This is an exclusive BHB+ story.
Resilience amid industry and federal uncertainties is something that substance use disorder (SUD) treatment providers aim to cultivate more of for stability and protection.
The One Big Beautiful Bill Act has repeatedly been cited as a driving force behind the palpable uncertainties in this sector since it was signed. However, the government’s rapid cut and then reinstatement of $2 billion in Substance Abuse and Mental Health Services Administration (SAMHSA) grants back in January rocked any stability SUD providers may have felt even further.
Doug Leech, CEO of Ascension Recovery Services, told Behavioral Health Business during a recent BHB+ members-only webinar that diversification needs to be synonymous with resiliency during times like these.
“My advice is always to look at your business,” Leech said. “If you have some contingent that is a cash pay, what’s that percentage? What’s Medicaid? What’s commercial insurance? Then, what are your grant dollars in there? If you’re all grant dollars and grant programs, in my opinion, your flank is open. You’re exposed.”
Morgantown, West Virginia-based Ascension Recovery Services is a behavioral health advisory and management organization that specializes in SUD treatment. The company partners with hospitals, health systems and providers to integrate care across all levels of SUD treatment, from outpatient and residential to partial hospitalization programs (PHP), intensive outpatient programs (IOP), medication-assisted treatment (MAT) care and recovery housing.
Diversification doesn’t mean “become a Swiss Army Knife” of all things, Leech stressed, but rather, providers should prioritize diversification of payer mix, social enterprise capabilities, multi-site and if possible, multi-state growth.
“If you’re just purely a Medicaid provider, start the discussions with your payers,” Leech said. “There are people out there who offer payer contracting services. …Try to get your foot into the door with other payers. I would do that right away. Don’t wait on the next thing to happen. If you are a program that solely relies on a SAMHSA grant …If it’s a three-year grant, we see people in year three start to think about that, and it’s too late… on day one, be thinking about, ‘How are we going to protect ourselves because this money is going to end at some point?’”
Successful SUD providers will also be the ones who prioritize diversification among their talent pool with clinicians who are strong in certain areas and can help build-out other service lines down the road as growth continues, Leech added. These providers will also be the ones who cultivate and strengthen relationships with community organizations, payers, and also lenders and banks, which can keep them afloat during times of uncertainty.
The following BHB+ TALKS conversation was hosted by reporter Ashleigh Hollowell. The transcript has been lightly edited for style, length and clarity.
Ashleigh Hollowell: Good morning, everyone, and welcome to our exclusive members-only BHB+ Talks: Funding Volatility and Provider Resilience, featuring Ascension Recovery Services CEO Doug Leech.
The start of this year has already brought a significant amount of uncertainty for the substance use disorder (SUD) treatment sector. Providers entered 2026 anticipating questions around Medicaid policy, slower deal activity, and general caution around the operating environment.
Those concerns intensified in January when the federal government abruptly cut roughly $2 billion in Substance Abuse and Mental Health Services Administration (SAMHSA) grants. While that funding was quickly restored after widespread industry backlash, the episode raised new questions about how reliable even established funding systems really are.
Around the same time, the Department of Health and Human Services (HHS) also announced a $100 million investment in the new Great American Recovery Initiative, a task force that is aimed at addressing addiction nationwide, though many details are still emerging around that new program.
Taken together, though, these developments leave many SUDs providers and operators thinking carefully about resilience, funding diversification, and how to plan for the years ahead. Today, we’re joined by Doug Leech, as I mentioned, CEO of Ascension Recovery Services, to talk about what these developments mean in practice and how to cultivate resilience. Doug, thank you for joining us today. To just start off, can you tell us a bit more about yourself and Ascension Recovery Services?
Doug Leech: Yes, and thanks for having me today. This is just an honor and a pleasure, and I look forward to the discussion. My name is Doug Leech. I’m the founder and CEO of Ascension Recovery Services.
I’m a person in long-term recovery myself and come from West Virginia. It’s my home state. When I hit my rock bottom and had a substance use disorder and pretty severe mental health disorders as well, there really weren’t any treatment options for me in West Virginia. I had to go halfway across the country to seek treatment solutions. So, that became my mission in life, to expand access to care around the country so more people could get good treatment.
That’s why I started Ascension Recovery Services.
