Healthy Data Podcast Manish Sapra (Northwell) & Jordan Cooper (InterSystems)-20250602_130249-Meeting Recording
June 2, 2025, 5:02PM
21m 55s
Jordan Cooper started transcription
Jordan Cooper 0:04
We’re here today with Manish Sapra, the executive director for the Behavioral Health Service line at Northwell Health, Northwell Health. For those who don’t know, is a health system based in Long Island, New York with 5200 beds, 17,000 providers across 20 hospitals and other care fac.
Manish, thank you so much for joining us today.
Sapra, Manish 0:23
Thank you.
Thank you for having me.
Jordan Cooper 0:25
So let’s talk about behavioral health.
I know there’s a lot going on with behavioral health integration and primary care settings, schools, colleges, faith-based organizations, as well as integrating mental health care into other service lines.
I know that’s core to your strategy.
I’d like to ask you to elaborate on that strategy.
What’s unique or interesting about it, and specifically what role data integration is playing in that effort?
After all, this is healthy data podcast.
Sapra, Manish 0:53
Sure. Yeah. You know, first of all, thank you for.
Your giving us an opportunity to talk about behavioral health and bringing the discussion about behavior health into the into forefront. You know, after the pandemic, we realized that and even prior to that, there was a a crisis brewing in behavioral health, access to care. And just me being.
Able to meet the demand, we just skyrocketed.
After the after the pandemic, we also understood our health care disparities in in many of our populations.
We’re we’re just not able to provide.
The the culturally competent access to care and to provide them.
In, you know, at a time when they need the most.
So one way to address that is really meeting the patients where they are, where they feel comfortable seeing us and. And So what we’re doing at Northwell.
Well, we’ve been in this journey over last several years of integrating behavioral health in our with physical health. So in primary care settings, we’ve set shop, you know, embedded therapists in in primary care.
Practices in our pediatric practices. We cover all of our Pediatrics practices across the health system.
Now where we have embedded therapists.
In the, we’ll provide immediate access to services.
As soon as any conditions are are identified, so therapists are then supervised by psychiatrists and we’re able to provide.
You know recommendations to the, to the pediatricians in the primary care doctors on how to provide services. We’ve taken this further to our schools.
You know we cover.
We have contracts with school districts, so we cover many school districts in in Nassau County and Suffolk County and are now starting to go into Westchester.
In in our New York geography, where we have immediate or same day or next day access available to child psychiatry services.
To students of these school districts, we cover more than 200,000 school students.
Through that program, we have partnership with colleges to provide behavioral health services, especially in acute care services.
We’ve had soccer, health side and and recently.
We went into uncharted territory of actually embedding.
Therapist in in our communities in faith-based organizations.
So we embedded therapists in a church in Queens.
What in Harlem and at a mosque?
In in, in Long Island and we’re learning, you know, as we go to the communities as to how we can use these services, not only to provide care but also build those bridges with these communities, right.
We’re working with trusted community leaders at these sites.
And and that is helping us reduce stigma, you know, build trust in these communities to provide care.
So that’s just, that’s a few things about our team of of integration.
We do work with other service lines as you mentioned.
In in specialty care, so we have programs especially for folks who are going through bariatrics procedures.
We have folks through perinatal care of Women’s Health issues.
We have programs that we have set up.
Or folks going through transplants at at Northwell.
So we have a transplant psychiatry program to name a few psycho oncology, which is, you know providing behavioral support for folks going through cancer care.
So those are some other.
Descriptions of integration of care.
You mentioned how does it all work with integration of data and which is like a really.
You know, it’s a, it’s a bit of a struggle in behavioral health because sometimes.
We’re not allowed to share.
Data because it’s sensitive or it’s considered behavioral health, though those restrictions are more on the substance use side.
But we have done as much as we can to improve access to those cares, at least to the providers within Northwell.
So when we see a behavioral health provider and we also have a primary care provider, the records are shared so they can see that information and then we.
Link to our HIE so.
That data is available if folks have come into our hospitals or or had a behavioral health visit and then.
We’re working now.
More on the back end of like you know, understanding.
The How all this is actually really helping our patients, right?
So we described you the program with primary care integration.
We wanna study if in providing behavioral treatment along with the medical care it in a Co located setting.
