Claim OwnershipThe Recovery Executive Podcast
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The business of recovery is changing fast. Many executives are getting left behind. The Recovery Executive Podcast talks to experts in the field on marketing, operations, M&As, billing, and growth to help you build your organization, serve more of those who need help, and stay on top.
106 Episodes
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Cumberland Heights is one of the most consistently profitable non-profit treatment programs in the country. If you look at the 990s of many well-known non-profit treatment programs, they have consistent annual fiscal deficits when donor contributions are removed from the P&L. They have also continued to successfully expand throughout the state, adding on service lines and locations. In this episode, I speak with CEO Jay Crosson to learn just what it is about Cumberland Heights' strategy that has made is so consistently successful.
How do treatment programs innovate and what innovations are on the horizon, especially as we move into more consistent use of AI across departments? In this episode, I speak with Brad Sorte, previous CEO of Caron and current Co-founder of Sober Companion AI to address these topics.
Teen treatment has been a hot topic for expansion and investment recently in behavioral health. "Lots of demand with not enough providers" is the current mantra. But is this accurate? What makes a good teen health provider? Should adult programs add on teen options? If the prevailing mantra is true, why are we seeing so many closures of teen facilities across the country? All these questions and more will be answered with my guest, Chris Perkins, CEO of Velocity Health Group and previous CEO of Calo (now part of Embark), one of the most successful teen treatment programs in the country.
Many OON providers don't realize that a number of employer-funded insurance contracts include clauses that provide for higher reimbursements in exchange for guarantees not to balance bill patients, often resulting in millions of dollars of unreimbursed care.
This episode is a deep dive into the complex world of third-party administrators (TPAs), downline administrators, self-funded vs. provider-funded insurance plans, and negotiating no balance billing clauses for OON contracts with Ali Beheshti, CEO of Zealie.
High-end private pay programs charge as much as $100,000 a month for patients entering these exclusive facilities. Cultivating referral relationships for patients in the income bracket that can afford such programs require a specialized approach.
Mark O'Connor has worked in outreach for both Caron and The Lighthouse, two programs renowned for the quality of care they provide, that comes at significant cost for their higher end programming.
Mark walks us through his relationships and approach that have helped him regularly place patients into such programming.
Stagnant community outreach and business development strategies are still the norm in much of the field of behavioral health, which is why so many providers struggle to build consistently high-performing teams.
Often, lack of results are ascribed to the outreach reps themselves, but the reality is that there is significant opportunity for providers to step up their hiring, training, and support processes for their teams.
Shelley Plemons, most recently the Senior Vice President of Strategy and Growth for Discovery Behavioral and now a Senior Consultant for Circle Social, discusses the strategies and tactics that define successful outreach teams. We discuss how much of it is really common sense, but this is certainly a topic where the adage "common sense is often not common practice" applies.
Groups Recover Together has developed a very specific care model that doesn't fit into standard fee-for-service arrangements. This required them to think outside the box when negotiating with payers, resulting in the majority of their contracts being value-based care arrangements.
Groups is committed to delivering positive outcomes for its patients and goes at risk with the payers to guarantee those results. They've developed robust outcomes tracking, something notoriously hard to do in the MAT space, enabling them to see what's working, what's not, and where taking risk is appropriate.
Cooper Zelnick, CRO of Groups, walks us through their care model, the data they collect, and how both those things create value for patients and payers.
Intentionality is different from desire. Many programs want to grow, they strive to grow, but there is not always intentionality as to how they go about that, especially when it comes to community need and program design.
In this episode, I speak with Jaime Vinck, CEO of Recovery Ways and former CEO of Sierra Tuscon, regarding building a program with intentionality. How should programs look at community need, payer relationships, and program development BEFORE they open up a new program? Jamie shares her extensive experience as well as Recovery Ways' current common sense strategy to growth and scale.
Successful call center operations are integral to the success of any provider. Your marketing and outreach teams can be phenomenal, but if your admissions staff on the phones don't do their job well, patients will go elsewhere.
Call centers are so much more than merely staff training. The staff have to be good, but you also need to set them up for success with appropriate technology, tracking, software, scheduling, and structure.
In this episode, Michele Santagata, CEO of Santagata Consulting, shares her expertise running call centers big and small for behavioral health.
How does a first-time entrepreneur bootstrap a treatment program starting with outpatient and then gradually building a full continuum of care?
