has become a buzzword in the behavioral health industry. Still, few providers have implemented it due to the laundry list of challenges, including parity issues, difficulties associated with determining a system of measurements and limitations to care access.
For grassroots providers building relationships with payers from the ground up, even the meaning of value-based care can be obscured by the noise of news stories, LinkedIn conversations and industry conferences.
That’s the experience of Sam Himelstein, a clinical psychologist and co-founder and CEO of Family Spring.
Berkeley, California-based Family Spring provides mental health and substance use disorder (SUD) treatment with a focus on teens and young adults. Family Spring offers telehealth and in-person services for patients across California.
Most of Family Spring’s business comes from its outpatient clinic, which provides telehealth and in-person care. The provider also offers specialty services to local probation departments, including mindfulness-based SUD treatment.
Himelstein has identified a clinician-focused roadmap to growth and plans to expand satellite offices throughout California.
Behavioral Health Business sat down with Himelstein to discuss his strategies for Family Spring’s growth, the importance of standardized operating procedures and the future of value-based care.
Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: What are your goals for the business over the next two years or so? How do you plan to grow?
Himelstein: It is definitely growth, and growth is simple for us. Not necessarily easy, but simple. It means making sure our operational staff can do what they need to do to run our ship smoothly or relatively smoothly so that we can continue to recruit and hire clinicians. More clinicians equals more growth. We will generate more revenue that way, and of course, the most important thing, we will serve more patients across the state of California.
We may expand interstate at some point in the future, but given that California is the fifth-largest economy in the world, it’s okay for now.
I work on recruitment a lot. I probably have anywhere from three to 10 calls booked per week with clinicians. I may be recruiting, we may be talking to each other just to refer to one another or I may be pitching them on something else about Family Spring’s services. I like recruiting because it helps me get exposed to more people and more services in the community and it ultimately fulfills our mission of growth and helping more people.
What are some of the biggest challenges that stand in the way of your goals for Family Spring? Obviously, the recruitment aspect is tough, particularly right now.
There is a provider shortage. Despite whatever LinkedIn posts people see or don’t see, I’m finding that it’s very hard to find the right people, particularly those with specialized training. It’s a grind to do that on the one hand, but it is possible. The recruitment side is tough because I don’t think we’re pumping out enough licensed clinicians to fill the need to meet the mental health crisis.
The other side of the coin is the health plans that we partner with. Part of my job is not just recruiting people but also getting us into new networks that actually make sense. I’ve passed on networks that won’t pay as much. If a regional contract manager at a major health plan undercuts what I think our value is, of course, I’ll try to negotiate. I’ll try to get those numbers up, but ultimately, I’ll pass on it because I think our employees are worth it. We do a percentage split model with our employees. Our employees are all W-2 employees, but when we get a raise, or more money as a business, they get more money as a business. We’re aligned in that way. It’s a challenge to get into new networks when you have certain contracts that you have that are established and you meet new contract managers or health plans and they want you to start from ground zero.
Those two things are the biggest barriers.
What are some of the top lessons you’ve learned as a leader as you’ve grown your business?
Despite the fact that connection is a very strong value for me, having authentic relationships at the company level is very doable, but they are professional. I would describe myself as somebody who has good boundaries and can be firm and a leader.
Among my employees, everybody wants something a little bit different. When somebody asks for a different benefit or something like that, I really want to give it to them, there’s that urge inside of me to do that. But what I’ve learned over the years is that in order to scale, whether you’re scaling fast in venture or doing more manageable growth in a company like ours, standard operating procedures and policies reign supreme so that the company can grow. To me, that’s the biggest thing I’ve learned. So on the one hand, I’m a human being, I’m very humanistically oriented as a person and also as a therapist. But on the other hand, being able to have standard operating procedures and policies, not that they can never be changed, but pointing towards those as our north stars for how to operate the company has been a learning experience for me and extremely helpful.
If I were to talk to other aspiring clinicians who are aspiring entrepreneurs, it’s easy for us to be empathetic. It’s more difficult for a lot of clinicians, at least in my experience, to learn the business side. It is very attainable, a lot of us have the personality for it. But there’s still a learning curve. As corny and as nerdy as it sounds, I find a lot of respite in standard operating procedures.
What are the trends in the behavioral health industry overall that you’re most interested in and why?
As somebody who runs a clinic or who runs a company that contracts, 95% to 97% insurance, I’m most interested in value-based care.
I’m most interested in it because of the conversations I hear about value-based care. The thing that comes up for me when I hear these conversations is, ‘What exactly are we talking about here?’ It doesn’t seem clearly defined to me. What is the value we’re providing? Are you looking for attendance metrics? Are you looking for patient satisfaction and engagement? Are you actually looking for movement in terms of treatment progress, like doing pre and post-measures, and showing that depression symptoms or anxiety symptoms, for example, are decreasing over time? Those are all three very, very different things.
The other reason why I’m so interested is because, in my experience, I’m interacting with different insurance plans, asking for raises, getting us in-network, making sure the partnership is a true partnership, etc. Each of these health plans operates so differently. I’ve heard nothing from them about value-based care, at least at our level, which is the grassroots provider who has come in from the bottom up. At the conference level and when I go on LinkedIn, I enjoy reading about it and I think it’s a good direction for the industry to go in. But what are we talking about specifically? Most events that I go to, or speakers I hear, or articles I read, don’t get into the nuance of what it can actually be.
I’m hopeful though. I hope to contribute to that over time and work with our payers and our partners to give them my knowledge as well, coming from a research background.
