November 16, 2023 • 36 mins
In the second episode of "Listen, Mental Health Matters," Brian Giebink, HDR’s behavioral and mental health practice lead, has an in-depth discussion with Tom Kozaczynski, chief advancement officer at Compass Health. Their dialogue covers the evolving post-pandemic landscape of mental health care and the challenges faced by Compass Health's diverse clientele — the vast majority of whom are experiencing poverty and navigating care through Medicaid. Tom highlights the critical workforce shortage that the behavioral health field is facing and Compass Health’s strategic use of telehealth to enhance patient care and increase accessibility. The conversation also delves into the organization’s commitment to evidence-based care and its advocacy for a more sustainable funding model. Tom also shares exciting plans for a new facility that will reshape the delivery of mental healthcare for the communities that Compass Health serves.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:07):
I'm John Torek, and I'm Danny Sullivan, and
you're listening to Speaking of Design, bringing you
the stories of the engineers and architects who
are transforming the world one project at a
time. Today, we bring you another episode of
a special podcast series on behavioral and mental
health called listen, mental health matters.
(00:27):
As part of this series, Brian Giebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebink, and I hope that by
listening, this series helps us consider new perspectives
(00:50):
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community. And now Brian's conversation with Tom
Kozachinski,
chief advancement officer at Compass Health in Northwest
Washington.
(01:14):
Alright. Well, welcome, Tom. This is Brian Geebink.
I'm the behavioral health practice leader at HDR.
And with me today is Tom Kozachinski
with Compass Health. And he's here to share
a little bit about his career and his
history of Compass Health, but more importantly, what
Compass Health is doing and what they're up
to and how they're improving the lives of
so many in their community
(01:34):
where they're involved. So, Tom, would you like
to say a few words, introduce yourself? Sure.
Yeah. Thanks, Brian, and thanks so much for
having me here. I'm really appreciative to take
the opportunity to talk about what we're doing
at Compass Health. So, again, my name is
Tom Kozachinski.
I'm the chief advancement officer at Compass Health.
I oversee two distinct business lines, that being
(01:55):
the marketing
and communication side of the business and then
also the fundraising side.
Been at the agency now for just a
little bit over ten years. So have a
long enough history to have seen some of
the the evolution of agency, evolution of mental
health care. So I'm very, very pleased to
be here with you today. Really happy to
have you. So do you wanna tell me
about a little bit how long you've worked
(02:16):
with Compass Health and why you joined the
organization?
Yeah. Absolutely. So like I said, just a
little bit over ten years. As I mentioned,
within the two business lines that I oversee,
my education history has generally been in the
fundraising sector.
I did a few other things before coming
to Compass Health. I worked in the arts
for a little bit, in higher education, and
social services.
(02:36):
But what really drew me and what really
draws a lot of people in this work
is a really close personal connection to the
mission. And that's certainly true for me,
both with familial mental health issues
and frankly, some of my own too, and
understanding
how challenging that is for folks who are
of means and have access
to then layer on top of it the
(02:57):
fact that Compass Health serves predominantly individuals
that who are on Medicaid,
many barriers
to care, be that food insecurity,
transportation,
you know, you name it. There's
the challenges are really compounded
when you're living in that in that scenario.
So I have a very, very close deep
connection to the mission. I live in the
community where Compass Health provides services. That's really
(03:20):
important to me too. For the record, where
we are located and where we operate is
in Northwest Washington,
North Of Seattle, 5 counties primarily,
Snohomish, Skagit,
Whatcom Island, and San Juan County. About how
far is that from Downtown Seattle? So our,
headquarters is in Everett, Washington.
So approximately 20 miles north. Everett's probably most
(03:41):
known for Boeing, but we don't serve King
County where Seattle is located. So we start
in the next county north and go all
the way up to the Canadian border. So
can you tell me a little bit more
about Compass Health? What is it, and and
what do you do there specifically? We are
one of the state's largest mental health providers,
primarily serving on Medicaid. We serve approximately 12,000
individuals in our five county region.
(04:02):
Really span, as far as geography is concerned,
both urban and very rural environments. In fact,
we call some of those some of those
offices are located in San Juan County, which
is island based frontier.
So we have both a wide geographic
reach and a good mix between urban and
rural.
Services range anything from general outpatient treatment all
(04:25):
the way into inpatient and voluntary treatment,
serve
both adults, older adults, youth, family, and children,
specialized programs that, you know, that really
augment and serve our community to the fullest
possible capabilities. So I'm talking things like camp
programs for kids that are specialized for our
youth, close alignment with law enforcement through partnerships.
(04:48):
So a large organization both in scope and
size. I think we're now over 700 FTE,
approximately $72,000,000
budget, 20 plus sites in those five counties.
That's really big. And you're you're able to
to manage all of that pretty well. I
think just like any large health care organizations,
there are, of course, challenges, and some of
those we can talk about. But I think
(05:09):
from the perspective of our impact on the
clients that we serve, I think we do
the best job that we could possibly do
and and really uphold the dignity and respect
of those that we're serving. So That's great.
That's really great. And why did behavioral health
health care become your calling? Why why do
you do this work, and what what drives
you personally? Yeah. Absolutely. So, yeah, I mentioned
a little bit on the personal side. I
think also though in the ten years that
(05:31):
I've been at Compass Health, there's been so
much change, and it seems to be
accelerating in pace. And I'm framing that in
a positive sense. You know? There's just there's
so much that needs to be done,
both practically speaking from a service delivery model
and the ways that we need to be
advocating for for change within the system that
then ultimately helps the people that we serve.
(05:53):
And then from a physical plant and our
buildings, there is a very quick shift that
needs to happen to making sure that we're
providing the facilities that are conducive to care.
For a lot of our history, it's been
anything that we can get to make buy,
and and that has worked for a long
time. I mean, we're a 20 year old
organization.
But if we're gonna be viewed as, you
(06:14):
know, primarily as a health care agency,
really partnering with other health care partners,
then we need the facilities that reflect that
same level of care, level of compassion, dignity,
and respect to the people that we serve,
their families, and then also to the people
that work for us. Frankly, I could go
do the type of work I'm doing at
any nonprofit, any university, any hospital.
(06:35):
I mean, there's someone like me at all
those places, and I could probably just go
do that work somewhere else. But I do
it at Compass because I see such a
bright future for the agency and for the
field in general. So many organizations have a
series of key moments that define who they've
become and why they do what they do.
What was the moment or moments that shaped
Compass Health into what it is today? Well,
(06:56):
there's a few. As I mentioned, a 20
years old organization
just out of interest for folks who are
listening. So we actually first started as an
orphanage
here on the Pacific Northwest serving youth whose
families, particularly fathers at that time, were killed
offshore fishing. You know? So kind of an
interesting
piece of history. The reason I mentioned that
(07:17):
is because it's important to note that serving
youth and families has been really a kind
of a core tenant of Compass Health and
continues to be.
But as far as how we've gone to
where we are now, I think or you
can point to a few key things. So
the Community Mental Health Act of 1963,
signed by president John F. Kennedy,
really paved the path for an organization like
(07:40):
Compass to really start the mental health aspect
of of our work, so moving away from
the orphanage piece of our history, which I
just talked about. But because that led to
a pretty large deinstitutionalization
of folks, we had to provide services
that they otherwise would have received in the
institutionalized setting in the community. So that is
really where Compass Health's mental health piece starts.
(08:03):
Now
through that, Compass Health has not always been
as large as we are. That has happened
through a number of mergers and acquisitions to
really increase our scope and scale
to be able to provide the full continuum
of care. But our most recent merger and
acquisition was just in 2013
with with Whatcom County, which added our fifth
(08:24):
county to our service area. So it's a
big part of our history. It's allowed us
to provide a full scope in the continuum
of care than not being too healthy or
too sick to leave Compass Health. And that's
true within the counties. It's also true within
the region because we now have a scope
and scale that allows us to do that
and, frankly, allows us to negotiate terms with
our payers that are favorable or at least
(08:46):
moving towards favorable. I'm not gonna at all
imply that they're where they need to be,
but it gives us that ability.
