RI International (formerly Recovery Innovations) is strengthening its core mission with a clear vision and road-map.
“Disturbative” and “Deep Change.” These were the two key words that fifteen members of the RI International leadership team considered as we convened for a two-day Strategic Planning Retreat last month to focus on the future vision of the organization.
The first concept, an amalgamation of “disturbing” and “informative,” was coined by a team member to capture the essence of the climate in which specialty behavioral healthcare organizations find themselves in 2015. Two key drivers comprise the disturbative:
- Integration’s impact on specialty behavioral healthcare administrative structures, and
- Consolidation of behavioral healthcare provider agencies.
Trend 1: Integration
The geeks on our team could not help but think about a Game of Thrones metaphor. For five years, we have known “Winter is coming.” But it seemed far away and the wall that separates us from the forces to the north has kept us safe from change. Until today.
In Arizona, the towering and indestructible, 30-year old wall protecting the specialty behavioral healthcare system from real world forces is…gone. The Division of Behavioral Health Services will dissolve in 2015, and the Arizona Healthcare Cost Containment System (AHCCCS), which is the Medicaid authority, will assume responsibility.
After nearly 20 years of carve-out Managed Behavioral Health Organizations like Value Options and Magellan Health, the new RBHA, Mercy Maricopa Integrated Care, is affiliated with a full-service Arizona health plan, Mercy Care (an Aetna company).
The nationwide trend is to dismantle the historic specialty behavioral healthcare administrative structure, and integrate fully into the primary care system. The former is a $30 billion industry, which is a sliver of the larger $2.4 trillion healthcare system.
RI designed a strategy with both sets of customers in mind.
Trend 2: Consolidation
We refer to the second major trend as the “Final Four.” The consolidation of American Airlines and US Air essentially means we now have four airline options. If the nearly $50 billion acquisition of Cigna by Anthem goes through, there will be the same number of major full service health plans.
March Madness-type whittling of contenders has found its way into mental health, which has been shielded from market forces and competition in much of the country. This has been done by its wall of separation and the catchment areas of legacy providers who were originally county-based mental health providers prior to the 1980s.
The complexity of demands faced by behavioral healthcare executives is accelerating year over year and new competitors are entering the space. For example, A.W. Holdings was unknown in behavioral healthcare prior to 2010, but their Benchmark brand now operates significant crisis services and has competed in RFPs against traditional community mental health providers from Colorado to Georgia.
So, in developing our strategy, the RI team had to consider the change in the behavioral healthcare climate, the melting of the great wall, and the integration and consolidation that follow.
We also considered deep change. The fire. That which ignites our passions and spreads in a flash. It’s not enough for RI to survive. We want to thrive. Eschew incremental change and improvement for frame-breaking innovation. Robert Quinn’s 1996 work Deep Change begins, “We must continually choose between deep change or slow death.”
Today’s pace of change can take your breath away. It took 150 years for the first iteration of behavioral health institutions and asylums to be supplanted by the Community Mental Health Construction Act. After only 50 years, the CMHC era is showing its age, and many are beginning to think about a third generation.
Authors like Rosalyn Carter (Within our Reach) and Frank and Glied (Better But Not Well) point to the future: one that is integrated, features peers and recovery, self-management, high technology, and better outcomes.
People with Serious Mental Illness today are unemployed at the rate of nearly 80%, frequently have poor or non-existent social supports, risk suicide at rates 12 to 15 times greater than the general population, and one in three have at least two chronic medical conditions in addition to mental health and/or substance abuse issues.
We can do far better.
While our team thought a lot about Version 3.0 emerging now, we also considered a fourth wave on the horizon. In that worldview, it’s less about the person’s recovery and more about the greater society’s responsibilities. We reflected on the following:
- The physical disability world where the focus is on the community, its businesses and services and appropriate accommodations and respectful language (and where individuals are employed at far greater rates)
- The call by former U.S. Representative Patrick Kennedy at this year’s National Council conference to shift from health promotion and stigma reduction to the law and rights
- The 25th anniversary of the Americans with Disabilities Act, which also provides protections for mental health and addiction
- The Ted-Talk by Arthur Evans on population health, non-medical, social determinants of health, and public health interventions
In addition, RI senior staff also prepped by reading Reframing Organizations, Artistry, Choice and Leadership (Bolman and Deal, 2008), which describes a four-frame model for management, with simultaneous focus on the structural, human resources, political/strategic, and symbolic frames. And, we evaluated strategic planning documents from SAMHSA and other leading healthcare organizations.
