4 August, 2023: CIO for BestSelf Behavioral Health, Kevin Wiese joins Bill in talking about the dynamics, challenges, and distinctions of Behavioral Health Systems. How does the integration of behavioral health systems with conventional healthcare systems affect the quality and accessibility of care provided to the patients? In what ways does the incorporation of digital tools improve the patient and staff experience in the behavioral health sector? How does technology and AI play a role in retaining employees and professionals in the behavioral health industry? Given the rise of private practices, how can organizations like BestSelf maintain their workforce and ensure the availability of essential healthcare services? How does the integration of social determinants of health into behavioral healthcare impact patient outcomes?
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in my area where we have is and bi and quality improvements and pop health, how do we try and better collaborate, work together not be real siloed?
Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.
📍 All right here. We are for Another keynote episode and today we're joined by a friend and guest Kevin Wiese Who is the chief information officer for best self behavioral health out of new york.
Kevin, welcome to the show bill. Thanks for having me. Great to be here looking forward to it. Now, there's going to be fair number of people who haven't heard of best self behavioral health. I'm looking forward to the conversation because we try to talk to all types of organizations and how they're approaching health care and yours is a little different from a lot of the people we do talk to.
So give us an idea of what Best Self Behavioral Health does?
Well, Best Self Behavioral Health is the largest provider of behavioral health care services in the Western New York region. We have nearly 30 brick and mortar locations across Western New York. We're actually embedded in around another 40 or so locations, and those are mostly schools and physician offices.
We serve a little over 40, 000 clients annually, here in the region, and we provide, just a wide array of services. We do our fair share of mental health and substance use, counseling services. We're a health home, so we provide care management type services to our clients.
We have a couple of residential treatment centers. We provide mobile based services. So if there's folks who can't make it into one of our clinics we meet them out in the community to serve, to meet their needs a wide variety, a wide scope of things going on here at BestSelf.
Yeah. So one more question really to give people sort of a scope is what would you say is different from. a health care system and a predominantly behavioral health system. Tell us a little bit about how you leverage technology to deliver behavioral health?
Sure. I mean, we have a lot of similarities between your, hospital health system.
I guess some of the big differences are that We're mostly outpatient. Aside from our residential treatment facilities, we don't provide any, inpatient type services that you get at a normal health system. A lot of the technologies are the same though.
We're primarily a Cerner shop, but we have, three different EHRs that we run across the organization here. One of them, functions in our opioid treatment facility. And then we do a lot of the other same stuff when it comes to, appointment reminders and we use some electronic visit verification systems in our mobile programs.
So when we're out seeing clients in the community, we can track, those staff and those services. So yeah probably a lot more similarities than differences.
Well, yeah, you have three EHRs. So there is a lot more similarities and differences.
Half joking, laugh at that, but that is one of the challenges of being a CIO in our space is the diversity of the applications and then trying to bring all that data together at the point of care, because it is still stretched out to a lot of places. And you guys interact with, I would assume a lot of third parties that you're interacting with as well.
And so the data sharing aspect of it and getting that into the right place is probably very similar to what health systems have to go through.
It is, and we would prefer to have one EHR, of course, probably like most health systems would. But, we have, the other two are really sort of specialty specific, again, working in the opioid treatment space.
And then. On the care management side of things we have another EHR that runs in that area. But we, like other systems, we have our enterprise data warehouse. So we pull in data from all those systems and many other systems as well. Here at best sell.
Give us an idea of what some of the priorities are for best self today.
Well, I think, I listen to you quite often and I think like many of your other guests, the workforce shortages and the financial challenges are happening here in the Western New York region and the best self as well.
On the workforce side, we employ a lot of licensed social workers here. There's been a trend over the past year or two of them moving into the private practice space. So that's put a strain, on us and our clinics and trying to retain those staff.
So, we're seeing them move into that area. And then, on the financial side, reimbursement, inflation all those things are, have had quite a significant impact, on our organization.
So when you bring up financial challenges, I'm curious where are you finding efficiencies?
Where are you finding areas that you can leverage more with less, is the question.
I think, a couple of things are a couple of key points. One of the goals now is, how do we sort of leverage and optimize our existing technologies, that we have at the organization?
And then, where can we improve operational efficiency? So I think, on the tech side itself, part of that is, application rationalization, right? We've taken 3 or 4, areas this year and really sort of streamlined and sort of consolidated from a vendor standpoint, what we're doing.
When it comes to mobile device management and video conferencing platforms and that sort of thing, multi factor, and then, on the operational efficiency side, what can we do with automation, process improvement and leveraging some of the skills we have in our quality improvement area and our business process improvement areas here at the organization.
Yeah, it really is similar. Just those answers are very similar to the conversations I'm having with CIOs right now. So, talk to me a little bit more about the patient and staff experience. A lot's being done in the digital side to enhance both the, on the patient side and the staff side.