I think the third thing I'd mentioned is
the Affordable Care Act, where it opened a
huge amount of individuals,
who previously were not Medicaid
eligible to being a Medicaid eligible. So for
a long time of our history, we knew
there were community members out there who needed
(09:08):
our service, but they were frankly unfunded.
And it's really hard. I think most folks
in the health care setting will agree that
it's hard to find ways to provide services
to completely unfunded folks.
And then the last thing I'll I'll mention
as far as your question's concerned, I think
now
is the focus on
providing facilities
(09:28):
that really are tailor made to the type
of work that we do, that are future
focused, state of the art for the care
that we're providing,
and
allowing those spaces to communicate the dignity and
respect to the folks that are receiving services.
Again, I I need to mention that the
overwhelming majority of the people we serve have
all sorts of life circumstances that create barriers
(09:50):
to entry, so we want them to come
to a space that that feels good for
them and their family.
And then there is a significant workforce shortage
crisis right now, particularly in our field,
and it's hard to recruit individuals
already for this very challenging work when they
have an office space that doesn't
make them feel
respected and valued themselves. Right? So I think
(10:12):
that that is this is a pivotal moment
right now that we're in, showing the community
that we can do that. Just a quick
note, because some folks may be wondering, oh,
why haven't you been doing that already? In
our field, 80 to 82¢
of every dollar of our our budget goes
to
hiring and retention.
And that leaves a very, very small margin
(10:34):
for massive capital projects like the one we're
gonna talk about. 82¢ per dollar is is
a lot to spend on on that staffing
or retention. How do you afford the capital
expenditure? I think that's that's a really interesting
conversation to have. So next question we wanted
to ask. So what what are you striving
to provide for the people in the communities
that Compass Health serves and what do they
need most right now? Yeah. I think that's
(10:55):
a timely question. And there's a few things
that come to mind.
I'm sure nationwide, you've heard that there's a
shortage of beds, quote unquote beds for folks
in mental health crisis. So part of what
this facility will do is there will be
32 beds in that facility. 16 of them
are in our evaluation and treatment facility.
So those are beds for involuntary treatment. We're
(11:17):
actually adding to the 16 we already have
in the community.
And then there's also a 16 bed crisis
triage facility that will be in this building.
That is a voluntary program, of course, with
rules and stipulations when you're there. But the
reason I mentioned those two, you know, from
the beginning of this conversation is that those
really
integrate most with the sort of social and
(11:38):
healthcare fabric in the community. I think a
lot of folks think, and rightly so in
some situations, that the emergency room at your
local hospital is a de facto mental health
crisis center, which actually it shouldn't be. Certainly,
there is people who are in mental health
crisis that have a serious health issue that
needs to be addressed. But the ER is
not an efficient use of resources for a
(11:59):
lot of reasons, and, you know, hospitals should
be focusing on what the ER is really
intended to do. Plus, a lot of the
times, those, individuals are interacting with our law
enforcement and first responders. Again, is that the
most efficient way of of providing services by
tying up a police officer or a medic,
that needs to sit there in the ER
until someone's admitted? I think we can probably
(12:20):
agree that's that's probably not the case.
And so I think for our community, particularly
because this facility is serving the most intensive
side of our spectrum of needs,
I think that really allows us to provide
those services through partnership,
ensuring that we're supporting the health care system,
supporting
the first responders and other community partners with
(12:42):
those services that they need, and
doing so in a in a really efficient
financial
model. Right? Because I think I think we
can and here located in Seattle, and I'm
sure this is the case in most urban
settings, I mean, the need is out there.
It's pretty it's pretty visual and and obvious.
And so I think I think that's probably
(13:02):
what I would key in most as far
as what this facility and what Compass Health
is really focused on is is providing those
making sure that those services are available
community wide. So
It's really great. And I think that's a
might be a good segue into the next
question. What do you do really well, and
what do you think you're doing differently than
your peers? Yeah. I think, as I mentioned,
particularly where we're located,
(13:23):
partnerships are a huge part of what we
do in our service model. I think most
folks have identified that replicating what Compass Health
does is pretty complicated and challenging.
And likewise, replicating what, let's say, I'll use
an actual partner like the library system. We're
not gonna become a library and a mental
health partner, and they don't wanna necessarily be
serving mental health folks, but there's crossover in
(13:44):
in both those areas. And so I think,
for us, what we've done really well is,
listen to the needs of our other partners
in the agency, find ways where we can
utilize our core competencies
in mental health and provide services to to
our other nonprofit partners. That's something we do
regularly,
either through actual physical collocation or we have
a Compass
(14:05):
Health clinical staff person on-site at another nonprofit,
or we provide outreach programs
where we have regular presence in the community
where our clients and our people are interacting
in other ways within their life. So the
library is an actual example. For instance, in
Bellingham, through one of our programs, we have
a regular weekly presence at the library system.
(14:26):
So when folks naturally come in and need
some sort of mental health support, they know
that Tuesdays and Thursdays, I'm I'm making that
schedule up. But we have a Compass Health
person there. And then I think for us,
really, the first responder
aspect
of health care, particularly how our police departments
interact with individuals and mental health crisis out
in the public, We have multiple partnerships
(14:49):
with various police departments throughout our region where
we're sending out a Compass Health side police
officer to make sure that when they're interacting
with folks that need mental health intervention,
the police department has that capability. Or if
there's issues where you need police presence, and
sometimes that line is pretty fine, we've got
the police officer there as well. And those
are very well received, very cooperative,
(15:11):
and something that we hope is we can
uphold as a model. I think also,
I wanna mention that and I I briefly
touched on this when we're talking kind of
about about our region. I think the other
thing we really need to do is make
sure that we're advocating
for
systems changes. And so Compass Health is part
of a group called Forefront Contributor
here in Washington state made up of three
(15:33):
other like organizations, essentially, but in different parts
of the state on the other side of
the mountains as well. So those three organizations
serve between 60 five and 70 percent
of all the folks on Medicaid that need
mental health services.
And one of the things that we're really
advocating for is a more sustainable
funding model, particularly the certified community behavioral health
(15:54):
center model, CCBHC,
which really would
drastically, I think, change that eighty to eighty
two cent dollar
figure that I mentioned and really allow us
to do what we're doing more efficiently. So
You mentioned sort of your involvement with the
police, and this is off kind of a
tangent here from one of the questions. But
you're engaged with the police
and bringing a clinician along. How do Compass
(16:17):
Health work with law enforcement
to allow that to happen? Did law enforcement
come to Compass Health and say, hey. We
we really need your support, or did Compass
Health advocate for the support, or is it
a community initiative in general? In our experience,
it's mainly been the first responders coming to
us. I think in Washington state, particularly, there's
been a real focus on providing
law enforcement, first responders the training to be,
(16:39):
more equipped to work with individuals who are
in mental health crisis, substance use disorder, and
homelessness,
so on and so forth. And I think
we've done a really good job of that.
But I think there's a realization also
that police officers are not social workers, nor
should they be, frankly. They have a job
to complete, and that's primarily public safety.
But I think there was a realization that
(17:00):
just as part of their normal
operations and the fact particularly that the community
member, they'll just say just the normal layperson,
when there's a problem, their initial reaction is
to just call 911 for better or worse.
And that's that's what's what is accessible to
them. So I think the police figured out
that considering that's gonna continue happening, they probably
should equip themselves with
(17:22):
tools to more effectively serve those community members.
And I think we've also then benefited from
being with police and also understanding what they're
experiencing on a daily basis. And I really
wanna be careful because I've mentioned a couple
times, I don't wanna conflate
mental health, homelessness,
and substance use disorder. Certainly, there's individuals that
(17:42):
span all three of those. Those. There are
some people that only have one or two,
but I think predominantly most folks and particularly
media just lump all three together. I wanna
be clear that I'm not conflating those three
things, but certainly for most people who just
kind of experience this out in the ether,
that's that's what they know what they're focused
on. And so back to the police and
first responder piece of this puzzle, you know,
(18:04):
that's what they're responding to from the community
standpoint. Last thing I'll say is it's not
just police. We also have partnerships with EMS,
particularly in Lynnwood
funded through the Verint Health Commission. That's a
public hospital district. They're fantastic to work with.