Is that better than treatment as usual than just referring somebody out to a practice?
So we’re we’re doing that update analytics right now to understand.
Benefits of behavioral treatment on medical care.
Jordan Cooper 6:06
So many questions I have. After all that, Manish, on the last thing you just said asking does providing care in a Co located setting, meaning some kind of physical care and mental health care.
Sapra, Manish 6:08
OK.
Jordan Cooper 6:19
Is that better? If you didn’t know that going into it, how did you justify this seemingly expensive investment as an experiment to see suite leaders at Northwell? Why did you?
Say we want to do this.
Do this and 2nd how did you get, you know, sign off to get permission and do it if you don’t have the data saying that this actually improves outcomes or reduce costs or has some other material benefit to patients or the organization?
Sapra, Manish 6:48
Well, yeah. I mean there are multiple ways to answer that question.
But first of all, collaborative care which is this model that I described of embedding therapists getting supervision from psychiatrists but working under primary care physicians is a well studied evidence based model that has over 20 years of research and has shown good outcomes and has shown outcomes that.
Actually saves healthcare.
Costs on these individuals.
So there is that.
Background of research.
The second piece is we were supported by the system, the redesign project to the previous Medicaid waiver.
Or call the dis Rep when within New York.
To so which gave a seat funding to get any of these programs going, and I have to show you the program is just so popular amongst the primary care doctors and pediatricians that even though we barely break even at times or sometimes we honestly do not on the.
Revenue side, it is just so popular amongst our providers in primary care and pediatrician offices, but that is one thing they want to hold on to.
And this will be the last thing for them to give it up.
Jordan Cooper 7:58
So in Healthy Data podcast, we often like to be very concrete to provide the most material benefit to listeners across the United States.
You mentioned that you integrate behavioral healthcare with a variety of specialty care service lines.
Bariatrics Women’s Health transplants oncology was just for the sake of getting concrete. Look at Women’s Health.
There’s a woman, Jane.
Jane lives in Long Island.
She gave birth three months ago.
And now has postpartum depression.
That’s a behavioral health condition.
Please walk us through not only what James experience of care is in terms of accessing mental health care while also doing well, baby check ups or doing her own OB/GYN appointments, but also how is the data being integrated? Because clearly postpartum depression has an impact on the baby.
‘S well-being and needs to be viewed by the pediatrician.
Caring for the infant but also in the EHR, but also needs to be viewed by the obstetrician gynecologist caring for Jane, who has a depression and needs to be aware that she is being treated for this. And that’s gonna have an effect on blood pressure, other comorbidities so.
Please the patient’s journey and also the data’s journey for Jane.
Sapra, Manish 9:19
Sure, sure. And by the great question. So, so, Jane, if she came to a visit and provided Northwell or even if she brought her three month old to a pediatric office, right, she’ll get a screening instrument and for depression.
And and for postpartum depression specifically, and if she if there is a screen, a positive Screener or maybe it is because there was a conversation with her provider or the pediatrician where she mentioned.
State that needing some help or support that will be quantified using these standardized scales and a referral will be made to an embedded therapist in that practice.
The therapist can do a few things.
They can. First of all, they do an assessment, right, their license, mental health providers as to what the situation is and based on what the situation is, they can do a few things.
They can provide care coordination to a provider in the community or within Northwell.
Be here for health services.
They can actually provide treatment.
They can do time limited 8 to 10 therapy sessions right there with the patient on on, on, on, on a frequent basis, they can refer the patient to a perinatal psychiatry program which we, which is a specialized programs that if the condition is such that it requires to.
Be seen by a reproductive psychiatrist.
They can.
They can be seen by that individual or they can just be seen by a general psychiatrist who may have interest in women’s behavioral health or expertise.
That area.
Jordan Cooper 10:51
Mm hmm.
Sapra, Manish 10:52
At times they can also recommend, after discussing it with psychiatrist medication, set up OB GYN or can prescribe to the patient if that is the person who’s holding the care of that person or patient during that time.
So that’s sort of the the patient journey. And if they do receive treatment with this care manager who we have embedded, there will be.
Monthly, you know, assessments on what is their.
Depression scores, if you will.
Using standardized instruments to measure that.
