Expanding Access to Improve Outcomes

A Sobering Snapshot of A Vital Industry

Working through a crisis in search of solutions

If a business is unable to recruit or retain skilled workers, it isn’t able to grow. Workforce development challenges typically stifle expansion and impact the bottom line.

But when that same challenge is experienced by mental health organizations, it means patients in need of treatment can’t get it. And all of a sudden, that same workforce development challenge comes with alternate, far-reaching consequences that can’t be overstated.

In the mental health industry, workforce development challenges impact the quality of people’s lives and can influence the character and strength of an entire community.

As a company dedicated to improving access to exceptional behavioral healthcare, we at innovaTel have seen the challenges and witnessed the successes of innovative workforce development solutions, since our inception, but particularly over the past 18 months with the rapid adoption of telehealth throughout the country. We’ve had a front-row seat as an industry of dedicated professionals tries to keep pace with a growing population of patients who are more readily seeking the treatment they need from organizations that were understaffed even when the demand for care wasn’t as high as it is now.

That reality, right now, is being felt far and wide.

A recent survey initiated by the National Council for Mental Wellbeing found that nearly 80% of its member organizations reported an increase in demand for treatment during the summer of 2021. And a staggering 97% of organizations said recruitment efforts have been “difficult,” which has led to growing waitlists for appointments at more than 60% of the organizations that participated in the survey.

83%

report increased demand for mental health treatment.

78%

report increased demand for crisis services.

76%

report increased demand for social support services.

69%

report increased demand for substance use treatment.

Increased demand coupled with a challenging recruitment environment and a workforce shortage means access to care is becoming more difficult. One report, which cites that the current behavioral health workforce is only able to meet 25% of the current needs, predicts a workforce shortage of at least 250,000 behavioral health professionals by 2025 — which is only a few years away.

The following impact report will shine a light on the opportunities presented by these challenges, particularly through CCBHC designation, and illuminate the successes we’ve seen this year as organizations integrate innovative practices by necessity and leverage them to emerge from crisis.

“This crisis demands that we find solutions that allow clients to get the treatment they need and provide organizations the resources they require to attract and retain staff in a competitive marketplace.”

Chuck Ingoglia, National Council for Mental Wellbeing President and CEO

As a company that grew out of a community mental health center, innovaTel happened to be ahead of the telehealth curve when the COVID-19 pandemic hit and inspired the industry’s rapid, exponential growth. In the midst of lockdowns and chaotic changes, we were fortunate to be able to work with the solid foundation we had already established over the years by providing highly qualified psychiatrists, psychiatric nurse practitioners and licensed clinical social workers in remote capacities to organizations in need of additional support.

Recruitment and retention issues are not new to the mental health industry. The fallout from the pandemic, however, exacerbated the problem.

At innovaTel, our unique and established approach has proven valuable as patient populations change, regulatory requirements are revised and new opportunities for treatment become available. As patients present with more complex needs, including the escalating problem of substance use disorder, co-occurring conditions, and social and economic stresses, mental health organizations not only need additional treatment support, but they need specialized providers who may not be available within their immediate geographic area.

A general workforce shortage makes finding specialized expertise, with proximity, that much more difficult. Partnerships that offer remote providers answer that need as the mental health care model continues to evolve.

Implementing Solution-based Services

Challenge

Provider shortage
Increase in substance use disorder
CCBHC Medical Director requirement
Regulatory hurdles

Solution

Remote providers
Medication-assisted treatment (MAT) program and MAT Readiness Toolkit
Remote Medical Directors
Chief Compliance Officer guidance

Our experience as clinical professionals and industry veterans has allowed us to see the successes that come when Community Mental Health Centers (CMHCs) seek and achieve Certified Community Behavioral Health

Clinic (CCBHC) designation, from the varied standpoints of access and funding that supports staffing levels needed to meet demand.

“Funding did not keep pace with the demand and as a non-profit community provider, the budget did not support the staffing levels to meet the continued increase in demand,” Jon Evans, innovaTel’s CEO, speaking of his experience as the leader of one of the first community mental health centers in northwest Pennsylvania. “We literally lost money on every hour of psychiatric care we provided and had to find alternative sources of funds to back fill the clinic. Up until recently, this was one of the fundamental challenges of community mental health centers, and now with the CCBHC model, we are seeing positive changes.”

In addition to workforce development, the support we provide, from guidance to specific provider needs, helps these organizations achieve and maintain designation — which improves access to care.

The takeaway?

Innovative services available to mental health organizations allow them to meet patient demand, expand their clinical staff and sidestep what could be a costly “wait and see” approach — which could result in less-than-desirable patient outcomes.

+10%

The total number of people receiving care increased by 10% across CCBHC demonstration states from the program’s first year to the third.

Informed Approach. Improved Access.

Studies have shown that the introduction of CCBHCs has been instrumental to increasing access to care. In addition to increasing access to behavioral health care, CCBHCs have experienced a high rate of follow-ups for transition in care and they’ve increased access to comprehensive care — including physical health and substance use disorder treatment.

The patient impact numbers for MAT services alone, as reported in the National Council’s recent CCBHC Impact Report, offer insight into how access to care improved at a critical time for patients in need.