Hollowell: We’re glad to have you today. I’m excited to dive in. I want to quickly remind the audience you do have the opportunity to ask questions via the Q&A or chat function. Throughout this conversation, as you wish, shoot those there, and I will keep an eye on that and incorporate those into the conversation as we go along.
Doug, I’m sure that in your seat as CEO, from your vantage point, there’s a lot happening in the sector right now. Even just since the year began, as I mentioned in the intro, you and I previously connected about this when it was happening live.
Can you walk us through what the 24 hours were like when the government ripped away and then reinstated the $2 billion in SAMHSA grants as the CEO of an SUD organization? How did that impact your organization? What did you see? Give us a broad overview of what that was like.
Leech: Actually, it was extremely impactful. In those 24 hours, this was the only discussion that my colleagues and I in the industry were having. It was scary. No one really knew what was happening other than everybody got an email that said, “No more payments are coming effective midnight.”
Inevitably, there are people on the payroll who are going to have PTO and things that need to be paid out. It’s going to disrupt their lives. Number one, there’s going to be more expenses that will continue. We’re not getting paid for that. What’s that going to do to the organizations? What is it going to do to the people that we serve and who we help?
As a provider and all of my other friends and business associates providing these services around the country, I said, “What happens to those people?” You just can’t abruptly stop it.
All of these things were just swirling around, and it was a very scary time. I saw people in complete panic. It’s like you’re losing your job. At the same time, you’re losing your ability to help people with a life-threatening disease. It was horrendous.
My time during those 24 hours was spent looking for solutions, reaching out to people that I knew in Congress, and trying to be heard and make sure that we were getting our voice out there. There were hundreds of thousands affected. I’m sure they were just inundated with phone calls, emails, and I believe that’s probably what ultimately led to this reversal.
It was a very scary time, and it’s something that people are still talking about. There are lasting effects from it. For me, I look at hard times like that as an opportunity for growth, and how do we prepare ourselves better in the future to avoid something like this, getting the rug yanked out from under you.
Hollowell: Yes, certainly. As you mentioned, a big wave like this is going to create lasting ripple effects for a certain sector of the industry. What kind of lasting effects do you think this had on the SUD industry as a whole, and how did this added funding volatility affect priorities and operations for providers?
Leech: That’s a great question. I’ve got many thoughts and feelings on funding and state and federal grant funds around substance use disorder, so feel free to prod me in those directions if you’d like me to give any more information.
Generally speaking, as these grant dollars from SAMHSA roll out to the organizations in the country, they’re doing this work and are paid far less than what would be a fair pay rate if they were in the private sector or treating any other disease apart from substance use disorder. This is, in my opinion, the nation’s backbone: our SUD workers and our health care workers. That’s how I look through everything.
The people who are doing this work do it because they believe in it. They care and they want to help people. They see the devastation that comes from people not accessing care. You’ve got folks who are working; they’re underpaid, overworked, have such tight funding anyway. Something like this that puts a bigger scare in it is really devastating. You have these organizations that are on such tight budgets. Any disruption in that cash flow, whether it’s a delay in federal funds getting approved or if it’s on a cost reimbursement basis. I think it’s just important to remember that organizations that get these grants likely are doing very good work.
It does not mean that they’re not run extremely well and efficiently, and run like a sound business. There’s just no margin. You’re dealing with a volatile situation anyway.
What I saw was everybody had to get notified. People woke up that next morning and probably didn’t know about it in the news, and got an email from their employer saying, “Your job is been eliminated,” without much explanation. You’ve got people who have health benefits and families that have chronic diseases other than SUD, that their health benefits are critical for providing support for. All of that’s gone.
We saw people be told that they were terminated. They went through a day of trying to find other jobs, telling their loved ones, “I lost my job.” It completely disrupted a day of work for everybody involved.
What I’ve seen is a couple of things. People who got this notice, some never returned back to the job. They left. They found something pretty quickly.
For most people, it takes longer than a day to find employment. I also saw people who did not get employment, but they just left the organization to look for something in a more stable environment.
I saw people at businesses; I can think of the controller at West Virginia Sober Living — which is a nonprofit that I started in West Virginia — Anne Christopher, she’s just as high-quality a lady and an accountant as exists. She cares so much. I’ve seen her over the years in this position. She donates to the organization that she works for. She believes in it. I just saw her totally devastated by this, having to break the news to dozens of employees who were going to lose their jobs.
