Helpful Advice for Small Organizations Managing Huge Demands and Challenges

In small organizations, we get so busy – as evidenced by the several weeks since my last blog. I agree with Mary Gay Abbott-Young, a NJAMHAA Board member and CEO of the Rescue Mission of Trenton, that in smaller organizations, leaders and other staff wear so many hats, which makes it is difficult to get to many things. As a result, the expectations seem unrealistic. This leads to the question: What do small service provider organizations need to do to survive?

Most days, I would describe my role at NJAMHAA as being an octopus that also has to stand on its head to manage the multiple – and growing – demands. While this makes my career exciting and never boring, it becomes very challenging. In terms of advocating strongly and constantly on many issues; meeting regulatory standards; staying on top of what is happening in the behavioral health field, related industries and the state and federal governments that affects our members’ abilities to provide services; and keeping up with daily operations and serving members/clients, both the NJAMHAA staff and our members face a gargantuan task every day.

“Small” in the behavioral health field does not necessarily mean being as small as NJAMHAA’s staff. Small provider agencies in this environment could have budgets of $10 to $15 million. On our staff, we have fewer than five individuals delivering member services, advocating, and developing and presenting conferences and other training events to NJAMHAA’s 160 organizational members and their 61,000 employees. That’s a lot of demand on a few people! And the employees at our member provider agencies contend with similar challenges.

In this environment, as demands are increasing while resources are declining, here are some ideas from Mary Gay and Jim Lape, a Past NJAMHAA Board President who recently retired from his position as Trinitas Regional Medical Center’s Vice President of Behavioral Health and Senior Services:

Mary Gay poses the following questions for providers in small agencies to consider: Does your agency need to become larger to survive or is the key to partner with other provider organizations? Does “bigger” necessarily mean better services? How can we act as a community of providers?

According to Jim, agencies need to be bigger, but they do not necessarily need to merge with other organizations. However, there is pressure to consolidate in all sectors to achieve economies of scale. What is essential is their participation in larger networks.

Jim emphasized that smaller agencies must be as strong as they possibly can be in order to be attractive to networks and larger entities. To do this, they need to manage costs by being as lean as possible, especially on the administrative side, and explore opportunities to outsource some functions, such as information technology, human resources and billing. They also need to offer special valued services to maximize their revenues – perhaps by facilitating groups, especially around medication management, and specific types of groups that would meet the needs of their communities, such as trauma-focused and dialectical behavioral therapies.

Jim added that mental health providers need to focus on the broad range of mental health disorders, not just serious mental illnesses. In addition, since money will flow from the federal and state governments to health plans when Medicaid is managed – which will probably begin within the next year or two – it is also important for agencies to have relationships with health plans and provide solutions for populations that are being insured.

The many changes taking place can seem overwhelming, especially when they appear to be at odds with providers’ mission to serve everyone in need – a population that continues to grow. I hope this advice from long-time, expert providers of both mental health and substance use services brings encouragement to all of our members.