Many behavioral health providers have traditionally operated in silos, leaving patients to navigate a fragmented system of care for substance use disorders (SUDs), mental illnesses and other co-occurring conditions.
SUD providers are now working to break down these barriers and offer more comprehensive, holistic treatments that address the full spectrum of a patient’s needs by integrating services for depression, anxiety, trauma and other conditions.
“From an efficacy of care perspective, it makes sense,” Jeremy Klemanski, CEO of Gateway Foundation, said at Behavioral Health Business’ Autism and Addiction Forum. “From the perspective of people getting [care], it makes sense. In terms of where we think payers are headed in the future, it makes sense.”
Chicago-based Gateway provides SUD and mental health treatment in Florida, Georgia, Illinois, Michigan, Missouri, New Jersey, Texas, and Wyoming. The nonprofit offers gender-specific care programs, including withdrawal management, residential inpatient treatment, partial hospitalization programs (PHPs), intensive outpatient programs (IOPs) and sober living homes.
While the benefits of diversifying services abound, certain key challenges must be addressed with care and attention to prevent unintentional negative impacts on patients, staff and providers’ bottom lines.
Clinical and business benefits
Expanding service lines benefits SUD providers and patients, and is largely supported by health plans.
Diversified services lower patient acquisition costs and help maintain viable businesses, according to Andrew Rothermel, CEO of Defining Wellness Centers.
“Because of the level of acuity of patients that are presenting to us, we have to defensively offer some of [diversified] services to take advantage of the leads that we’re generating,” Rothermel said. “If we were to say we’re just a strict pure-play, SUD place our conversion rate would go way down, our cost of patient acquisition would go way up, and it just wouldn’t be financially viable.”
Jackson, Mississippi-based Defining Wellness Centers has incorporated additional mental health services, trauma care and care for medically compromised people. Even if the provider does not get reimbursed for these services, the investment is still worth it, Rothermel said.
Fulcrum Equity Partners acquired Defining Wellness in November 2023. Fulcrum partner Tom Greer previously told BHB that the provider wanted to expand to eating disorder treatment as part of a more comprehensive behavioral health company.
Offering comprehensive care may also aid in recruiting clinicians, a persistent problem for the behavioral health industry overall.
In some cost-based models, like the CCBHC model, better health outcomes associated with comprehensive care can result in providers offering increased clinician pay. Higher wages can cause clinicians to migrate to facilities with comprehensive care models, according to Klemanski, who previously worked for a New York-based CCBHC.
“Because we had that greater depth of resource and competence, we started getting more specialty referrals from our insurance market, not our government payers,” he said. “When you have a more comprehensive offering, you have a better product, as long as your staff are competent and trained properly to deliver that product.”
Diversifying services also aid whole-person care models. SUDs do not occur in a vacuum, Stacy DiStefano, CEO of Consulting for Human Services, said. Adding wrap-around services that keep social determinants of health and contributing factors of SUDs can support a comprehensive approach to care.
Consulting for Human Services is a behavioral health-focused consulting firm that works with service provider organizations, startups, payers, state systems, tech vendors and private equity firms.
Due to the long-term benefits of wrap-around care, payers are largely on board with reimbursing services.
“It makes perfect sense from a payer perspective,” DiStefano said. “[When] you start to remove those silos and provide the care that’s needed in a much more efficient way, you’re going to get better outcomes, and you’re going to save money in the long run.”
Diversified services may be even more essential for SUD providers with patients insured through Medicaid or Medicare.
“When we take a look at the public market, for example, the Medicaid, Medicare market, if that’s a payer source that you rely on and you chase, the models are moving in the direction of demanding integrated care, whether you historically want to provide it or not,” Klemanski said.
Commercial insurers can also benefit when patients receive wrap-around care.
Defining Wellness Centers exclusively works with commercial insurance plans and private pay clients. The payers the company contracts with are largely cooperative when reimbursing for wrap-around services, Rothermel said.
Implementation challenges
While diversifying service lines can benefit patients, providers and payers, some high-stakes challenges arise for providers seeking to expand their care continuums.
“Mistakes can be very, very expensive in terms of the impact to the people we’re treating, but also to the bottom line, if the treatments don’t go well,” Klemanski said.
Organizational cultures differ between mental health providers and SUD providers. Providers must shift culture intentionally and not rush, according to Rothermel.
Service deliveries also differ, including how much group therapy is used versus individual therapy, and attitudes about medication, Klemanski said. When integrating the two, SUD companies must take the time to build culture, train clinicians and develop competency.
“Ownership” issues can also arise, DiStefano said, in which providers must determine whether patients belong to the SUD or behavioral health side of the business. Integrating services like peer support can also be difficult since peer support looks different depending on which behavioral health specialty it is geared toward.
“It’s a paradigm shift to go from one to the other,” DiStefano said.
The measure of success when integrating expanding care continuums is when clinician teams across services can work together, Rothermel said. Leadership teams therefore have to be available and responsive to inevitable issues that arise when integrating staff.
Despite these challenges, there is still a “race” to fill white space in underserved areas.
Growing SUDs among the neurodivergent population is an untapped market, DiStefano said. Klemanski recommended providers consider services for impulse control disorders, digital addiction and gambling, issues he sees as more difficult to treat and increasingly common.
