How Eagle Valley Behavioral Health is building a new model for addressing mental health

Chris Lindley, Chief Population Health Officer with Vail Health, speaks at the groundbreaking of the Precourt Healing Center on Sept. 1, 2022, in Edwards.
Chris Dillmann/Vail Daily Archive

Since its inception, Eagle Valley Behavioral Health has sought to do things differently when it comes to addressing the Eagle County community’s mental and behavioral health needs.

From becoming the state’s first new community mental health center in nearly three decades to bringing together community organizations and resources as well as filling community behavioral health needs, the wholly-owned subsidiary of Vail Health is forging ahead to bring changes to a flawed system.

“We’ve learned a great deal over the last few years. We’ve started off on different paths and learned that that path, for whatever reason, might not work well for our community or didn’t make the most sense. And we’ve constantly adjusted paths,” said Chris Lindley, the executive director of Eagle Valley Behavioral Health and chief population officer for Vail Health.

“We have a long ways to go, but we’re building something that truly is unique in this country and is designed for this community and the partners that are here and the organizations are here. I hope we never become complacent and, if you will, rest on our laurels,” he added.

While the organization first got started as a result of community members rallying around a marijuana sales tax to fund behavioral health — a tax that now generates around $800,000 annually (projected at $810,000 in 2022) — the fuel and engine behind the momentum was Vail Health stepping up, Lindley said.

“None of this happens without our health care system fully owning behavioral health. And I can tell you that is not happening in any other community in America where the health care system has leaned in and said, behavioral health is just as important as physical health, and we are going to invest the time, money and resources to solve it just like we are physical health,” he added.

Filling the gaps

Prior to Eagle Valley Behavioral Health spinning up in 2019, there were numerous mental and behavioral health needs not being met in the community.

“The reason Eagle Valley Behavioral Health decided to become a community mental health center is that we, along with many other community members, did not feel that our local behavioral health needs were being properly met,” said Dr. Casey Wolfington, the senior director of community behavioral health at Vail Health.

And in the last two and half years, the organization — alongside numerous community partners — has sought to fill the gaps and better address community needs. This has included increasing the number of providers — particularly those that accept insurance — building a full crisis response network, bringing in youth counseling and behavioral health services to local schools, building infrastructure and facilities to support inpatient and outpatient treatments and more.

“We now have all the pieces in play that we didn’t have just five years ago,” Lindley said.

Getting more specific, Lindley said that the number of providers in the valley that accept insurance grew from two to 20 since Eagle Valley Behavioral Health was formed.

“Overall, we went from having a provider deficit in this valley to now, we have one of the highest provider density ratios probably in the country today, and people are using those services,” he added. “Not only the providers that work in our health care system through Colorado Mountain Medical, but all the private providers are staying extremely busy and doing an amazing job serving our community.”

While the growth in numbers is important, what’s even more critical, Lindley said, is that not only are all the Colorado Mountain Medical providers accepting “every type” of health insurance — including Medicare, Medicaid and more — but Olivia’s Fund provides an option for those that are uninsured, which was another previous gap in the community.

“If you didn’t have insurance, and if you did not qualify for Medicaid — which there’s many reasons why an individual might not qualify for Medicaid, but one of the most glaring is, if you’re not a citizen, you cannot apply for Medicaid in this country — and with a large population of undocumented individuals in our valley, we had a big gap,” he said.

Since launching in 2020, Olivia’s Fund has also delivered over 4,000 “unique sessions to people in our valley,” Lindley said. Over 100 providers in the community accept this scholarship fund —which is all but two of the valley’s licensed providers, Lindley said — and provides six free sessions to anyone who needs them.

One of the most unique aspects of how Eagle County has filled these behavioral health gaps is the model and system that has been built around crisis response.

“This model also does not exist anywhere in the country, to my knowledge,” Lindley said.

