Angie Fiedler Sutton
Welcome to Destination change podcast where we talk recovery treatment and more. I'm your host Angie Fiedler Sutton with the National Behavioral Health Association of Providers.

Our guest today is Nick Stavros. He is the CEO of Community Medical Services where he has worked for the past 10 years. Previously, Nick was an intelligence analysis and Arabic linguist in the US Army and finished his military career as an Airborne/Ranger qualified Infantry Captain and Iraq war veteran. Upon honorably discharged from the Army, Stavros received his MBA from UCLA Anderson School of Management and is an alumnus of the Arizona Valley Leadership Institute.

Nick is on the board of the National Association for Behavioral Health (NABH) and chairs its Medical Medication subcommittee. He is also the Arizona representative to the American Association of the Treatment of Opioid Dependence (AATOD), and the President of the Arizona chapter of AATOD, which provides collaborative opportunities versus facilities throughout the state. Nick is also on the ASU Medical Advisory Board, a Arizona's parents Commission's on Drug Education and Prevention with the Arizona governor's office, an advisory board member of the National Conference on Addiction Disorders, and a board member for HMP's Treatment Center Investment & Valuations Retreat, both the East and the West. Thank you very much for joining us today.

Nick Stavros
Yeah, thanks for having me.

Angie Fiedler Sutton
For those who are familiar with the podcast, they know my first question is always the same. Basically, kind of how you got into the addiction treatment space, especially with the background in the Army? How did you get from that to wanting to work with the addiction treatment and behavioral health?

Nick Stavros
Yes, so good question. I mean, I came out of the Army in 2011. And let's see, I came to Community Medical Services in 2013. And at the time, it was partially family owned business, my entire family works in this space. My dad and brother, both physicians, my mom, sister, are both nurses, my other brother and sister are both social workers. And so I was the oddball in the Army. And so cane to Community Medical Services, actually, in 2013, really, to help prep them for a sale at the time, all the owners and it was not family run at the time, it was being run by non-family members. All the owners were like, you know, there's kind of like a consolidation happening in the market for opioid treatment programs.

And so I came to help prep the company for sale, and I really just very, very quickly got passionate about the cause, you know, coming out of the military where, you know, and then I mean, I was, I was Army infantry. So I was kind of, I felt like I was, you know, on the frontlines, like tip of the spear, dealing with kind of global crises at the time. And so, coming into this field, where the opioid epidemic in this country was kind of, like, and still is one of society's biggest problems, I saw an opportunity for us to really make an impact with this company, because I knew, you know, there was this shortage of treatment, which the gap between those getting treatment and those needing treatment was getting bigger and bigger and bigger, it's still getting bigger and bigger, and knew some solutions were needed. And so got really excited about being able to make an impact.

And so yeah, that's been like our drive to grow there. We had six clinics in two states at the time, we're at about 75 clinics in 13 states right now. And so it's been cool, been able to grow, meet the need expand access and underserved communities. And that's really what our company is focused on doing.

Talk a little bit more about that. I guess you don't really have a typical day, per se, but kind of what do you do as part of your job duties in terms of working with these companies?

Well, yeah, I mean, so I'm the CEO. And so what that means, like the role of a CEO changes pretty dramatically as a company kind of develops and morphs into new phases of growth, like constantly. And so I've had to kind of, like redefine my role with each kind of phase of growth. And so I'd say today, I'm at the point where I have a really strong executive team, you know, I've actually spent the last couple of years like building a strong executive team. And now I'm at the place where I have a very strong executive team.

So I'm much less involved in like day to day, you know, tactical decision making and stuff like that, and more focused on fostering a good strong culture and team environments, and providing just overall kind of direction and vision for the company. And so that's where I spend my time today. I also do a lot on you know, just kind of being the face of the company. So presenting at conferences, fostering relationships with kind of key stakeholders working on strategy and planning and stuff like that. And so and then whenever, like, if we do have a gap somewhere like I'll step in and fill in where I can help if we have a gap. If one of the executives is on a leave of absence or something and I need to I with their team or something like that, I'll step in and help. And so it's it's pretty dynamic job right now.