New Jersey nearly doubled the number of MAT program clients from its first to second demonstration year.
Missouri reported a 122% increase from year one to year three.
Oklahoma reported a 700% increase from year one to year four.

The CCBHC model, widely touted as the most effective way to improve access to comprehensive care, gave organizations the necessary tools and support to allow them to offer new services, from MAT treatment to primary care. Further, the CCBHC program increased use of evidence-based practices, expanded use of electronic health records and health information exchange, and improved capacity to engage in care coordination with health system providers, law enforcement and other public service sectors.

From a crucial workforce development standpoint, CCHBC designation helped participating states hire and retain providers — which led to scheduling flexibility, expanded hours and the ability to initiate outreach efforts to underserved populations.

innovaTel’s team of highly qualified and specialized providers offered valuable support to organizations aiming to earn CCBHC designation and to CCBHCs working to maintain their designation by developing a CCBHC Success Package that contains:

Offering highly qualified providers that meet the specific needs of their patient population via telehealth
Regulatory guidance and support
Creating partnerships that offered remote Medical Directors, mandated for CCBHCs
ntroducing a MAT services program with remote providers and a MAT Readiness Toolkit

The overall goal of the CCBHC program was to improve “availability, accessibility, quality and outcomes of mental health and substance use services,” targets innovaTel wholeheartedly supports from a philosophical standpoint but also in practice as evidenced by the valuable partnerships we form.

Success Measured

Among Oklahoma and Missouri CCBHC patients, the need for emergency department visits decreased between 20-47% and 76% respectively.

In Oklahoma, up to 69% fewer clients required inpatient care.

In Missouri, CCBHC clients experienced improvements in housing security and nearly 70% of clients with previous involvement with law enforcement had none after six months.

“Because it’s difficult to find Medical Director training programs, here at innovaTel we have created a rich network of fellow Medical Directors that meet on a biweekly basis to offer support and collaboration, which we have found is one of the best ways to learn the complexities of the position.”

— Dr. Liberty Eberly, Chief Medical Officer, innovaTel Telepsychiatry

Leaders in the community mental health center system in Kansas, along with policy makers in the legislative and executive branches of government, recognized that the Certified Community Behavioral Health Center (CCBHC) model would provide the greatest opportunity for expanding quality access to care for all patients, especially for youth in foster care and veterans, while enhancing therapeutic crisis care and medical services. Plus, the CCBHC model allows providers to maximize their resources, specifically in rural and frontier areas with telehealth by working with outstanding partners like innovatel.

– Kyle Kessler, Executive Director of Association of CMHCs of Kansas

“By becoming a CCBHC, we are working to change the entire healthcare delivery system in the seven counties Woodland Centers serves. We want to be a center of excellence for mental health and substance use and this starts by ensuring we are providing our clients with needed services and resources to ensure whole health. In addition, CCBHCs offer the ability for community mental health centers to have a sustainable financial model allowing us to pay our staff what they are worth and ensuring access to high quality evidenced based treatments.”

– Dr. Ashley Kjos, CEO, Woodlands Center

“The opportunity to offer life-saving MAT services to individuals suffering from addiction is a
very exciting endeavor and we are so pleased to be able to make these services available to our communities. The affiliation with innovaTel has been invaluable as a resource to offer support, education, contacts and guidance in navigating the initiation of this programming. innovaTel has prepared a package which includes a toolkit to assist CCBHCs and like organizations in setting up MAT services which will save organizations countless hours in organizing such a program.
This guidance also offers reassurance that quality care can be delivered, as it includes written policies and procedures, received a complete legal review and was created under the purview of an experienced Addictions Specialist Psychiatrist. We are helping to reach more people in need of these services with quality and accessible MAT services delivery via telemedicine.”

– Dr. Veronica Harsh, a psychiatrist at innovaTel and a remote Medical Director for the Minnesota-based CCBHCs Alluma and Woodlands Centers

“Becoming a CCBHC was a game changer in providing an integrated approach to care for the adults, children and families served throughout our region. The transformation has allowed Alluma to increase access to services through creating same day availability, increasing the amount of psychiatry, dedicated 24/7 mobile crisis team, Medication Assisted Treatment and using technology through telemedicine. Through our CCBHC model of care, we continue to evolve through our quality improvement process to refine and develop the best services and systems to meet our clients’ needs and those of our communities.”

– Shauna Reitmeier, CEO, Alluma (CCBHC in Minnesota)

“As facilities work on CCBHC designation, an important component to focus on is the implementation of MAT services. I’ve enjoyed collaborating with innovaTel to design a comprehensive readiness tool-kit to assist facility leadership in preparing to deliver these life- saving services. These tools are like having a virtual coach guiding leadership every step of the way to ensure patients with substance use disorders have access to evidence-based care in the same place they receive psychiatric treatment and therapy. “

– Dr. Ashley Peak, Board Certified Psychiatrist, innovaTel Telepsychiatry

“Consistent advocacy efforts by key individuals and associations have provided the necessary supports for the system to evolve to what is hopefully a community system of care that is financially sustainable. Initial results from the pilot programs have been very encouraging with improved access to care, initiation of MAT services and budgets that support growth.”

– on Evans, CEO, innovaTel Telepsychiatry