Behavioral health teams are typically built around psychologists, therapists and psychiatrists. Nashville, Tenn.-based Centerstone is adding engineers to the mix, and CEO C.J. Davis said they are helping the organization tackle problems clinicians have long solved by instinct, from waiting room queues to missed appointments.
Mr. Davis, who has led Centerstone for about a year, described the work during a fireside chat at Becker’s Fall Behavioral Health Summit. Centerstone describes itself as the nation’s largest nonprofit behavioral health provider, with $1.2 billion in annual revenue. He said the field still leans too heavily on intuition and personal connections, and Centerstone is trying to replace both with data.
Fidelity, measured
Centerstone uses AI agents to score how closely therapists follow evidence-based treatment models, known as fidelity. The agents review progress notes and listen to sessions, then assign a score. The work sits inside Centerstone’s research division, which has about 200 people and also covers clinical quality and outcomes, training and education — including a 10-slot residency program — and a patient safety organization.
“When we have a bot listen in on a therapist providing care to fidelity, they have about an 85% chance of that person getting better. And when they don’t, it’s about a 50% improvement in symptoms,” Mr. Davis said. “And that data alone suggests that maybe it’s not coming up with new fidelity models, but standards of care that can make a difference in different diagnostic classes.”
Centerstone wants to build on those findings. It is recruiting a chief research officer, plans to publish more, and wants to form a research consortium of organizations that would open test clinics across the country and compare outcomes data to set national standards of care.
Engineers in the waiting room
Centerstone is also bringing engineering into behavioral health operations, an idea Mr. Davis credits to his son, an industrial systems engineer now pursuing a PhD in engineering.
“I really had an awakening from him,” Mr. Davis said. “He started to show me that there’s a math formula to solve for staffing patterns. I thought, wow, there’s a math formula for staffing patterns and queuing people up in a waiting room. I never would have imagined.”
The organization took on 15 University of Missouri engineering seniors for a semester-long capstone project on waiting room throughput. That led to three efforts now underway:
- Clinic sentiment scores. By scraping and analyzing online reviews from sites such as Google and Reddit, Centerstone now generates a sentiment score for each clinic, letting leaders compare clinics against one another using data the organization once dismissed.
- Case manager deployment. A model prioritizes visits for Centerstone’s 1,000 case managers using variables such as recent hospitalizations, chronic conditions and time since the last visit, then routes them to homes based on patient complexity rather than individual judgment.
- No-show prediction. AI engineers are working to predict which patients will miss appointments. Patients who miss one appointment in a month tend to miss a second, Mr. Davis said, which hurts both care and finances.
What’s still challenging
The biggest constraint is data infrastructure. Centerstone runs seven EHRs, and even with a data lake, getting clean and accurate data is challenging work.
“It’s like building a ship. You just can’t build the ship tomorrow. Even though you know the water’s coming in,” Mr. Davis said.
The goal, he said, is a system where getting someone into care no longer depends on who they know.
“The fast track for services in behavioral health is [to] call your local therapist that you know and say, ‘Hey, I’ve got somebody that needs [to get] in fast. Can you get me in?'” Mr. Davis said. “That’s not throughput. That’s called luck. And we can’t depend on luck in behavioral health when communities need us.”
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