This is done primarily through a close partnership between Your Hope Center and Eagle Valley Behavioral Health. Some of the things being done differently include fully integrating with local law enforcement agencies, having 24/7 crisis response that ties into the local 911 network and the addition of Your Hope Center clinicians providing free care to students at every public elementary, middle and high school, Lindley added.

One of the prominent gaps that still currently exists, but that Eagle Valley Behavioral Health and Vail Health are seeking to fill, is with infrastructure, specifically behavioral health facilities.

A rendering of the Precourt Healing Center in Edwards, which will fill a remaining gap in Eagle County’s mental and behavioral health services: a psychiatric inpatient facility for adults and adolescents.

Earlier this year, the organization broke ground on the Precourt Healing Center in Edwards, which will serve as an inpatient facility with 28 beds for adults and adolescents. The new center is located on the Edwards Community Health Campus, which will soon be home to the Wiegers Mental Health Clinic, providing intensive outpatient therapy, as well as a number of other integrated services from community partners, which includes everything from nutrition to physical activity, spiritual wellness and more.

“When we have the psychiatric facility, our objective is that no one will have to leave our valley to get any level of behavioral health care. We are trying to create a model and a system to where, if you need services, you can get that treatment, that healing, that care, those resources right here in this valley,” Lindley said.

Creating a roadmap for collaboration

While Eagle Valley Behavioral Health has taken a “lead cheerleader” role to fill these needs, it has largely been a community effort with numerous other organizations “working with each other, supporting each other in a way so no one falls through the cracks,” Lindley said.

Part of the need in Eagle County five years ago was also a “lack of shared ownership and responsibility for who and all were going to tackle the behavioral health crisis in our community and help develop a plan going forward,” Lindley said.

This, however, was not driven by a lack of desire to address the mental health challenges.

“What we found is there are many entities, governmental, non-governmental, commercial, etc. that want to improve the mental health in this community, and had a passion and desire to do it. It just wasn’t being coordinated and that collaboration — what we call collective impact — was not happening before this whole initiative got started,” he added. “Today, there are over 50 different organizations that have received funding to work on the behavioral health transformation.”

Within its role as lead cheerleader, Lindley said that Eagle Valley Behavioral Health serves to support its partners’ work and provide “coordination and collaboration.”

“We are huge supporters and fans of the great work that’s going on in this community, but we are aiming to help the coordination, collaboration with all of them,” he said. “It just makes sure we’re all moving in the right direction. So providing a lot of updates, sharing a lot of information, keeping folks connected, knowing what’s going on is really the key role that we hope to do with them.”

This support also includes the distribution of funds. According to Lindley, Vail Health is distributing $3 million a year to its community partners, funds which have come from a variety of streams.

Recently, this group of partners convened to discuss successes, lessons learned and the path ahead. From this meeting, Lindley said that it was obvious “every partner is making huge impacts and each partner is working with each other to make these impacts.”

“They’re out accomplishing stuff and working in different lanes and little nooks and crannies that we didn’t even know were issues and they’re fixing them before they even become issues. And the impact is really extraordinary,” he added of the community partners.

Seeking sustainable funding, state designations

A map showing the designated Community Mental Health Centers in Colorado. In 2021, Eagle Valley Behavioral Health became the 18th one to be designated in the state and the first since 1989.

While many of the ways that Eagle Valley Behavioral Health has stepped up are unique, one of the ways the organization made waves was by becoming the first new designated community mental health center in Colorado since 1989.  

There are only 17 other organizations with this designation across the state serving different regions, including Mind Springs in northwest Colorado. However, according to Stefany Busch, the media manager for the new Colorado Behavioral Health Administration, these centers are not geographically bound.

While the Behavioral Health Administration expects a certain number of providers and services to be available regionally, there are no hard and fast service lines,” Busch said.

While not geographically bound, Eagle County — in forming Eagle Valley Behavioral Health — also made history by breaking away from its existing center, Mind Springs. Mind Springs still provides outpatient counseling, therapy, and psychiatric services to children, adolescents and adults to the county in its Vail and Eagle offices.