But what the fire department was noticing
was
they had frequent flyer 911 callers, particularly folks
(18:27):
who are homebound.
The only contact they would have these were
folks with pretty persistent severe mental health issues.
Their only contact with other people was just
call 911.
And so they said, Well, we're, you know,
we're required by law to go every day,
but is this is this really the best
use of resources? This person's actually getting better.
And so we now have a collocated
(18:47):
clinical staff person. So when they know that
they're going to this one person's house all
the time, they can actually start to get
them on the path to some sort of
recovery. So That's really great. It's such an
important initiative to have
here and but anywhere Yeah. As that engagement
with law enforcement in the EMS. So what
roadblocks do you typically face, and how have
(19:08):
you been able to pivot to move behavior
health initiatives forward? One of the major roadblocks
for Compass Health and the people we serve
is the stigma associated with,
mental health treatment. Now I think that's changed
significantly
in the last,
few years. I think I don't really like
to talk about the pandemic because I I
I feel like that's sort of a crush
for a lot of things, but I can
(19:29):
I can say that the pandemic really shone
a light on mental health in general even
if you're, like, didn't think you had mental
health issues or, you know, didn't know a
lot of people, although I I find that
that's a rarity these days if you don't
know a single person in your life that
doesn't deal with mental health issues? But I
think that really shone a line on mental
health. So I think part of that is
that the stigma
(19:50):
is predominantly getting better. I will also mention,
as I said before, is that the conflation
of those three issues, homelessness, substance use, and
mental health is pretty common. I will say,
for instance, and this is a real statistic,
that ninety five percent of the people that
Compass Health serves are not homeless. They're on
Medicaid, so, you know, they're living below the
poverty line, but a lot of these folks
(20:11):
are employed and have the places of their
own. They just happen to be living with
a mental health issue. And I mentioned
the workforce shortage crisis is substantial.
The vacancy rate right now across all staff
members is 19%.
The annual turnover rate is 31%.
You know, it takes more than eight months
on average to fill a clinical,
(20:32):
position. And so
while that is a vacant position, we're either
having to increase case loads across the board
or, you know, wait times are long. I
mean, it's
it's pretty critical. And then so what that
then goes back to is how do we
find a a funding model that's more sustainable?
Because
quite candidly, we do everything we possibly can
(20:52):
to pay people the most that we can,
but we there are other areas in the
health care sector where our folks can go
work for more money, and we're doing everything
we possibly can in the current situation
to rectify that situation. But then back to
the CCBHC
funding model,
advocating strongly for that transition. So, you know,
we have the ability to be paid appropriately
(21:15):
for the work that we do. You're doing
a lot of really good work to move
your initiatives forward, and I know that's hard.
Many organizations
have unique strategies they implement to improve access
and follow-up with behavioral health patients. Would you
share some that you found to be the
most effective? Any lessons learned that you can
share with other organizations
so that they can learn from your experiences?
When the pandemic started and we really were
(21:38):
concerned about how we're gonna continue care for
our folks when there's all sorts of restrictions,
and one of the things that we're able
to implement very quickly that has really changed,
I think, our business model for the better
is is telehealth. We were fortunate enough to
work with a company called ITS.
Before the pandemic started, we were testing out
various telehealth models. Well, when we knew what
(22:00):
was actually had the full scope of what
was going on, we immediately implemented their product
as quickly as we could. We were able
to take advantage of it was a little
bit of building a plane as we're flying
it, but it was what saved us, frankly,
both from a financial aspect and also save
the clients that required our care. Now I
(22:21):
mentioned that because
now we have the ability
to be serving folks via telehealth
in really interesting ways that provide them access
to care and give us certain efficiencies. So
I'll use a real example. Whatcom County, our
northernmost county before you get into British Columbia,
Bellingham is the major urban center, but then
(22:41):
the rest of the county is very rural.
And we have partnerships with every single school
district within Whatcom County to provide
mental health services to kids that qualify.
Well, for a long time, we had to
get someone from our Bellingham office to drive
clear across the county
to maybe go do a one hour visit
with a client. Maybe that client has something
come up and they don't show up, and
(23:03):
then our person has to drive back, so
on and so forth. Now on top of
that, if we needed a prescriber,
which are hard to come by, we have
to figure that whole thing out. Well, through
a fantastic grant through the United Way of
Whatcom County, we're able to purchase telehealth stations
for every single school in in those rural
counties. They're there permanently,
and now we're able to serve those
(23:25):
folks, those from the Bellingham office
through telehealth
and
completely cutting out the commute, making sure that
we've got the best possible person at the
office serving that client. So that's really something
that has stuck with us, and I think
it's gonna evolve, like, we're not gonna be
doing it in the same capacity, but we
had a huge learning opportunity.
And then I think for
(23:47):
for improving access,
really, the facility,
the one that's being constructed in Downtown Everett,
70 2 Thousand square feet, the The current
facility is still there. It's actually, as we
speak, in abatement mode.
It's a full city block.
There's gonna be significant abatement about two months
or so to get rid of it. But
the reason I bring it up is because
(24:09):
it is a perfect example of a facility
that was gifted to us. We're very thankful
for it. There's a lot of healing and
care that was provided in that facility.
But frankly, if you were to go into
it, you'd be like, oh my gosh. Like,
this is
not what I was expecting, right, from an
agency this big. And we don't make any
excuses about it because of all the reasons
(24:29):
I just told you about the issues that
we have that are out of our control
in a lot of ways around financing. But
we are now in the position
of tearing that building down and constructing from
ground up a facility that's tailor made to
the services that the community needs, particularly around
some of these involuntary treatment options and some
of the crisis centers. Those
(24:51):
really need to be constructed in a way
that both provide the care that they need
and the safety for our staff, especially when
we're working with folks who who are on
the higher end of acuity. So
just super excited about that facility. Again, 72,000
square feet, $65,000,000
for total construction costs,
variety of sources,
(25:11):
federal,
state, local. There's a private philanthropic piece of
it. So there's a capital campaign that I'm
mentioning that because my team's in,
in charge of raising that. It's $14,000,000
of the total.
And so I think I think that's gonna
completely change both the community's perception
of the care, but also allow us to
actually provide care in a in a facility
(25:32):
that allows us to do that for the
benefit of the client. We've been doing some
digging recently, and we understand that the federal
funding for telehealth services that was put in
place because of primarily because of the pandemic
is set to end at the, I believe,
at the end of twenty twenty four.
Mhmm. Is that something that you've been thinking
about, and how is that going to impact
telehealth
care in the long term? Yeah. We're we're
(25:53):
aware of the fact that that there's some
changes happening, and some have actually already happened.
If I'm not mistaken, I think for a
long time that using just telephonic services, like
literally a telephone that was HIPAA compliant was
a billable service
during the throes of the pandemic when we
were just trying to get services to people.
I know that has gone away.
The great thing about working with a company
(26:15):
like ITS though is that it's not just
a telehealth company from just using a Zoom
application in a different way. They've actually created
a physical machine that's completely
telehealth compliant. It's we call it the robot
because it actually is that. It's a proprietary
machine that that can be set up that
is not only HIPAA compliant, it's low bandwidth
compliant. So if you're in areas that are
(26:36):
rural and have cell phone issues or other
Internet access issues, which, believe it or not,
is an actual problem still in parts of
of Western Washington where we're serving folks.