That’s just some of the things that we saw, and those lasting effects.
People have lost confidence in the industry somewhat. A lot of that has been restored. It’s just looked at as a blip on the radar, but I have seen people leave this workforce and not return.
Hollowell: Right, which is significant in a workforce that’s already under-resourced and facing a staffing shortage, of course. Lots of ripple effects, right? Maybe a blip in the radar of the year overall, but it can definitely change confidence and perception, and ideas around planning.
I’m curious, for Ascension specifically, were there any strategies or pivots you were either intentionally making or not making during that 24-hour period or right after because this was all so sudden?
Leech: I think we’re always looking at diversifying the revenue sources for the organizations that we work with. At Ascension, we are a developer. We start brand-new programs around the country on behalf of other people, hospitals, nonprofits, community organizations, physician practice groups, you name it. We’re starting new businesses. That’s something that we always preach. We always try to build in a diversified revenue base so that if something does happen like this, they’re a little bit insulated against it.
I guess I’d say that’s something that we’re always working on. Obviously, we’re never expecting something like this to happen, but we are building programs that can be resilient in times of uncertainty.
During this 24 hours, we were, a lot of times, putting out fires and trying to help people find employment in organizations that we manage, plus other organizations that we’ve helped over the years, sharing information. My team was on the phone and on Teams meetings with folks around the country all day.
I think the work that we did prior to this was trying to build businesses that can withstand something like this. I think during those 24 hours, we tried to help mitigate some of the risks and find solutions for these programs that were going to lose all of their workers.
What we’ve done since this has really helped some of these organizations build and insulate against something like this in the future. For us, we can always try to prepare as much as we can, but nothing really prepares you for this.
Some of the areas that were the biggest pain points, we looked for, how to solve that in the future. Most of it comes back to having multiple sources of income. For the nonprofits that have a grant-specific program, how do we make the program self-sustaining and sustainable on its own if those grant dollars eventually taper off?
Some of the things that we’ve done in the nonprofit world are social enterprises. That’s a business that the nonprofit operates that can generate income outside of federal or state dollars. Yes, I think it was all about trying to reduce the amount of damage that was done that day and then helping prep these same organizations to guard against it in the future.
Hollowell: Certainly. This will tie into what you just said, but want to flesh this out a little bit more. That moment, did it change how reliable government funding feels to the industry, even when it’s technically restored? How can providers plan for a year and plan for funding that’s supposed to be guaranteed when suddenly it isn’t, and then it is again? You mentioned diversifying revenue streams, but anything else you would tack on?
Leech: One thing I’d say is with a lot of the changes that have happened throughout the year, everybody has had this feeling of uncertainty about federal dollars as it relates to substance use disorder. Some of the things in the One Big Beautiful Bill that are job requirements or work requirements for people with substance use disorders have caused worry.
We’ve seen, really, for a period of time, just an industry that has been almost bracing for something that might happen. I think it’s actually helped things a little bit.
That’s something that we’ve seen: people not opening up certain new programs with the government uncertainty. I think that always exists. It doesn’t matter if there’s a Democrat or a Republican in office. I think that uncertainty is always present, especially around times of elections and things like that. I think something like this, on one hand, created a lot of, “Geez, can we really trust anything or build anything?” I also think, in the end, the right thing was done.
I think all the shock waves that happened as a result of this might prevent it in the future. As I look at the business of tax dollars being allocated to address substance use disorder and the opioid epidemic and things like that, there’s always room for improvement. There’s always room for more efficient spending of the dollars.
I think this highlights that it’s very devastating, and it produces an unintended result if you just stop it immediately. There has to be a gradual phase-out, or, if you’re going to be tightening things up, you need that anyway.
I think for as long as I’ve been in this industry, which has been about 15 years, there have been a lot of poorly spent and poorly managed federal grant dollars. I think there are so many restrictions on this or that when those dollars do go out, it really goes out to somebody who had a professional grant writer write the grant, versus it being based on merits and the good work that a program normally does and historically has done in a community.
I think this event that happened wasn’t surprising that something was going to change. I think it’s about how it happened that it’s just an immediate off switch. There’s always that hesitancy about government funding. I think this really did add a lot of uncertainty. People are much more cautious now.
