Adaptive standardization is the concept of creating an organizational approach where all common services are delivered with a standard, replicable protocol. This is a much-needed operating model for health and human service organizations—as my colleague Monica E. Oss, OPEN MINDS Chief Executive Officer, pointed out in her closing keynote at The 2018 OPEN MINDS Management Best Practices Institute, Reinventing Your Organization: Key Management Best Practices For A Value-Based World.
Following our institute, she wrote about the need for most organizations in the field to address the strategic issue of declining margins, and develop new and profitable service lines to support their organization and their mission (see Finding Your Next Cash Cow)—and, “adaptive standardization” is one of three key elements in operationalizing that strategy.
But putting “standardization” into practice is complicated—particularly for service delivery. There are evidence-based clinical practices, best administrative practices, strategic quality issues, performance measurement, and management, not to mention the meta-leadership it takes to bring it all together. Last week, I had the opportunity to see successful adaptive standardization in action—when I sat down with Anthony Hassan, Ed.D, LCSW, Chief Executive Officer & President at Cohen Veterans Network; and Bob Vero, Ed.D., Chief Executive Officer at Centerstone Tennessee, and had a look at a model built on the strengths of standardization.
The Cohen Veterans Network (CVN) was funded by Mr. Steven A. Cohen with $275 million “to improve the quality of life for Post 9/11 veterans, including those from the National Guard and Reserves, and their families” through strengthening mental health outcomes through evidence-based service delivery, particularly around post-traumatic stress and related issues such as depression, anxiety, transition, and relationship issues (see Cohen Veterans Network Mission & Vision). To achieve that mission effectively and efficiently, CVN has created a replicable model for serving veterans and their families—a model that is being reproduced across the country.
CVN identifies a city where veterans and their families need mental health care and then builds a local collaboration with an existing provider organization to address those needs. The local partner organization then delivers care in accordance with a “master agreement” prescribed within a detailed clinical care model. “There is room for creativity and opportunity to leverage innovation and existing practices,” Dr. Hassan noted. “But we do come in with a proven model we expect to be delivered.”
The financial model follows a six-year plan. CVN provides funding for the number of estimated clients the clinic is likely to see in years one, two, and three—with the ability to roll over unused funding to the following year, or to augment the program with additional funds if they serve more veterans than expected. The clinics accept third-party reimbursement from TRICARE and other payers; however, this typically does not cover the full cost of providing services. Dr. Hassan estimates that the cost per session is about $280; third-party reimbursements typically only cover about $100 of the cost. The remainder is supplemented by Mr. Steven A. Cohen, the founder and funder of CVN, and, when available, city, county, and state grant funding, and philanthropy.
In years four, five, and six, the expectation is that the local partner will be responsible for 25%, 35%, and 50% of operation costs, respectively. In year six and beyond, each clinic is responsible for an approximate revenue target of $1 million, depending on the market. For some clinics, this sustainment goal is a heavy lift, and Dr. Hassan explained that even if some clinics can’t make the cut, that doesn’t immediately mean an end to the relationship. He explained, “If they can’t meet their sustainment funding goal, we work with them to reassess their capacity. Collectively, the network’s goal is to contribute $20 million a year by 2022 and beyond to leverage Mr. Cohen’s philanthropic gift.
An example of this model in action is The Steven A. Cohen Military Family Clinic at Centerstone, in Clarksville, Tennessee. Centerstone partnered with CVN in 2017 to become the 10th Steven A. Cohen Military Family Clinic in the country (see Steven A. Cohen Military Family Clinic at Centerstone). Dr. Vero explained that in Clarksville they are serving veterans, not active military, and their families. The veterans they are serving are mostly post 9/11 and are served regardless of their previous role in the military, and regardless of their discharge status. Often that status ends up not giving them Veterans Affairs benefits.
How does CVN maintain and insure that evidence-based practices (EBP) can be delivered across their entire network of clinics? Dr. Hassan explained that CVN relies on a data team that constantly looks at the outcomes and spends half a million dollars a year on training for EBP. Measuring quality comes down to a continuous quality improvement process that includes monthly, quarterly, semi-annual, and annual review in which they look at clinical quality pre- and post-utilization, no-show rates, stewardship, staff training, and compliance. Dr. Hassan also noted that CVN “continually focuses” on access to care (including emergency care access, and access to care within seven days), service utilization, and maximizing compliance which includes Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation. He noted:
We want the clinics to succeed, and in turn they help us across the network. It’s nice to have a diverse set of partners who can advance our training, learning, innovation, and opportunities. Our network partners elevate the whole network and bring unique opportunities for us to explore. Across the network, there are opportunities for massive cross pollination so that services are state of the art. And really, the whole network thrives because of the uniquely qualified staff we hire. The consumer is ours to lose in that early engagement process. If there are any indications that our staff just don’t understand what veterans have gone through, and if they don’t understand the family served as well, it’s a lost opportunity.
Dr. Vero also added that in this model, it’s important that clinical professionals have some military experience, either as service members or as members of military families. He noted that they are very intentional about hiring staff who have military experience, explaining that about 90% have military experience.
What does the future hold? Dr. Hassan outlined a vision that CVN will see 25 clinics opened in the network by the end of 2020 and develop a network that doesn’t only focus on clinical care, but also expands the concept of best practice, and advances the science in the field. He noted:
Cohen Veterans Network is capturing loads of data across the network of clinics which has the potential, in time, to power a range of models for specific consumer care treatments to business efficiencies; we aspire to be that place in veterans’ mental health care where others will look to our model-driven business for insights. We are growing our clinical research program to help advance the field through clinical trials and innovation. Additionally, we want to grow the profession through our graduate intern and post-graduate clinical professional programs where unlicensed professionals can train with us under supervision to get to licensure. We are doing our part to grow the clinician pipeline and our own.
To hear more about the work being done at CVN and The Steven A. Cohen Military Family Clinic at Centerstone, join Dr. Hassan and Dr. Vero, along with OPEN MINDS Senior Associate Richard Louis on September 20 for their session, “Creating Public/Private Partnerships: Making Meta Leadership Work”, at The 2018 OPEN MINDS Executive Leadership Retreat.