Behavioral Health Compliance: An Interview with Theresa Wray, LMFT
Today we interview business owner, clinician, and consultant Theresa Wray of Synergy Consulting Services. A rare and exciting connection for us because of one major factor: Theresa loves finding needles in haystacks. In fact, she excels at it. All of the necessary yet hair pulling work that counselors and Behavioral Health organizations dread to do are actually fun for Theresa. Things like reading your Managed Care contracts, auditing your charts, reviewing compliance plans, and verifying state regulations. Enjoy getting to know her during our interview on Mental Health News Radio. More importantly, enjoy getting to know what she can do for your Behavioral Health organization.
What made you start your consulting firm?
Simultaneous feelings of fascination and frustration with the behavioral health system and the ways that the various players interact within it.
I’ve always been interested in understanding how systems work – that’s what lead me to becoming a Marriage and Family Therapist – but as I got my first jobs in behavioral health, I quickly realized that there’s a lot more to doing clinical work than simply doing clinical work. Working in community mental health primarily with Medicaid populations, I experienced firsthand how complicated and confusing – not to mention inefficient – the behavioral health system can be. It seemed that no matter what question I asked, I couldn’t get a straight answer.
For every person who told me one thing, there were two more telling me something entirely different. It was extremely frustrating to me and I was wasting a lot of time having to go back and redo things. So, I started scouring state and federal websites, reading bulletins and regulations, my managed care contracts
and provider manuals, and calling ‘the people in charge’ to figure out exactly what it was that I was supposed to be doing. During this process, I realized how hard it is to gain access to and make sense of the information we need to know.
However, I also understood that I needed to have this information, so I didn’t give up. I grew up volunteering in some of the long term care facilities where my mother had worked and worked in some during grad school. During those times, the facilities underwent routine licensing inspections, as well as ‘surprise’ visits from the state. I saw firsthand the impact that experiencing something like receiving a provisional license had on the facility-as-a-whole, staff morale and workloads, and, ultimately, the residents.
So it was against this backdrop that I entered my own career.
During the time that I worked at the Medicaid Behavioral Health Managed Care Organization, I really gained a deeper understanding of the role that relationships between providers and payers play in service delivery. There’s a lot of misunderstanding, anger, and mistrust between the two groups. It shouldn’t be this way. It doesn’t have to be this way. At the end of the day, it really hurts our clients.
I remember going in to audit providers, and hearing over and over again, “I didn’t know I was supposed to be doing that,” and the MCO’s response being, “It’s in your provider manual. We sent you newsletters and offered webinars. You signed that you understood everything.” The MCO was right – the information was given, and the providers should have taken the time to review everything and make sure they understood it. However, what the MCO didn’t always take into account was the fact that providers were out there doing the hard work of providing services and didn’t always have the time to navigate through unfriendly websites and go through volumes upon volumes of information that is often difficult to understand.
When I began working in private practice and was getting to know other private practice clinicians in my area, I was stunned at how few had actually taken the time to really understand what they needed to be doing to remain compliant – ethically and legally, not just contractually. There’s a misconception that if you’re in private practice you don’t have to focus on the things that agencies and clinics focus on.
Sadly, I saw more than a few really great clinicians and programs have to close their doors because of not knowing what they didn’t know. So, my goal in starting Synergy was to help prevent that by bridging the gaps between what providers want to do, what they are doing, and what they’re supposed to be doing.
Why the name ‘Synergy’? What exactly does that mean?
Briefly defined, Synergy means ‘Cooperative Interaction’. It’s what happens when two or more people work together to create something greater than either would have on their own. Basically, the whole is greater than the sum of its parts.
It really is at the heart of all my work with clients – what is at the heart of all of the work we in behavioral health do. We work synergistically with our clients, our communities, and the systems in which we are embedded – that is, we create things together that could not have been created had we tried on our own.
You “officially” launched earlier this year. How are things going?
Amazing! My head is actually spinning from how quickly Synergy has taken off! It’s really very exciting – and humbling – to be part of the great work that’s being done in communities. I’ve been blessed to work with clinicians and organizations from eight different states already!
So who do you typically work with?
I specialize partnering with solo-practitioners, group private practices, and smaller nonprofit behavioral health agencies. More often than not, my clients focus their work on serving under-served and disadvantaged populations. They all tend to be innovative visionaries with great clinical skills and offerings, but they aren’t exactly sure how to get everything off the ground, or are feeling overwhelmed with everything that goes into being compliant. These are so energizing because the teams are so full of heart and enthusiasm. Many just simply don’t have the resources, specialized knowledge, or time to make their visions come to life. That’s what I help with.
How so? What types of services do you provide?