The county used to provide funding to the provider with funding from the marijuana tax for crisis response in 2019 and 2020. However, starting in 2021, the county now contracts and provides funds to Your Hope Center (serving the Eagle River Valley) and Aspen Hope Center (serving El Jebel and Basalt) for crisis response.

There are two reasons, Lindley hypothesized as to why it took over 30 years for a new community mental health center to be formed and designated by the state.

“Number one is no one thought you could do it. When we first asked a few years ago if we could become a (community mental health center), the answer was: ‘No. The ones we have are the ones we have, we don’t know how to do that,’” Lindley said.

“I think two — what really is the most important piece — is other communities don’t have this amazing effort taking place in their backyard. They don’t have 30, 40 organizations all aligned, pushing in the same direction, covering their specific pieces, if you will, of the pie or the puzzle to really transform the behavioral health system,” he added. “We did not do this alone.”

In the past, community mental health centers have been designated by the Colorado Department of Human Services, Office of Behavioral Health — which has since transitioned to the new Behavioral Health Administration — and are statutorily mandated to provide inpatient, outpatient, partial hospitalization, emergency and consultative and educational services.

The community-centric approach and collaboration, Lindley said, is what allowed Eagle Valley Behavioral Health to meet all these requirements and get the designation.

“If we applied as just Eagle Valley Behavioral Health or Vail Health or Colorado Mountain Medical, we would not have been awarded. But because we applied with our partners, where we can truly show the full scope of care across the whole continuum, we were able to qualify without a single finding,” Lindley said. “When we became a community mental health center there were no issues, nothing we had to go back and address, we were immediately approved.”

In receiving the designation, Eagle Valley Behavioral Health also became the first not to join the state’s trade association: the Colorado Behavioral Healthcare Council.

“Vail Health and Eagle Valley Behavioral Health feel like it is critical that our community’s voice is directly represented during behavioral health meetings with the state, legislature, public payers and commercial payers. Our desire to be directly involved in advocating for our community was one of our biggest reasons for not joining Colorado Behavioral Healthcare Council,” Wolfington said.

“Essentially, we wanted our community voice to be directly heard, rather than having our community’s needs communicated through a trade organization that has not historically proven to represent our local interests and priorities,” she added.

One of the primary reasons that Eagle Valley Behavioral Health sought this designation was to bring in more sustainable funding for the programs, initiatives and services it provides and supports in Eagle County.

The reason why we became a community mental health center was to become more financially sustainable. We looked at the statute of what a community mental health center was. We realized that we, and our partners collectively, were meeting all the requirements to be a community mental health center,” Lindley said.

Collectively and historically, the other 17 community mental health centers have been paid more than $437 million a year in tax dollars by the state.  

With the designation, Eagle Valley Behavioral Health received $300,000 of funding from the Office of Behavioral Health for fiscal year 2021. And for fiscal year 2022, it received $600,000 in funding from the same office. All of these funds, Lindley added, have gone to its partners — $820,000 of which went to Your Hope Center and the remaining which went to Eagle Valley Behavioral Health employment and competency education services.

“Now, we’d like to receive more. There’s no question about that. And we are working with the state on that as we go forward,” Lindley said. “But at the end of the day, that’s $900,000 of additional funding that is coming into this community, that’s supporting our collective efforts, that was not before. And so it’s a huge win for us.”

Specifically, Dana Erpelding, senior operations director at Vail Health, said that “based on the amount of funding that is issued each year to other CMHCs with population sizes similar to Eagle County, we estimate that we should have received closer to $3 million over the past two years to provide statutorily required safety net behavioral health services.”

According to Busch, funding allocations for community mental health centers are “adjusted each year based on legislative funding.”

“Typically there is not the capacity to be able to fund a new community mental health center without additional funding from the legislature. However, with recent stimulus dollars — the Behavioral Health Administration was able to dedicate some short-term funding to Eagle Valley Behavioral Health,” Busch said, referring to the $600,000 allocated for the current fiscal year.

