In the behavioral health and substance abuse treatment sector, outcomes and profitability are influenced by a multitude of factors. Let's delve into some of these issues:
Access to Care vs Profitability: In behavioral health and substance abuse treatment, ensuring access to care for all those in need is a pressing issue. However, providing that access, especially in underserved areas or to uninsured or underinsured patients, is financially challenging for providers. Providers must navigate the complexity of being a good community partner (e.g., helping treat patients from local referral partners) while meeting budgeted expectations (e.g., volume, payor mix and cost containment). As you pursue increased volumes, it can be difficult to hold the line with the integrity of your milieu because there is a direct correlation between the socio-economics of your patients (i.e., payor mix) and the clinical acuity, and often times, you must pick one or the other.
Quality of Care vs Cost Efficiency: High-quality care often leads to better outcomes in behavioral health and substance abuse treatment. This includes evidence-based treatments, individualized care plans, and long-term follow-up. However, these approaches demand significant resources - both in terms of time and money - which can strain profitability. Balancing high-quality care while maintaining cost efficiency is a monumental challenge. Treatment centers often find themselves having to compromise amenities (e.g., recreational groups, nursing groups, etc.) and focusing on only what is required. This default thinking compromises any competitive advantage and the volumes end up being a reflection the patients that live nearest, ish.
Long-Term Treatment vs Short-Term Profitability: Substance abuse and behavioral health disorders often require long-term treatment strategies for successful outcomes. But longer treatment durations can be costly and may not be fully covered by insurance companies, impacting short-term profitability. On the other hand, shorter treatment periods may not provide lasting benefits to patients. Herein lies the essence of our challenge. Provide good enough treatment that meets the standards, helps patients enough and always try to do right by people. It costs a little more to do a little more and that is where treatment centers get stuck. We are often competing for the same staff with the same resources and also trying to differentiate.
An Example: Stepping Down to a Lower Level of Care
Facilities often budget their projections expecting a percentage of patients to step-down from Inpatient treatment to Partial Hospitalization or PHP. This is both clinically recommended (the same as you would rehab an injured limb) and a financially viable service line. The initiatives created to enact this program are often left to trusting the staff to "sell" the program to patients to convince them to try it as they are about to discharge, which rarely happens. Instead, it must be built in as a part of treatment from day one and reinforced by the treatment team as an expectation rather than an option. We still need to help overcome the social determinants but its often used as an option rather than a requirement.
In conclusion, there's often a complex interplay between outcomes and profitability in the field of behavioral health and substance abuse treatment. Providers must navigate these challenges carefully to ensure both effective patient care and financial sustainability. We must think of the models we create, the incentives and efficiencies as it relates to what is best for patients. Thinking that the staff will have enough buy-in to mold your culture is a mistake. Treat everyone well, be strategic and understand the psychology how people work. Put people in the right positions that compliment their skills sets and hold them accountable.
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