kintsugi-ing a company [strategic plan part 2]
“Kintsugi is the Japanese art of putting broken pottery pieces back together with gold — built on the idea that in embracing flaws and imperfections, you can create an even stronger, more beautiful piece of art.” – NBC News
We started 2022 with major changes. I passed the CEO torch to Nick Slovak at Green Hill and I focused on building out Advaita Integrated Medicine and Advaita Health Ventures. Six months later, we decided instead of operating the organizations as three separate entities, we should consolidate the operations. What follows describes the thought process behind several operational decisions made at Green Hill and AIM.
“We started Advaita Health Ventures (AHV) because we believe that addressing the growing mental health and substance use crises will take a patchwork of programs – insurance-based, private pay, and government-funded – that serve specific populations by providing whole-person care. Our healthcare system needs leaders looking for new ways to serve our patients and their providers. That is why I’m positioning myself between (1) policymakers, (2) patients, (3) providers, and (4) technologists at AHV so we can address the social determinants of health, create innovative payor-provider structures, and come up with effective, technology-enabled interventions, all while creating provider-centric environments. I’m tackling that by going full Don Quixote and fighting one giant windmill: the healthcare system.
I’m hellbent on increasing access, affordability, and quality in the healthcare system. Doing all three simultaneously through one program, like Green Hill, is impossible. That’s where Advaita Health Ventures (AHV) comes in. AHV is a platform. Technically, it’s a managed services organization whose purpose is to support clinical operations at Green Hill Recovery and Advaita Integrated Medicine (AIM). AHV is designed to take the complexity out of Green Hill and AIM. This is accomplished through holding several administrative and non-client-centric functions -- i.e., human resources, digital marketing, finance, compliance, legal, insurance contracting and credentialing, and facilities management -- so that the operating companies refine their craft, and serve patients instead of navigating bureaucracy and red tape.”
If you want to read the full letter, check out this document: CEO Signoff
When I wrote a strategic plan for 2022, I wanted an organizational structure and the legal framework necessary to accomplish the ultimate vision: building a healthcare system. Instead of transforming Green Hill into a multidimensional healthcare company, it made more sense to become one of the portfolio companies of the system (e.g., the first piece of the Advaita Health Ventures puzzle).
Intentions
Limit Complexity: As I said in the CEO Signoff, “AHV is designed to take the complexity out of Green Hill and AIM.” We had a good thing going with the community outpatient and transitional living programs at Green Hill. I didn’t want AIM (plus AHV) to interfere with established operations.
Balance Stretch Roles with Proven Competency: It’s a bad idea to have everyone in an unfamiliar role, especially if it’s one with more responsibility than they’ve previously had. I hoped that a few of us would sprint ahead to explore uncharted territory while others could develop methodically.
Take the pressure off managed care: If you’ve worked at Green Hill, or any other organization that provides residential, PHP, or IOP services, you know that the ebb and flow of the census can cause anxiety. We thought we could lower the ambient pressure on the transitional living and community outpatient programs by offering therapy and medication management (covered by insurance).
Strong theoretical framework: Nick and I crafted the following vision statement in the good ole days at West Johnson Street.
In ten years, there will be a Green Hill Model. Due to superior client outcomes, other organizations will model their programming on what we have created, implemented, researched, and refined. We will be an undisputed leader in the field of young adult substance use disorder treatment, evidenced by the adoption of our curriculum which will have been validated through research.
As I said in this blog post, “We should embrace insurance and broader healthcare paradigms and frameworks. For those of us in the substance use treatment space, The ASAM Criteria is a good place to start. Insurance-driven levels of care aren’t terrible either.” We want to deliver the best possible outcomes, so we need to have a solid theoretical foundation for our services. You can’t call yourself a world-class treatment program if you don’t offer psychiatry. We also need our treatment model to align with what we know about addiction – a chronic, relapsing medical condition.
Reality
Integrated care requires integration, duh. Green Hill and AIM must operate as a single entity to be a system of care. Patients shouldn’t feel like their experience at Green Hill is separate from their experience at AIM and vice versa. One of the coolest things I’ve witnessed about the systems approach is that folks who complete treatment stay connected through outpatient therapy and psychiatry. If they slip up, we’re there to catch them without immediately assuming they need residential treatment (saving families hundreds of thousands of dollars, sometimes). Without AIM, Green Hill’s programs had to take a black-and-white approach to admissions. With AIM, we can work with folks in a less restrictive manner, build rapport, and then help them navigate to the appropriate care they need.
We wildly underestimated the administrative complexity. I completely underestimated the organizational complexity of running AIM. Take a straightforward example: revenue cycle management. At Green Hill, most of our revenue came from monthly invoices sent directly to families. In an insurance-driven model, you’ve got to collect copays and bill insurance daily, or you’ll run out of money, which we almost did back in August. I didn’t listen when people (like Teresa) said to slow down. The administrative complexity, coupled with a majority of our team in stretch roles, led to many of us solving “novel” problems daily. That’s a recipe for burnout and discontent.
We lacked leadership cohesion, and too many folks were in stretch roles. Even though we tried to limit the number of folks in stretch roles, it didn’t pan out that way. Adding AIM to the mix threw off certain aspects of Green Hill that worked smoothly. We’ve got some team members (I’m looking at you, Nick) who can’t let the organization fail, so they selflessly jumped in when AIM was struggling to get off the ground. From the top down, we fumbled through establishing cohesion and clarity. We asked too much of team members who didn’t have the necessary experience or skillset to make the vision a reality.
Information technology has plagued us. Who is happy with our electronic health records system? Crickets. We’ve got considerable IT challenges, from the dual Google Drives to Ring Central, stemming from the attempt to separate Green Hill and AIM. Ironing things out will take a few more months, but we’re progressing steadily.
I would make many different decisions if I had a replay of the last few years. For Green Hill transitional living folks, I think the cracks started to show when we opened the Leonard Street apartments. From then on, there was a rift between certain individuals and departments, and we began to see fissures in the organization like never before.
the path forward
The leadership team has acknowledged and taken extreme accountability for our blunders, both in public and private. We are now playing with a full deck of cards, and it’s time to focus on the future. We broke things apart, and now we’re putting them back together. From here on, I will refer to the team “Advaita” or “Advaita Health.” I’d like to see the arbitrary distinction between Green Hill and AIM dissipate. Folks that have long been here have a deep loyalty to Green Hill Recovery as an organization, but we’ve got to evolve. We’re not “killing” the Green Hill or AIM brands, but I want everyone to speak, act, and communicate as if we’re part of one team.
From a leadership perspective, we’ve got the strongest team we’ve ever had. We’re building depth in each department and investing in team members who exemplify our values. Hopefully, this information was useful, or at least shed some light on last year's decision-making and thought process.
Next week I’ll share updated information on our mission, vision, and values as Advaita Health. After that, I’ll share information that is more actionable and relevant on a daily basis.