Angie Fiedler Sutton
Let's talk a little bit more about your work with the AATOD, for those who may not be familiar with it not really the kind of the elevator pitch as to what, what exactly that company, what AATOD does, and kind of how you got involved with them. You talked a little bit about that already. But just a little bit more in terms of what made you get into that space.

Nick Stavros
Sure. So ATOD is the American Association for the Treatment of Opioid Dependence. And so it represents OTPs throughout the country. It's not a trade organization, by definition, it's more of an association that similar to a trade organization, but it's not technically one. And so, you know, it's working on ... whether it's states, while AATOD is a national organization, but then it has state chapters, and not every state, but almost every state has a chapter, and then there's a representative for that state. So I'm the representative for Arizona, I served on the AATOD board. And so I help work with all the OTPs, for instance, in Arizona, on you know, if we're having specific issues or sharing best practices, or if there's like legislative things we want to work on, either in Arizona or nationally, you know, AATOD is there to support. And so, yeah, that's primarily kind of what AATOD does.

Angie Sutton
Well, what are some of the resources that you use on a regular basis, one of the things I like to share with people who are listening is it's kind of where they can go to get help. So if they're trying to do more in terms of the industry,

Nick Stavros
You mean providers?

Angie Fiedler Sutton
Providers. Yeah.

Nick Stavros
Yeah. So that association is specific to opioid treatment programs only. And so it's not as every, almost every state, like I said, has a chapter. So you can reach out to your local chapter, if you want to learn more.

But like I said, if you're not an OTP, you can still most likely participate. Like we have our chapter meetings, which are monthly, I'd actually say the majority of the participants, they are not OTPs, they might be universities and people from the MCOs, or the Medicaid agency or state. And it's kind of like just a place where we come together and collaborate on, you know, what are we seeing with trends regarding, you know, drug trends in the states? And what are people doing about it? And how can we find kind of, like innovative solutions to deal with some of those problems?

Because the more we can, you know, well, I mean, I'm a pretty firm believer, the more we can build a strong ecosystem of supports, the more successful we're going to be as an industry and the more success patients are going to have when they have, you know, treatment providers working, whether it's treatment providers working with each other or working with, you know, let's say Correctional Health System or hospital systems, or other mental health and behavioral health providers, like the more that ecosystem could work in like alignments, the more success you're gonna get so. Constantly, you know, I know our chapter in Arizona is trying hard to make sure we're fostering like those relationships and building bridges that might historically have divided different entities.

Angie Sutton
I'm assuming that's through your your advocacy effort or at work, primarily, talk a little bit more about that in terms of, you know, how much do you work with somebody who's I know, BHAP, for example, as an advocate that we work with Andrew Kessler, is that something like you do? Or is that you, yourself? Go in and do the advocacy?

Nick Stavros
We do that. I mean, so AATOD has like, for instance, AATOD has the lobbyist. And we're on a couple of different, I'm a part of a number of associations that have kind of their own lobbying and advocacy efforts. But a lot of times those are more geared towards like industry specific issues. And we, you know, we do have like our association in Arizona has a lobbyist. We, as a company, have a lobbyist in Arizona, and we have lobbyists in multiple states.

But a lot of times when we're doing lobbying and advocacy, it's not necessarily like for industry necessarily related issues, like we do a lot on the harm reduction front. So that might mean lobbying to get good Samaritan laws passed or syringe access programs legalized or more access to Naloxone, things like that. So not necessarily stuff that pertain to specifically like to like to our business or even our industry, but does pertain to the patient population that we treat. You know, we have the ability to advocate on behalf of our patient population, which a lot of times there's a patient population whose voice is not always heard, I mean, and it's kind of left out of a lot of the things that you see in legislation and stuff like legalizing syringe access programs, let's say. There's not any financial interests for anybody to do that. And so sometimes it's hard to find like legislative sponsors but if it's the right thing to do, like somebody's gotta maybe front the bill for lobbying for that, or build a coalition around it. And so we find ourselves doing that quite often. .

Angie Fiedler Sutton
Let's talk a little bit about you the state works specifically, BHAP's very similar. We although we are a trade association, or national organization, but we partner with states because obviously, state level laws are different, depending on states to talk a little bit more about your work with Arizona specifically versus the national level.