Hollowell: As you mentioned, regardless of who’s in office, especially during a midterm election year, everybody, I think, is in a “hurry-up-and-wait-and-see” mode in many industries. Given all of that, what will set a provider up for success during this time of uncertainty and a feeling that the ground is actively shifting beneath their feet? What should providers avoid? What would you say they should prioritize? How can they prepare for success?
Leech: Whenever I talk about diversified revenue streams, that is your program that if it’s a SUD treatment program, prevention, anywhere on the continuum, it doesn’t really matter, but provide for and have relationships with multiple payers. Not just the Medicaid and state Medicaid, but also getting contracted with the various commercial insurance plans.
Have a specific effort within your practice to solicit and try to recruit and get members with private insurance to your business. If you cater specifically to the Medicaid patients, which that’s a lot of what we do, but you just have to have the other payers involved in treating members from Blue Cross Blue Shield, you name it, so that something like this is minimized.
I think it’s looking at the global percentage of revenue for your business and how big of a chunk Medicaid is. Some people go the way of all commercial because commercial rates typically are higher. I think that can be a trap as well.
We’ve seen over the years that the out-of-network benefits are somewhat eroding, and the commercial payers are directing more in-network. We see treatment more on a local and regional basis versus these destination treatment centers around the country.
My advice is always to look at your business. If you have some contingent that is a cash pay, what’s that percentage? What’s Medicaid? What’s commercial insurance? Then, what are your grant dollars in there? If you’re all grant dollars and grant programs, in my opinion, your flank is open. You’re exposed.
One of the things that I did, the first program I ever opened in this business, was a men’s sober living home, a recovery home in Morgantown, West Virginia. I was shocked, coming back from treatment in Minnesota, like I mentioned at the beginning, and coming back to West Virginia, I was shocked at how few resources there were.
There were almost no sober living homes in the northern part of West Virginia at the time. There was one that was within an hour of Morgantown that had been open for a long period of time, but it had closed maybe 18 months or two years before I started my program. I remember trying to figure out, “Really? There are none of these businesses in the area? Am I crazy for opening one up? Why aren’t there programs?” I knew it was going to be a challenge.
The story that I heard about the program that was open and closed is they had grants. They had grant dollars that came in every year. They essentially paid for the gap. There was a gap between the revenues that they had and their expenses, and this grant filled that gap. When the grant went away, they went away.
Before I even opened my first program, I just made a commitment to myself that I was not going to build a business that was reliant on grant funding because that means someone else can yank the rug out from under me and end the good work that I’m doing. That’s the advice. It’s foundational to me.
The risk that we saw that happened here is something that’s always been present.
Again, this was very dramatic, but I always set up programs, and whenever we guide people to open up programs, to have diversified streams of revenue.
I mentioned earlier, a social enterprise that produces revenue for a business if it’s a nonprofit. There’s lots of restaurants or bakeries or pallet making, fiber optic wire splicing. We see social enterprises that provide jobs in these sectors to produce revenue. Then that revenue, mixed with your grant fund, your Medicaid, commercial dollars, all those things, is what keeps your boat stable in rocky times.
Hollowell: It certainly keeps the ship afloat. Absolutely. You mentioned something that I want to dig into a little bit deeper. Do you think a pivot to obtaining contracts with more commercial payers could be a strategy for some SUD providers who have historically relied heavily on grants and federal and state funding? I know you also mentioned the anecdote that there are also complications with commercial payers. Is that even a strategy for resilience, or what are your thoughts around that?
Leech: No, I definitely think so. Providers find their niche and what they like. Part of my mission is I want to provide treatment for folks with Medicaid because historically, this is where there was a lack of treatment options. You couldn’t go out of state. You were confined by the state wall.
It’s always been on my mind, but I think you have to. Getting in network with as many commercial payers as you can is definitely the way to go. It provides more options for people to access your services.
If we’re a provider and we want to help everybody in an area, then, in my opinion, being able to accept the broadest mix of insurance plans is the way to go.
You’ll just see in most states there’s a handful of commercial payers that are dominant and that provide insurance benefits for 80%, 90% and the market is usually made up of four or five payers or something like that. I think you should at least go to the top payers that are in your region or state and be contracted.
I think you ought to spend time with those payers and let them know about your program, who you are, and what you do.
