Leadership Interview: Shelly Spalding, CEO, Center for Mental Health

Shelly Spalding serves as CEO for the Center for Mental Health, a non-profit community mental health center serving residents of Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel counties. The Center provides both mental health and substance use disorder services through its seven offices and eight outreach locations. Spalding also serves on the Western Colorado Executive Committee, which provides direction and accountability for achieving aligned local, regional, state and federal policy objectives.
The Ascent: What is the Center for Mental Health’s role in this phase of the Colorado Regional Accountable Care Collaborative, the Regional Accountability Entity (RAE)?
Spalding: The Center for Mental Health is a partner in Reunion Health, which comprises the community mental health centers and the federally qualified health centers serving 22 counties in Colorado. We partner with Rocky Mountain Health Plans in the RAE so we can collaboratively further care integration. Our executive committee meets weekly with Rocky to really look at how we can create a wider, more coordinated safety net for our patients for both physical and behavioral health.
The Ascent: Reunion Health shares in financial risk for behavioral health benefits with Rocky Mountain Health Plans on the RAE. How does that benefit patients?
The Medicaid Prime project gave us a glide path for making great progress in integrating behavioral health and getting us ready to go at risk in the RAE. We’re the only region in the state that is equally sharing risk between the providers and the RAE. That makes us partners with Rocky to ensure we have really good access to care for patients. At the same time, we're trying to bend the cost curve with care integration and by working across our disciplines to really provide whole-person care.
Our goal is to make inpatient care for behavioral health a last resort—so people don’t need to go to the hospital unless they truly need that level of care. We really want to try to treat people in their homes and in their home communities as much as possible. There is only one psychiatric hospital on the Western Slope, so we have put a lot of services in place at the community level, like crisis stabilization units where you can stay up to five days. That helps us to be able to serve whole-person needs while giving patients more choices.
The Ascent: Why is it important that Colorado is taking this step toward behavioral health integration with primary care?
In my mind, whole-person health is the only way to go. When you can treat 100 percent of the body’s systems, you’re going to get better care. We have a long way to go to integrate the funding systems, but what we’re doing with the RAE is a great way to start. We can integrate the lessons learned from Prime into the bigger picture across Colorado primary care because Rocky is ahead of most other payers.
It opens more doors. We’ve really tried to see this through the eyes of the patient, because we’re working to create better access and care integration for both behavioral and physical health services.
There are people who won’t ever walk into a community mental health center, but they’ll see their primary care physician. The Center is partnered with River Valley Family Health in our service area, and they are providing primary care in our facilities while we’re providing specialty behavioral health care in their facilities. We have many miles to cover and not always a ton of people, so this has allowed us to stretch finite resources. Many people can be seen in the primary care provider’s office first, and then use community mental health services for specialty care. This system is allowing us to think creatively about funding for the whole person for the first time.