Modern Healthcare: Hello, I’m Matthew Weinstock, managing editor of Modern Healthcare. Thank you for tuning into the latest edition of the Check Up. One of the lasting tolls and impacts of the COVID-19 pandemic is sure to be the heightened attention that everyone is paying to behavioral health issues that are facing millions and millions of Americans these days. In past episodes of the Check Up, we’ve talked to leaders from pediatric hospitals and pediatric health systems about the challenges facing children and adolescents and the unique circumstances they faced. Well, today, we’re going to turn our attention a little bit to the adult population. And I’m very pleased to welcome Stuart Archer, he’s president and CEO of Oceans Healthcare, a behavioral healthcare provider that operates facilities in Texas, Louisiana and Mississippi. We’re going to talk a little bit about what they’re seeing in their marketplaces, but also this broader idea of of addressing behavioral health going forward. Stuart, thank you so much for being with us.
Stuart Archer: Well thank you, Matthew, for having us and allowing us to be part of this dialogue.
MH: Absolutely. So just before we delve into some of the issues, you know, a lot of our viewers, readers may not be familiar with Oceans Healthcare. As I said, you’re operating those three states in the south. Give us a little bit of demographic on your operations. Twenty-three facilities, right, in those three states?
Archer: Yeah, yes. Thank you for, again, asking us to join today. Oceans as an organization has been around for almost 20 years, a quiet part of the behavioral health industry. Today we operate across the southeast and in communities that others find challenging, and historically in a space that’s been underrepresented in the behavioral health industry. Our roots and and again, a large focus of our organization, are in the care of the behavioral health needs of older adults in geriatrics space. That’s been fairly under represented historically in this dialogue and, certainly over those years, we’ve expanded our services to include adult and adolescent services with a real emphasis on outpatient services as well, hoping to extend our reach and work with patients in whatever way we can.
MH: Got it. So let’s talk a little bit then, Stuart, about what you’ve been seeing over the past year. Again, as I sort of alluded to at the beginning, mental health, behavioral health has really started to come to the forefront as the pandemic wore on and social isolation and things like that were taking hold. What have you seen in your marketplaces? You know, in terms of the impact of behavioral health, on your patient population?
Archer: Sure.You know, I think that every provider has had its own journey through COVID. And certainly a lot of the national attention and the focus has been on the care of, and in the interventions posed and ICU use, and in more traditional acute-care settings, which makes sense. But as a backdrop, I think the behavioral health industry and ourselves specifically, have certainly seen our own challenges. If COVID has done anything, it has opened the door for folks who maybe thought of behavioral health as something that happened over there, or something that happened to other people, or some other healthcare provider took care of that. I think COVID has opened a window for everyone as we’ve experienced this isolation, as we’ve experienced these changes that have affected us all. Behavioral health and mental health is something that affects every one of us. All of our employees, all of our health systems, all of our communities have experienced tremendous stress during these periods. And certainly I think it’s brought to light the inadequacies and how much work is still left to be done in this industry to connect patients with sometimes the most basic of services.
MH: And so have you seen real peaks in certain markets that you operate in? And maybe not so much in other markets?
Archer: You know, I think we have and as we’ve seen these different waves of COVID hit our communities, and certainly as we’ve seen the COVID numbers drop a bit, although I think we’re still we’re beginning to see those rise a little bit more. We are seeing a mental health epidemic begin to follow what we saw as a physical pandemic. And so today for prior adult patients and for our geriatric patients and then certainly our adolescents, we’re seeing surge in need follow this pandemic.
MH: Yeah. And I think one of the things that’s been interesting, that I’d like to talk to you about is that isolation and loneliness factor. You know, as you said, we’ve sort of, at the beginning have focused on those patients who were in the hospital. But I’m curious what you’ve been doing and how you’ve been reaching those seniors and adult patients who are at home, who are alone. And they’ve been isolated there because of social distancing and the pandemic, and what kind of impact you’ve seen on their behavioral health, that isolation and loneliness factor.
Archer: Sure, I mean, I think that the isolation is something that we probably all felt at some point during this pandemic, and many of us continue to feel as we’re disconnected from some of the basic social norms that we have in our in our day. Humans are social creatures, where we’re wired to be connected to others. And certainly as we age, we know that that plays not only part of our healthcare, but a fundamental part of our day and our well being. And so for many of our patients, the needed protections that we’re putting into place during the pandemic have now affected a whole new part of their healthcare. And so, at Oceans, one of the big things that we tried to do is find a way to stay connected with our patients. I think this is where the innovations around telemedicine, we were early adopters of those in the nursing homes and in SNF units and in other areas, partnering with home health providers across our states to support the work that they were doing. But all too often in behavioral health, we’ve made the patient come to us or we’ve made the patient meet us on our terms. And I think one of the things that COVID has made us rethink and I think has made the industry continue to rethink is, you know, how do we provide services in a way that’s accessible by the patient on the patient’s terms?
MH: Yeah, that’s it. We hear that a lot on the physical health side, right? Care for the patient, where the patient can be cared for, whether it’s a retail clinic or something like that. It’s interesting to hear you talk about that perspective, from a behavioral health setting, to think about meeting the patient on on their terms as well. You referenced telehealth, I’m curious. It’s worked. But what are the limitations for you in terms of telehealth from a behavioral healthcare standpoint?