At the end of the day, the payers, whether it’s Medicaid or commercial insurance, they want to know that their dollars are being spent to help their members recover, whether that’s a physical problem or a substance use disorder. It’s a behavioral health issue. They want to see a quality program. Those relationships with the payers are critically important. You don’t want to just go get a contract with Optum or Blue Cross Blue Shield and never talk to the payer.
We like to invite payers for residential treatment centers. We like to invite them to come out, see the center, participate in our open house and our grand opening celebrations, and things like that.
I think the payer relationship is critical. Payers have flexibility. If you have a really longstanding, good relationship with the payer and you enter a time where there’s an issue, we’ve seen things over the past few years with some of the exchange systems getting hacked and going down, and just all payments halting. This is over the past, I think, four or five years.
We had payers that we had longstanding relationships with that worked around it for us. They weren’t able to process claims, but they went back and looked at the previous 90 days and what our average was and just fronted us payments because those claims weren’t able to get processed, which kept us in different programs that we worked with afloat during that time.
I think contracting with many payers is the way to go, and then taking it a step further and building those relationships. That’s what it’s all about.
Programs that are better insulated for things like this crazy 24 hours are ones that also had strong community relationships with their United Way, with the Chamber of Commerce, and local businesses. You can go in a pinch and say, “We need some support right now.” There’s organizations that provide that type of stuff.
Hollowell: The payer-provider relationship is so important, especially in behavioral health. Any tips, any advice you would give programs or providers who are maybe looking to diversify and add more payers to their mix? How should they start those conversations? How should they navigate them? Any tips or tricks? I know that these can historically be challenging conversations. They’re not always seamless in this space. Anything you would recommend on that front?
Leech: I think it’s important to be very authentic and reach out to the payers. If you have not done it before, you can let them know that and ask for advice and help. I think a lot of times we don’t use, even on the Medicaid side or at the state, with the various boards through Health and Human Services that do provide the behavioral health licensing, reaching out to those folks on a proactive basis and saying, “Is there anything that you know of that can help us?” They license hundreds of groups and institutions in the state.
Be a resource to us versus us just submitting something. You’re never hearing from us or seeing us, and then you just get this application. Reach out.
With the commercial payers, there’s always the representatives who meet with the community providers. I think connecting with them initially and sharing about your program and why you’re proud to do what you do to get that conversation started.
Most of the folks, in my experience, who work on the payer side and interface with treatment programs, they like to learn about it. They like the opportunity to be asked their opinion on things and to be helpful.
I think that’s one way. Conversations, don’t be intimidated by it being something new to you and something you’re not that familiar with, but be proud of the work that you do, and tell them about it, and ask them what you’re missing, what else should you be doing?
The payers have the ability to say, “Look, we pay for these different levels of care. We see a big gap for adolescents,” and whatever the program might be that they see a gap in, and they’ll bring that up in conversations.
They want to see programs open up that provide the services. Like I said, adolescent treatment, if it’s purely mental health disorders or sub-programs, is usually a gap area in states. That street can go both ways. It’s not just you asking them, “Hey, please pay me for these services,” but figuring out what services their members are not currently getting.
Hollowell: We’re just coming off of our Behavioral Health Business VALUE conference that was last week. I feel like a resounding theme in general is just have the conversation with your payers. Start somewhere and start having those conversations. Don’t be intimidated by these other dynamics at play. Just start somewhere. Start talking about these things, which is hugely important.
You mentioned a little earlier, I know that providers who maybe can’t easily pivot away from public funding, you mentioned that they could rely on community resources, right? Like local United Way chapters or talking to local chambers of commerce for a bit of extra support during times of volatility, perhaps.
Is there anything else you would add to that for providers who cannot easily pivot away from public funding? Where else can resilience be built?
Leech: I would say diversifying your services that you’re offering. Not just the payer, but the services. Sometimes, if there is going to be a cut or something that’s eroding that typically was earmarked in a state budget, if you’re providing very specialized services, that’s great because you become the best and the go-to. If something happens to that specific offering, you’re out, and you’re not able to provide services to anybody.
To me, it’s about maintaining the business in a strong position so that you’re open and able to continue providing your critical services to the community.
Diversifying your service mix. If you’re an SUD provider that is just detox only, ASAM 3.7 level of care, look to expand to 3.5, the residential component. Look to outpatient programming.
