We’re Not A Car Wash

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the State of Wisconsin Dose of Reality Real Talks reminding you that opioids are powerful drugs and that one pill can kill. I'm Mike McGowan.

Mike: I think it's safe to say that addiction and mental health services are needed across the country, and I think it's also safe to say that the job of providing those services while incredibly rewarding is also extremely challenging. We're gonna talk about all that and more with Joe Henderson, the CEO of Sierra Health and Wellness Centers, and founder of the Elijah House Foundation in California.

Mike: Joe is a skilled and passionate leader who has direct oversight and aspects of Sierra Health and Wellness, all of their programs. Welcome Joe.

Joe: Thank you for having me. Love it.

Mike: Well, thanks for being here. Before we talk about Sierra Health and Wellness, I always ask this, 'cause I don't think it's anybody's first choice of career vocations.

Joe: Yeah.

Mike: What led you to get into the field of addiction? Addiction treatment.

Joe: Yeah. No, absolutely. It is always interesting. Everyone has their unique stories, of course. Mine, I always tell people it's it's in my blood. So for me personally. I was born in Medford, Oregon, and my dad was the program director for the Men's Recovery Program out there in Medford through the Salvation Army.

Joe: And he was program director there for mid-late eighties, early nineties. And we grew up involved in the Salvation Army, which is always very much involved in kind of the recovery world and helping folks who have various criminal charges like low criminal charges from, drug paraphernalia, et cetera. We all know those struggles through the early two thousands and on and Salvation Army was always a big help to that court system and really was the beginning of helping people. So that was in my blood. We've always been involved in that, whether it's the Christmas program or what have you.

Joe: Coupled with obviously, like everyone, we have family members that struggle with mental health or addiction issue and and so it's in my blood.

Mike: It's interesting you say "Like everyone", because we, I'm nodding because yeah, like everyone. Isn't it amazing how common this is? And then we still have keep it this little secret.

Mike: It still seems hidden. It's still this thing, right? It's amazing.

Joe: Yeah.

Mike: What, you have numerous programs and many locations in California. Talk a little bit about Sierra Health.

Joe: Yeah. So Sierra's goal is to obviously be a true comprehensive ecosystem, an internal ecosystem for folks that are struggling with not just addiction issues, but behavioral health issues.

Joe: So in California we have a large presence, approximately a 140 beds out of Northern California. And then we have three outpatient clinics. For 2026, we're obviously implementing TMS. We're providing pharmaceutical services out of Sacramento area, not just for us, but for our competitors.

Joe: One of the big logistical nightmares with detox in California is finding a pharmacy that's going to get your medications to your facility in a timely manner so you can properly detox a patient safely. And what we found throughout the years is we typically get folks starting pharmacies or we can work with one and then now they're no longer 24 hours or they go out of business or what have you.

Joe: And that's just not, that's not gonna work for us, right? And those are the little things that you find and you go, "You know what? We just gotta do it ourselves." We have X amount of hundreds of patients in NorCal counting our outpatient clinics, of course. And so it's just a demand. Once we have it, we can help our competitors with the same demand that we have and whatnot.

Joe: So we've really been just affected by the currents of what is needed. In 2024, we started investing heavily into mental health only. We've launched a few crisis residential facilities for folks that are really a direct step down from acute psych. Folks that aren't appropriate for a mental health residential facility, but not necessarily appropriate for acute psych 5150 type level of care.

Joe: And so we've implemented that and we've expanded in Nevada, Texas now, looking elsewhere in Florida and other locations as well. But really just refining that, that ecosystem, that true ecosystem.

Mike: Back when I was a kid, there was a saying that whatever was in California would hit the Midwest in about two years.

Joe: Yeah.

Mike: I think the internet and social media and everything else has accelerated that a great deal. But I do, I have heard from my friends in California that of the drugs that you're dealing with, we went from the, of course, the pills, to heroin, to fentanyl, and now it's just fentanyl. And my friends now tell me that's slacking a little as we actually lose people who would be demanding it, right?