Nick Stavros
Hmm, well, we don't do a lot of work on the national level at all. Because I mean, really, there's there's a lot of associations that are out there doing that work. And so we see like, I mean, it's, it's a lot easier to foster relationships at the state level. Now, I guess, are you asking as a company like Community Medical Services, or as part of some association?

Angie Fiedler Sutton
Both. Just kind of compare the working on a state level versus working on a national level. What some of the differences and some sort of similarities?

Nick Stavros
Hmm, I'd say, on a national level, well, it's always harder because it's, it's, it's hard to get unity a lot of times, when you have a bunch of big, let's say, big national providers trying to get unity on a specific issue, let's say. That's, that's difficult a lot of times, and there's some organizations that are out there that are really good at it, and some organizations that struggle, and so I'd say ....

Plus, you know, stuff at the national level, you know, is obviously bigger and broader. And at the end of the day, a lot of stuff that happens at the national level still has to be, you know, maybe implemented at the state level, or states can can have a big say in how things are, you know, how some national legislation actually gets gets adopted in the state. I mean, states have a lot of saying that. So, I say we do, we do a lot more at the state level.

And it's not I mean, not just Arizona we're in 13 states, and there's, you know, every state has their own kind of issues. And maybe one state might be more stigmatizing against, you know, treatment in general or against methadone treatment, for instance. And so we'll try to make a lot of effort in those states to affect change or another state, you know, might have, you know, not great Medicaid enrollment or Medicaid reimbursement or Medicaid support or even Medicaid interest in like expanding access to medication assisted treatment. And so, you know, we'll try to I mean, every state we kind of do something different.

I mean, we're opening a lot of clinics, too, throughout the country. And a lot of times, you know, a lot of times communities don't want treatments in their community initially, and they don't like value what treatment has to offer. And so sometimes a lot of our advocacy efforts will be, you know, just trying to, you know, build relationships and educate communities on the data and the statistics around addiction and around treatment for addiction. And so we find ourselves doing a lot of that just kind of like grassroots advocacy on the ground.

Angie Fiedler Sutton
That's definitely we've talked before on the podcast about the NIMBY, not in my backyard, as well as the stigma attached to it as one of the barriers to move forward in the addiction treatment journey. We talk about how it's not a straight line, it's more of a path that you kind of to possibly can backtrack and whatnot. What are some of the other barriers that you've seen for people to come across in terms of moving forward on the addiction treatment journey?

Nick Stavros
Well, yeah, I mean, sometimes states have pretty restrictive regulations. You know, counselor ratios is a great example. Like, it really frustrates me when you see states kind of trying to dictate things like at that level, like with, you might say, a state might say, you know, the counselor rate to patient ratio should be like one counselor to every 50 patients, or 50 patients per counselor. And that's a very, like finicky heuristic to rely on. Because if you have one counselor that has, you know, very, very stable patients on a monthly dose of buprenorphine or Suboxone, let's say, they could probably handle a pretty high caseload. But if you have another counselor that does nothing but deal with the most acute patients with comorbidities, they're gonna have a much smaller caseload. Or if you have a counselor who just focuses on doing intakes, right, they could have a very low caseload. And then you might have another counselor, who, who, again, is dealing with a certain patient like population. And so it's all over the place, like kind of what the needs of each individual patient are.

So sometimes, and you'll see that some states allow for the use of mid level practitioners like nurse practitioners and physician assistants. And some states make it very difficult to get approval. Some states have requirements around, you know, we need a medical provider there 40% of the time versus other states. You know, there's there's no mandate at all.

So we will try to work to, you know, there's regulations that are making it really difficult to get people hired or to provide like the highest quality care in an environment that's kind of defined by scarcity of resources in general, like that does become a barrier to treatment. I mean, we have places where there's are so few counselors, for instance licensee, they might require a specific licensure type. And it's so restrictive that it's very hard to find. I mean, if we were to, if we were to go very aggressively to try to hire more counselors, then the only way to do it is basically steal counselors from some other program that then is going to be hurting. You know, and a lot of times you see, when it's super restrictive around like licensure requirements in a state, then there's just not enough counselors to meet the need. And so, you know, we're constantly looking like, you know, is there ways we can incorporate, you know, AI, or other technologies like to help or you know, process improvements or things like that, but sometimes it is like trying to get the regulations in the state change to be a little bit more accommodating.

