Behavioral Health and Addiction Services

A two-hospital health system based in Providence, RI with 400 beds and net revenue of $330M was challenged with an underperforming $30M behavioral health (BH) program. The service line included 110 acute inpatient (IP) beds across two hospital campuses, ED services, and IOP, PHP, and outpatient services. IP services included acute inpatient, memory disorders, and dual-diagnosis and addictions programs. Ongoing challenges to BH services included low census, poor provider productivity, lack of program integration across the two campuses, high staff turnover, and weak clinical leadership. David Kobis was tasked with assessing the service line, developing improvement strategies, and implementing the changes. Strategies included the following: 

• Refreshing strategy and aligning clear performance metrics; organizing the programs under a single, streamlined management structure; and creating a management system that tracked outcomes and improvement strategies.  
• Growing the service line by $10M (33%) to more than $40M and increasing patient volumes by 35%.
• Recruiting new providers, including an integrated system Executive and Medical Director over both campuses, implementing new coverage and compensation strategies (including telemedicine), restructuring contracts to include productivity incentives, and expanding use of mid-level providers.
• Integrating BH services across the two hospital campuses, including medical and administrative leadership, clinical services, and provider coverage. 
• Developing a novel 20-bed Long Term Behavioral Health Unit (LTBHU) in partnership with the Rhode Island Department of Mental Health with the express purpose of transitioning long term patients housed in state psychiatric hospitals to a community hospital for treatment and stabilization, and ultimate transition to  group homes or other community settings. Within two years of startup, the LTBHU Program was at full occupancy with a waiting list and had a 60% successful transition rate of patients transferred to community settings.  
• Growing sub-specialty services such as ECT by 40% and achieving status as the first hospital in the state of Rhode Island to gain credentialing for mid-level providers (APRNs) to perform ECT procedures.