Joe: Yeah, for sure. So it's, as everyone knows, huge fentanyl demand. But I will say, for our patients at Sierra, most of these folks are working class individuals, folks that have employment somewhere and therefore have commercial insurance and whatnot. And I would say just off the top of my head, it's about 80% alcohol. And the rest is some sort of opiate use disorder. Very little are actually other substances like methamphetamines or amphetamines or stuff like that. But I would say fentanyl, of course. For us alcohol, fentanyl, benzo, and then the rest is just mixed in there, but absolutely.

Mike: I have a friend of mine who when listening to this will be cheering from the mountaintops 'cause she's always talking about how we don't talk about alcohol nearly enough is the number one drug in the country.

Joe: That's right.

Mike: I mentioned in the introduction about the Elijah House Foundation. And is it tell me what that is and how you're connected to that.

Joe: Yeah, absolutely.

Joe: So I started both the Elijah House Foundation and Sierra Health and Wellness, which has its subsidiaries. Elijah House is focused on a completely different population. And though it does behavioral health services, it's not just a behavioral health provider.

Joe: So the Elijah House Foundation is indeed a foundation. It's a nonprofit organization. It started in 2015, and its focus is on individuals. At a poverty level class. And so this typically encompasses people, a part of the criminal justice system, but not all, but mainly individuals on Medi-Cal or through some sort of state funded program.

Joe: And then I would say primarily for individuals involved in the criminal justice in some sort of degree. Additionally it provides, which is a kind of an obvious number two, employment development services. And at one point when California had their Clean California Dollars.

Joe: They implemented a program called the Back to Work Program. And the idea was fantastic. It was funded through dollars brought through the the Caltrans department, the Department of Transportation. And California always has its own definition of programs, but Caltrans. And what it allowed, which I thought was great, is a bucket of money that goes to individuals with employment barriers and typically it's the same population, right? It's typically individuals who. Low economic stance growing up. They get into drugs or alcohol, and they just stick into that mode. They get into trouble, they go through the criminal justice kind of process, and then they get out, they're grown men or women, and they have zero employment history. And little things that we take for granted, like working with crew members and, following direction. And those sorts of things are just foreign to a large population, at least in California, but throughout the United States. And so Elijah House was able to focus on that heavily. They had 19 crews throughout California prior to a California cut after, I think it was a few years running and maybe not so popular.

Joe: But I thought it was effective and it really helped a lot of people. It still exists but not in its magnitude that it once was. But all the same stuff as well.

Mike: It's fascinating that you talk about that. My very next conversation on this podcast is with a gentleman who wrote a book and part of his journey was just what you're talking about.

Mike: Getting into substances early. Getting into trouble, then not being employable. And the one thing that he could always do, is go back to dealing. And had he had the availability of programs, perhaps it would've been sidetracked a little bit earlier.

Joe: Yeah.

Mike: Your programs also, you make a big part of this on your website, focus on first responders and the veterans and their families.

Mike: That's a uniquely challenged group.

Joe: Yeah, no, absolutely. I'll speak on veterans specifically. Veterans have really, through the community care network, they have access to privately owned options for behavioral health, and that's funded through a bucket of money that's been allocated to a company called Troy West.

Joe: Who in 2026 and 2025 handles both the community care network for veterans and then they also manage a separate bucket of money, which is for TRICARE members or active duty members and their dependents. And, the idea is that folks, vets who need care and locally through the local VA system, have a wait time of greater than 20 days or in or is in a crisis that they can be placed in a community care provider, which we are one of those.

Joe: And realistically we all know the federal government, and being the VA specifically, isn't the operational cheapest ran program and there was a member, I can't recall his name, but he was a veteran's fair executive out of San Francisco posted that their domicile cost the VA around $4,000 a day to treat a veteran.

Joe: And the community care network reimbursement today is around 12 and some change, 1200 and some change per diem daily. And you just gotta think. Why the heck are these places open? And I don't think anyone argues that the domiciles are not as effective and don't have such fantastic outcomes.