I think it’s expanding your service offering. If there’s a rate change with Medicaid or commercial for a specific level of care, maybe it’s a detox, then your business model’s not crashed. Also, I always say, you don’t want to be everything to everyone. You want to have what it is that you do, if you’re an outpatient provider, and you’re really good at that. Look to have different levels of care, PHP, IOP, individual therapy, group therapy, family counseling, some other things that you can do.
Typically, what we see is it’s just one segment or sector that gets hurt. Everything pretty much always balances out over the years. We see something go away, and then it comes back later.
That’s like rates. Maybe it’s something for, like I said, detox rates on a decline versus an incline. Look at what other services you can provide. Certainly, it’s an effort, and it takes a lot. It’s like having an insurance policy. You pay for the insurance, you pay for it every month, and you hope to never use it. But whenever you need it, it’s there, and that makes all the difference in the world. I just don’t like to have a program that somebody else can shut down with their decision.
Hollowell: Right. We’ve talked about diversifying funding streams. We’ve talked about diversifying services. What are common mistakes you’ve maybe observed throughout your career in providers trying to make this diversification, either funding or services, happen too quickly?
Leech: I’ve seen programs. You’re saying doing something very quickly, as in this 24 hours that happened, and making a rapid change. It could be something that’s so far out of your comfort zone. You don’t have the internal resources to provide those other services, so you’re just trying to do it to simply hedge against some rate change at the federal level or at the state level or with a commercial payer.
I think it’s expanding your team, your core competencies, and having a broad mix of providers on your team.
Providers that have, in psychiatry, for example, they have substance use disorder experience, some who practice psych, some who are adolescent-focused, ones on your team who have other areas of expertise, so if you do need to change and focus, you’re not taking all your SUD people trying to do family behavioral health services.
I’ve seen that. I’ve seen places, typically, what happens whenever people try to change really quickly is they’re going after something that’s a higher rate. For example, a rate raises in a state, and it’s for residential treatment. The detox providers who don’t really know that model are coming in and trying to change and take advantage of an opportunity.
I think one thing that I believe in so much in behavioral health care is that you have to collaborate and you have to work with other providers.
Having relationships with other providers who do the same thing as you, try not to think of that as competition. That’s just a big, core belief for myself and Ascension Recovery Services. It’s not about competition. There are enough people dying of this disease that we need to work together and try to provide the proper resources.
Inevitably, everywhere that I go, I find people who compete; they don’t work with anybody, they’re in their little bucket and don’t work outside of the walls of their building.
To me, that is very shortsighted. It leads to things happening in a vacuum, trying to make a change very quickly for something, and it may or may not work out.
I think it’s having those relationships with those providers, sharing patients back and forth, having continuity of care so that someone can come to your program and then choose to go to this other program. You’ve got a pathway set up to exchange information if we have the proper releases.
You have your case managers at both facilities who are friendly and understand and know each other enough to work together. In my organization, we share our insights and things we know.
I’ve got experience in more than 30 states that do this work. I’m happy to share that knowledge with people.
That’s another part of the diversification is having things in multiple states. If you can really grow outside, now we have two different state Medicaids that might operate differently or do something different. I might have a Blue Cross in Florida and a Blue Cross in West Virginia that are two different and somewhat hedged there.
I think not just jumping towards the shiniest object when the new rate comes. I see so many people do that. That area gets flooded. You’re doing it for the wrong reasons. You’re doing it for that rate increase versus what you’re really good at.
Yes. This stuff is very important. It’s not just, “Oh, we collaborate. I know so-and-so over there.” It’s really getting together and sharing and being helpful to one another. That helps the systems of care that we set up.
If we’re working on opening up a residential program in a community, we’re working directly with the hospital, with their emergency departments, with their social workers who are discharging patients and seeing people on the front end. We’re working with the outpatient provider, the community recovery housing provider, and the harm reduction program in the community. We go in and truly believe that we want to strengthen all areas of this system. That’s how we’re going to do the best for the patient.
If you’re focused on patients first, no matter what, that’s fundamental for everything else to work. Then, I think it’s not looking at this as competition; it’s working together and sharing your resources. Those are the best ways that I see to do that.
Hollowell: You’ve underscored many times today throughout this conversation that it sounds like the key to resiliency, what that looks like operationally, really also comes down to a lot of relationship building: relationships within your community, with other organizations, with payers, etc. even internally, that will continue to build resilience and grow that throughout an organization.