For providers who are interested in expanding their service lines, I provide full project management services. A lot goes into developing a new program – developing policies and procedures, getting licensed and accredited, staffing considerations. It’s very easy to get overwhelmed or discouraged. I’ve heard from some of my clients that having someone objective to help guide them through the process, while also providing backend technical assistance, accountability, and motivation were critical to the success of their projects.
I also provide a great deal of consultation around issues related to working with managed care, particularly around Compliance/Fraud, Waste, and Abuse, documentation, state-specific regulations, as well around some of the business-related issues that we weren’t taught about in grad school. For example, NPIs, CAQH, taxonomy codes, coming on board with managed care organizations, developing paperwork. Often these aren’t long term projects, and a person’s questions can be answered in an hour or two. It’s great being able to help my peers save time and get accurate information.
What would you say sets you and Synergy apart from many of the other coaches and consultants who are available to providers?
There are three main areas that makes what I do differently from others.
First, I focus on regulations and compliance: There are a number of coaches and consultants out there who focus solely on marketing and growing one’s practice. While creating a vision for one’s practice, developing a niche, and building a web presence are critical to a practice’s success, they’re not the only factors that a clinician-business owner needs to consider. Especially in this day and age of increased regulation and oversight. You could say that I help my colleagues with the less glamorous aspects of practice ownership. My focus is on helping clinicians make sense of a complex system that is highly regulated. Compliance Plans, documentation, contracts – these aren’t exactly sexy concepts – but they’re an important part of our work and staying in business.
Secondly, I really am not in the business of terrifying people or selling them something they don’t need. A few months ago, I came across a $100 book that promised that one would never get audited or have to pay money back if they read it. It claimed that insurance companies only exist to make providers’ lives miserable and that they will not stop until every provider is audited and put out of business. I’m not at all about that kind of fear mongering.
I’d say that the third factor that sets me apart from other firms is that I am first and foremost a clinician. I really get what it’s like to be out there doing the work and when I’m working with an organization, I don’t limit my involvement solely with the executive team. Instead, I bring the front line staff into the project and really focus on developing plans that are going to be meaningful to them and their clients. Too often, consultants don’t focus on how their plans and systems are going to actually work in ‘the real world.’ They tend to take Top-Down approaches rather than working from the Bottom-Up. I’ve learned from experience that this just doesn’t work. If the whole organization isn’t on board – truly on board – it’s just not going to work and the organization just wasted a ton of time and money, and likely significantly impacted staff morale.
What advice would you give to someone considering opening their own practice or expanding their services?
It really comes down to focusing on The Four P’s: Being Planful, Proactive, Persistent, and Patient. It’s so tempting to jump head first into making our dreams reality – I’ve often been guilty of this – but in doing so, we actually end up making things a lot harder on ourselves than they have to be, and then when we hit roadblocks, we get frustrated and discouraged. It’s a lot like The Song that Never Ends from Lamb Chop’s Play Along. We start doing something not knowing why we’re doing it – and we keep on doing it forever just because. A lot of time, energy, and money is wasted, and for those of us working in this field, we know how precious these resources are. We can’t afford to squander what we have – nor can clients afford it.
How can people find out more about working with you?
Synergy also has LinkedIn and Facebook Company pages where I post a lot of helpful information and tips. These can be found at:
Theresa M Wray, MA, LMFT is the Founder and CEO of Synergy Consulting Services, a firm that the serves the behavioral health community. She is a Licensed Marriage and Family Therapist in Pennsylvania with over 15 years of experience in the field, and has worked with individuals, couples, and families in community-based mental health programs, inpatient facilities, educational settings, and private practice. For several years, Theresa worked in the Clinical and Quality Management Departments at a Behavioral Health Medicaid Managed Care Organization in Pennsylvania where she completed utilization management reviews and provider audits, participated in local and state work groups and committees, and developed and monitored quality improvement projects.
Theresa has made it her mission to help behavioral health clinicians, practices, and organizations understand the regulations and laws that govern the field, as well as the standards and practices required by managed care organizations. Through her work, she is able to help her clients connect these requirements to the services they provide within their communities in clinically meaningful ways.
She routinely works with clinicians, private practices, and behavioral health organizations on issues related to Program Development, policy creation, Fraud, Waste, and Abuse, and Managed Care. She prides herself in providing common-sense and workable solutions to many of the challenges behavioral health providers face today.
Tags: Behavioral / Mental Health Information, behavioral health, business professional, Business Tips, Consultant, Fraud, Healthcare Policies, Kristin Sunanta Walker, Kristin Walker, Mental Health, Mental Health Is Real, mental health news radio, MHNR, Not Changing the Name, Practice Management, Project Management, psychology, support, Synergy Consulting Services, Technology, therapy, Theresa Wray, What is Mental Health?