On this episode of The Vurge, Rebecca sits down with Melissa Giampietri, Consulting for Human Services, to talk mental health. Together, they dig into the nuanced distinctions that set behavioral health apart from physical healthcare systems – from the complex web of regulatory and billing challenges to the intricacies of crafting effective treatment plans.
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On this episode of The Vurge, Rebecca sits down with Melissa Giampietri, Consulting for Human Services, to talk mental health. Together, they dig into the nuanced distinctions that set behavioral health apart from physical healthcare systems – from the complex web of regulatory and billing challenges to the intricacies of crafting effective treatment plans.
Thanks for listening! Like what you hear? Follow us on LinkedIn, Twitter, Instagram, Facebook and be sure to subscribe to The Vurge for the latest episodes and more!
Interested in being a guest on the show? Click here to learn more.
Hi everyone and welcome to another episode of the Verge. Today we have Melissa GM Petrie from Consulting for Human Services, which is an organization near to my heart. Her CEO is actually a board member on my nonprofit Bluebird Leaders. Welcome, Melissa.
Speaker 2:Thank you so much. I'm glad to be here, Rebecca.
Speaker 1:Why don't you tell us about your dual titles and a little bit about what you do at Consulting for Human Services?
Speaker 2:Great. So, rebecca, I have 20 years in behavioral health, a good portion of that in starting out working for a community mental health center in Portland, oregon in clinical and leadership roles. Then pivoted to the world of behavioral health information technology, specifically working with leading behavioral health EHR companies for really the last 13, 14 years, before pivoting to the world of consulting. So I currently work with Consulting for Human Services. I serve as the director of business development. Also, I'm a principal consultant in dual project work, helping organizations and vendors with their technology strategy and helping them find solutions to support their delivery systems and vendors. Understanding market viability.
Speaker 1:Awesome Thanks, Melissa. Do you want to dive into the integrative care model and how behavioral health is different from hospitals or ambulatory care and what are the biggest differentiators than just having one visit and how the behavioral health it really goes over a longer timeline.
Speaker 2:Great question, rebecca. There is very different delivery systems when it comes to behavioral health and physical health and organizations. Really, the market has been siloed for many, many years in terms of there being mental health centers, community behavioral health organizations or community mental health centers, cmhcs and then community health centers, primary care organizations, and the reason for them being separate is complex and there's just many reasons for it. From CMS down, there's been very different regulations, very different ways in which you bill and get reimbursed for services, for Medicaid and Medicare, and really the delivery systems are different because the needs of the populations are different and the treatment provided is also a bit different. And so when it comes to these delivery systems and behavioral health, it's all based on getting enrolled in a program based on the needs of a population, the level of care needs that they have, and so, as well as being episodic, and so this tends to be a little bit longer term episodes of care. It's not that kind of encounter based, visit based methodology on the physical health space, and so because of that, it's also necessitated very different technology from an EHR standpoint.
Speaker 2:There is behavioral health EHRs and there's physical health EHRs, and they're different when it comes to the regulations, being able to support the regulations and mental health. It requires very complex technology solutions to be able to do that, as well as the way in which services are reimbursed. Clinical care delivery there is also differences in terms of it not being as straightforward, in terms of it's easy to diagnose an infection or a broken arm in physical health, and then there is a standard set of solutions and interventions to solve for that particular problem. Well, the human psyche obviously is not as easy to assess and so it tends to be longer term, with several assessments to really inform a diagnosis which can be very complex and require even an interdisciplinary treatment team working together. And then treatment plans for the individuals receiving care is a requirement in behavioral health, where typically an interdisciplinary team all contributes to these plans and they're living, breathing ongoing plans. They change over time and so the care delivery side is different.
Speaker 1:I love that you're bringing up the plans right. So I've done some work in behavioral health and helped organizations that move from an archaic paper model over to EHRs and so, you know, keeping track of that plan on paper as it's ever changing, instead of just an ER visit where you you know it might be a little bit easier. What have you seen in the changes of, you know, going from paper over to EHRs or the first edition of somebody's EHR, and then COVID hits and there's a bigger push for that, and so I still see paper out there. What's the biggest driver right now? I know COVID health, but you know what else is driving change?
Speaker 2:Well, I would say that, generally speaking, behavioral health is about 10 years behind physical health when it comes to technology adoption. There is still many, many organizations that are on paper. Most of those organizations are in the mid market, if you will. These are organizations from really you know, whether it's a small behavioral health practice and five users, if you will, to 200 users. But the larger organizations community behavioral health organizations over you know a couple hundred employees, over 20 million in revenue typically do have an EHR because they have to in order to meet the regulatory requirements and all the compliance rules that come with receiving public funding. So are they on an antiquated EHR? Yeah, many of them are, in terms of it being very rudimentary and not leveraging and adopting it to its full capabilities.