And that way we can at a on a population basis, maintain a registry of all the patients that we are treating and also measure the clinical outcomes. You know if people are getting better or not and as I mentioned we we do have, we do follow that track.
That at this time, but we’re we are trying to analyze now is, is that what are the effects on the?
Physical health outcomes, yeah, but you help.
Jordan Cooper 11:56
So and the the data journey, how are you integrating the behavioral health with the traditional clinical EHR, especially when there’s such overlap with one affecting the other?
Sapra, Manish 12:10
So one of the things that all documentation that that happens is is happening in right in the medical EHR, there is no separate behavioral health EHR in this condition except if they get went to the to the specialized perinatal program that they would have that that sort of.
Jordan Cooper 12:19
Hmm.
Sapra, Manish 12:26
You know a separate EMR cause because we are embedding these providers in the in the physical host setting.
They’re using the same Emrs, so the they’re provide referring providers are getting access to all the behavioral health nodes.
And in the standardized instruments, they can graph out the depression scores and they can follow all that right there in their radical records.
Jordan Cooper 12:50
So just to be clear, the epic electronic health record as a portal is either available to providers on a phone or in a desktop at schools and churches as well.
Sapra, Manish 13:04
Well, when I’ve yet on epic, but we will.
Jordan Cooper 13:07
Right, all scripts.
Sapra, Manish 13:08
Be a journey over the next two years.
Yes, but the all scripts program is is available to all the providers in who are coming in the medical settings. Also in in the school and colleges program, we do have a separate way of documenting for the faith-based program just because of the community based setting that.
We are in.
Jordan Cooper 13:31
And so how does that data?
I’m really trying to hone in on data since that’s the focus of this, this, this, the audience expects that with this episode is is, you know, how are you integrating whatever electronic data is being input?
Sapra, Manish 13:36
Sure, sure.
Jordan Cooper 13:48
In kind of a remote community based location into the organizational enterprise EHR.
Sapra, Manish 13:56
Yeah. So it is not different.
Right. It is in the organizational EHR, it is not a separate behavioral health EMR.
Jordan Cooper 13:59
OK.
Got it.
Sapra, Manish 14:02
So anything that’s getting integrated is getting integrated there.
And we’re running dashboards on depression screening across the system. We have a initiative to do depression screening, not just in OB/GYN practices, but across all our specialties. Whether you went to a dental visit to your rheumatologist or dermatologist, they’re also screening you for depression. And all that is.
Jordan Cooper 14:16
Mm hmm.
Sapra, Manish 14:23
Being monitored for all the service lines across the system in data that sits with just a General Medical ENR.
Jordan Cooper 14:30
And So what are some of the obstacles to providing care in these settings if one of our listeners says, hey, I’m in Minnesota and I would love this program to begin to be rolled out at my organization.
You know what are some of the challenges that I need to be aware of going into trying to set up this kind of program?
Sapra, Manish 14:51
Yeah, there, there are a few challenges for sure.
One, you know the medical community, the non behavioral health, right?
They have to to really want this and adopt this and be be friendly to it and and you know they suddenly see a lot of behavioral health in their day-to-day work.
But do they really?
What? What are they gonna do to to bring in a new discipline?
Excuse me.
Into their practice and integrate them well and endorse them. So Andre, for patients to them, right.
So I think the 11 challenge is to to just working with our medical community to to be adapters of of behavioral health integration.
The second challenge is which is I think is much better now than it used to be when when we started in this journey 1520 years ago, just having behavioral health providers who worked in that settings, you know it used to be we we had, you know, a.
Therapy offices on our couches and and, you know, do not disturb signs of the door. When we were in a therapy session.
You cannot work like that in a medical setting where you’re where the you know, the primary care physician or knock on your door and introduce a patient, you know, to you right then at that spot time, right.
Jordan Cooper 15:51
Mm hmm.
Mm hmm.
Sapra, Manish 16:03
So, so having behavioral health providers who want to work in medical settings and do time limited treatment do a lot of care coordination. I think we have done a lot in, in developing that workforce.
I think many of these EMR related integration over the years.
It is much better now, but that is certainly a thing to make sure that you know the electronic medical records are integrated and are part of that. And if I need a big one is the financial reimbursement right that that always lacks all the innovation that we do.
