In-House Pharmacies: Improving Recovery & Revenue in Behavioral Health

Growth Sherpa's cross-departmental approach to behavioral health00:00

Gary Garth: Hey everyone, we're here at the Recovery.com Marketing Summit in Madison, Wisconsin. I'm sitting with Steve Donai from Growth Sherpa. We were just on the tech expert panel together, and I'm going to hit him with some curve-ball questions. Steve, do you want to introduce yourself?

Why treatment centers need diversified revenue streams01:00

Steve Donai: Sure. Steve Donai, Founder and CEO of Growth Sherpa Consulting. Based out of Charlotte, North Carolina.

The business case for in-house pharmacies02:00

Gary Garth: What is Growth Sherpa focusing on right now in terms of revenue streams, and how are you helping behavioral health facilities?

Operational requirements before launching a pharmacy03:00

Steve Donai: Growth Sherpa is cross-departmental by nature. All our projects involve admissions, marketing, BD, and some multi-departmental component. What we're really focused on right now is finding ways to solve challenges that treatment centers don't know they have. One of those is the singular revenue stream problem — you have billable hours and billable days, and that's it. Add in the seasonality December brings every year, and you've got facilities freaking out over census every winter. So we've partnered with another company to help treatment centers install in-house pharmacies. The treatment center actually owns the pharmacy. It's a considerable new revenue stream — but what it also solves is post-discharge continuity. How many patients leave and say "I can't get my meds, I can't see a doctor"? With an in-house pharmacy they can stay engaged with their treatment center for months, years. The facility has a clinical reason to maintain that connection.

Managing admissions and pharmacy call workflows04:00

Gary Garth: I love it — Blue Ocean strategy to the T. What's the ideal client profile for this?

Steve Donai: I wouldn't do this for a brand-new program. It works for facilities that have their infrastructure in place — a telephony system, an HR department that can handle additional complexity, core values and internal systems dialed in. The first client we introduced it to, we helped them build everything from the phone system to staff training to CRM before we even introduced the pharmacy concept.

Alumni engagement and post-discharge continuity of care05:00

Gary Garth: When you add a pharmacy, how do you make sure it doesn't hit those 30–40% missed call rates on the admissions line?

Why patient outcomes should shape future marketing06:00

Steve Donai: Completely separate line of answering. It's truly a different business — a different LLC. The phone number is different. You have IVR routing so that even if someone accidentally hits the main number, they can be directed straight to the pharmacy. You cross-train admissions staff minimally, but you don't want admissions people filling prescriptions. And you decide: is this a closed pharmacy for patients and alumni only, or do you open it to the public? In areas with pharmacy deserts, there's actually a compelling case for opening it publicly.

The importance of measuring clinical outcomes07:00

Gary Garth: What are the projections for alumni engagement and re-admissions as a result of this initiative?

Increasing patient lifetime value beyond admissions08:00

Steve Donai: Let's say one-fifth of discharged patients stay with your pharmacy. They don't want to go to Walgreens and disclose they need Suboxone — they stay connected with your facility's pharmacy and get drop-ship delivery. You now have HIPAA-compliant visibility into their health status. If new medications suddenly hit the chart — medications associated with overdose treatment — you know immediately that person may have relapsed and can reach out. It's also incredibly valuable for outcomes data. You can now see how people are doing post-discharge in a trackable way, which lets you refine your front-end marketing to target the patients you achieve the best outcomes with.

Gary Garth: So it creates a cyclical approach — better outcomes data drives better marketing targeting, which drives better admissions. Beyond the pharmacy, what are the other highest-leverage ways to increase patient lifetime value?

AMA prevention strategies that improve retention09:00

Steve Donai: Strong AMA-blocking protocols are probably the biggest. I've worked with organizations whose AMA blocking is outstanding — they really empathize, they get with the person, they make it genuinely difficult to leave in a compassionate way. Average length of stay compounds. If you have a 30-bed facility and you can increase LOS from 28 to 30 days, that's equivalent to an admission or two without acquiring a new patient. And there's actually a crisis intervention billing code for AMA attempts — so you can do it and get reimbursed. The other big one is knowing your core demographic and marketing specifically to them. When facilities take anyone who wants to get sober without regard for program fit, milieu gets sideways fast and ten people AMA on Monday morning.

Mystery shopping admissions teams to improve conversions10:00

Gary Garth: You've done some mystery shopping at facilities. Tell us about that.

Why answering every phone call can literally save lives11:00

Steve Donai: I've gone undercover a few times under an alias. I show up as a patient and admit. Each time I'll fake an AMA and see how staff reacts. The best time I did this — it was like kicking a hornet's nest. They were all in action so quickly. I was immediately in the director of nursing's office. It was quick, precise, and compassionate. Not lackadaisical at all. That sense of urgency is what keeps people in treatment. I also have admissions reps call other facilities under an alias and report back: what did they like about the call? What felt off? What would they steal? We can learn a lot from each other.

Gary Garth: Final question: if you had a magic wand to change one thing in this industry, what would it be?

Steve Donai: There's a lot of different ways to go with that. Outcomes visibility is a big one. But honestly, the biggest magic wand — the one that would not only change the industry but save the most lives — is literally just picking up the phone when it rings. I always say there's a no-wrong-call policy: you call my facility, we answer immediately. And no matter whether you're a fit for us or not, we're going to make sure you get to a place that is. Because from the human side, that person might not ever make that call again. There's shame, there's guilt, there's fear. They decided at that moment to pick up the phone — and if it's not answered, they might say "God's telling me I'll go back to drinking." We're doing a huge disservice. If I could just wave a magic wand, it would be a compassionate, warm person on the end of that phone call every single time.