I'm curious in the behavioral health world. What your initiatives around that might look like?
Sure. I think, there's a couple of things happening now. We have we use a third party telehealth platform. So, a big project that we're getting close to finishing now is just an integration between, our Cerner platform and our telehealth platform.
So that'll be bi directional which will, obviously get information moving back and forth between the two and we're hoping to see some efficiencies there for the patient and the staff. We have, in the behavioral health space, and maybe not. Unlike other spaces.
A lot of regulatory paperwork. So when we have a new patient who comes to us, they have anywhere from 12 to 15 consent releases that they have to sign, at the time of intake. So we've digitized about half of those. So we can push those to the client, before they come in, for their visit.
They can review those, acknowledge those. On their own time in the living room saving them time when they come in and then just stay saving our staff, quite a bit of time, at the front desk, when those clients are presenting for their appointment. So we're excited, about, about that project that's happening now.
We did last year. A big assessment of our intake operations. So we partnered with a consultant that looked at from our, at our contact center, and sort of the operations of that. And then we looked at all the sort of different points of access that a patient may, where they may find us and how we can sort of improve the efficiency there.
So, we want to modernize that experience, really modernize our contact center and just make it as easy as possible for clients to find us and get the services that they need.
Did anything in that area surprise you from the findings?
For me, I want to say no. I knew there were some opportunities to be more efficient. We want to to place a new technology in our contact center. So we're in the process of, searching for our next gen phone system here. And then, learning over some sort of, contact center platform that can help us Manage a monitor, all those, intakes that are coming into the, to the organization.
And then, just have a consistent approach to, people who are calling us and, wanting to get services. We also want to try and, prevent people from having to always pick up the phone to contact us, you
know, can they do some pre visit paperwork that allows them to complete that information on their own time. And then save time, when they come into our offices. So, I'm not sure for me, there were any big surprises. It did bring to light maybe for other leaders within our organization, just some opportunities that we have, on that, you know, sort of the digital side of the business.
So talk about the experience as well? Are majority of your clinicians employed? Are they contracted? What does that look like? And then how do you improve their experience?
Yeah. The the vast majority of folks that we have are employed by best self here in the organization.
I think, a big pain point now for clinicians not only here, but I think, across the industry is the documentation burden. So we had a major Cerner go live here at the end of last year. Now we're at the point of trying to do some optimization there, on that new platform.
And then we're also talking to vendors on what we can do to alleviate that documentation burden. Certainly AI and augmented intelligent intelligence is a hot topic nowadays. So, it's been interesting to meet with some vendors to see what their offerings are. Decide where it might be most beneficial for us to deploy that type of technology And where you're going to get the biggest, you know roi obviously for that investment.
Yeah, it's interesting I didn't think we would end up talking about ai that much it comes up in every conversation but even in the Behavioral health space ai is creeping into that conversation as well, isn't it?
It is. It's creeping in, we're getting questions from our executive leadership and senior leadership saying, Hey, what can we use this, can we, implement chat GPT.
Right? The vendors are doing some cool things. Obviously, we went with a couple of them and they've had some different approaches. One of them the demo was great. They can, we, we had this mock visit that happened with two of our counselors. And it generated this great note.
Now, what was interesting, with that demo was just the content of the note and the length of the note that was created was much longer than what one of our staff would normally document, with a traditional counseling visit. So, where does that fit best? Does it fit best or work best for a counselor?
Does it work best for a doctor who's maybe doing a longer, health assessment with one of our clients? And then can you tweak that technology, to maybe have a shorter, more concise note? We've seen some other vendors in the space who will, have that ambient intelligence that generates sort of what sections of a note might be, and then you can sort of point and click and select what you want to pull into a progress note.
So we're seeing a few different approaches there and really just trying to explore what, might best serve, our staff to, reduce the burden and then, maybe help with retention as well if they know that they can, use some pretty. Cool technology here at our organization.
We can see we see it as a way to potentially retain folks as well
Yeah, and I think the other problem it addresses is, No offense to the clinicians who happen to be listening to this podcast, but they're not good clerical workers so even the same person if you go throughout the day their notes will look different and they will document different or they might even forget some things and the hope is that By having a, for lack of a better term a generative AI scribe, we're going to get more consistent notes, more complete notes, so that, we don't miss things and we're able to, because we have that consistent we're able to get to a higher level of data quality, I think, across the board and maybe, I don't know, unearth some insights around driving better behavioral health in the community.
I think so. And I think, there's only so many things we can streamline here, from a documentation perspective, because a lot of the stuff that we have to document is regulatory. Right. So, as much as we, we look at our templates and our notes and our EHR and say, where can we streamline some of this?
