Behavioral health organizations are changing to meet the increasing need for behavioral health services, with more emphasis on person centered approaches and outcome driven services.
We spoke to Don Rogers, chief clinical officer at New Vista. New Vista assists individuals and families in the enhancement of their emotional, mental and physical well-being by providing behavioral health, substance use and intellectual and developmental disability services. Below are the highlights.
MN: How has New Vista changed to meet the increasing need for behavioral health services?
DR: I have worked at this organization since 1994 when I first completed graduate school. I have seen major shifts in clinical philosophy and program design particularly over the last seven or eight years.
As far as clinical philosophy, there is much more emphasis on person-centered approaches and outcome-driven services. With the advent of Medicaid managed care, decrease in individuals without a third-party payor because of Medicaid expansion, and reduction in public funds to support the indigent population, many of the old community-based programs and treatment approaches had to be abandoned or significantly altered so the highest level of efficiency in helping as many clients make as much positive change as quickly as possible has become the focus.
There have been growing pains, but New Vista’s leadership team and clinical providers have stepped up to the challenge. We are stretching our resources in a responsible way to make the biggest difference in our communities.
MN: What trends have you seen in the behavioral health community that you have adopted at New Vista? What trends do you see coming down the road?
DR: One of the trends we were early adopters of is the use of routine outcome monitoring as a clinical feedback system in treatment. This process has been demonstrated to have a significant positive impact on the outcomes of clinical care through multiple randomized clinical trials.
We adopted a feedback model called Partners for Change Outcome Monitoring System (PCOMS) in 2013. Two years ago, The Joint Commission established a standard that requires behavioral health providers to use a routine outcome monitoring system, and we were well prepared to meet that standard.
PCOMS and person-centered recovery philosophy go hand in hand to both ensure that clients have a voice in their own recovery, and that efficiency of treatment is maximized in addition to the overall enhancement of treatment outcomes.
On the horizon is integration of behavioral and physical healthcare. There are more providers trending in this direction and payors are slowly starting to restructure payment models to support this integration. New Vista recently was awarded a grant to pilot an integrated care function in our substance use disorder services.
Also, on the horizon is increased use of telehealth as a mode of treatment. For many years, psychiatry services via telehealth have been reimbursable across most payors in Kentucky, but only last year was there an expansion of coverage of telehealth services for all other behavioral health services by Kentucky Medicaid.
New Vista has started providing routine outpatient therapy services through telehealth and is in a partnership with the University of Kentucky in a telehealth pilot that will help advance clinical protocols and training for behavioral health clinicians as we advance this mode of service.
MN: As it relates to your work, what issues keep you up at night?
DR: There remains some destabilizing factors in the behavioral health safety net. For example, most of the 14 CMHCs that serve Kentucky participate in the Kentucky Retirement System and are subject to extreme increases in the costs associated with that participation.
Although New Vista is in a strong position to meet the challenges that come with this, some CMHCs and other participating quasi-governmental agencies face significant threats.
Another big disrupter has been workforce challenges. There is a strong market for qualified staff at all levels, but there is a shortage of professional clinical staff and a growing number of provider agencies in Kentucky that are competing for the same staff.
Although it is a good thing that our communities have more clinical professionals available, with a constant churn of staff moving from one provider agency to another the full capacity of those providers is never fully met. There are also sometimes major differences in funding resources available to provider agencies resulting in huge ranges of salaries across agencies in the same basic market.
MN: What does Kentucky need to do to improve access to behavioral health services in Kentucky?
DR: Support the community mental health system through stabilizing the Kentucky Retirement System and providing adequate funding to carry out robust safety net services.
We provide the core safety net services to individuals in our communities. We need robust resources to carry out these functions so that all individuals, including the most vulnerable in our communities, have high quality mental health, substance use and Intellectual and Developmental Disorder services. This requires a full commitment on the part of our communities, legislators and government.
MN: If you could change anything about our healthcare system, what would you change?
DR: Regarding healthcare, I think there are no losers in a society that has universal healthcare. I have no strong opinions about the model, but almost every advanced society has figured out how to ensure that 100 percent of the people in their communities have healthcare regardless of their financial resources or circumstances.
MN: What professional accomplishment are you most proud of?
DR: I am proud to be part of the team that has successfully led this organization through major systemic changes and to have come out of those changes with improvement in the quality of services we provide.
A Closer Look at New Vista
- Outpatient services in 13 of the 17 county Community Mental Health (CMHC) region.
- Residential substance use disorder services in Lexington and Richmond.
- Assertive Community Treatment (ACT) in Lexington.
- Homelessness services in Lexington.
- Housing services in residential housing properties owned by New Vista in Fayette, Clark, Madison, Franklin, Lincoln, and Boyle counties.
- IDD case management services across all 17 counties plus Pulaski County.
- Specialty residential IDD services in intermediate care facilities in Somerset and Louisville.
- Residential and family home provider services for individuals with IDD in Fayette and Pulaski counties.
- Employment services in Lexington.
- Substance use and suicide prevention in all 17 counties.
- Medication Assisted Treatment services for individuals with substance use disorder in Lexington.
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