Angie Fiedler Sutton
Great. You've been with Community Medical Services for at least 10 years, probably a little bit over, we talked a little bit about one of the things that you've paid attention to some of the trends. What are some of the things that are different now than they were when you first started in terms of the working within the addiction treatment? What are some of the things that have improved, or maybe have gotten worse?

Nick Stavros
A lot. That opens a whole can of worms. I mean, I think, you know, when I came to the field, there was a lot of animosity, and a lot of stigma towards addiction in general, and treatments for addiction such as methadone and buprenorphine products, I'd say that's definitely not gone away, but it's moving like in the right direction.

So we've always had a very strong harm reduction paradigm. And, you know, I think that comes from the fact that we operate, we have clinics in some super rural places, like Montana is an example where, you know, our Chief Science Officer's in Montana, he was he was our chief medical officer. So the for the last decade, pretty much, we're the only program in Montana, the only OTP the only program that does methadone in Montana. So we've kind of developed this mindset, like if somebody's struggling in treatment there with us, it takes a lot for us to quote unquote, kick somebody out of treatment, because that in Montana, when there's nowhere else to go, that could be a death sentence, you know.

I mean, it's like, if we discharge somebody from treatment, because they're continuing to use, you know, methamphetamines, or they're not adhering to their counseling protocol, or something like that, we kick them out of treatment, there's nowhere else for them to go. Right? And so so we kind of developed the strong harm reduction paradigm, because I think of those kinds of experiences. And then we ended up you know, as we are growing in more both rural and urban environments, like we've kind of kept that mentality, like harm reduction, we think is a much better way to approach treating addiction.

And so I've been encouraged to see the rest of the industry moving in that direction as well, having a more harm reduction oriented approach, and even the federal regulations that are changing right now have better, more harm reduction oriented language, because really the regulations that exist for our space for opioid treatment programs and for addiction in general, I mean, our country has, has had such a stigmatizing view against people struggling with addiction and people who use drugs for a long time. And that means that a lot of the regulations that have been written over the last couple of decades, have been pretty punitive in nature.

And so as we as a society are being more adopting of harm reduction, and more and more people are experiencing either addiction or a loved one with addiction, like it's causing all of society to have a more compassionate view towards addiction, which we think is a that's a very positive trend that we've seen. It's exciting.

Now, the flip side of that is we're seeing much more .... So, I can tell you the the three factors that influence retention rates the most in our treatment programs, and retention being one of the most important indicators of success in our programs because, you know, there's a lot of research out there that says like the minimum amount of time needed on methadone is at least a year. The most adequate amount of time is probably something like three years. So retention rate that are people being retained for one year or three year is a very, very important indicator. Well, we've seen retention rates go down dramatically over the last few years.

And the three indicators that are most correlated with retention rates for our patients are 1) are they testing positive for fentanyl upon intake? If they are, the retention rates tend to be worse. Are they testing positive for stimulants upon intake? If they are, retention seems to be worse. And what is their social determinants of health status upon intake, if it's worse, if they're not housed, if you know they have more anxiety, depression, all those things upon intake, then their retention rate tends to be worse yet.

The conundrum here is, is we're seeing a dramatic increase in all of those three factors. More people tested positive mental, more people tested positive for stimulus, and worse social determinants of health scores upon intake. And so we're in this period where the things that cause worse retention are increasing, and it's pretty dramatic and you know, fentanyl is changing the way treatment is done. In this country, 75% of our patients are testing positive for fentanyl upon intake. That's a high number. But you know, that's something we're spending a lot of time thinking about as a company, like, how do we impact those things?

And then I'll pause. Do you want to ask any questions? I'll keep going.

Angie Fiedler Sutton
Keep going.