Sometimes you just can't because there's certain data that you need to capture, for for certain metrics or certain, regulatory, purposes. So, if we've exhausted all those possibilities, how can we then move to something like generative AI to, help those clinicians.
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📍 So let's turn inward a little bit and talk about your IS team and the things you're doing around IT operational efficiency and quality in that area. What are some of the initiatives You're looking at as either over the last year, or as we enter into the next year,
a big 1 is around lean culture.
So, in addition to the function, here at the organization, I also support our quality improvement in our population health function. So, we, as I mentioned earlier, we're looking to, leverage existing technologies and then see what we can, improve operational processes and efficiencies.
So we have some lean trained folks, certified folks in the organization. But we want to further embed that in the culture here. So we're getting ready to start a cohort of certified lean professionals this fall. That we're excited about. I think automation. Is another area that we're looking into.
So we're actually sort of redefining some job roles here at the organization. We have some folks who are really strong in the process improvement and the technology side and just, listening to the business, identifying where problems and maybe inefficiencies reside and then seeing where we can apply technology to, to help.
So, we're heavy users of the Microsoft power platform. And we continue to try and leverage the app to especially on the administrative side, reduce some of those burdens and those manual things that, folks are doing across the organization,
When I think of reimagining job roles, is that just happening as a result of the.
technology evolving or is that being proactive in terms of career growth and retention?
That's a great question.
Probably both if I thought about it.
It's really all of the above. I mean, that's a fantastic question. So, some of it has been a result of the past several months of staff changes. So, moving some people around into different roles it's career growth.
When I sit down and talk to folks here, two of my favorite questions to ask, always ask folks and find out are like, what are your strengths and what do you really enjoy doing? So we have really good people here and maybe they're not in a role or a job where, they're, leveraging those strengths and doing what they enjoy. How do we get them into that, into that position, we want to retain them, keep them here at the organization, develop them and, have them, find meaning in their work and, be able to impact, the clients that we serve in our organization.
So, yeah, it's a combination of trying to retain folks. See where we have gaps, that we need to fill. And then how do we get those people into a spot where they can flourish. , in my area where we have is and bi and quality improvements and pop health, how do we try and better collaborate, work together not be real siloed?
And all those things have gone into sort of, re-imagining how we. deliver these services here at the organization.
I'm going to show my ignorance a little bit here, but you have some building projects and new facilities that you're opening up. When I think of behavioral health facility, a traditional hospital, we would have all sorts of gadgets and gizmos and things connected to the wall.
And we'd have to think about, 10 drops into a room and high density wireless and that kind are opening your buildings a little bit. easier? Is there not as much of that requirement?
Yeah, I think it's fair to say that there's not as much of that requirement. We don't have, traditional like your biomed stuff that we're like a hospital is having to deal with.
But you're still your basics, as far as, connectivity and providing a good experience and, your access control video surveillance. We're in the process of constructing our new administrative offices and in our child advocacy center.
Here at the organization, that's a building that's scheduled to open next spring. So our, we're at the tail end of a capital campaign to move our Child Advocacy Center. And what that is it's a place for those who've been affected by children and families who've been affected by physical or sexual abuse and trauma to come and get support and services.
We're in a small facility now. We're not able to serve, everyone in the community who needs to be served. So we're, constructing that building to be able to move to a larger space. So that building will quadruple, the amount of clients that we're able to serve. We have some, I guess, maybe some unique technology that we put in there around sort of digital evidence and forensic, management.
We have a multidisciplinary team that works at that center. So it's mental health counselors, it's law enforcement, child protective services, victim advocates health professionals. So when someone comes to the center, they only have to tell their story once. So we have some technology there that allows us to, record those forensic interviews, manage that data, use it for investigations and securely share it.
with that, that multidisciplinary team.
So you're also opening a new crisis stabilization center. What is that location about?
Yeah, that's another large initiative here at the organization. That is a result of some major funding that came out of New York state. They awarded I think it was 12 grants to develop these crisis stabilization centers across the state.
I think four or five of them are in the downstate, New York city area, and then eight or so are up, in the upstate New York area. So, what the crisis stabilization center will do is provide a 24 by seven by 365 urgent response center, if you will. So if someone's experiencing like an acute mental health or substance use crisis or symptoms they can come to the center.
They can also be transported there by first responders. So it's essentially like a hospital diversion. Instead of someone having to go to the E. D. or to, like, a comprehensive psychiatric emergency program they can come to the Crisis Stabilization Center. What our staff there will do is they'll triage, they'll screen they'll provide counseling services, peer support services and then provide care transitions or linkages to those people who might come to the center.
We caught up last year and it was on the tail end of the mass shooting that happened in Buffalo. Give us an idea of what it looks like for your organization to respond to that kind of crisis.