I’m curious if any of these shifts federally throughout the last several months or even the last year, has any of that shifted how you think about hiring, compensation, or program expansion at Ascension? Is there any new resilience lens you’ve had to put on your CEO glasses in terms of those areas as well?
Leech: Yes, there is. One thing I want to say before I forget, when talking about community partners, something that can be helpful is also your lender and community banks. This is a big thing for us. If you have a relationship with a lender, well, if you’re a business that is– You don’t need debt. You’re proud of not having debt. Get debt. Get a line of credit. Get something that you can establish a relationship with a lender on so that in a time of need, they can step up and help you. It’s those relationships that I mentioned. I just wanted to highlight lenders as such a critical part.
For Ascension Recovery Services, the programs that we provide in West Virginia, some of our lenders, First United Bank and Trust, and MDB Bank, have been critical to us in times of uncertainty and provide a level of support that is very different from federal or state payers. They can provide a resource to you, emergency funding, relaxing credit agreements, and things like that. That’s something I definitely would encourage people to seek out local banks and build a relationship.
As far as being the CEO of an organization in times like this and after that 24 hours, we definitely do look at variable pay. Hiring folks on a contract basis versus W-2s and things like that, that’s always in our mind.
A lot of people who are in this profession are in it because we care and we want to help people. We always want to increase that base salary. For me, one of the things I am the happiest about, other than treating our patients and changing their lives, is changing the lives of the people who work for my organization. I want them to earn a great living.
You can set things up in their pay so that the base is livable and it’s a great wage, but bonus pay is more reflective on how the business did, things like that. I see places that end up with base pay too high and bring on too many people too quickly, and then something happens and there is a disruption, and you can’t make payroll. That really hurts people.
I think build cautiously and slowly. It’s so hard to have cash reserves in a business like behavioral health because the rates are so low, and the providers who are accessing grant dollars, such as the SAMHSA dollars, things are just so tight.
I guess generally speaking, I wish more dollars got out and got directly into the hands of the providers versus sitting at the states and having this whole network of people that care more about the margins and the font size on your report when you send them, versus the good work that you do.
I think that’s critical. Don’t grow too fast.
I see this all the time, like in Indiana, the Medicaid rates just went up really high for residential treatment. There are dozens upon dozens of new centers that are opening. It’s just like the gold rush. They’re just trying to get there as soon as they can, and not with a well-thought-out plan.
They’re not establishing themselves as real community fixtures and partners. I think you just miss a lot. Yes, I think some of it’s on the hiring standpoint. Some of it is just being careful how fast you grow. Growth is always there, especially in this field. We see people who grow too big, too fast, and then they fail and have to shut down centers.
Hollowell: A great segue into my next question, which is really around what smart growth looks like in the SUD sector right now. You touched on many points, building these relationships to ultimately cultivate resiliency, building cautiously, not outpacing yourself and running out of runway. Is there anything else you would tack on to what smart growth may look like for SUD providers in times of uncertainty like this?
Leech: I would say, and I mentioned it earlier about multi-state, so be multi-site and then be multi-state if you can. If you have a program versus having a massive residential that’s 300 beds in a community or 400, have smaller. There’s a certain number, 30 beds on a Medicaid level is never going to work. But 50 to 60, something like that, if it’s residential treatment, there’s certain rules of thumb. I’d rather have three different 50-bed centers than one 150-bed center in an area.
Then, as far as the uncertainty with Medicaid dollars and federal and state dollars and things like that, having a two-state system can make all the difference in the world. It all balances out. Things that change in one state, maybe doesn’t in the other.
Then, it’s having those commercial-payer relationships. That’s part of the growth. I think you ought to look to grow into multi-site. I think you ought to look to have multi-state if you can.
Some organizations that are small and just provide a community resource, that’s wonderful and that’s great. I think those are the ones that you want to diversify, as we said, with having commercial payers as a part of your mix.
If you’re really growing and growing smart, look to add in another state. To do that, we see people go to different states all the time. That’s a lot of what we do. It’s not about going and planting your flag and spending more marketing dollars than the guy down the street. It’s going into a community and figuring out what they really need and providing those services and figuring out how you work to fill a gap in care in a community.