Nick Stavros
Yeah. So obviously, I mean, the environment since I mean, the last couple of years, COVID and everything else, you know, obviously, we've seen a positive, we've always been advocates for telehealth because we operate in super rural areas like Alaska, North Dakota, Montana. So we've used telehealth for a long time, we've had to be relied on it. But COVID really, really ushered in kind of a new era in healthcare over reliance on telehealth, which I think was long overdue. And so that's kind of one of the obviously silver linings that happened during COVID. But, you know, we've also seen dramatic increases in interest rates in general, inflation, you know, inflation over the years that that means that wage labor, inflation has been the issue, I mean, and we're primarily Medicaid and Medicare funded. And it's not like Medicaid keeps up with inflation by any means. So we have salaries going up, revenue staying pretty much the same when you look at Medicaid rates. And so that's just like making it I mean, squeezing margins, making it harder and harder for providers to operate.

And then you pile on, you know, the effects of interest rates on that. I mean, we have debt, we can't do all the growth we want to do without debt financing. And so we have debt, which means more money towards interest rates. And so that's all leading to just less available cash and less available cash means less ability to do the things we want to do: open clinics, give raises to employees, you know, give bonuses, all those things, it's a lot harder to do it in this environment that's super cash constrained.

And then, you know, we refer to AI as augmented intelligence, not artificial intelligence, because it's, we don't think that we want to be very clear, we're not trying to replace human beings with robots, right? We're trying to augment and supplement the value that humans have to offer. And so you know, if the most value that a counselor brings to work every day is the time spent counseling patients, then we want them to spend as much time as possible counseling patients. Not scanning and leaking documents, not even entering notes into charts, like all those things that are part of the job, we're spending a lot of time saying, is there something ... can we use AI to augment the human value? And so that's been great. I mean, the last year, and particularly, there's been this kind of explosion in AI, and that's a that really is a paradigm shift for a lot of people.

Because it's like, historically, when you think about, okay, how do you solve this problem? Well, the go to, for a lot of companies is like, well, we need to hire more people, you know, or it could be, you know, could be, well, let's look at like process improvements. But eventually, there's only so much process improvement you can do and the labor shortages, I mean, there's not enough counselors to treat all of the mental health and behavioral health issues that exist in this country, you know, and so working with incredibly source, our scarce resources, we have to look at technology to solve some of these problems. So AI is been a big thing, you know,

Digital therapeutics, it's interesting, because we saw digital therapeutics, like take off over the, over the years and tons of like venture capital funding went into developing new digital therapeutics, because everybody knows, like, hey, we have, there's a problem here that we have to solve. There's, there's not enough people to treat all the issues that we have, technology's got to play a role. We don't know what role technology's gonna play, or the best use cases to apply that technology.

But it's got to be something. So we got to try lots of different things. So tons of investment has gone into things like digital therapeutics. We, we worked with a company and the white labeled and an app that was like, specific for our needs, and our company. And and we're right now rolling it out across the company, we're really, really excited about this app, we've piloted every app out there and decided just kind of to build our own in conjunction with this other company. And so things like that will be a game changer. And I said, you know, we saw the rise and fall of digital therapeutics, we saw tons of money get poured into it, we saw bundle payers come in with a bundle rates around digital therapeutics and stuff. And then we saw the kind of fall where people started saying, but we're not ... this sounds great, the sound, this looks cool, this app looks great and looks cool, but we're not actually seeing the outcomes we should be seeing. So it's not actually adding value. It just looks cool. It looks like it's adding value, but it's not. And so we saw that kind of rise and fall with digital therapeutics, and there's got to be some digital therapeutic solutions that come up in the future. There's no way that I don't think there's any way to solve some of the issues that we're dealing with without a lot of innovation. And most of that's going to come in the form of some new technology. So I could go on.

Angie Fiedler Sutton
My next question was just going to be kind of where do you see the industry going in the next five years or so? What kind of things do you see happening, especially with COVID, still, technically around, with telehealth, gonna stick around, that kind of stuff?

Nick Stavros
Oh, yeah, tell telehealth has to stick around because it's the ... telehealth improves economies of scale, because like, you know, especially if you see, you know, national providers, multi state providers, a lot of times like when we go into some rural town, there might not be any doctors available that you know, that treat addiction or that might treat addiction. And so the only way to get care there is via telehealth so ... telehealth.