Archer: You know, a couple thoughts. Telehealth has the ability to provide anonymity, which at times can be the biggest barrier to care. We hear over and over and over that the parking lot at the therapist’s office or the parking lot at the psychiatrist’s office is the single biggest barrier to care in the sense that there still is this stigma. Someone from my community or someone from my church sees me in that parking lot. What are they going to think about me? And so I think on the positive side, telehealth does provide the needed anonymity, especially early in these interactions for folks to feel comfortable and understanding what treatment is and what it isn’t. I think the limitations are for the more moderate and for the severely mentally ill, you know, technology is proving to be less effective. And I think not because of something the therapist or doctor isn’t doing. But I think there’s just inherent limitations, you know, in too many of those interactions. And so I think that’s why, you know, we view these as adjuncts. We view these as an important tool in the toolkit, if you will, but certainly something that is provided on a continuum of services.
MH: So as we start to see, you know, states open up and loosen restrictions, Texas obviously has done that more than some other states. What do you think that balances between where you’re going to be providing telehealth services versus more in-person services? Have you thought through that process yet?
Archer: You know, we have and I think many of those answers are still up in the air a little bit. I think it appears to be a national dialogue, and I think a fair amount of hand wringing about what is going to be the long-term status of patients and their ability to access care through telemedicine. We provide care several rural areas where internet connectivity is even tough. So doing therapy and having interactions with caregivers through voice is still really important. And so from our perspective, you know, we’re always very skeptical of silver bullets, things that fix everything. Again, I think this is an important tool in the toolkit of providers and for communities and I think it would seem really tough to put this back in the bag. I mean, I think we as providers have been waiting for this to be paid for and funded in a manner similar to other levels of care, and they would it would seem to be taught to go backwards in this in this aspect.
MH: And I definitely want to talk about that funding, the payment piece, you know, Mental Health Parity, even though we have the national law, we’re still coming up short on some of that parity issues. So where do you need to see reimbursement change for behavioral health?
Archer: Well, this could be a this this could be its own its own talk. But I would say, from my perspective, I think parity is still an aspiration. I think we work with a wide range of payers, our organization has always strove to be an in-network provider. And so we work with a wide range of payers, which, frankly, a very wide range of approaches when it comes to behavioral health. I think that, you know, I look at what we can control as a provider. And I think, you know, many times the advice that we give our patients and our loved ones is the same ones that we try to take its organization. And so from a provider standpoint, what we can control is partnering with payers on evidence-based outcome data. And I think that’s one thing our industry could do better is engaging proactively in outcome data, outcome studies, and really looking at what is making an impact. There is an inherent skepticism still with some payers around behavioral health services. And I think that piece of parity is still an area that we’re working on as an industry. And I think the best way to combat that is proactive dialogue around, what does a successful outcome look for a patient in this space?
MH: Yeah, that’s a thing that’s been an ongoing challenge for this space, right, is to create those metrics that are really solid and measurable. So who are you working with to try to help develop some of those metrics?
Archer: We have worked pretty closely with frankly, a wide range of people. You know, all of the states that we operate in, we partner with them pretty close to the look at the outcome data that resonates with them. And I would say, from a Medicare perspective certainly we provide and play a part in those. I think many of the metrics that we’re looking at today, or that we’re asking to be provided, really are more utilization metrics than outcome metrics. And so I think we’re dealing with individuals who many, many times this is going to be a chronic illness. And so I think we’ve got to change our mindset, you know, length of stay is not a quality metric, we like to say. And so thinking bigger picture and connecting patients to services is crucial. We championed, both in Louisiana and in Mississippi, the addition of outpatient services for Medicaid patients, and I’m happy to say that in both states, both the governor and the secretaries of health supported those. And I think the addition of those services has made a huge impact in the lives of those patients, for instance,
MH: Lastly, you reference some of the partnerships you’re doing with payers, but also you talked about the partnerships you’ve done with some SNFs and other facilities. I know you recently opened a facility with Ochsner Health System. And so can you just talk about where you see the need for greater partnershipsbetween behavioral health providers such as yourself and those more traditional acute-care health systems?
Archer: Sure. Well, I think first of all, it starts with behavioral health providers being at the table. All too often there’s a dialogue going on around behavioral health, good or bad. There’s conversations going on around patients and all too often the behavioral health providers are still not at the table, whether it be legislatively, whether it be from a funding or different areas. And so I think, you know, progressive health systems, health systems that are leading, are definitely saying, look, how can we do more for our behavioral health patients in our community? And we were certainly honored to partner with Ochsner and LSU in Louisiana to build one of the premier behavioral health facilities in Louisiana. And I think that it starts with the behavioral health patient, which both LSU and Ochsner certainly share the same sentiment that we do, that they deserve access and a quality of treatment equal to any other patient that enters the hospital, but recognizing that this patient’s going to have a special journey, they’re going to need a special a special set of caregivers. And they’re going to need to be connected on an ongoing basis with services that may be in-person, that may be accessible through technology, but then again, meet them where they are.
MH: Got it. Got it. Well sir, we appreciate your time. Obviously the behavioral health crisis is one that we could talk for much more than 15 minutes. But we definitely appreciate you taking some time here. And we we’d love to check back in with you, you know, as we get out of the pandemic, and sort of see where behavioral health goes from here. Hopefully it can continue to be a national dialogue.
Archer: Well, thank you again for your time today.
MH: Thank you, Stuart. And I’m Matthew Weinstock with Modern Healthcare. Be sure to come back next Monday for another edition of the Check Up.