Joe: But that's the way the system is supposed to work. I would say around a year ago, the VA ended up cutting rates pretty drastically. And it's made it increasingly difficult to treat vets. I hear from a lot of my peers throughout the United States and we advocate for veterans healthcare as well all the time at Washington DC and we're always working on these things.

Joe: And it cost a lot more to treat a veteran. Vets typically, when we get them, I can only speak for our program, they are typically I'd say at least 45% of 'em are homeless and they have additional medical issues that they have not dealt with. And realistically I would say about 80% of 'em all have other medical issues that have to be dealt with.

Mike: Yep.

Joe: And so we have vets with dialysis, we have vets with liver failure, heart failure, et cetera. And that's not necessarily what TriWest is paying for or what the VA is paying for. But those are things that providers like us have to cover if we want to be able to serve our veterans and treat them, so very needed service.

Mike: I wanna switch gears and talk a little bit about stigma, mainly 'cause it's bugging me.

Joe: Yeah.

Mike: I spoke at a conference recently that focused on substance use disorders and Joe, I heard professionals contributing to the stigma we experienced through jokes, language especially their attitudes, if that's a reflection of some in the professional community.

Mike: We've still got a long way to go. How do we overcome stigma?

Joe: Yeah, that's the never ending battle, right? And I think that what I have found personally is folks that treat our individuals that struggle with addiction issues or other mental health issues, they really need to have a track, a professional outlook track that talks about this as they finish their treatment and they go back to the workforce and they increase their careers. And, I know plenty of executives, c-suite executives and junior executives that have had addiction issues themselves.

Joe: It's typically not something that they hide because they're working in the field and they use that as a part of their methodology. But I don't think providers talk about it enough in treatment itself, both in inpatient and outpatient. And I can tell you that's one of the things that we're talking about at Sierra is having an employment type track that we run to really talk about that, to encourage people to stay in the field.

Joe: And talk about it so that the stigma starts to lighten up.

Mike: Because it's also they're tied to reimbursement, right?

Joe: Yes.

Mike: If we diminish it, then it's easier to dismiss. We don't hear people talking the same way about other diseases.

Joe: No, not at all. Not at all. Yeah. And I think that will as we continue to build out the industry, we continue to talk about it.

Joe: I think that will lessen for sure.

Mike: And I've been hearing lately from lots of therapists that insurance companies are reducing their rates in some cases for couples and families counseling.

Joe: Yeah.

Mike: Which is making some facilities just discard that part of the program. Talk a little bit about support.

Mike: Al-Anon is a great program, but we, it's not we need more than Al-Anon. It's a disease that affects everyone.

Joe: Yeah, for sure. Yeah. We talk about that, right? Often in the industry, a family member comes to treatment and that member may have the addiction issue, but it affects the entire family, right?

Joe: If someone's struggling with alcohol and they complete treatment and they go to dinner to celebrate, uncle Ted's not gonna be able to have his beer, so to speak, at least in the beginning, right? When it's fresh. With relapse being such a high risk at the time. But I think providers, and when I say providers, inpatient, outpatient providers, professionals, psychiatrists, et cetera.

Joe: Anyone who's providing these sets of services really need to as an obligation, have a family program that they offer. In my opinion we do that at Sierra, and it's, for one, it increases your outcomes, generally speaking. So for us, when we admit somebody for the first seven days.

Joe: If allowed, of course, if released by the patient, for the first seven days, we have a dedicated family member that's in charge of that person's care. That could be mom, it could be wife, it could be best friend, it could be whoever. And what we do is for the initial seven days, we're actually giving daily updates, not in detail, but general high level updates of how the family member's doing in our care.

Joe: And what it does we found is it really equips them. It aligns them with what's really happening clinically. So that when that person potentially wants to AMA or when the person does discharge successfully and follows up. They understand what are the high risk issues?

Joe: What are the things that we need to change? What are the negative things that happen after treatment when someone successfully discharges and they're equipped to be able to help their family member out. After treatment, I think it's an obligation for all providers to do something like that.

Mike: And I think it also helps post discharge.

Joe: Yeah.

Mike: If they know what's going on, when the person may say, oh, they told me at that center that I didn't need to go to these meetings.