Speaker 2:For years and years it's been about getting services into the system. It's been all about providers supporting providers, not necessarily touching clients themselves, but getting service notes in to bill for services, to be able to bill effectively while also being in compliance. What we have seen, trend-wise, is that COVID did really push us over the proverbial edge in behavioral health in terms of adopting technology in more robust and meaningful ways, including advanced technologies to extend beyond the bricks and mortar model to telehealth, virtual care delivery, and not only through telehealth but also engaging with clients through technology to manage their symptoms, to engage with their care providers. Behavioral health was a bit late, or behavioral health was slower, to adopt some of those technologies and there was a resistance. But we've really seen that changing from COVID since COVID.
Speaker 1:And having seen a lot more EHR, new implementations, paper to EHR are you seeing more EHR upgrades, where they were on somewhat of an EHR but now they're saying, oh, we really need to get our stuff together and they're upgrading to a bigger platform?
Speaker 2:Well, I'd say, with meaningful use, when it several years ago, that really pushed several organizations to adopt, in a lot of cases, their very first EHR. And so I'd say that the answer to that is both Organizations are looking to upgrade to find, as they've grown, to find a solution that is able to support them scaling and growing, and what that looks like is more robust applications that have configuration tools that really allow them to evolve their EHR and their solutions and their tech workflows alongside of their evolving organization right, and so we do see folks that, or larger organizations that are adopting more advanced technology stacks and EHRs, as well as organizations moving from paper. I'd say there's certain submarkets within human services that have been slower to adopt than others. For example, intellectual developmental disability organizations are slower to adopt in terms of being able to sometimes afford technology solutions, but more of those organizations are on paper than mental health organizations, if they're sizable organizations. So there's a lot of complexity there depending on the different segments within behavioral health.
Speaker 1:Melissa, let's switch gears and talk about the amazing conference you went to for behavioral health tech that is run by Solome and her team, and what new technologies or innovations were you seeing at that conference that will hopefully be utilized in many behavioral health organizations in the future?
Speaker 2:Absolutely. It was a phenomenal conference and amazing that for a first year conference in person, there was 1,200 folks that attended this conference, and one of the insights that I took away was that really there had been an untapped part of the market that some of the traditional conferences had not attracted, and it's really the newest startups and innovators with digital behavioral health, digital health tools that convened came together. It was digital health companies, it was payers, it was emerging telehealth companies, a lot on the for-profit side, as well as just really a group of stakeholders coming together that are introducing new solutions to market that are beyond DHR technology. These are solutions that really enhance care delivery and make a material difference in improving mental health and addiction through solutions such as virtual technologies and tools Technologies and tools too. One in particular is video games that help adolescents work through PTSD, through experiencing and kind of exposure of certain situations to teach them how to respond to certain things differently. I mean so these technologies really impact clients themselves in a way that is has yet to really be fully utilized in the field.
Speaker 2:Also, tools to augment therapists, with this workforce shortage that we have on our hands and clinicians being overly burdened with high case loads and you know massive amounts of just inefficiencies and administrative overhead and paperwork Tools to automate or leveraging AI to really automate much of what has created that burden right. And so, for example, there's tools to help with the clinical documentation process and really listening in on, say, a psychotherapy session, being smart enough to not only dictate the notes into the EHR but understanding the dynamics within the situation, within the therapeutic relationship and, if cognitive behavioral therapy is something that was used, it being able to indicate that when the therapist certainly does view the note, they review it, they make edits. It really is coming ultimately from the clinician, but it creates efficiencies for them. I think for years there was a reluctance to adopt and clinicians were afraid that technology was going to take their jobs, if you will. But now many clinicians and organizations are seeing it differently and they're seeing it as really a tool to augment and support these providers.
Speaker 1:Melissa, that sounded like an awesome conference. I know I got offered to go, but I had already been in. Arizona two weeks in a row. And that would have been three weeks in a row and I think that my husband and kids might have disowned me at that point, so I really hope to go next year. Let's switch over to the rural health and access and mental health there. And where do you see the landscape changing for rural health, along with the post-COVID and telehealth really advancing on all levels of health care?
Speaker 2:Absolutely when it comes to rural health, and there's many organizations that provide telehealth services to folks in remote settings, and so we're just seeing growth there and the expansion of virtual care delivery in these organizations to be able to provide better access to folks in rural communities. We're also seeing one of my last roles I was the behavioral health specialty director at NextGen, which was a leading kind of integrated care provider, so I was able to just really get a view of federally qualified health centers and what they're doing with integrated care as well as the behavioral health market. And we're also seeing the expansion within federally qualified health centers of behavioral health services in building robust behavioral health arms, and so some of these FQHCs and community health centers are also providing access in rural communities by, first of all, bringing behavioral health providers on board and leveraging technology as well to be able to extend into areas where there is not access to these services.