For instance, in some of our rural communities,
particularly
San Juan County. And if you are on
the other end of the country, just imagine
a entire county, entire community that's only accessible
(26:56):
by boat, be that private or ferry and,
I guess, plane. Not only is are they
only accessible, there's multiple islands
within that community that all, have some sort
of services that we need to provide. So
if we have a client that needs to
go quite literally from one island to another
just to get to our office and they
miss the ferry boat or miss whatever ride
(27:17):
they're gonna get over there, telehealth may be
an option for them to still get served
that day, also an option for us to
hopefully have a billable service.
But you start talking about the ferry system
and all that in some of these rural
communities. That's another example in addition to, like,
the school systems in Whatcom County, where we
can still be providing a service even though
there is a a perceived access to care
(27:39):
barrier. Right? So that's something that was not
possible before telehealth was really widely implemented. I
think that the concerns about that type of
service being not funded anymore are pretty low.
Plus,
back to the forefront contributor and Washington state
and the advocacy that we do, you know,
we've been able
to be in front of some of the
decisions that would have they're well intentioned, but
(28:00):
would have been a a an issue for
Compass Health. We've been able to show some
perspective about kinda how our clients have been
positively impacted and what may happen if we
remove that funding. Last thing I'll say, by
the way, is that telehealth doesn't work for
some people. And both from a clinical and
service delivery model, you're not gonna provide telehealth
in settings where you, for instance, need to
(28:20):
be providing injections or delivering medicine or someone's
in crisis. Like, that's not what I'm implying.
It's like, oh, then everyone just goes on
telehealth. But for on the flip side of
that, we found that telehealth, particularly with our
younger clients, teenagers,
they prefer
doing telehealth because they're so accustomed to being
in front of a screen. Not making a
value statement on that. But but they're more
(28:41):
likely to be engaged and more likely to
come to an appointment if it's virtual,
as silly as that sounds. Right? But that's
been our experience with that. So One of
the other things here, integration of primary care
and mental health care is very important. Is
that something that Compass Health is involved with
in any way? Great question. And this, goes
back to our commitment to whole person health
(29:02):
care. So one of the ways that we
describe Compass Health is for our folks who
are primarily their main,
health care concern is mental health. We are
really I think this is really true, considered
their their health care home. Right? This is
where they have the most interactions with the
health care system where it would be through
Compass. So we understand also that comorbidity
(29:22):
and folks that we're serving for the record,
by the way, folks that Compass Health serves
have approximately twenty percent reduced
life expectancy rate from the general public. A
lot of that has to do with the
fact that there are physical health care issues
layered on top of that. So I think,
ultimately, the future of Compass Health will be
to collocate
physical health care. I'm not I'm not, and
(29:45):
we are not sure yet if does that
mean that Compass Compass Health then staffs up
on the medical side? Do we work with
some partners within the community?
For the record, we have
experience doing this. Molina Health Care in Washington
in Washington state, one of our managed care
organizations,
fantastic partner. They're also a payer
for of Compass Health Services.
(30:05):
For a while, they had an actual in
the building that we're about to tear down
in Everett, by the way, had a funding
available to them to open a primary health
care clinic.
So within one building, we had Compass Health
serving the mental health needs.
We had a pharmacy through general health care,
which will be in the building again. Again,
another fantastic partner. So there's pharmacy services tailored
(30:28):
to mental health individuals with mental health issues.
And then Molina Healthcare. So
some of these folks
that we serve could come and do everything
in one area and leave, and it was
hugely
successful
and was and ran up until the funding
that the state had provided for that model
ran out. And then so the question is,
when we
provide that facility
(30:48):
in or that opportunity in the third and
final phase of the capital redevelopment, which is
not the one I've referenced. This is gonna
be the second half of our city block.
It is slated to have a primary
care component. And, really, the question is gonna
be, how successful is CCBHC implementation?
Do we have the funding available to, you
know, to consider this as a reality? And
(31:10):
then do we work with a partner in
the community,
or do we try to do it on
our own?
And so
I think it's a really timely question. And
it really everything I say always has to
go back to the people that we serve.
As I mentioned, if we're seeing these folks
on a regular basis and they have another
physical health care issue that's going unaddressed,
(31:31):
we need to figure out what our role
is in that that coordination. I will say
we do a very good job of that
already,
and we integrate with our health care partners.
The issue, though, is, you know, if someone
doesn't have reliable transportation, what's the likelihood that
they're gonna go from point a to point
b after their appointment? And that's, I think,
what people need to keep in mind that's
a little bit different than the commercial
(31:52):
health care market is that you can just
assume that folks have that ability, and you
you can't make that assumption with the folks
that we serve. So how do you measure
success with encompass health? I think for us,
implementing models of care that are research based,
evidence based, I think, is is a huge
part of that. We're really big on
ensuring that we are providing
(32:12):
services that have a track record of of
success. So that's a big part of it.
I mentioned, I think, briefly that we don't
want someone to ever be too sick or
too healthy to leave Compass, and what I
mean by that is we really pride ourselves
on our continuum of care. And so when
you enter services,
if you are getting better, we wanna make
sure that there's a step down option for
(32:34):
you at Compass.
And, also, if you're getting sicker or worse,
however you wanna define that, we wanna make
sure there's a step up model for you.
We're doing everything we can to keep people
out of the state hospital because there's research
that once you remove someone from their community
where they have community supports,
it becomes a more dire situation than it
would be. So I think if we can
(32:55):
provide people the services that they need and
can do that within our continuum of care,
that's fantastic.
And, of course, we ultimately want folks to
get better enough that they don't need Compass
services, but there are folks that we've served
for their whole lives, and that's just part
of what we do. I think also
back to the partnerships and what we wanna
do with the community, integrating with other health
(33:16):
care systems. So we're providing services that allow
them to focus on what they do really
well, allow us to focus on what we
do really well. That success is is measured
by both the client outcomes and then also
the financial
efficiencies. And as everyone
using their resources to their best ability, I
think that that's a really big part of
what we define as success at Compass. So
(33:38):
What's next for Compass Health? Say it again.
CCBHC
funding and ensuring that we move away from
this very, very, very complicated
system of reimbursements. Just as reference point, we've
got five different
insurers, managed care organizations
with different payment models, sometimes for the same
services. It's very complicated.
(33:59):
We've done a very good job of negotiating
variable
contracts. But again, it's still not on on
par. And for some listeners who are familiar
with the Federally Qualified Health Centers, FQHCs,
CCBHC is essentially a similar model for the
mental health site. So that's a big part
of it. I think for us also being
a thought leader and doing stuff like what
we're doing today and talking about this and
(34:20):
really getting
the mission and work of Compass Health and
other, like, organizations out there so folks can
really understand what we do and some of
the barriers. And, also, I think having conversations
like this reduces the stigma associated with folks
with mental health issues. So I'm really thankful
for this for this today,
so I can talk about that a little
bit.
And
(34:41):
without question,
to the facilities piece and what's probably interesting
that a lot of the folks listening is
providing those facilities that are conducive to care.
I will say that from a a learning
perspective,
I'm not aware of any facility
of a type of organization like Compass anywhere
else in the state.
So I think we've learned a lot in
(35:02):
the time
that we've been doing this. It's, again, hugely
complicated,
this, spaghetti
mix of funding,
different timelines. You're in the business. You know
how complicated it is to get medical facilities
constructed and built. And then on top of
that, you know, we've got different funding streams
coming in at different times. So I'm hopeful
that what we're going through can be a
(35:23):
model for other agencies that wanna go through
this type of process. I know that there
are other mental health providers around the state
and certainly around the country that also have
facilities that don't really meet their needs. And
it's hard to visualize it without actually being
in it, but you can go on our
website, compasshealth.org,
and look at all the renderings and and
see what we're planning for the facility itself.
(35:44):
That is the most immediate
project that is going to really change the
face of Compass Health and serve our clients
better. So It's fantastic. We could talk about
this all day. I love listening to you
and and your story. I'm glad someone likes
to listen to me. Talk. Great.
Really, really great job. Thank you. I do
appreciate it.
(36:04):
For more information on our listen mental health
matters series,
please visit hdrinc.com/listen.