Joe: That's right.

Mike: That I'm good. If you don't know any better, you'd say, oh, okay.

Joe: Yep. That's exactly what happens.

Mike: Yeah. It's just, it's amazing to me how little we understand that dynamic. And also the dynamic Joe, that the family unless they change also, has a real need to bring things back to what they're comfortable with, no matter how dysfunctional that was.

Joe: That's right. Yeah. And that's the importance of the second phase to that we provide which is the family therapy component.

Joe: So our Chief Clinical Officer, Dr. Angela Chanter runs these on a monthly basis and a version of it on a weekly basis. But it is a group family therapy dynamic where we understand the disease of addiction, of mental health. We talk about those impacts and what is the family's responsibility and how the family really influences the high risk, low risk scenarios that happen both during treatment and after.

Joe: And it significantly helps. It significantly helps.

Mike: You talk about, personally, you talk about the importance of rebuilding identity. I had a guy I worked with a long time ago, and maybe this is a thing, but he said to me, I used to be a drunk SOB. Now that I'm, now that I quit drinking, I'm just an SOB.

Joe: Yeah.

Mike: Okay. So I won't tell you my answer to him. It probably wasn't very appropriate. But how does somebody whose identity was enmeshed with substance use disorders, reform their identity? That's not easy.

Joe: It's not easy. And that 's one of the things that a lot of people miss, is they remove the addiction.

Joe: And that's great, but you gotta replace it with something. You gotta replace it with something. And we hardly ever see a scenario where folks come in and they don't do the latter. And my recommendation really 'cause it's such a needed industry is work in the industry.

Joe: Somehow, some way because what, I've been doing this for around 14 years now, 15 years now in terms of our current brands that we're discussing. And what we have found is the long-term success of individuals who stay within the industry, whether they're an admission worker, they're an executive, they go to nursing school, they go to tech school, whatever that is.

Joe: Their chances of long-term recovery skyrocket. And so I always recommend people find a niche in the industry and continue to help people for the rest of your life.

Mike: I would assume then that you're not adverse and I actually encourage the hiring of people who are in recovery.

Joe: Oh yeah, absolutely.

Joe: Absolutely. Yeah. No, we obviously, we have ethical boundaries in terms of folks who have come with us or through treatment with us. We have certain things that we gotta boundaries that we have to maintain. But absolutely, that's the only way we're gonna be able to break these things down is we gotta be, we gotta be okay with hiring folks back into the industry. We just have to, otherwise we're gonna be in the same cycle as what we're talking about, the stigma and all these other things. We gotta break it. We gotta break it.

Mike: I think it's also important, go back to the previous question about family is, as you reform your identity, the family has to reform as well, right?

Joe: That's right. Yeah. And family's gotta be able, and that's the importance. You learn that stuff during that family therapy session is. I used to tell people, look, we're not a carwash.

Mike: That's right.

Joe: You can't just send me your family member. And we take care of business. And on day 31, they're good to go.

Joe: We're just not. This is a long-term effort and this includes everyone and we gotta make changes everywhere.

Mike: Okay, I'm writing that down.

Joe: Sometimes there's a laugh after that. Sometimes there's not. (laughs)

Mike: I'm writing it down because unless you're adverse to it, that's gonna be the title of this episode.

Joe: Yeah, there you go.

Mike: That's just great.

Mike: I hate to even ask you this, but I gotta it in today's day and age, because you're the CEO. So I gotta ask you this. A million years ago, Joe, I was you, right? So I was doing what you did, and part of the reason I do what I do now.

Mike: This part got so frustrating for me. It says on your website, on the CR website put this in quotes. Navigating the complexities of insurance coverage for adolescent behavioral therapy can be daunting. I love the word daunting. That's an accurate statement. Gimme a break, right? That is an incredibly, it minimizes everything.

Mike: So how do you navigate the ever-changing reimbursement system and do you even get it? I got tired of dealing with it, to be honest with you.

Joe: Yeah. Yeah. No, it's you talk to a lot of people in the field and one of the most common phrases is for folks who need help. They don't know where to start.