That’s probably the strongest thing I’d say. If you’re growing and really want to build a solid organization, if you can have a footprint in a different state, it just hedges you more against potential risks.
Hollowell: Right, you’d have a little bit more protection and resiliency baked in, of course.
So, from your perspective, what should SUD providers, regardless of size, be prioritizing throughout the rest of the year heading into 2027 when a lot of those one big beautiful bill provisions will begin to take effect? What should they be prioritizing? What will Ascension be prioritizing? What will that look like as we move forward?
Leech: I think a summary of what we’ve chatted about is really the best place. If you’re just purely a Medicaid provider, start the discussions. There are people out there who offer payer contracting services. You can Google and find that out. That’s stuff that we do. We can help anybody with that.
Try to get your foot into the door with other payers. I would do that right away. Don’t wait on the next thing to happen. If you are a program that solely relies on a SAMHSA grant, the SAMHSA grants are wonderful. I think they ought to be used as seed funding to get a program up and running. Then, we work to make it sustainable. If you haven’t done that, you should really start to think about that.
If it’s a three-year grant, we see people in year three start to think about that, and it’s too late. If it’s a three-year grant and you get awarded the grant, on day one, be thinking about, “How are we going to protect ourselves because this money is going to end at some point?”
I think a lot of times we see funding from SAMHSA, if you’re doing a good job and providing great resources to communities, they want to keep funding it. You end up possibly being able to get more years or more dollars just allocated to you, which is a great thing. But always be looking to build up your revenue sources.
I talked about the social enterprise deal. I think that’s a critical aspect. Maybe it’s through a partnership with another organization. Those are all important. Different payers in your mix. Make sure that you truly do have folks that you hire who are used to working with different payers. If you’re going to expand the services that you offer, that’s another way. Try to hire a therapist with deep experience rooted in trauma. Try to hire a therapist who also has a lot of adolescent experience. If you need to provide more services for adolescents, you can do that. Diversify your workforce and your payer streams. And always, if you can, start to think about multi-site growth or multi-state growth.
Hollowell: Well said. Is there anything else on this topic that maybe I haven’t asked you directly that you just feel is pertinent for the industry to know that you think is top of mind, you want to mention? In closing, any parting words for our audience?
Leech: I would say that, and I mentioned it a couple of different times, but there are wonderful providers out there. There are a lot of them, and they’re doing wonderful work. With federal or state dollars given to them, they’re able to do so much more.
I wish that the federal funding agencies would look at getting these dollars into the hands of competent providers who do great work and let them do their thing, versus sitting around and waiting on a group to put together a fancy application from a grant writer and giving it to them, and just, “Boy, they wrote everything perfectly here.” I would weigh that so much more on experience and providers. It doesn’t mean it has to be a nonprofit.
There are good for-profit companies, and a nonprofit that is not profitable doesn’t exist. You want to see, regardless of the tax structure of the organization, whether they are doing good work? Do they run an efficient and financially sustainable business? Are they providing good outcomes and results? If so, get the money and get it to them.
A lot of times on the grant side, for me and organizations that we work with, you just get such a small amount that you can barely do anything with, and you have to go back and do so much reporting on it. Of course, there should be reporting, but I just think that we really miss the big picture here with the federal and state dollars that come for substance use disorder.
I think if we really want to make an impact in the country, get the dollars out in big chunks, not little micro-grants, that way you don’t have them coming back each month and just begging for the next month with all your reporting. That’s, a lot of times, what happens.
Certainly, we want new organizations and new ideas and things like that. I’m not saying all the money goes to the existing giants. I’m certainly not saying that. To me, that’s the biggest way that we can really make an impact on the addiction crisis.
It seems like every time a new person gets into office, we go and we spend billions of dollars on assessments and studies to try to figure out what it is that we need. We know what we need. It’s 2026. We know exactly what we need. We know what works. We just need to get those dollars out into the hands of the providers and let them do their thing. That’s my little pitch there for what I would like to see nationally.
Hollowell: Well said. Thank you for being here today, Doug, and sharing your insights with us on the field. A lot remains to be seen. We’re still very early in the year, so many more conversations to be had around a lot of things. I know you and other providers will be watching. Behavioral Health Business will be tracking and reporting on these aspects, too.
Thank you all for joining us today. I hope to see some of you in May at AIS West. Thank you all again.
Leech: Thanks, everybody. Thanks for having me.