Why WellSpan's biggest behavioral win is in the ED

Despite the financial headwinds facing many hospitals, York, Pa.-based WellSpan Health is charging ahead with new behavioral health initiatives and partnerships.

Becker's sat down with Kenneth Rogers, MD, vice president and chief medical officer for the behavioral health network at the eight-hospital system, to discuss the organization's biggest achievements in the behavioral space and how its service lines continue to evolve.

Dr. Rogers also previously discussed WellSpan's Behavioral Health Emergency Response Team program, or BERT, a group of nurses, security and behavioral employees trained to respond to incidents of workplace violence and de-escalate the situation. Since its inception in 2019, there have been more than 3,500 BERT calls documented across the health system, with about 75 percent of those situations successfully de-escalated.  

Question: You've been in your position for just over a year. What has surprised you most about behavioral health at WellSpan?

Dr. Kenneth Rogers: I came from South Carolina previously, where behavioral care is state run versus county-focused in Pennsylvania. That alters our strategies because we have to think about how to provide care to populations that are county sized. In WellSpan's case, those strategies are spread across five different counties. A good example of this is with crisis services. We're a vendor for two of our counties but not three of the others, so we have to figure out where to send people and how to get them access to services, especially on the ambulatory side.

Most states generally focus on behavioral care rather than individual counties. With school-based services for kids in South Carolina, we could centrally plan how to deploy services to all schools in the state. For WellSpan, you're talking about 100 different school districts that each are doing something a bit different, so our strategy is geared to very local, specific entities.

Q: During your tenure, what do you think has been the biggest behavioral "win" at WellSpan?

KR: The biggest win for us has been a focus on our emergency departments. In the past, we had an approach that was largely "general hospital" with a possible consultation to psychiatry. Now, we've built out behavioral health units in our emergency departments across three of our hospitals. That allows us to focus operations in the ERs; we're getting to folks a lot quicker and we're medicating a lot faster. Our staff in these areas are all masters level-trained therapists, along with nurses, nurse practitioners and psychiatrists. This aggressive treatment management and our behavioral disposition has really helped us go down this path, which is really showing dividends at this point.

Q: Where are you collaborating with other providers in your communities to create better access to behavioral healthcare?

KR: One of the things that we've tried is partnering with our local FQHCs. Some of those health centers in certain areas are much stronger than others and provide really good behavioral health services. We've tried to figure out how to send some of the folks that have chronic medical issues, and may also be uninsured or have Medicaid, toward services available in an FQHC versus in a health system like ours. On the other hand, we are really focused on some of the more seriously mentally ill individuals in our system that we have a lot of resources geared toward for getting them into the right place.

Q: Do you see any emerging treatments or therapies on the horizon in behavioral health that you think health systems should be preparing to integrate into their service lines?

KR: We're starting to see more biological treatments such as transcranial magnetic stimulation being utilized in more and more systems. We're finding that either people don't want to take medications or medications are not effective for a lot of people, so trying to expand TMS services is a big change. 

Q: Final thoughts?

KR: Health systems have taken two approaches to behavioral health: trying to get as far away from it as possible or leaning in and making it work at a critical service. We've done a lot in this space through telemedicine, with about 60% of our visits conducted virtually. At first, I had wondered how this was going to be accepted, but I've found that it's actually increased access to care and folks are more willing to engage because they don't have to leave work to do it. The other thing that we have really leaned into more recently is collaborative care, and we're working with Concert Health now to roll out a collaborative care initiative at the beginning of next year. Though we are always trying to be more efficient within a relatively constrained budget, we're continuing to expand even with the headwinds that are out there.

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