Joe: What do we do? And the you're constantly fighting the fact that insurance companies have built their business model to not pay for these services and just services in general, right? Insurance companies are for-profit companies and they don't want to pay.

Joe: They don't want to pay, so they make it very difficult. And so for us, it 's really our duty to be able to, as unfortunate as it is. You said it yourself, you've had to do the same thing. We have to stay well versed on what are the dynamics, what are the payers? One of the things, I won't name the payer, but one of the things that I had an issue with a few years ago is I ended up going to our broker and going look I do not want this insurance company for our employees. I just don't want it. The reason I said that was specifically how difficult they have made it for us. And I thought, how could I in good faith use this even though it's a little bit cheaper. Use this payer when I know dang that if any of my employees have an addiction issue, a mental health issue they're, for one, most providers are not gonna accept that payer because they're just too difficult to work with.

Joe: And then the ones that do accept them are, unfortunately, because of the low reimbursement rate, they're not gonna be a good payer. It's not gonna be for adequate days. And so I had to make the judgment call to walk away from that, eat the cost. And, there's just, there's simply not enough oversight in that and not just about how ambiguous and obscured they make it for the members to identify who's in network? What are my options? But on the flip side when you talk about utilization review, initial authorization. TMS is such an incredible service, and TMS has a 50% denial rate.

Mike: Right.

Joe: For pre-authorizations. And you look at the outcomes and you go wait a minute, TMS is actually healing the brain. We're solving the problem, but it has a 50% denial rate.

Mike: We've been doing this for a very long time and I'm still doing it 'cause I'm somewhat optimistic and I'm convinced that if we can just convince them.

Joe: Yeah.

Mike: That the investment is profitable.

Joe: Yes.

Mike: In the long run.

Mike: Now they must know that Joe. So not to take us to the cynical side of life, are they just pushing it onto the next payer?

Joe: Yeah, so there are some payers that track recidivism and the ones that I know that do track recidivism, 'cause when you say that, the first thing I think of is we need to convince the payers that invest in this service line, whether that be true inpatient service, at a rate that allows the providers to truly provide the service that's needed.

Joe: Meaning in-house psychiatrist, 24/7 this, all access to that, those things cost money. And I've always argued if you look at the recidivism rate, how many times did that member go into a facility, discharge because the services were not adequate, and then you had to pay for another 30 day cycle.

Joe: How many times are you gonna do that before you just up the rate a little bit? Put in your agreement that these positions are required for you to be in network, pay a higher rate, but less often. And to us it's common sense and I don't think it's common sense to them, and I don't think some of 'em even know that, and I've asked that question. Do you know, do you track this. VA being one of the worst. Where we've had to make that argument and they've looked at me in a call like this and said, we don't know. We don't have that data. And I'm thinking that is, that is a very basic data you should have. (laughs)

Joe: So yeah, that's but that's what we gotta do, man. We gotta continue to bring this stuff up and talk about it.

Mike: Yeah. I'll have you end this with more of an up, up note than that. What's the best part of the job?

Joe: Yeah. The best part of the job for me is the results, right?

Joe: We can't get everyone, everyone is in their different stage of desire, of commitment, et cetera. B ut we often get these letters, these letters that are sent to me by either clinical managers or Chief Clinical Officer or whoever who files these and, these guys will write a thesis of how they appreciated this, how this has saved their life.

Joe: And those are really what continues to drive me is to see the families actually restore, to see it actually work and come together. That's what drives me every day.

Mike: Me too. That's exactly it. People say, why aren't you retired? I'm like, because it's so enjoyable.

Joe: Yeah, that's right.

Joe: That's right.

Mike: Joe, thanks so much for your insight and your expertise and your dedication to your work.

Mike: For those of you listening and watching, you should know this by now if you've been here before, but we'll put links to Sierra on the podcast blurb.

Mike: We hope that you find courage and support wherever you are. As always, we thank you for listening, watching. We want you to be safe, and we want you to be well, and whatever you do, don't go into the car wash with the windows down.

Joe: (laughs) That's right.