The safety-net and nonprofit segments of the addiction treatment industry have long faced immense challenges. But those challenges have produced some of the most compelling innovations in terms of clinical, operational and reimbursement models.
One key element of this development is the necessity to understand a community’s needs, Beth Keeney, CEO and president of Jeffersonville, Indiana-based nonprofit LifeSpring Health Systems, told Addiction Treatment Business.
Keeney has led the organization in her current role for three years but has worked at the organization for the last 17. During that time, LifeSpring Health Systems has grown to 30 outpatient locations across Southern Indiana. It employs about 650 people and serves about 20,000 patients each year.
Over the years, LifeSpring Health Systems’ focus on the Southern Indiana community has led to tailoring each service and each location to the hyperspecific needs of the surrounding community.
“If you visit our office on Spring Street in Jeffersonville, it’s very different from our office on Sharon Drive in Jeffersonville,” Keeney said. “They’re a mile and a half, maybe two miles apart. But the population is totally different, and so the service delivery is totally different.”
The Spring Street location sees mostly patients with long-term serious mental illness (SMI) challenges who tend to be older. The Sharon Drive location offers addiction treatment and primary care services.
Across the LifeSpring Health Systems footprint, the nonprofit offers comprehensive primary care, behavioral health care and substance use disorder (SUD) treatment. It is certified by the federal government as a community mental health center (CMHC), a federally qualified health center (FQHC) and a certified community behavioral health center (CCBHC).
The State of Indiana has its own CCBHC program. LifeSpring has not yet joined that program but plans to, Keeney said.
Keeney recently sat down with ATB to talk more about the importance of integrating care, the power of zeroing in on community-specific needs and the dynamic her organization faces with working with payers.
Highlights from that conversation are below, edited for length, clarity and style. Keeney will join ATB at the coming Addiction Treatment Forum, a live event in Chicago on July 17, on a panel entitled “Who’s at Quarterback? Ensuring Smooth SUD Handoffs and Building the Partnership Playbook.” Jaime Vinck, president of Meadows Behavioral Health, and Nicholas Mercadante, CEO of PursueCare, will also join the conversation.
ATB: LifeSpring does a lot by integrating behavioral health and physical health care in one organization. At the broadest level, why would one want to do it in the first place?
Keeney: It’s impossible to separate mental and physical health care. The scope of a person isn’t limited to one or the other.
If you are somebody who maybe doesn’t have mental health concerns, but you have chronic health issues, we also need to be concerned about your mental wellness. But we see a lot of overlap. Folks will come in for mental health issues and may disclose ongoing physical health issues.
Having all of it in-house and just right down the hall makes it so much easier in terms of access. We’re able to really make sure that those patients are able to access everything that they need.
I can definitely see how it makes it easier to access care from the patient perspective. But I also imagine that it’s not easy from an operational and management perspective, seeing as how so much of health care bifurcates physical and behavioral health care. Is it a struggle to coordinate the two operationally or at the payer-relations levels?
We’re pretty fortunate with our managed care organizations (MCOs). They understand the importance of integrated care. We’ve talked about access, but the real driver of integrated care is the improved clinical outcomes.
Over the last 15 to 20 years, there is an entire body of research — that has been validated many times over — that finds that people with a serious mental illness die 25 years faster than their non-mentally ill counterparts. It’s almost always due to modifiable physical health issues. It’s not due to suicidality or substance use disorder; it’s due to things like cardiovascular disease or lung disease.
We’ve been very fortunate in Indiana. Once [MCOs] could see the benefit, they’ve been able to really make sure that the payment structure and model was there. It was challenging, certainly, in the early 2010s, but they certainly understand it now, I believe.
Is there a learning curve for newly hired clinicians who haven’t worked in an integrated care setting like at LifeSpring?
That’s a great question. And the answer is, absolutely. I don’t do a lot of hiring of direct service staff anymore, but when I did, I told doctors and nurse practitioners that this is not like any other health care environment you will ever work in. There’s a place in health care for everybody, and this isn’t for everyone. This is Safety Net health care, and it is a team-based environment. And in a traditional environment, you know, the physician is the quarterback, and they call all the shots. And that’s not necessarily how it works here.
The case manager, the technician or the nurse might have the most important piece of information about a patient that day because they spend the most time with them.
You really have to be willing to take and receive information from everyone on the care team and use that to inform your decision-making. Now the technician and care manager aren’t going to be making prescription decisions, certainly, but we expect everybody to be participating in team-based care and be willing to see patients that other health care providers may not want to see.
We treat everybody, regardless of their ability to pay and regardless of what else they’ve got going on.
Why do organizations like yours — those in the nonprofit safety-net space — seem to be ahead when it comes to adopting innovative payment or clinical models?
I think part of that comes down to this: What is the purpose of your organization? We exist to serve a very specific population. To serve the community, you have to continue to evolve as your communities continue to evolve, like you have to continue to change as health care continues to change. The decisions that you make, both in innovation and clinical delivery, aren’t just informed by evidence-based health care and evidence-based medicine. It’s informed by what your community needs.
If there was one thing you could change about the industry, what would it be and why?
I would reduce the administrative burden. The administrative burden adds absolutely nothing to patient care. I’m talking about prior authorizations, insurance auditing, payment denials — that sort of thing. You spend an unbelievable amount of staff time and money responding to that and addressing that. You end up working that out, getting paid for it. It adds so much cost to the system and limits your ability to do meaningful things, to new programs and innovate because you have to have so many staff that do nothing but things like medication prior authorizations or sub-acute admission prior authorizations.