To kick off a process of communication and engagement with staff and stakeholders, survey data was gathered prior to the session in the areas of values, goals, programs, services and priorities, as well as strengths and weaknesses. More than 500 staff participated. A separate survey of staff training, skills, and supports for suicide care was also conducted.
Our agenda started with an environmental scan of the industry, both current and forward-looking. Within that context, the group identified the unique current and future contributions RI International can make to the health care field. The second day focused on how the organization can achieve stability, sustainability, innovation, and profitability moving forward.
This process included group discussion to identify:
- The Customers: Who are the RI stakeholders and what do they need?
- The Good to Great Sweet Spot: Where is the intersection between what RI is passionate about and what it does really well?
- The Matrix: What are the central RI services and programs, as well as the cross-cutting leadership principles they embody?
- The SWOT: An analysis of the Strengths, Weaknesses, Opportunities, and Threats
- The Plan: Development of targeted objectives
Later in the month, the Board of Directors held a one-day follow-up. Additional cascading events will occur, engaging the full Company workforce, over the course of the summer and fall. This is where the vision will become a tangible action plan.
This is the result of our company-wide planning process:
Empower people to recover, succeed in accomplishing goals, find meaning and purpose in life, and reconnect with themselves and others.
Activate the next generation of frame-breaking healthcare innovation to support people going beyond their behavioral health needs to succeed in the community where they live, work, and play.
- Healthcare Innovation: We’re putting the “innovate” back in RI with enhanced services in four primary areas. These key business lines will target the central needs of our primary Customers, which are the state and county mental health authorities and health plans that fund RI services and programs, with the intent to migrate all programs to the “bull’s eye” (where RI is viewed as indispensable to the fulfillment of the funder’s mission and responsibilities).
- Employee Investment: RI will value our employees by attracting the best talent and cultivating in our work environments a highly confident, competent, and caring work force. Through our survey and dialogues, we’ve gained valuable insight to the needs of our employees. To help them thrive in their career, we’re co-creating a plan to implement skill-building and professional development, greater two-way communications, consistent performance reviews, and leadership training.
- Solution Optimization: RI has some significant gaps in the electronic systems required to support a $60+ million per year company. We are going to leapfrog to best-in-class systems across the board, and anticipate and exceed the pace of future change. We’ve hit a point of growth that requires improved electronic systems so we can work and serve others more effectively. RI will first conduct an assessment of gaps and risks. Solutions will be identified, prioritized, and implemented.
- Strategic Expansion: RI will develop the business/program scale and capabilities to exceed the pace of current and future change related to healthcare and system reforms. RI International has experienced rapid growth since its inception, and we’re going to ride a wave of growth again. Rather than taking on the cost and time to re-invent the wheel, we’re looking to broaden our horizons by partnering with others who can help us offer even more effective and innovative healthcare services.
This requires that we create a strong and attractive international brand and identify and pursue not-for-profit organizations that would strengthen RI International (including the Balance Sheet), complement our recovery culture and services, and add an advantage to the fulfillment of the strategic plan.
Four Major Business Lines
- Crisis Services: our fastest growing area with new programs in Arizona, California, Delaware, Texas and Washington State will add new partnerships to enhance technologies and service lines to our existing array of Recovery Response Centers (Crisis Stabilization Programs), Evaluation & Treatment (Involuntary & Court-ordered Treatment), and Crisis Respite.
- Transition Management: another area of strength, the Company will expand our Peer, Crisis, and Health Navigators to ensure successful community transition of our participants (diverting from inpatient hospitalization and re-admission) and demonstrate measurably both the recovery and cost-savings benefits to our funders.
- Integrated Outpatient & Peer Supports: our national footprint of Wellness City programs is impressive, and the Company will add clinical, medical, and routine primary care, creating fully-integrated health homes. This will provide even more well-rounded services and will strengthen our capabilities to support individuals at risk of suicide, co-occurring substance use disorder, and/or co-morbid serious medical conditions like diabetes, COPD and heart disease.
- Consulting and Training: today’s international success is based largely on how the Company has shared our innovations through the Recovery Opportunity Center over the past decade, and we will expand and extend these consulting and training services.
Strategic Visual Framework
The Way Forward
There are definitely challenging times ahead for non-profit behavioral healthcare providers that were established in the shadow and protection of the great wall.
Yet, it’s a great time to work at RI International. I am excited and looking forward to the journey. Our Company is dedicated to deep change and making a difference in the lives of all those we serve. With our employees around the world and our Board of Directors, we will partner with our Customers, both old and new, and create this vision of recovery and community inclusion together.