Remember that one brilliant student in school that always got the maximum score on the test… thereby blowing the curve for everyone else. This past week I traveled to Charlotte to speak at an event sponsored by Carolinas HealthCare, and Carolinas is that student when it comes to behavioral health.
I spoke alongside Carolinas’ Dr. John Santopietro at a HEALTHWORKS event attended by over a hundred employer leaders. Dr. Santopietro is a nationally prominent healthcare leader educated at Harvard Medical School and Yale and recently quoted in the Washington Post on healthcare reform and parity. HEALTHWORKS is a division of Carolinas HealthCare, which is one of the largest non-profit organizations in the United States with 40 hospitals, 900 care locations, 60,000 employees and nearly $9 billion in revenues.
After the morning event, I had the opportunity to visit and tour The Mindy Ellen Levine Behavioral Health Center in Davidson and learn more about Carolinas HealthCare. During the short 30 minute drive north of Charlotte, Dr. Santopietro related the history and described the “clinical soul” that Carolinas has infused into their culture and programming. My anticipation built as I imagined what this would look like capitalized.
In 2012, Carolinas launched a behavioral health service line, and hired Dr. Santopietro as Chief Clinical Officer and Martha Whitecotton as Senior Vice President. Their decision to go all in was driven by several factors.
- The shift of hospital systems from Curve 1 (fee-for-service) to Curve 2 (value payment/population health) is accelerating (more here), and a mental health diagnosis, like depression, can increase the cost of care by 60 to 70 percent.
- The impact of people waiting in their Emergency Departments for days because of mental health and addiction challenges. Carolinas’ baseline average delay was 40 hours, and they believed they could improve the experience and performance by investing in behavioral healthcare.
- Carolinas already possessed key behavioral health infrastructure through a no-cost contract with Mecklenburg County. They had not previously integrated these programs into their larger enterprise or invested materially in their advancement, but they had experience with physical health integration, telepsychiatry and bed placement systems.
The speed with which Carolinas has created a world-class system is dizzying. As we left the main road towards their Davidson facility, I assumed we had taken a wrong turn. Nestled in a perfect rural setting surrounded by woods, the facility looks more like a resort.
“Does this feel like you are in a psychiatric hospital?” asked Dr. Thomas Gettelman, Vice President & Facility Executive, as we toured the 66 bed, three unit program. He was right; I’ve never seen anything like the thoughtful attention to detail that this program has at every step.
The covered sally port for drop off has a wonderful mural on the inside wall that transforms an area that would otherwise feel imposing. Dr. Gettleman talked about their intention to create a facility characterized by safety and privacy while being richly trauma informed. After I asked to photograph an amazing granite rock surrounded by trees just outside the window and adjacent to the cafeteria, Dr. Gettelman asked another staff member to assist, as it required two employee pass cards to exit. It dawned on me that the combination of approaches would yield a different set of outcomes related to AWOL challenges:
- They have not experienced a single elopement from the facility
- What’s more, the readmission rate is less than half that of comparable facilities
- And, 21% of discharges occur on the weekend as a result of a seven on/seven off scheduling pattern for psychiatrists and clinicians (see write-up quoting Medical Director Dr. Cheryl Dodds here)
While most individuals convert to a voluntary status for the services at Carolinas’ Davidson center, a collaborative approach with the Chief Judge, public defender’s office and the county magistrate resulted in tele-court for those individuals on involuntary commitment (IVC).
A family practitioner provides integrated medical coverage during day-time hours. Clinicians are trained in CBT and DBT with a strong focus on recovery. And, Peer Specialists on each of the programs units have replaced some of the traditional technician roles to provide coaching, peer supports and post-discharge navigation (see Carolina’s Peer Support Specialist Joe Swafford’s YouTube presentation on hope and recovery). The design has been nursing and physician driven with a strong focus on the Patient and Family Advisory Council, and the results show!
In addition to the Davidson center, Carolinas operates:
- 24/7 crisis triage call center in Mint Hill that manages approximately 250,000 calls per year and operates a bed patient placement system
- Expanded telepsychiatry program credited with a 50% reduction in ED wait times
- Integrated virtual mental health care at primary care sites (see Washington Post article)
- Another behavioral health campus in Charlotte with inpatient, crisis stabilization, partial hospitalization, Assertive Community Treatment, and medication clinics
Dr. Gettelman spoke with pride about how hospitals become part of the soul and essence of a community, and in this case it is a behavioral health hospital in Davidson. It seems that top leadership at Carolinas HealthCare feel that way, too. Their 2015 Impact Report prominently highlights their innovative approach to behavioral health. In fact, it’s first before key sections on ICUs and cancer care.
Carolinas is truly blowing the curve, and they are doing it with a combination of strong investment, medical and clinical expertise and heart that will be changing the way behavioral health is delivered for decades to come.