There, you'll find more on HDR's approach to
behavioral and mental health design,
meet our team, and see samples of our
work.
If you like what you heard, be sure
to rate us or leave a comment on
Apple Podcasts,
(36:24):
Spotify,
or wherever you get your podcasts.
I'm John Torek, and I'm Danny Sullivan, and
you're listening to Speaking of Design, bringing you
the stories of the engineers and architects who
are transforming the world one project at a
time. Today, we bring you another episode of
a special podcast series on behavioral and mental
health called listen, mental health matters.
(00:27):
As part of this series, Brian Giebink, behavioral
and mental health practice leader at HDR,
visits some of the world's leading health care
providers for candid conversations
about the challenges they face and the opportunities
to transform the patient and caregiver experience.
I'm Brian Giebink, and I hope that by
listening, this series helps us consider new perspectives
(00:50):
in our quest to create transformational mental health
facilities that improve the quality of life for
individuals and families and promote a shared sense
of community. And now Brian's conversation with Tom
Kozachinski,
chief advancement officer at Compass Health in Northwest
Washington.
(01:14):
Alright. Well, welcome, Tom. This is Brian Geebink.
I'm the behavioral health practice leader at HDR.
And with me today is Tom Kozachinski
with Compass Health. And he's here to share
a little bit about his career and his
history of Compass Health, but more importantly, what
Compass Health is doing and what they're up
to and how they're improving the lives of
so many in their community
(01:34):
where they're involved. So, Tom, would you like
to say a few words, introduce yourself? Sure.
Yeah. Thanks, Brian, and thanks so much for
having me here. I'm really appreciative to take
the opportunity to talk about what we're doing
at Compass Health. So, again, my name is
Tom Kozachinski.
I'm the chief advancement officer at Compass Health.
I oversee two distinct business lines, that being
(01:55):
the marketing
and communication side of the business and then
also the fundraising side.
Been at the agency now for just a
little bit over ten years. So have a
long enough history to have seen some of
the the evolution of agency, evolution of mental
health care. So I'm very, very pleased to
be here with you today. Really happy to
have you. So do you wanna tell me
about a little bit how long you've worked
(02:16):
with Compass Health and why you joined the
organization?
Yeah. Absolutely. So like I said, just a
little bit over ten years. As I mentioned,
within the two business lines that I oversee,
my education history has generally been in the
fundraising sector.
I did a few other things before coming
to Compass Health. I worked in the arts
for a little bit, in higher education, and
social services.
(02:36):
But what really drew me and what really
draws a lot of people in this work
is a really close personal connection to the
mission. And that's certainly true for me,
both with familial mental health issues
and frankly, some of my own too, and
understanding
how challenging that is for folks who are
of means and have access
to then layer on top of it the
(02:57):
fact that Compass Health serves predominantly individuals
that who are on Medicaid,
many barriers
to care, be that food insecurity,
transportation,
you know, you name it. There's
the challenges are really compounded
when you're living in that in that scenario.
So I have a very, very close deep
connection to the mission. I live in the
community where Compass Health provides services. That's really
(03:20):
important to me too. For the record, where
we are located and where we operate is
in Northwest Washington,
North Of Seattle, 5 counties primarily,
Snohomish, Skagit,
Whatcom Island, and San Juan County. About how
far is that from Downtown Seattle? So our,
headquarters is in Everett, Washington.
So approximately 20 miles north. Everett's probably most
(03:41):
known for Boeing, but we don't serve King
County where Seattle is located. So we start
in the next county north and go all
the way up to the Canadian border. So
can you tell me a little bit more
about Compass Health? What is it, and and
what do you do there specifically? We are
one of the state's largest mental health providers,
primarily serving on Medicaid. We serve approximately 12,000
individuals in our five county region.
(04:02):
Really span, as far as geography is concerned,
both urban and very rural environments. In fact,
we call some of those some of those
offices are located in San Juan County, which
is island based frontier.
So we have both a wide geographic
reach and a good mix between urban and
rural.
Services range anything from general outpatient treatment all
(04:25):
the way into inpatient and voluntary treatment,
serve
both adults, older adults, youth, family, and children,
specialized programs that, you know, that really
augment and serve our community to the fullest
possible capabilities. So I'm talking things like camp
programs for kids that are specialized for our
youth, close alignment with law enforcement through partnerships.
(04:48):
So a large organization both in scope and
size. I think we're now over 700 FTE,
approximately $72,000,000
budget, 20 plus sites in those five counties.
That's really big. And you're you're able to
to manage all of that pretty well. I
think just like any large health care organizations,
there are, of course, challenges, and some of
those we can talk about. But I think
(05:09):
from the perspective of our impact on the
clients that we serve, I think we do
the best job that we could possibly do
and and really uphold the dignity and respect
of those that we're serving. So That's great.
That's really great. And why did behavioral health
health care become your calling? Why why do
you do this work, and what what drives
you personally? Yeah. Absolutely. So, yeah, I mentioned
a little bit on the personal side. I
think also though in the ten years that
(05:31):
I've been at Compass Health, there's been so
much change, and it seems to be
accelerating in pace. And I'm framing that in
a positive sense. You know? There's just there's
so much that needs to be done,
both practically speaking from a service delivery model
and the ways that we need to be
advocating for for change within the system that
then ultimately helps the people that we serve.
(05:53):
And then from a physical plant and our
buildings, there is a very quick shift that
needs to happen to making sure that we're
providing the facilities that are conducive to care.
For a lot of our history, it's been
anything that we can get to make buy,
and and that has worked for a long
time. I mean, we're a 20 year old
organization.
But if we're gonna be viewed as, you
(06:14):
know, primarily as a health care agency,
really partnering with other health care partners,
then we need the facilities that reflect that
same level of care, level of compassion, dignity,
and respect to the people that we serve,
their families, and then also to the people
that work for us. Frankly, I could go
do the type of work I'm doing at
any nonprofit, any university, any hospital.
(06:35):
I mean, there's someone like me at all
those places, and I could probably just go
do that work somewhere else. But I do
it at Compass because I see such a
bright future for the agency and for the
field in general. So many organizations have a
series of key moments that define who they've
become and why they do what they do.
What was the moment or moments that shaped
Compass Health into what it is today? Well,
(06:56):
there's a few. As I mentioned, a 20
years old organization
just out of interest for folks who are
listening. So we actually first started as an
orphanage
here on the Pacific Northwest serving youth whose
families, particularly fathers at that time, were killed
offshore fishing. You know? So kind of an
interesting
piece of history. The reason I mentioned that
(07:17):
is because it's important to note that serving
youth and families has been really a kind
of a core tenant of Compass Health and
continues to be.
But as far as how we've gone to
where we are now, I think or you
can point to a few key things. So
the Community Mental Health Act of 1963,
signed by president John F. Kennedy,
really paved the path for an organization like
(07:40):
Compass to really start the mental health aspect
of of our work, so moving away from
the orphanage piece of our history, which I
just talked about. But because that led to
a pretty large deinstitutionalization
of folks, we had to provide services
that they otherwise would have received in the
institutionalized setting in the community. So that is
really where Compass Health's mental health piece starts.
(08:03):
Now
through that, Compass Health has not always been
as large as we are. That has happened
through a number of mergers and acquisitions to
really increase our scope and scale
to be able to provide the full continuum
of care. But our most recent merger and
acquisition was just in 2013
with with Whatcom County, which added our fifth
(08:24):
county to our service area. So it's a
big part of our history. It's allowed us
to provide a full scope in the continuum
of care than not being too healthy or
too sick to leave Compass Health. And that's
true within the counties. It's also true within
the region because we now have a scope
and scale that allows us to do that
and, frankly, allows us to negotiate terms with
our payers that are favorable or at least
(08:46):
moving towards favorable. I'm not gonna at all
imply that they're where they need to be,
but it gives us that ability.