I mean, you could look at, you could look at the rest of healthcare and say where is behavioral health heading in the future, and where's the rest of healthcare heading? Well, whole person, you know, integrated care, for instance, where you're providing more, you're treating more than just the physical health aspects. But it's kind of like that bio psychosocial model where you're treating the whole person -- like, that's the way healthcare is going, right? Healthcare is moving towards pay for outcomes in the form of value based purchasing arrangements. The rest of healthcare is moving more towards ... I've been doing telehealth for a very long time, you see health care moving towards more like concierge services, you know, where it's more convenient access for people.

You see health care, doing a lot of stuff with like AI and blockchain and, and different things like that. And so that's where I see I mean, behavioral health has just kind of always been a little bit behind. And so I think it's pretty easy to see where behavioral health is going in the future by looking at where the rest of healthcare has gone. And so, you know, it's exciting times, but even in healthcare in general, there's still a lack of there, I would say a lack, but there's still always a lot of room for improvement via innovation. And so that can be exciting. I think it will be exciting. It should keep us up at night, the amount of work that we have to do to make even more of an impact on our society. And so ....

Angie Sutton
This podcast is for people at all levels. So I kind of always ask your advice for people who might want to get into the industry or might want to be more involved with it. So what kinds of things would you if you were to talk to yourself, when you first started out? What are some of the things you would tell yourself as to keep an eye out for?

Nick Stavros
Well, for people who want to be in the industry, or for people who don't know, they want to be in the industry?

Angie Fiedler Sutton
For people who are in the industry and want to like maybe get more information?

Nick Stavros
Well, I kind of believe that you kind of have to feel called to work in this space, because it's not always the easiest space. I mean, you're dealing with I mean, there's so much stigma in our society against not just patients, but treatment providers themselves, right, there's stigma against the treatment providers, there's, you know, we're dealing with a population that there are a lot of times, like when you're treating people with substance use disorders, you know, you're dealing with people who, who might have been relying on a coping mechanism in the form of a substance for the last 20 years of their life. And they're having to give that up when they come into treatment.

Now, I will say there's a lot of people who don't, I was one of them, who have no interest in working in addiction treatments. And then once you ... once you dip your toe in the water, and you and you see the impact that we're making, it's very, very easy to get passionate about it. Right? I think a lot of people I mean, I say this to I think more doctors should be treating, way more doctors should be coming out of medical school with a passion towards treating addiction, because a lot of times, that's not maybe the sexy you know, field to go into, or it's not something that had much exposure to or something, but once people do have exposure to it, like it's very, very easy to get passionate about it.

So they're, you're dealing with incredibly like vulnerable population that has a lot of like pretty acute needs when they're entering treatment. And it's encouraging that we get to see the impact we're making on patients lives. But it's also I'm sure a lot of people get frustrated, a lot clinicians get frustrated when they're not seeing consistent impacts, you know, it might take somebody two years to stabilize a treatment and might take another person two weeks, you know? And so it takes that kind of patience and compassion and caring. But all of that can lead to can we say compassion, fatigue, I think empathy, fatigue might be a better term. We struggle with things like empathy fatigue, and so I say to people all the time, like, and I say to all of our employees, like as part of the NEO like, if you're just looking for like a nine to five job paycheck, like, this probably isn't the right place for you. Because it takes really feeling that you're, you're called to be here to make an impact. And that takes a passionate type of person.

So I'd say like, make sure you have the passion. You have the calling to be in this field. And then I'd say you know, find a company that that really aligns with your values. I mean, that's really important because I think just like people give them empathy fatigue, I think companies get empathy fatigue as well, where it's kind of like companies get in, they get they lose their focus, and I think this goes for all types of businesses all throughout all industries, whatever makes you special when you're small and growing, sometimes you lose sight of that you lose sight of your mission, vision and values as you grow. especially if you're doing a good job. Because if you're doing a good job, providing good product or service, then it actually attracts more customers and then you end up growing in response to that, and then it becomes a cycle of you grow, provide good service or product, attract more customers then grow from what were to, to cater to more customers and then attract more value becomes a cycle, it's very easy for that cycle to unravel.