Speaker 1:Yeah. Yeah, there's still so much of a gap there. But I've worked with a lot of FQHCs that do have behavioral health right there next to pediatrics and primary care, and I see the synergies and how much they're able to work together to provide better care for the patient and it definitely is helpful. It's also helpful to get the behavioral health aspect and them at the table for governance and change, because the way that they do their visits and their care is so different than just a primary care, so it's been really eye-opening. One thing you mentioned to me when we were talking was how some of the EHRs have a data offline offline mode, I guess you could say or a mobile disconnect that they are able to accommodate from really rural areas that don't have 5G or Wi-Fi, and then they come back and reconnect and all gets uploaded. Do you want to speak to?
Speaker 2:that Absolutely. So many of the leading behavioral health EHR vendors have mobile applications for clinicians that have a disconnected component and functionality where they're able to upload clinical information on their caseload and review that clinical documentation through their mobile app while they're out in the whether it's a school, it's a psychiatric hospital, it's a rural area, it's working with somebody struggling with homelessness, under a bridge where there might not be 5G, there might not be Wi-Fi, and what happens is they're able to complete their clinical documentation, review critical information maybe it's with the medications that this individual is on as well as previous case management notes, and then, once they get back to Wi-Fi or 5G, they're able to sync all of that data into the EHR and then it builds. It wants the notes in the EHR, then the billing process is able to happen and they're able to bill for services.
Speaker 1:Yeah, that's nice. I think we should have more solutions like that for the rural health area. Are you seeing in rural health that the patients are able to do more telehealth and that the connectivity is either still a really big issue, or are there other outlets that they're able to utilize to get their behavioral health via telehealth available now?
Speaker 2:I think, generally speaking, internet connectivity has gotten better in terms of access to Wi-Fi and access through 5G on folks' smartphones, but it is very regional. It very much depends on where they're at. For example, I've done a lot of work with behavioral health organizations in Alaska, where that's not always the case, and there was mental health programs up there that I worked with that would fly their psychiatrists to see patients in rural tribal communities where there wasn't access to Wi-Fi and that was the only way they were able to get help and services. A lot of it depends on the state, the region and just variable connectivity in those areas.
Speaker 1:Are you seeing the mobile buses or vans, just like dental for rural health area and for primary care, being launched out for behavioral health as well?
Speaker 2:Many behavioral health organizations have crisis services and crisis teams and mobile response teams where they do go out into the community. In that way whether it's buses or just really crisis response after getting an inquiry about somebody experiencing mental distress or whatever the situation may be whether it's suicidal ideation, violence it's an emergent situation where they do dispatch and go out to meet clients where they are Not typically in rural areas. But it really depends on the community. One of the great things about mental health organizations and being really run at a state level is that they're able to build delivery systems that are responsive to the needs of the community that they're in. In Alaska, for example, they develop programs and services that are in response to very different needs with those populations. For example, again, flying providers to a remote area is something that would exist in Alaska but not in Nebraska, right? No, absolutely.
Speaker 1:I mean, I think we need to meet the patient where they are and whether that's telehealth and they are able, definitely in a behavioral health setting, to be where they feel safe and on their couch but still meet with their provider, or whether it's getting on airplane and meeting with a remote set of people, I think that it's getting better, but we still have so far to go to be able to reach out to the rural health areas and population. Agreed. Thank you All of you. Let's touch on other things that you all do at consulting for human services. It's a lot of behavioral health, mental health, but you also do the consulting and the EHR work, but you also do mergers and acquisitions and other things. Do you want to tell us a little bit more about the other things? Absolutely.
Speaker 2:Yeah, so consulting for human services is really a leading consultancy within the human services space that focuses on a wide array of segments within the market really mental health, SUD, substance use disorder, intellectual developmental disabilities, child and family services, foster care and even public health. In terms of services provided, it's really at a strategy and operations level, primarily traditional management consulting firm. However, in addition to having C-suite executives that ran multi-stipot state mental health centers and executives from behavioral health payers really the full gamut of experts over 60. At this juncture, we like to take a holistic approach and focus on organizational change in a multitude of different levels. For example, we do focus on the technological, because technology is a critical part of an organization that touches nearly every aspect of the delivery system.