I think the third thing I'd mentioned is
the Affordable Care Act, where it opened a
huge amount of individuals,
who previously were not Medicaid
eligible to being a Medicaid eligible. So for
a long time of our history, we knew
there were community members out there who needed
(09:08):
our service, but they were frankly unfunded.
And it's really hard. I think most folks
in the health care setting will agree that
it's hard to find ways to provide services
to completely unfunded folks.
And then the last thing I'll I'll mention
as far as your question's concerned, I think
now
is the focus on
providing facilities
(09:28):
that really are tailor made to the type
of work that we do, that are future
focused, state of the art for the care
that we're providing,
and
allowing those spaces to communicate the dignity and
respect to the folks that are receiving services.
Again, I I need to mention that the
overwhelming majority of the people we serve have
all sorts of life circumstances that create barriers
(09:50):
to entry, so we want them to come
to a space that that feels good for
them and their family.
And then there is a significant workforce shortage
crisis right now, particularly in our field,
and it's hard to recruit individuals
already for this very challenging work when they
have an office space that doesn't
make them feel
respected and valued themselves. Right? So I think
(10:12):
that that is this is a pivotal moment
right now that we're in, showing the community
that we can do that. Just a quick
note, because some folks may be wondering, oh,
why haven't you been doing that already? In
our field, 80 to 82¢
of every dollar of our our budget goes
to
hiring and retention.
And that leaves a very, very small margin
(10:34):
for massive capital projects like the one we're
gonna talk about. 82¢ per dollar is is
a lot to spend on on that staffing
or retention. How do you afford the capital
expenditure? I think that's that's a really interesting
conversation to have. So next question we wanted
to ask. So what what are you striving
to provide for the people in the communities
that Compass Health serves and what do they
need most right now? Yeah. I think that's
(10:55):
a timely question. And there's a few things
that come to mind.
I'm sure nationwide, you've heard that there's a
shortage of beds, quote unquote beds for folks
in mental health crisis. So part of what
this facility will do is there will be
32 beds in that facility. 16 of them
are in our evaluation and treatment facility.
So those are beds for involuntary treatment. We're
(11:17):
actually adding to the 16 we already have
in the community.
And then there's also a 16 bed crisis
triage facility that will be in this building.
That is a voluntary program, of course, with
rules and stipulations when you're there. But the
reason I mentioned those two, you know, from
the beginning of this conversation is that those
really
integrate most with the sort of social and
(11:38):
healthcare fabric in the community. I think a
lot of folks think, and rightly so in
some situations, that the emergency room at your
local hospital is a de facto mental health
crisis center, which actually it shouldn't be. Certainly,
there is people who are in mental health
crisis that have a serious health issue that
needs to be addressed. But the ER is
not an efficient use of resources for a
(11:59):
lot of reasons, and, you know, hospitals should
be focusing on what the ER is really
intended to do. Plus, a lot of the
times, those, individuals are interacting with our law
enforcement and first responders. Again, is that the
most efficient way of of providing services by
tying up a police officer or a medic,
that needs to sit there in the ER
until someone's admitted? I think we can probably
(12:20):
agree that's that's probably not the case.
And so I think for our community, particularly
because this facility is serving the most intensive
side of our spectrum of needs,
I think that really allows us to provide
those services through partnership,
ensuring that we're supporting the health care system,
supporting
the first responders and other community partners with
(12:42):
those services that they need, and
doing so in a in a really efficient
financial
model. Right? Because I think I think we
can and here located in Seattle, and I'm
sure this is the case in most urban
settings, I mean, the need is out there.
It's pretty it's pretty visual and and obvious.
And so I think I think that's probably
(13:02):
what I would key in most as far
as what this facility and what Compass Health
is really focused on is is providing those
making sure that those services are available
community wide. So
It's really great. And I think that's a
might be a good segue into the next
question. What do you do really well, and
what do you think you're doing differently than
your peers? Yeah. I think, as I mentioned,
particularly where we're located,
(13:23):
partnerships are a huge part of what we
do in our service model. I think most
folks have identified that replicating what Compass Health
does is pretty complicated and challenging.
And likewise, replicating what, let's say, I'll use
an actual partner like the library system. We're
not gonna become a library and a mental
health partner, and they don't wanna necessarily be
serving mental health folks, but there's crossover in
(13:44):
in both those areas. And so I think,
for us, what we've done really well is,
listen to the needs of our other partners
in the agency, find ways where we can
utilize our core competencies
in mental health and provide services to to
our other nonprofit partners. That's something we do
regularly,
either through actual physical collocation or we have
a Compass
(14:05):
Health clinical staff person on-site at another nonprofit,
or we provide outreach programs
where we have regular presence in the community
where our clients and our people are interacting
in other ways within their life. So the
library is an actual example. For instance, in
Bellingham, through one of our programs, we have
a regular weekly presence at the library system.
(14:26):
So when folks naturally come in and need
some sort of mental health support, they know
that Tuesdays and Thursdays, I'm I'm making that
schedule up. But we have a Compass Health
person there. And then I think for us,
really, the first responder
aspect
of health care, particularly how our police departments
interact with individuals and mental health crisis out
in the public, We have multiple partnerships
(14:49):
with various police departments throughout our region where
we're sending out a Compass Health side police
officer to make sure that when they're interacting
with folks that need mental health intervention,
the police department has that capability. Or if
there's issues where you need police presence, and
sometimes that line is pretty fine, we've got
the police officer there as well. And those
are very well received, very cooperative,
(15:11):
and something that we hope is we can
uphold as a model. I think also,
I wanna mention that and I I briefly
touched on this when we're talking kind of
about about our region. I think the other
thing we really need to do is make
sure that we're advocating
for
systems changes. And so Compass Health is part
of a group called Forefront Contributor
here in Washington state made up of three
(15:33):
other like organizations, essentially, but in different parts
of the state on the other side of
the mountains as well. So those three organizations
serve between 60 five and 70 percent
of all the folks on Medicaid that need
mental health services.
And one of the things that we're really
advocating for is a more sustainable
funding model, particularly the certified community behavioral health
(15:54):
center model, CCBHC,
which really would
drastically, I think, change that eighty to eighty
two cent dollar
figure that I mentioned and really allow us
to do what we're doing more efficiently. So
You mentioned sort of your involvement with the
police, and this is off kind of a
tangent here from one of the questions. But
you're engaged with the police
and bringing a clinician along. How do Compass
(16:17):
Health work with law enforcement
to allow that to happen? Did law enforcement
come to Compass Health and say, hey. We
we really need your support, or did Compass
Health advocate for the support, or is it
a community initiative in general? In our experience,
it's mainly been the first responders coming to
us. I think in Washington state, particularly, there's
been a real focus on providing
law enforcement, first responders the training to be,
(16:39):
more equipped to work with individuals who are
in mental health crisis, substance use disorder, and
homelessness,
so on and so forth. And I think
we've done a really good job of that.
But I think there's a realization also
that police officers are not social workers, nor
should they be, frankly. They have a job
to complete, and that's primarily public safety.
But I think there was a realization that
(17:00):
just as part of their normal
operations and the fact particularly that the community
member, they'll just say just the normal layperson,
when there's a problem, their initial reaction is
to just call 911 for better or worse.
And that's that's what's what is accessible to
them. So I think the police figured out
that considering that's gonna continue happening, they probably
should equip themselves with
(17:22):
tools to more effectively serve those community members.
And I think we've also then benefited from
being with police and also understanding what they're
experiencing on a daily basis. And I really
wanna be careful because I've mentioned a couple
times, I don't wanna conflate
mental health, homelessness,
and substance use disorder. Certainly, there's individuals that
(17:42):
span all three of those. Those. There are
some people that only have one or two,
but I think predominantly most folks and particularly
media just lump all three together. I wanna
be clear that I'm not conflating those three
things, but certainly for most people who just
kind of experience this out in the ether,
that's that's what they know what they're focused
on. And so back to the police and
first responder piece of this puzzle, you know,
(18:04):
that's what they're responding to from the community
standpoint. Last thing I'll say is it's not
just police. We also have partnerships with EMS,
particularly in Lynnwood
funded through the Verint Health Commission. That's a
public hospital district. They're fantastic to work with.