Yeah, that May 14th shooting here in Buffalo from last year certainly a close to home.
Literally we have facilities just within a couple of miles of, that site there. So. We had within hours, had deployed staff to that area to support people, it was at a top supermarket there and in the community we had counselors who resided there for several weeks, afterwards, providing support there was a local library, that we were, meeting clients at, and then we were just meeting the community out of their homes as well, trying to support that.
The folks, coming out of that event. So yeah, it was something that we were heavily involved with and we're happy that we could, support the community.
Yeah, it's the work you and your team are doing is so important, not only from the crisis standpoint, but also just ongoing.
I, the people who struggle with mental health and just a, we know that it's a growing challenge within the United States. But we just don't see it, right? You don't see people with like a crutch or, walking with a limp or that kind of stuff. And it's still prevalent in there.
One of the things I wanted to ask you about with social determinants of health. It's one of the things that we keep talking about in the of fiscal health care. I'm curious how much S. D. O. H. plays a role in behavioral health.
I mean, it plays a huge role, right? Things like housing, food insecurity employment, right, are all pretty big determining factors when it comes to someone's, mental health.
So we were a lead founder Of an organization called value network back in 2018. It was us and three other behavioral health care organizations here in the Western New York area. And what value network is it's a behavioral health care collaborative IPA. Most folks are familiar with what an IPA would be.
Right? So it's an organization now that has over 70 partners, here in the Western New York area. It consists of behavioral health organizations, community based organizations, and local health systems, and what that organization is designed to do really is, improve health outcomes in the region through sort of integrating care improve health equity.
And innovation as well. So there's a lot happening there. A lot of our value based care initiatives are done in collaboration with value network. We have a new platform that's been around for about a year now called the community connector. And that's a social care platform that we're using for closed loop referrals.
So, these 70 organizations they're not all involved right now, but many of them are, can make referrals, receive referrals for individuals who need certain services pertaining to those sources of determinants of health.
Yeah, Is your organization focused on capturing new data elements in order to bring to bear?
I think what we find in health care is we don't have those points where we're asking specific questions around social determinants of health. And so sometimes we happen upon them and we don't necessarily have a great way to document it. We do if it happens at the right place, but if it happens at the wrong place, they just look at it and go, well, I don't know where to put that in the medical record.
it goes. Ar specific S. T. O. H. is there a good way of do the process?
We do collect a big part of the care th and it's also for some of the reporting that we have to do, for, state and federal reports for quarantine, we ask that information. So, yeah we already have a lot of data on healthcare, as and then this just adds to the data.
So we track that one of the ways we documented are just to, diagnosis codes, Z codes in the record. And then, there's some other. Sections within the HR where we have to document
that as well. That makes sense. And so from the area of analytics, data and analytics and research are you participating in some of that, like really diving into the data to find trends and things that are going on in your community?
internally here at best self. We have a great data analytics program. So we look at, all sorts of data, even outside of the HR, right? We are also a certified community behavioral health clinic. That's a program that's in its seventh year. It's a federal program that was designed to integrate behavioral health and physical health provide easy accessible care.
So as part of that, CCBHC program. There's a variety of reporting requirements that we have, and some of that's related to outcomes. So we'll leverage, we'll leverage that, data here in house. We're also talking, on the value network IPA side of things.
Just recently is, how do we develop, KPIs and metrics to look and really see if, the work that we're doing is having an impact on the health of the community. We have contracts. Value based payment contracts with four or five, managed care organizations. So we do have data there.
Most of that is HEDIS, HEDIS metrics that we can use to see whether, we're seeing improvements and things like medication adherence and follow up after hospitalization and initiation and engagement or treatment.
All right. Closing question. Yeah, I'm curious if you were to project out five years looking at behavioral health.
Is there a technology you think that will impact behavioral health or how do you see it changing the way we deliver behavioral health, say, over the next five years,
future futures questions are always the most difficult because. There's so many new things emerging even as we speak and
we know five years ago, there were, we didn't envision a lot of the things happening today that occurred today. So it's tough. But I think, the augmented and the artificial intelligence is.
Certainly going to be heavily embedded in the next five years. So we talked about, reducing documentation burden. I think other opportunities are around, modernizing sort of the access and the intake process. So, can we have. Bots that, deal with someone who's, reaching out to us as an organization can collect their information, can get them scheduled for an appointment can get their health history, their insurance information to save time, when they come to see us and reduce the amount of time that it might take for us to get them into services.
So hopefully we see some some advances, in that area.
Yeah, fantastic. Kevin, I want to thank you for your time and thanks for sharing your experience with the community. It's greatly appreciated.
Bill, it's great being here. Thanks for taking the time out to speak with me and a little bit more about BestSell and what we're doing here in Western New York.
Love the work that you're doing and I appreciate your time. Thank you.
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