Michael Genovese, MD, chief medical officer of Franklin, Tenn.-based Acadia Healthcare, one of the largest behavioral healthcare providers in the U.S., joined Becker's to share the company's philosophy, treatment model and more.
Question: Acadia has established itself as one of the leading providers of behavioral healthcare in the country. What do you think has contributed most to your success?
Dr. Michael Genovese: So that's a big question. Acadia started back in 2006, I think it was with a very small handful of hospitals. I was able to join their team. I started at Sierra Tucson, which was acquired by Acadia pretty soon thereafter. I started there in 2014. So I've been with three CEOs that Acadia has had.
One of the things that I will say is that all three of them are very smart, dedicated people. All three of them were very patient-centric. So there was no idea that good patient care and good business were mutually exclusive. I think that Joey Jacobs, Debbie Osteen and now Chris Hunter all see that they're actually aligned, that if you provide really good patient care, that their business grows. People want that kind of care. The thinking that happens at the top tends to flow down, and so does the culture of Acadia. Everyone recognizes that we're not making widgets, everyone recognizes that we need to provide really good care and everyone recognizes that if we do that, it gives us the best opportunity to grow. What flows from that is the examples of the growth levers that are observable.
What comes to mind first is our joint ventures. Other health systems and very reputable health systems are coming to us — or we're engaging in competitive processes. Systems tend to focus more on things like what you would expect; they're focused on cardiology and surgery and those sorts of things and in the acute hospital setting, they might have a psychiatric floor, which really isn't the best environment of care for patients. A lot of time they don't have room for a patient in need of psychiatric treatment. Recognizing that they needed help with all sorts of things and wanting providers who have the expertise with which they are willing to associate their name would look to us, and that's why we've been growing so rapidly through joint ventures. We have seven that are active now on our site, [and] there are others that have been announced, like Henry Ford in Detroit and Geisinger in Pennsylvania.
I've engaged with those teams. When they're looking for a partner, they all bring their clinicial team. They bring as many clinical people to the room as they do business people, and their reputation is on the line as much as ours. The sort of philosophy of Acadia … comes to the forefront during those meetings. The other part of it is that our operators, the people who are everyone from our senior vice president of operations, John Hollinsworth, down to the group presidents, the division presidents, the hospital CEOs. It's hard to think of someone who is not highly motivated, who's not hardworking and smart and doesn't carry that same philosophy of patients first. I think that that allows us to grow through that expansion because people are referring people to our facilities. It allows us to grow because our balance sheet is strong, we're actively building and active in mergers and acquisitions.
Q: What have you learned from Acadia's acquisitions?
MG: We acquired some hospitals in Missouri, we acquired a hospital recently in Chicago. What we're finding now is that these facilities that have been standing alone on their own, doing the best they could, are now benefiting from sort of the institutional strength of our corporate office and the collective knowledge that we have. So they're getting much more support than they've had. They're getting support both on the clinical side, because we have all sorts of people at the corporate office with medical training and knowledge of evidence-based therapies that can provide resources to them, but we also have human resources and recruitment and accounting and everything that they didn't have before. So that sets up those acquisitions to grow in a very successful manner.
Q: You mentioned the philosophy that's very prevalent in your work. And is alignment with that a factor that you look for in venture partners?
MG: I view the joint venture process as we're interviewing them as much as they're interviewing us. We're gonna grow and if someone doesn't have or doesn't share our philosophy and we know that if not going to be a good fit, then it's better to recognize that at the beginning and move on so they can find a better partner and we can find a better partner — because not everyone's philosophy is the same.
Q: You mentioned you provide both clinical and administrative resources. In healthcare, there seems to be a lot of instances of administrative issues leading to headaches for both patients and providers. How does having a solid administrative team affect care?
MG: When you think about it, a very small hospital system or a single hospital that's acquired, they just don't know what they don't know. So we bring all sorts of experience — everything from patient acquisition to the intake process streamlining, which is better for both the facility and the patient. You don't want a patient waiting for hours. It should be a very quick process. The paperwork that needs to be done is done. We make sure that everything is correct and we get them into a therapeutic milieu as quickly as possible. If you haven't had the experience of running the large number of facilities that we have, you just wouldn't know that should be the standard. They're learning from us and we learn from them pretty quickly. When we do our due diligence, we already know what we're getting into, we know what areas of opportunity they have, and then we move quickly to try to provide the resources that they need in order to optimize their operations.
The other thing is that we're fairly unique in that we have such a heterogeneous patient population. You have lots of data, lots of systems that treat patients with substance use disorders. There are lots of systems that treat patients that need acute inpatient hospitalization. There are separate systems that treat outpatient opioid use disorder. I think we're the only ones who do all of that, and child and adolescent residential treatment. We're the largest freestanding pure play behavioral health system. We have such a broad range of patients that we treat, so we're able to grow because we treat almost everybody who needs any type of behavioral health care.
Q: How do you think the fact that you treat patients on each step of their care process, not just like those in crisis, has helped your care model?
MG: I think it brings us in line with our brethren and other areas of medicine. My dad was a cardiologist. So if a patient came to his office with chest pain, he could send them to the hospital system and where he was on staff right, go to their emergency room, they would go from their emergency room up to the cardiac cath lab. Have an angioplasty, step down within that same hospital to where you recover, then step down to maybe then a regular floor and discharge and then get cardiac rehab at the same hospital system. They can treat them there, all in one place and get whatever other services they need. Maybe there's an ancillary finding that they have — not only did they come in with a heart attack, but they came in with some sort of gastrointestinal problem. So there's another part of the same system that could address that. In our system, we have patients who are admitted with a primary diagnosis, say major depressive disorder — but then we also know that they have a substance use disorder. So acutely, the suicidality can be managed in our acute psychiatric inpatient hospital, then we can provide the follow-up care that they need to treat their substance use disorder in one of our outpatient programs or we can treat them in our comprehensive treatment center. We have all the tools in place to really treat patients with a high degree of expertise and treat them comprehensively.
What we're looking to do is create a full continuum of care the same way NYU or any major hospital system does. We want to offer all the services, we want warm handoffs, we want the professional that's going to be treating you at the lower level of care be the same as who is at when you require a higher level of care, because disease states fluctuate. Patients want professionals speaking with each other, they want to know that the people doing intake already know something about them so they're not just being bounced around from one place to another, which is the way things had been done in the past.
Q: How do you think the spectrum of care available at Acadia affects patients?
MG: Creating the full continuum of care allows us to operate. It allows us to operate more efficiently, and it also provides the patient with a better experience. In all of medicine, I think that the patient experience is really important, particularly in psychiatry, it can influence the outcomes. We are measuring the outcomes of our patients. Just measuring outcomes can influence how well someone does, because then patients know we're keeping track of it, we're utilizing it. We don't have a red blood cell count that can measure your depression or your post-traumatic stress. But we do have validated rating scales that we can use and share. So patients look at their scoring here and it gives them something to look at in black and white, something tangible, which allows them to benefit in a more meaningful way from the treatment.