But what the fire department was noticing
was
they had frequent flyer 911 callers, particularly folks
(18:27):
who are homebound.
The only contact they would have these were
folks with pretty persistent severe mental health issues.
Their only contact with other people was just
call 911.
And so they said, Well, we're, you know,
we're required by law to go every day,
but is this is this really the best
use of resources? This person's actually getting better.
And so we now have a collocated
(18:47):
clinical staff person. So when they know that
they're going to this one person's house all
the time, they can actually start to get
them on the path to some sort of
recovery. So That's really great. It's such an
important initiative to have
here and but anywhere Yeah. As that engagement
with law enforcement in the EMS. So what
roadblocks do you typically face, and how have
(19:08):
you been able to pivot to move behavior
health initiatives forward? One of the major roadblocks
for Compass Health and the people we serve
is the stigma associated with,
mental health treatment. Now I think that's changed
significantly
in the last,
few years. I think I don't really like
to talk about the pandemic because I I
I feel like that's sort of a crush
for a lot of things, but I can
(19:29):
I can say that the pandemic really shone
a light on mental health in general even
if you're, like, didn't think you had mental
health issues or, you know, didn't know a
lot of people, although I I find that
that's a rarity these days if you don't
know a single person in your life that
doesn't deal with mental health issues? But I
think that really shone a line on mental
health. So I think part of that is
that the stigma
(19:50):
is predominantly getting better. I will also mention,
as I said before, is that the conflation
of those three issues, homelessness, substance use, and
mental health is pretty common. I will say,
for instance, and this is a real statistic,
that ninety five percent of the people that
Compass Health serves are not homeless. They're on
Medicaid, so, you know, they're living below the
poverty line, but a lot of these folks
(20:11):
are employed and have the places of their
own. They just happen to be living with
a mental health issue. And I mentioned
the workforce shortage crisis is substantial.
The vacancy rate right now across all staff
members is 19%.
The annual turnover rate is 31%.
You know, it takes more than eight months
on average to fill a clinical,
(20:32):
position. And so
while that is a vacant position, we're either
having to increase case loads across the board
or, you know, wait times are long. I
mean, it's
it's pretty critical. And then so what that
then goes back to is how do we
find a a funding model that's more sustainable?
Because
quite candidly, we do everything we possibly can
(20:52):
to pay people the most that we can,
but we there are other areas in the
health care sector where our folks can go
work for more money, and we're doing everything
we possibly can in the current situation
to rectify that situation. But then back to
the CCBHC
funding model,
advocating strongly for that transition. So, you know,
we have the ability to be paid appropriately
(21:15):
for the work that we do. You're doing
a lot of really good work to move
your initiatives forward, and I know that's hard.
Many organizations
have unique strategies they implement to improve access
and follow-up with behavioral health patients. Would you
share some that you found to be the
most effective? Any lessons learned that you can
share with other organizations
so that they can learn from your experiences?
When the pandemic started and we really were
(21:38):
concerned about how we're gonna continue care for
our folks when there's all sorts of restrictions,
and one of the things that we're able
to implement very quickly that has really changed,
I think, our business model for the better
is is telehealth. We were fortunate enough to
work with a company called ITS.
Before the pandemic started, we were testing out
various telehealth models. Well, when we knew what
(22:00):
was actually had the full scope of what
was going on, we immediately implemented their product
as quickly as we could. We were able
to take advantage of it was a little
bit of building a plane as we're flying
it, but it was what saved us, frankly,
both from a financial aspect and also save
the clients that required our care. Now I
(22:21):
mentioned that because
now we have the ability
to be serving folks via telehealth
in really interesting ways that provide them access
to care and give us certain efficiencies. So
I'll use a real example. Whatcom County, our
northernmost county before you get into British Columbia,
Bellingham is the major urban center, but then
(22:41):
the rest of the county is very rural.
And we have partnerships with every single school
district within Whatcom County to provide
mental health services to kids that qualify.
Well, for a long time, we had to
get someone from our Bellingham office to drive
clear across the county
to maybe go do a one hour visit
with a client. Maybe that client has something
come up and they don't show up, and
(23:03):
then our person has to drive back, so
on and so forth. Now on top of
that, if we needed a prescriber,
which are hard to come by, we have
to figure that whole thing out. Well, through
a fantastic grant through the United Way of
Whatcom County, we're able to purchase telehealth stations
for every single school in in those rural
counties. They're there permanently,
and now we're able to serve those
(23:25):
folks, those from the Bellingham office
through telehealth
and
completely cutting out the commute, making sure that
we've got the best possible person at the
office serving that client. So that's really something
that has stuck with us, and I think
it's gonna evolve, like, we're not gonna be
doing it in the same capacity, but we
had a huge learning opportunity.
And then I think for
(23:47):
for improving access,
really, the facility,
the one that's being constructed in Downtown Everett,
70 2 Thousand square feet, the The current
facility is still there. It's actually, as we
speak, in abatement mode.
It's a full city block.
There's gonna be significant abatement about two months
or so to get rid of it. But
the reason I bring it up is because
(24:09):
it is a perfect example of a facility
that was gifted to us. We're very thankful
for it. There's a lot of healing and
care that was provided in that facility.
But frankly, if you were to go into
it, you'd be like, oh my gosh. Like,
this is
not what I was expecting, right, from an
agency this big. And we don't make any
excuses about it because of all the reasons
(24:29):
I just told you about the issues that
we have that are out of our control
in a lot of ways around financing. But
we are now in the position
of tearing that building down and constructing from
ground up a facility that's tailor made to
the services that the community needs, particularly around
some of these involuntary treatment options and some
of the crisis centers. Those
(24:51):
really need to be constructed in a way
that both provide the care that they need
and the safety for our staff, especially when
we're working with folks who who are on
the higher end of acuity. So
just super excited about that facility. Again, 72,000
square feet, $65,000,000
for total construction costs,
variety of sources,
(25:11):
federal,
state, local. There's a private philanthropic piece of
it. So there's a capital campaign that I'm
mentioning that because my team's in,
in charge of raising that. It's $14,000,000
of the total.
And so I think I think that's gonna
completely change both the community's perception
of the care, but also allow us to
actually provide care in a in a facility
(25:32):
that allows us to do that for the
benefit of the client. We've been doing some
digging recently, and we understand that the federal
funding for telehealth services that was put in
place because of primarily because of the pandemic
is set to end at the, I believe,
at the end of twenty twenty four.
Mhmm. Is that something that you've been thinking
about, and how is that going to impact
telehealth
care in the long term? Yeah. We're we're
(25:53):
aware of the fact that that there's some
changes happening, and some have actually already happened.
If I'm not mistaken, I think for a
long time that using just telephonic services, like
literally a telephone that was HIPAA compliant was
a billable service
during the throes of the pandemic when we
were just trying to get services to people.
I know that has gone away.
The great thing about working with a company
(26:15):
like ITS though is that it's not just
a telehealth company from just using a Zoom
application in a different way. They've actually created
a physical machine that's completely
telehealth compliant. It's we call it the robot
because it actually is that. It's a proprietary
machine that that can be set up that
is not only HIPAA compliant, it's low bandwidth
compliant. So if you're in areas that are
(26:36):
rural and have cell phone issues or other
Internet access issues, which, believe it or not,
is an actual problem still in parts of
of Western Washington where we're serving folks.
For instance, in some of our rural communities,
particularly
San Juan County. And if you are on
the other end of the country, just imagine
a entire county, entire community that's only accessible
(26:56):
by boat, be that private or ferry and,
I guess, plane. Not only is are they
only accessible, there's multiple islands
within that community that all, have some sort
of services that we need to provide. So
if we have a client that needs to
go quite literally from one island to another
just to get to our office and they
miss the ferry boat or miss whatever ride
(27:17):
they're gonna get over there, telehealth may be
an option for them to still get served
that day, also an option for us to
hopefully have a billable service.
