Demand for behavioral health services remains constant

When we last visited with Scott DiChristofero, he explained how he has always appreciated the exactness of numbers. He fondly recalled being an 11-year-old calculating the all-important Little League batting average.

Later, he took a high school accounting class and found that numbers still made sense. It was no surprise when he pursued an accounting degree at Providence College and later became a CPA.  

Now, DiChristofero is Vice President of Finance and Chief Financial Officer at one of the state’s largest non-profits, Gateway Healthcare, a Lifespan partner.  Gateway Healthcare serves some 25,000 Rhode Islanders and is the state’s largest non-profit behavioral health organization providing treatment, intervention and prevention services.

For Gateway, change has meant consistent growth. Its roots were planted during the 1960s revolution in mental health care. With the passage of the Community Mental Health Center Act of 1963, addiction and mental health treatment philosophy underwent a radical change as emphasis on large hospitals and public asylums fell from favor. Rhode Island became a leader in the deinstitutionalization movement and treatment shifted from large, inpatient facilities to community treatment centers. Eight community centers were recreated from what had first been local, non-profit treatment programs. Gateway’s original mental health organizations – Community Counseling Center and Mental Health Services – were an integral part of that original community programming.

Gateway’s formal network was born when like-minded organizations with a common vision came together to respond to managed-care challenges. The leaders of several community mental health centers saw the need for more sophisticated administration and by the early 1990s began discussing the need for a regional network. By 1995, the boards of Community Counseling Center and Mental Health Services agreed to form Gateway Healthcare, Inc. to undertake administrative duties and enable them to once again focus on client care.

During July of 2013, Gateway began a new chapter in its history, affiliating with Lifespan, Rhode Island’s largest health care provider. Among Lifespan’s partners are Rhode Island Hospital and its Hasbro Children's HospitalThe Miriam HospitalBradley Hospital and Newport Hospital. Both regionally and nationally, Lifespan is well-regarded as a provider of innovative, high quality health care services and superior patient outcomes. Gateway’s scope of behavioral, substance abuse and social services complements Lifespan’s array of health care services. Today, Gateway and its affiliates employ more than 550 staff members including psychiatrists, clinical specialists and other paraprofessionals. Gateway reaches over 25,000 Rhode Islanders each year through residential, outpatient and community-based programs and stands alongside its affiliates in a mutual effort to address creative solutions for community care. 

WC: What kinds of challenges do you face at Gateway, in terms of providing the services you want to provide, while at the same time navigating through a changing economic landscape? 

DiChristofero: I believe our most significant challenge is securing appropriate reimbursement for services.  Our revenue streams impact every aspect of Gateway’s business from our ability to attract and retain a skilled workforce, maintain adequate facilities and provide free or subsidized care to uninsured or underinsured clients.

WC: Would you say the health care industry overall must be flexible to operate efficiently under an economy that ebbs and flows? 

DiChristofero: The service delivery elements of our business are based on best practices and benefit when stability and consistency exist.  That being said, our administrative infrastructure needs to be flexible enough to adapt to change. For example, Gateway has to administer multiple reimbursement models, including fee-for-service, per diems and case rates, as well as capitation arrangements.  Also, reporting client demographics, staff credentials, service units delivered and client outcomes all differ by funding source.  This requires a sophisticated IT platform and a myriad of talented staff to utilize that platform to its fullest potential.

WC: Does your background in public accounting serve you well in your present role at Gateway? 

DiChristofero: Absolutely.  My time in public accouting provided a solid foundation in understanding financial operations and analyzing financial results.  That background is helpful to me now when evaluating program operations, new programming or program expansion.  Gateway also receives federal awards and various grant funds.  My public experience with accounting for temporary and permanently restricted funds and dealing with A133 audits has significant value in our daily accounting practices, preparing for the annual audit and drafting financial statements.

WC: How would you describe your clients?

DiChristofero: Our services are provided through 13 residential facilities, 100-plus apartment units, several community outreach programs and our six outpatient locations.  Gateway services clients dealing with behavioral health issues.  Children with severe emotional disorders and adults with severe and persistent mental illness constitute the largest component of our client population.  We also provide general outpatient counseling and substance abuse treatment.  Additional services are also available through Gateway’s affiliates... The Autism Project provides consultation and support to professionals and families relating to children with autism.  FRIENDS WAY is Rhode Island’s only child and family bereavement center.  Capital City Community Center operates a meal site for seniors in the Smith Hill area and offers child care and pre-k services.  

WC: How has the demand for the services you provide changed in recent years? 

DiChristofero: We have seen an increase in the demand for our services consistently over the past several years.  Mental health issues can be influenced by social and economic factors so the recent economic struggles of Rhode Islanders can certainly be seen as one of the drivers of the increased demand.  Another driver has been the implementation of the Affordable Care Act.  Medicaid expansion and the health insurance exchanges have made health insurance, and therefore healthcare, more available to folks previously uninsured. 
WC: From a financial perspective, are group homes a model that can be made to be sustainable and efficient? 

DiChristofero: Gateway’s goal is to serve the client in the least restrictive clinical setting possible and for some a group home setting is appropriate.  Operating a group home is challenging because of the constant upkeep of the physical structure.  Reimbursement rates for residential services seldom factor in the need to fund a replacement reserve for a new roof, house painting or paving a driveway.  Ideally, a group home setting is a step in the process of getting the client to live more independently.  Gateway owns a significant number of apartment units that we rent to clients.  They live in the apartment, sometimes in a roommate arrangement, and receive supportive services from us that allows them to stay on their own without 24/7 Gateway staffing.