These stimulus dollars, she added, were distributed based on “certain initiatives and capacity to spend for certain programs.”

Erpelding acknowledged the role that timing played in the lower amount of funding, stating that Eagle Valley Behavioral Health received its designation just after the start of the fiscal year.

“As such, the state had already allocated state funding for the other 17 (community mental health centers), leaving little funding to allocate to our newly designated organization,” Erpelding said.

With the expectation that the organization will “obtain additional state dollars in the future,” Erpelding said that the “goal is to issue this funding to local organizations in our community already performing the work that is aligned with state priorities, including prevention, education, intervention, treatment and recovery services.”

Additionally, the designation allowed the organization to receive “enhanced Medicaid reimbursement rates,” which the organization is already receiving, Lindley said.    

While the designation certainly creates new opportunities for the organization, getting there wasn’t without its challenges. But, as Lindley likes to put it: “If everybody’s comfortable, you’re not making change.”

“(The Office of Behavioral Health) had to learn how to do it as well, because there wasn’t a single employee working at the state who had ever brought on a community mental health center,” Lindley said.

Thom Miller, division director of quality and standards in the Colorado Behavioral Health Administration said that he doesn’t believe there was a “limit on the number of community mental health centers in the state to begin with and there’s certainly not going to be a limit” heading into the future.

The process of bringing on a new center after a long time was, on the state’s end, “essentially saying, here are the regulations that apply, you need to write policies and procedures that show you can demonstrate compliance with those rules, and we need to see all that and vet all that before we can issue that type of designation,” Miller said.

“It’s always a struggle, I think for a new provider to understand all the new requirements that exist in law and regulation. But that is our role to assist those new providers to understand that,” Miller added. “And we not only act as regulators, we also act as technical assistance to help guide them through that process, and I believe we did exactly that with Eagle Valley Behavioral Health.”

And for Eagle Valley Behavioral Health, creating positive change in how the county addresses mental and behavioral health meant “a lot of extra work and a lot of extra processes,” Lindley said.

The team across Vail Health — the legal team, the financial team, the rep cycle management team, the IT team — had to jump in and provide such amazing support and leadership as we’ve learned how to do new billing procedures, new compliance procedures, the legal protections that need to be put in place for the patient’s safety and privacy, et cetera,” Lindley said.

“It’s caused a lot of extra work for a lot of folks, but I think we can all see where we’re going and we know the impact this will have for years and years to come. And so it’s worth it,” he added.

Colliding with the new state agency

As Eagle Valley Behavioral Health forges ahead to make changes in how the Eagle Valley community approaches mental and behavioral health, statewide changes are also afoot. In July, the state launched a new Behavioral Health Administration, replacing the prior Office of Behavioral Health.

The goal of this new state agency was to improve mental health care and substance use treatment in the state. Further, Miller said that there are two main gaps across the state that the new agency seeks to address: quality and quantity of services.

“Quality in terms of some of the issues that have existed around the state in terms of workforce — that there’s a shortage of folks that work in substance use disorder, opioid treatment disorder and mental health services. That’s something that the (Behavioral Health Administration) seeks, very specifically, to address with workforce development activity,” he said. “Then also, the quantity of services, particularly in rural Colorado, Western Slope Colorado, where there just aren’t enough providers, particularly when it comes to safety net services.”

Miller added that the legislation that created the new agency specifically sought to require “expanded safety net services” for Coloradans.

So far, the administration has released its Behavioral Health Strategic Workforce plan as well as has begun building a robust online platform called OwnPath for people to find services for their behavioral health needs  — something, which will eventually also include providers’ compliance history, bringing more transparency and accountability to the oversight and regulation of behavioral health in Colorado.    

Currently, the new agency is working hard to redraft and transform the rules and regulations of the prior Office of Behavioral Health to conform with the legislation as the newly formed Behavioral Health Administration. 

“When the Behavioral Health Administration sprang into being July 1, along with it came other requirements for rule drafting and propagation. So we have to have those drafts complete and to the Department of Human Services state board this spring, in April,” Miller said.