Speaker 2:We provide technology strategy advisory services, as well as some solution design services, but partner with other firms in terms of procurement and the deeper technical components. In terms of the types of organizations and companies we work with, we work with organizations themselves. We work with vendors, startups and helping them with their go-to-market strategy and business development in terms of understanding how to go to market in the space. Then about a third of our business is mergers and acquisitions and working with private equity firms as well as organizations on all things mergers and acquisitions from really the front end pipeline development, looking for organizations that are a match and target organizations with very specific services and values, Really serving as a matchmaker through due diligence and then post merger, acquisition integration and helping organizations after this with change management, with technology integration, streamlining and standardizing operational structures and processes Really the full gamut.
Speaker 1:Yeah, I see you guys as such a huge player in this next wave that is coming and, thankful or not, covid started it Years ago. We had the EHR implementation for hospitals, then it really got big for ambulatory and then I feel COVID helped with the mental behavioral health and all the work that you all are doing there around that to help move their technology and their operations forward.
Speaker 1:I also see and I've worked with clients that are in behavioral health or even primary care that are choosing not to use insurance and are just cash, and so are you seeing a lot of the cash payers in behavioral health popping out as well.
Speaker 2:I would say in certain markets within behavioral health that is very much true In terms of private practice, small providers for example with, say, commercial payers, not as much on the Medicaid side, but when it comes to the commercial side, for one it's very hard with commercial insurance to sometimes find a provider that has availability in a community.
Speaker 2:From having worked in behavioral health for 20 years, sometimes a family member or somebody that a family member knows or a friend knows comes to you because, let's say, they have a cousin or a son that's in crisis and they have commercial insurance and they're looking for help for this person. And I have to say, even after 20 years you'd think that I could navigate it well and get them help quickly, but no, it's very hard. It's much easier to actually find services for folks if they're on Medicaid or Medicare, because the whole system in these community mental health centers is really designed around that market, right when you've got to go shopping at private practices that are smaller typically and it's much easier for providers rather than kind of dealing with the insurance. Or if it's a client where they can't find a provider that's on their insurance panel, it's easier for them to pay cash and with insurance changing and deductibles being extremely high, a lot of folks just decide they're just going to pay cash because it's all going to be deductible anyways, right?
Speaker 1:Yep, yep. Well, they can put it through their flex fund in the other way For sure. Yeah, what do you do outside of work for fun? To check out. You're in a very hard field and working on some very complex topics, and so you must have a need to check out. So what do you do for fun?
Speaker 2:Yeah, I travel as much as I possibly can. I don't have children, and so my one thing that I've been doing is traveling and working remotely. Since we live in this new world of where most things are remote even client engagements are remote I try to spend as much time as possible traveling to different places. Sometimes I completely disconnect and I'll go to Europe for a couple of weeks and explore, but I'd say that is probably my greatest passion is just traveling and thinking of snowboarding to Arizona, actually starting next year. I have also spent a couple of weeks in Arizona recently and realized I hate the snow and I deal with it for months a year where I live, and the older I get, the less cold I want to get and just going to do it. So snowboarding will be something moving forward. And then golf About a year ago I took up golf, so in the summertime that's what I spend my time doing.
Speaker 1:I just golfed recently at Chime for a time in probably 10 years, and so I learned very quickly don't run on the wet grass in the morning. All the way to my leg, my whole shoe. It was funny. I can shake it off so. I laughed about it, but I think the guys I was golfing with were like didn't know how I was going to react, but I loved it.
Speaker 2:And I bet you just handled it with.
Speaker 1:Grace got back up and started golfing yeah, but I found that to be so great to talk to like-minded people, but to be outside on the golf course, especially in Arizona, it was relaxing. At the same time it was very like and enjoyable to hang out, so yeah.
Speaker 2:Yeah, I find it so peaceful, you know it's I mean, it's nice being able to connect with people as well golfing but there's also kind of this tranquility and calmness and usually a beautiful environment you're surrounded by and being, you know, working in healthcare and tech and with your face in a computer screen 90% of the time. I really need that contrast for just self care.
Speaker 1:Yeah, yeah, no, absolutely my last question before we go. I ask everybody, I want to know what your superpower is, that you are giving back to the industry or the world, or to mentees. What would you say is your one superpower?
Speaker 2:My one superpower. I'm very passionate about the work that I do, and I do have a few folks that I mentor that are looking to really move more deeply into this space, and that brings a lot of joy, but I would say that one of my greatest passions is helping women in very difficult situations. I just joined the board of directors for domestic violence coalition here in my hometown in Spokane, and helping to create better systems of care is one of my biggest strengths. I love analyzing complex systems and coming up with solutions, and the biggest problem we have is access to the critical services that so many people need to that are suffering, and so helping women in particular get out of very difficult situations is probably on the top of the list, and so I'd say that that's one.
Speaker 1:I love it. I love it. You're amazing, like life. You come in person and just so impressed with all the work that you're doing. Keep it up. I know I'll see you soon and thanks for coming on.
Speaker 2:Thank you so much, Rebecca.
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