But you start talking about the ferry system
and all that in some of these rural
communities. That's another example in addition to, like,
the school systems in Whatcom County, where we
can still be providing a service even though
there is a a perceived access to care
(27:39):
barrier. Right? So that's something that was not
possible before telehealth was really widely implemented. I
think that the concerns about that type of
service being not funded anymore are pretty low.
Plus,
back to the forefront contributor and Washington state
and the advocacy that we do, you know,
we've been able
to be in front of some of the
decisions that would have they're well intentioned, but
(28:00):
would have been a a an issue for
Compass Health. We've been able to show some
perspective about kinda how our clients have been
positively impacted and what may happen if we
remove that funding. Last thing I'll say, by
the way, is that telehealth doesn't work for
some people. And both from a clinical and
service delivery model, you're not gonna provide telehealth
in settings where you, for instance, need to
(28:20):
be providing injections or delivering medicine or someone's
in crisis. Like, that's not what I'm implying.
It's like, oh, then everyone just goes on
telehealth. But for on the flip side of
that, we found that telehealth, particularly with our
younger clients, teenagers,
they prefer
doing telehealth because they're so accustomed to being
in front of a screen. Not making a
value statement on that. But but they're more
(28:41):
likely to be engaged and more likely to
come to an appointment if it's virtual,
as silly as that sounds. Right? But that's
been our experience with that. So One of
the other things here, integration of primary care
and mental health care is very important. Is
that something that Compass Health is involved with
in any way? Great question. And this, goes
back to our commitment to whole person health
(29:02):
care. So one of the ways that we
describe Compass Health is for our folks who
are primarily their main,
health care concern is mental health. We are
really I think this is really true, considered
their their health care home. Right? This is
where they have the most interactions with the
health care system where it would be through
Compass. So we understand also that comorbidity
(29:22):
and folks that we're serving for the record,
by the way, folks that Compass Health serves
have approximately twenty percent reduced
life expectancy rate from the general public. A
lot of that has to do with the
fact that there are physical health care issues
layered on top of that. So I think,
ultimately, the future of Compass Health will be
to collocate
physical health care. I'm not I'm not, and
(29:45):
we are not sure yet if does that
mean that Compass Compass Health then staffs up
on the medical side? Do we work with
some partners within the community?
For the record, we have
experience doing this. Molina Health Care in Washington
in Washington state, one of our managed care
organizations,
fantastic partner. They're also a payer
for of Compass Health Services.
(30:05):
For a while, they had an actual in
the building that we're about to tear down
in Everett, by the way, had a funding
available to them to open a primary health
care clinic.
So within one building, we had Compass Health
serving the mental health needs.
We had a pharmacy through general health care,
which will be in the building again. Again,
another fantastic partner. So there's pharmacy services tailored
(30:28):
to mental health individuals with mental health issues.
And then Molina Healthcare. So
some of these folks
that we serve could come and do everything
in one area and leave, and it was
hugely
successful
and was and ran up until the funding
that the state had provided for that model
ran out. And then so the question is,
when we
provide that facility
(30:48):
in or that opportunity in the third and
final phase of the capital redevelopment, which is
not the one I've referenced. This is gonna
be the second half of our city block.
It is slated to have a primary
care component. And, really, the question is gonna
be, how successful is CCBHC implementation?
Do we have the funding available to, you
know, to consider this as a reality? And
(31:10):
then do we work with a partner in
the community,
or do we try to do it on
our own?
And so
I think it's a really timely question. And
it really everything I say always has to
go back to the people that we serve.
As I mentioned, if we're seeing these folks
on a regular basis and they have another
physical health care issue that's going unaddressed,
(31:31):
we need to figure out what our role
is in that that coordination. I will say
we do a very good job of that
already,
and we integrate with our health care partners.
The issue, though, is, you know, if someone
doesn't have reliable transportation, what's the likelihood that
they're gonna go from point a to point
b after their appointment? And that's, I think,
what people need to keep in mind that's
a little bit different than the commercial
(31:52):
health care market is that you can just
assume that folks have that ability, and you
you can't make that assumption with the folks
that we serve. So how do you measure
success with encompass health? I think for us,
implementing models of care that are research based,
evidence based, I think, is is a huge
part of that. We're really big on
ensuring that we are providing
(32:12):
services that have a track record of of
success. So that's a big part of it.
I mentioned, I think, briefly that we don't
want someone to ever be too sick or
too healthy to leave Compass, and what I
mean by that is we really pride ourselves
on our continuum of care. And so when
you enter services,
if you are getting better, we wanna make
sure that there's a step down option for
(32:34):
you at Compass.
And, also, if you're getting sicker or worse,
however you wanna define that, we wanna make
sure there's a step up model for you.
We're doing everything we can to keep people
out of the state hospital because there's research
that once you remove someone from their community
where they have community supports,
it becomes a more dire situation than it
would be. So I think if we can
(32:55):
provide people the services that they need and
can do that within our continuum of care,
that's fantastic.
And, of course, we ultimately want folks to
get better enough that they don't need Compass
services, but there are folks that we've served
for their whole lives, and that's just part
of what we do. I think also
back to the partnerships and what we wanna
do with the community, integrating with other health
(33:16):
care systems. So we're providing services that allow
them to focus on what they do really
well, allow us to focus on what we
do really well. That success is is measured
by both the client outcomes and then also
the financial
efficiencies. And as everyone
using their resources to their best ability, I
think that that's a really big part of
what we define as success at Compass. So
(33:38):
What's next for Compass Health? Say it again.
CCBHC
funding and ensuring that we move away from
this very, very, very complicated
system of reimbursements. Just as reference point, we've
got five different
insurers, managed care organizations
with different payment models, sometimes for the same
services. It's very complicated.
(33:59):
We've done a very good job of negotiating
variable
contracts. But again, it's still not on on
par. And for some listeners who are familiar
with the Federally Qualified Health Centers, FQHCs,
CCBHC is essentially a similar model for the
mental health site. So that's a big part
of it. I think for us also being
a thought leader and doing stuff like what
we're doing today and talking about this and
(34:20):
really getting
the mission and work of Compass Health and
other, like, organizations out there so folks can
really understand what we do and some of
the barriers. And, also, I think having conversations
like this reduces the stigma associated with folks
with mental health issues. So I'm really thankful
for this for this today,
so I can talk about that a little
bit.
And
(34:41):
without question,
to the facilities piece and what's probably interesting
that a lot of the folks listening is
providing those facilities that are conducive to care.
I will say that from a a learning
perspective,
I'm not aware of any facility
of a type of organization like Compass anywhere
else in the state.
So I think we've learned a lot in
(35:02):
the time
that we've been doing this. It's, again, hugely
complicated,
this, spaghetti
mix of funding,
different timelines. You're in the business. You know
how complicated it is to get medical facilities
constructed and built. And then on top of
that, you know, we've got different funding streams
coming in at different times. So I'm hopeful
that what we're going through can be a
(35:23):
model for other agencies that wanna go through
this type of process. I know that there
are other mental health providers around the state
and certainly around the country that also have
facilities that don't really meet their needs. And
it's hard to visualize it without actually being
in it, but you can go on our
website, compasshealth.org,
and look at all the renderings and and
see what we're planning for the facility itself.
(35:44):
That is the most immediate
project that is going to really change the
face of Compass Health and serve our clients
better. So It's fantastic. We could talk about
this all day. I love listening to you
and and your story. I'm glad someone likes
to listen to me. Talk. Great.
Really, really great job. Thank you. I do
appreciate it.
(36:04):
For more information on our listen mental health
matters series,
please visit hdrinc.com/listen.
There, you'll find more on HDR's approach to
behavioral and mental health design,
meet our team, and see samples of our
work.
If you like what you heard, be sure
to rate us or leave a comment on
Apple Podcasts,
(36:24):
Spotify,
or wherever you get your podcasts.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!