If you're not staying focused on something like, you know, to us as mission, vision, and values, like there's got to be something grounding you, it's like our country, you know, goes back to the Constitution all the time. Like we have this kind of these central tenants and bill of rights that we can turn to at all times when we lose our way. And I think companies need to think that way as well. You know, pay attention to things like mission, vision, and values, cultural norms, and stuff like that. Let that guide every decision you make. And so for people coming into the industry, I'd say it is very important that you work for an agency that really has that passion, and aligns with your values, because it makes it a lot more enjoyable to come to work every day when you're surrounded by like minded people who are just just oozing with passion for what we do.

Angie Fiedler Sutton
Well, speaking of that, how do you kind of keep that yourself? How do you keep that passion going? How do you stop from yourself having fatigue or burnout?

Nick Stavros
I mean, I go to therapy myself, I've gone to therapy, since I was probably 18. I think everybody should be in therapy for the rest of their lives. And, and I have a you know, I do I do mindfulness therapy, for instance. And, and my therapists, you know, when I'm having a rough day, and I do sometimes I'm like, Man, why am I doing this, I could be like running dental practices or something, I don't know, something a lot less stressful. And my therapist will have me sit there and meditate on the impact we're making. Like, think about the lives, the amount of wives you're impacting, and the amount of lives your company is impacting and dwell on that like, just, you know, be cognizant of it, remind yourself, that's one way I do personally.

But I also think that, you know, we, there's ways you could operationalize that as well. So we, for instance, as a company, we have a town hall every Friday. every week been doing this for six or seven years, whole company every Friday, usually about 20 to 30% of the company's on it, because it's during work hours, and it's recorded so people can listen. But we start every single town hall with a patient telling their story to the company. And that wasn't actually our intent. Our intent was when we started the town hall, it was like we'd have a counselor talking about a success story, a patient success story, right? And they'd be like, Yeah, I had this great patient success story I want to share with everybody, it would take about five minutes. Patients started hearing about this and wanting to tell their story. So now every week, we have patient who comes on and says, I'd like to tell my history with addiction and the impact you all have made in my recovery. And it's usually about 20 minutes of them talking and, and just sharing the impact that we're making.

And you know, we do that every single week, because that is the time we remind ourselves. And I say this to the patient when they're talking and I say this to our entire staff, because we have a lot of staff that might work in a corporate function and HR or IT or something that don't get experienced this on a daily basis. And it's like, and I say to the company, this is a reminder of ... this one story right here, we're treating 20,000 patients right now. But this one story is why we come to work every day, you know? Seeing one person turn their lives around, and our patients are some of the most noble members of our society, I mean, to see people who are in recovery, what they've had to overcome it throughout their lives, to get just to get into treatment, and then to make the decision to get into treatments to stabilize the treatment.

And in a lot of them, I say in recovery. I mean, that can mean a lot of different things. A lot of different people you know, you have a lot of patients who are still maybe struggling with the with their relationship with a substance. But you know, they've gotten their jobs back, if that's what they wanted, or they're or they've been, they've been housed if they if they wanted to be housed, or gotten reunited with their families, all these things, we're dealing with the learning coping skills, you know? They're in therapy, and they're, they're oftentimes tied into other modalities of treatment on the behavioral health, physical health, mental health side. So us as a company sitting there every week together, listening to a story like that. I mean, there's actually research that talks about when you hear a story like that, as a group, your brains start kind of synchronizing a little bit, you know, your brainwave activity and stuff as a group actually start synchronizing by just by listening to stories like that. And so it's very powerful.

And so we spend a lot of time celebrating successes on that town hall. I also go through, I always go through about five shout outs, people, any employee could give a shout out to another employee, we got some shout outs. We have an open forum where anybody could ask any question they want on any topic, like is there something we can improve on as a company and then we'll open it up to discussion. So it's really powerful. I mean, that's one example, I personally do a mission, vision, and values presentation, as part of our video live to 100% of employees that start with our company, we have about 1,000 employees now. And so that turns into maybe 40 ... 40 employees every two weeks or, and I go through like our mission, vision, and values and talk about how important it is that we hold ourselves accountable each other I need to be held accountable, too, because sometimes I'll get hyper focused on something and ....