In in in the medical community.
So you know, we just need a reimbursement models.
That’s that.
Do reimburse well for non reimbursable activities of care coordination of reaching out to patients and helping them.
Through these behavioural journeys, and I think that that’s only lagging area.
Jordan Cooper 16:57
I appreciate that, Manish.
We are approaching the end of this podcast episode. A few more questions though.
I just asked about some of the obstacles to providing care with this integrated model of behavioral health in multiple service lines.
I like to ask the converse, which is what are the benefits?
Why do and? You already spoke improved outcomes reduce cost, but why?
More specifically, why is there such high engagement among patients?
Why do the patients love this integration and behavioral health?
In traditional physical, physical clinical care and why do providers love it?
Why would a primary care provider love this delivery model?
Why would a patient love it?
Sapra, Manish 17:34
So I think the patients like it because it is done in a medical setting, it’s destigmatized and it also meets the patient where they are, right.
So so they don’t have to like now be labeled as a behavioral health patient, mental health patient and go to a separate clinic. They’re getting the treatment in a very destigmatized medical setting.
There is great communication between.
Their medical provider and behavioral health provider, which you know, benefits the patient, but that’s it’s a good segue into why the providers.
Like if they’re not sending these patients into some behavioral black hole out there where they will never hear back from the psychiatrist or therapist is to go how that treatment is progressing.
Everything that is being done every every wizard is documented right there with with their own notes, and they can see the progress of the patient.
They like it that they can do curbsides with actually actual experts, like psychiatrists.
When things get tough and they also like the fact the providers that.
If there are some care coordination available, because honestly, like navigating the mental health space, it’s hard for patients. But it’s also hard for for providers as to where do they send this person, who has? You know, there’s depression, anxiety. They started a treat. But I don’t know if.
They’re looking like a bipolar disorder.
Or is it looking like OCD?
Who’s an expert in what?
Which place we send them and they’re they have somebody in their practice who can handle that.
So I think that’s great for them. And I’ll lastly I’ll say why for the.
Or the senior leadership or large health systems. You know you want everybody. We’re working in this world of narrower and narrower networks and and and and large health systems. Wanna make sure that their patients have access to all care within that health system. Right.
And what better way of expanding behavioral health care?
Then you know the integrating care in medical settings because it costs much less. And even if you lose money, you’re losing much less than if you work.
You know, just opening our, you know, dozens of outpatient practices out there and it’s a real, you know.
Booster for patient experience in in A and if if any systems get ready for value based care or population health that really sets them well. You know if there’s a program like this.
Jordan Cooper 19:54
Mm.
So the last question I’ll ask you, Manish, before we wrap up this episode.
Someone’s listening to this episode and they love everything that you’re saying.
Again, the Minnesota example I want to do this.
What’s 1 word of advice that you’d give to them?
Or perhaps a word of advice that you’d give to yourself five years ago before you start this kind of journey?
What would should someone do or keep in mind as?
A begin to move in this direction.
Sapra, Manish 20:27
Yeah. I mean, I think especially in a large health system where I work, it’s it’s a constant work.
It’s as I said, you’re introducing new discipline in in an existing.
Space that has honestly been been the same for decades, right? So.
You know, getting as senior an executive sponsorship, you can get you know a a top down approach on saying that this is the strategy of where the system is moving.
You know, why is it important to treat?
Depression and primary care setting.
You know why?
It’s it’s, it’s, it’s actually your job to, you know, screening for suicide and.
And having those discussions were in a busy medical office.
That message really needs to come from a senior leadership in the organization, so getting that in is the first thing.
Then, of course, analyzing what are the resources are available in the Community and and just doing a very good analysis of of that primary care setting or medical setting where we want to integrate services is done prior to moving in. I think those will be two big things.
There.
Jordan Cooper 21:33
Well.
Manish, thank you very much for joining us today.
Sapra, Manish 21:37
Sure. Thank you for having me.
Jordan Cooper 21:38
For those.
For those who’ve been listening, this has been Manish Sapra, executive director of Behavioral Health service line at Northwell Health.
And again, very glad to have you on today Manish.
Sapra, Manish 21:51
Thank you.
Thank you.
Talk to you later.
Jordan Cooper stopped transcription