In Arizona, many treatment programs were started, and almost as many failed within short order, Tyler Tisdale, CEO of Pinnacle Peak Recovery, shares his story of success and what it took to get there, how he succeeded where so many others did not. He takes us through the pivots, systems, processes, and strategies that have made Pinnacle Peak one of the leading providers in the Greater Phoenix area.
AI, call flows, tech stack, and intelligent routing, all to improve call center conversions, decrease staff burnout, and reduce patient frustration on admissions calls. We'll talk about all that and more with Karl Fischer, Managing Director of DecisivEdge.
Everyone wants to know, "How do we get the best reimbursement rates possible?" Stu Segal, Principal at FlormanTannen, and I discuss this question in depth. Obtaining better reimbursement rates requires far more than asking for them or "hard-nosed negotiation." Instead, it requires planning, patience, outcomes data, and relationships, all integral pieces of successful negotiation with payers.
Through focused training and ongoing feedback, therapists can significantly improve their intervention skills in order to achieve stronger patient outcomes. With the payers focused on outcomes more than ever, the time is now to hone in on ways to strengthen clinical delivery.
Zac Imel, Chief Science Officer of Lyssn and Professor in Psychology. speaks with me on the research regarding therapeutic skills and fidelity in clinical delivery. We talk about specific skills and actions therapists can take that help them become better therapists and help patients obtain better outcomes through the therapy received.
Payer expectations continue to change every year and so provider RCM benchmarks and best practices need to change as well. We're seeing more payers deny contracts or opt to not renew contracts based on a variety of trends in SUD.
In this episode, I speak with Erin Burke, CEO of Hansei Solutions. With over 1 million processed claims from providers across the country, they have a ton of data to inform strategies for sustainable operations and strong payer relations.
Building the backend data infrastructure to track both business metrics and clinical outcomes is costly and time-intensive. Even for a medium-sized organization, this can cost upwards of $500,000 per year, so the last thing anyone wants to do is build it wrong or get off on the wrong foot.
Dr. Nick Hayes, Chief Science Officer at Cumberland Heights, walks us through their best-in-class data science department. He and his team built out what I consider to be the best setup in the field.
Nick shares how they built it, what that setup looks like, the outcomes they've gotten, and how it's helped Cumberland improve as an organization overall and deliver even better outcomes for patients.
As more programs implement patient outcomes tracking, it's become clear that care delivery becomes more effective when tailored. Some programs may be excellent with veterans while another may do better with something as specific as women using heroin over 40.
Efficacy in delivery changes by demographic, geographic location, and even individual clinician delivering programming. In this episode, I speak with Eric Gremminger, CEO of ERP Health. We take a look at how providers are starting to implement outcomes tracking and the changes they're able to make as a result to improve results for patients.
The delivery of group therapy hasn't received an update or serious attention since Irvin Yalom's work back in the 50's. Because most therapy delivered in addiction treatment is group therapy and, as a field, we're finally talking about trackable outcomes, it has become clear that improved techniques are needed.
Andrew Bordt, Executive Director for The Institute for the Advancement of Group Therapy, and I walk through the neurobiology of learning and how effective group facilitation can significantly improve outcomes not just in the group, but beyond as patients reintegrate into their daily lives.
There are many opportunities for payers and providers to work together in order to improve care and reduce barriers to treatment.
In this episode, Debra Nussbaum, Senior Director of Behavioral Health at Optum, provides insights into what she looks for when partnering with a provider. She also explains what not to do and gives us a look at Optum's new provider portal to expedite UR.
If your program has in-network contracts, you won't want to miss this episode.
Through the integration of digital and peer recovery supports, JourneyPure was able to double improvement of recovery outcomes compared to treatment as usual.
In this interview, Dr. Brian Wind, Chief Clinical Officer of Regard Recovery and JourneyPure, shares how the integration of these supports came about, what results they've seen, and the success they've had in getting reimbursed for those efforts as well.
Specialty tracks are springing up all over these days, the most common being veterans, first responders, and LGBTQ. Some providers have also embarked on specific faith-based tracks, but these programs are not easy to do well.
In this episode, I speak with Devora Shabtai, VP of Clinical Development for Onward Living. Having built both Christian-specific and Jewish-specific tracks at different providers, she walks us through the logistics and complexities of faith-based programming to help providers do it right.
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