In May, Jessica Fear was appointed as the new Senior Vice President and head of VNSNY’s Community Mental Health Services (CMHS). This is Jessica’s second stint at VNSNY. Frontline spoke with her recently about her new role and her vision for CMHS.
Before we talk about your new position, can you tell us a little about your previous time at CMHS?
First of all, I can’t talk about my role here without paying tribute to Neil Pessin, who recently retired from his role as Vice President of CMHS. He started the division and was at the helm for 35 years, ensuring its successful growth and consistent commitment to excellent care for the most disenfranchised New Yorkers. I’m thrilled to be able to continue that legacy. Neil brought me on in 2004, and I went on to work here for 10 years. Before that, I did many years of direct practice as a Licensed Marriage and Family Therapist (LMFT) in California, specializing in children, adolescents and families. At CMHS, I began as the Division Manager, assisting with the operational needs for all 21 of the different programs we had at that time. In 2008, I helped open our FRIENDS child and adolescent outpatient mental health clinic in the South Bronx and went on to serve as Director of Children’s Services for several years. Then in 2011, the Affordable Care Act came along and I helped launch CMHS’s Health Home program, which supports clients with complex chronic mental health and co-occurring medical conditions.
You then pivoted to work for a large health insurance company, Healthfirst. What was that like?
In 2014, Healthfirst offered me an opportunity to work on the managed care side of the healthcare industry and learn how health plans work, from soup to nuts. I was there for six and a half years, helping to develop their in-house behavioral health capability. It was a huge job—we built the whole behavioral health program from scratch, and worked on integrating it into the existing medical infrastructure—and I learned a tremendous amount! Now that I’m back at VNSNY, I’m looking forward to leveraging my experience on both sides of the business—having known the provider side for a very long time, and then learning the payer side.
How do you see your current role as SVP of CMHS?
Now that I’m back to the provider side, I want to use my knowledge of the areas where health plans struggle to meet the needs of their members to help develop products those plans will find valuable. CMHS’s main goal going forward is to expand our services to meet the needs of more people with behavioral health conditions, and to ensure we are doing this in a financially sustainable way. Achieving this goal means pivoting our focus toward partnering with health insurers, because that’s where New York City and State are funneling the funding for managing behavioral health conditions. So, we’re looking to develop CMHS services and products that health plans will find valuable for their members’ overall health goals. We recently completed a several-day strategic planning process, and we’ve identified five key areas that we want to focus on in terms of building products for the future. Some of these products will expand on what we’re already doing, and others will be brand new.
Can you briefly describe those five areas?
Sure. One is substance use services. We have a deep knowledge and experience in managing the care of people with substance use disorders, and we have a lot of staff who are very seasoned in providing these services. Another is integrated care—working with medical providers, including other parts of VNSNY, to care for people’s physical health and their emotional and mental well-being. We also want to expand our children’s services and our geriatric services. Of course, we will ensure that a focus on addressing social determinants of health is woven throughout everything we do. We have always done this, and the pandemic has brought home for us how vital this focus continues to be. The fifth area is tele-behavioral health, where there’s a lot of opportunity right now.
Is that partly because of COVID-19, where more people started getting behavioral health services remotely?
Yes, definitely. Until now, tele-behavioral health has really struggled to get off the ground—but with the pandemic, that genie was let out of the bottle and we believe it’s not going back in. That’s good news for us, because what we’ve found is that the option to have virtual visits actually produced better outcomes for many of our clients. For example, we have traditionally had a high no-show rate in our FRIENDS clinic, which makes a lot of sense because people’s lives are complicated and it’s hard to keep afternoon and evening appointments, especially if a client has young children and has to balance competing priorities like work and childcare and dinner. During the pandemic, when we connected with clients in their homes by phone or video, our no-show rate dropped dramatically across the board, so we were able to provide more consistent care to people. That’s not to say that we stopped all of our field visits, and our staff are regularly going back out into the field now. But going forward, we want to be able to leverage telehealth as a tool in our toolkit, especially with populations who are historically difficult to reach and respond well to it.
You mentioned that CMHS is also looking to partner internally with other areas at VNSNY. Could you expand on that?
This is part of our goal to more fully integrate behavioral health and medical care enterprise-wide. I’m a big believer in the idea that you can’t treat people just from the head up or from the neck down. The data clearly shows that the cost of caring for someone medically goes up several-fold if they also have behavioral health issues that aren’t being addressed. VNSNY has deep experience caring for both physical and behavioral health, so how can we do a better job of blending those capabilities? One area where a natural synergy exists is with our Care Management Organization. We’re exploring what it could look like to build a program that brings together a behavioral health care manager and a physical health care manager, and use that team to manage a complex population with overlapping needs. The CHHA is another natural partnership. We could help support their patients who have behavioral health needs, and could conceivably even continue managing their care after their home care episode has concluded. We’re excited about forging new partnerships that will really positively impact the lives of all the people served by the organization.
As CMHS focuses more on creating sustainable collaborations with health plans, what is your vision for the grant-oriented safety-net programs that CMHS is known for?
As I’ve been saying to CMHS team, it’s really a “yes and” proposition. The more growth and the more volume we have with managed care contracts that are reimbursed in a financially sustainable manner, the more margin we’ll have to carry out the intensely mission-driven work that’s not as financially viable. We will always continue to have grant-funded programs, because those contracts allow us to serve the people we have built our reputation serving—New Yorkers struggling with very difficult-to-treat chronic behavioral health conditions. But these grants can be challenging from a financial perspective. If we can build a financial buffer, it lets us to do more of everything, including really digging in with the mission-driven work. It’s a win all around.
It sounds like an exciting new chapter in CMHS’s long history of bringing care into the community.
For 35 years, people have been letting CMHS staff into their homes to help them solve these problems collaboratively. That foundation sets us up very well for the future. As we enter this next phase of growth and development, I want to highlight the tremendous support we’ve received from Dan Savitt, VNSNY’s President and CEO, as well as so many other members of VNSNY’s leadership team. Dan is a true believer in the value of behavioral health care, and is committed to investing in VNSNY’s behavioral health services. That focus is crucial in this moment, when the pandemic has taught everyone a lesson about the fragility of the human psyche and how much we need to focus on caring for and attending to it. Once we are truly on the other side of this pandemic, I believe there’s going to be systemic trauma that our society will be dealing with for years to come. We’re ideally positioned as an organization to meet those needs going forward, and to grow and expand our work in order to benefit even more New Yorkers—which is what we’re here for.