Part of this includes changing the language around the current community mental health center designation. Moving forward, this designation will be replaced by either a designated “Essential Safety Net Provider” or a “Comprehensive Safety Net Provider.”

The legislation dictates nine services that a provider must provide in order to receive the comprehensive designation. An essential safety net provider only has to provide one of those things. These nine services include emergency and crisis; mental health and substance use outpatient; high-intensity outpatient; care management; mental health and substance use recovery; care coordination; outpatient competency restoration; care outreach, education and engagement as well as screening, assessment and diagnosis. 

All current community mental health centers will have to reapply under the new designations. This is something that Lindley said Eagle Valley Behavioral Health is ready for.

Starting next year, they’ll have a new designation. But whatever that is and whatever requirements those are, you can rest assured we, with our partners, will apply for that, and we will get licensed under that new designation so we can continue to bring in as many financial resources as we can to this valley to ensure we have the behavioral health services to treat everybody in this valley,” he said.

With all these changes, Busch said “all of the historic funding for community mental health centers will be accounted for as the Behavioral Health Administration plans the transition to the Behavioral Health Administrative Services Organization model.”

As such, as these providers receive their new designation, these models will “make funding determinations to ensure that there is an adequate and comprehensive safety net” across the state.

Erpelding said that the organization recognizes the timing of its designation as an “incredibly exciting time” for behavioral health in the state.

“During the last legislative session, one of the most comprehensive behavioral health bills in the history of Colorado passed; not only creating the Behavioral Health Administration but also creating reform and opportunity for new organizations to be eligible to receive state behavioral health funding,” Erpelding said. “We are very excited for this transformation and we look forward to working closely with our state partners to provide input to assist other local communities in transforming the behavioral health system in communities across Colorado.”

A new model

The effort to transform behavioral and mental health has been a community effort in Eagle County.

In setting this new tone and being the first new community mental center in three decades, there comes a certain opportunity to do things differently and to innovate, something that Eagle Valley Behavioral Health has strived to do from the beginning.

“This isn’t a model we’re seeing anywhere, and we are creating something,” said Sally Welsh, Vail Health’s director of public relations. “So when you talk about being innovative and what we’ll be able to do differently, we’re already doing things differently. We’re the example for other mountain communities.”

This includes helping inspire statewide programs, modeled after what has worked well in Eagle County.

“We are daily communicating with our partners at the state about the great programs or services that are taking place in this valley and constantly pushing them to explore them, share them, fund them,” Lindley said.

One example, he added, is Olivia’s Fund. Recently, the state launched a similar scholarship fund called I Matter, which provides up to six free counseling sessions to Coloradans under the age of 18.

“The state’s program is funded at approximately $5 million per year. In this little valley of 45,000 people, Olivia’s Fund is serving more people than the whole state program combined, which is really very much modeled after what we have in place, providing six free sessions, but for kids under the age of 18. Our program offers it to anybody, regardless of age,” Lindley said.

Overall though, what Eagle Valley Behavioral Health hopes it can do is inspire other communities to take similar action.

“We hope we can be an inspiration, be a model. We will share anything that we’ve done and learned with any of our state partners or other communities,” Lindley said. “In our mind — and we told this to the state recently— if we are the last entity to become a community mental health center, or what in the future will be considered a comprehensive behavioral health provider, we will feel like we failed because we want every community to have these resources, this success going forward as we’ve been able to leverage over the last few years together.”

This has included working closely with Summit County on its own Project Building Hope, collaborating and sharing information “daily” with local officials, Lindley said.

However, while it seeks to spread the information and resources, the organization’s main focus will remain here, in the Eagle River Valley.

“Our goal is not to be a large community mental health center with a massive geographic footprint,” Lindley said. “We want to learn how to solve the problem for our community and our valley and we want to share that with others so they can do the same. Health is a local issue. Mental health is a local issue. And we got to have these resources locally in the community for folks to tackle.”

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