There's activities like that, that you could put in place to reinforce, you know why we do what we do every day. And I really think that's what helps stave off the empathy fatigue. And by the way, I call it empathy fatigue, I read this in a book, and I really just latched on to it, because we use the term compassion fatigue a lot. But I actually think that being compassionate towards other people actually builds up our soul. You know, it's like being a practicing compassion actually edifies us. Practicing empathy, without compassion is what drains you. Like just constantly empathizing my wife, and empaths. You know, she's very empathetic, she empathizes with everybody all the time, and that's draining. But if you could then take that empathy, and add compassion, that it actually I think that edifies you.

So finding that right balance, so I'm not sure if people get compassion fatigue as much as they do empathy fatigue, and so I think the more we can actually practice compassion as people and as a company, like the more it's actually going to build our own selves up and our own psychology up and and build up other people around us.

Angie Fiedler Sutton
Now, before we move on to how people can get a hold of you, was there something that you wanted to talk about that we haven't, or that something that you thought I was going to ask, but we didn't?

Nick Stavros
No, I liked the question about where do you think the industry is going. Because that's where, you know, I spent a lot of time thinking about that, too. And it's a good question. You know, I guess the only other thing is like, because the current environment that we're in, there's been a lot of disruptions. I don't know if that's the right word. But there's been a lot of kind of disruptions over the years, which has really been a stress test for the industry. And I think, I mean, look, a lot of a lot of providers went out of business, you know, over the last couple of years. And I think that's the kind of natural evolution of things is that like, the stress test causes the good providers to get better and more disciplined, and, you know, causes and then the bad providers either adapt, or fall by the wayside.

And, you know, you've seen it with things like medication assisted treatment, I mean, there's still a lot of programs out there who don't use it, and don't utilize it, don't accept it. In my opinion, those providers should should be going out of business. I mean, that's the... Can you imagine if industries, if tech companies, and let's say, you know, Netflix was focused on, you know, shipping out DVDs when they first started, well, can you imagine if Netflix, I use this example, all the time, stayed focused on just that aspect of their business, and didn't change, they'd be out of business. And that's what happened to Blockbuster, for instance.

You know, there's a lot of companies who don't change with the times and when new evidence comes out, and new data comes out, and new technologies come out, and they don't get adopted, then bad providers shouldn't be forced to adopt them. They should, it should be natural selection, and good providers should excel. And I'm not gonna sit here and say like, we're one of the good providers, but I think we're trying to be and so this new environment, which is a lot more disciplined and focused, and it's caused us to have to do a better job prioritizing, do a better job of, you know, running efficient operations, doing a better job of taking care of our employees: all those things like these stress tests really do lead to kind of this I mean, that's, that's how, you know iron sharpens iron. It's how human beings develop through, through struggles and, and by overcoming obstacles. And I think that the current, like just economic environment in general is causing a lot of companies to grow, which is an awesome thing. It's also causing a lot of companies close. And so I gotta imagine that the industry will be better off because of it all in the next couple of years.

Angie Fiedler Sutton
Great. Now, if someone wants to learn more about you or get in touch with you, how would you recommend them do that?

Nick Stavros
Probably, you know, you can look me up on LinkedIn, you can email me my email address is nick.stavros@cmsgiveshope.com. You could also add me on LinkedIn message me and yeah, I always love helping out other providers that are, you know, maybe dealing with something that I've dealt with in the past and I'm always reaching out to other people for help as well.

Angie Fiedler Sutton
Awesome.

Nick Stavros
Well, thanks for having me.

Angie Fiedler Sutton
You've been listening to destination change our guest today with Nick Stavros: thank you for being here. Our theme song was Sun Nation byKetsa and used to be a Creative Commons licensed by the Free Music Archive. Please consider rating and reviewing the podcast on Apple podcasts so we can get more listeners. In the meantime, you can always see more about the podcast including show notes and where else to listen on our website, www.nbhap.org. If you have questions for the podcast, please email us at info@nbhap.org. Thanks you for listening.