At a time in the post-pandemic recovery when the need for mental health care is surging, meeting the demand continues to be a struggle for one of the largest providers of such services for uninsured and underinsured residents in El Paso, Teller and Park counties.

Fewer counselors, therapists, psychologists and psychiatrists are working directly with patients at Diversus Health. The nonprofit was formerly known as AspenPointe, and prior to that Pikes Peak Behavioral Health Group and Pikes Peak Mental Health Center.

Of 130 clinical positions at Diversus Health, 44 are

vacant, said Kevin Light, chief financial officer.

If all were filled, the organization could accommodate 3,300 more clients, said CEO and President Adam Roberts.

“If we could hire 200 more clinicians, we would,” he said.

Even that would not fill the void, said Chief Clinical Officer Katie Blickenderfer.

The number of clinical vacancies are on top of a nearly onethird reduction of the organization’s staff after Medicaid reform that occurred in 2018, Roberts said. The organization has 420 employees today; down from about 550 five years ago.

In response, Diversus Health has altered its course.

In the four years since Roberts took over leadership of the community mental health center that has roots dating to 1875, the organization has adopted a new name, vision, mission and internal restructuring.

There are different approaches as to how patients are seen, and staff conduct free trainings on suicide prevention and other programs, to raise awareness for residents on how to better ward off psychiatric emergencies.

“We’ve tried to be as efficient and effective as we can, given the resources,” Roberts said. “We’re continually improving, changing and evolving.”

Among improvements cited by Roberts, wait times for care have been reduced and providers have increased their productivity by 25%.

Challenges to improving, Roberts said, have included pandemic effects, a significant cyberattack on its system, a decline in Medicaid and commercial payers amid heightened need, the rising costs of doing business and ongoing state-level industry reform.

“We’ve gotten creative,” he said. “It has taken some resiliency, determination and agility.”

But an inability to adequately serve the community with its addiction services, counseling, crisis assistance and psychiatric treatment has plagued Diversus Health and its predecessors for years, said Lori Jarvis, executive director of the Colorado Springs office of the National Alliance on Mental Illness, or NAMI.

“There have been some longstanding reputation issues around timeliness of service and access to care,” she said.

And despite the new initiatives, programs and strategies, Jarvis said, some issues have yet to be resolved.

“There’s been a lot of change at our community mental health center in leadership and in practices, and there continues to be a serious shortage of prescribers and a chronic lack of providers and clinicians who serve the indigent, uninsured and low-income populations,” she said.

As evidence of the community’s growing need, NAMI fielded 2,100 calls last year from individuals looking for assistance with mental health services and support, Jarvis said, and calls are tracking 10% to 15% above that this year.

Cassandra Walton, executive director of Pikes Peak Suicide Prevention Partnership, echoes the concerns.

“We continue to feel the pain of not enough providers, especially when looking for culturally competent care,” she said.

“Private practice is attractive (as an alternative) because providers can choose not to accept Medicaid and which insurance providers they want to deal with, but the average hourly rate out-of-pocket is at a minimum $100 per hour, and that is out of reach for many.”

Diversus has worked hard on shortening the length of wait time for its clients — 72% of whom under a five-year average receive Medicaid benefits — to see providers, Roberts said.

At Diversus’ 24/7 mental health crisis response center in Colorado Springs, the wait time from walking in the door to receiving deescalation techniques has dropped to 13 minutes, said Blickenderfer, the chief clinical officer.

In outpatient settings, a 30- to 90-day wait for access to clinicians has been reduced to three to five days, from the time a patient requests an appointment or medications to being seen, Roberts said.

“Four years ago when I got here, it took three to four months to see a clinician,” he said. “We’re bringing more people in, in a more timely manner.”

The organization also has implemented immediate assistance for new clients.

A person who calls, walks in or schedules a virtual visit for initial intake at two “same day access” locations can receive an appointment in nine days, and in three to five days for psychiatry, said Blickenderfer. Access to treatment for substance use disorder can happen the next day, she said.

However, the schedule doesn’t always work as promised, said Walton of Pikes Peak Suicide Prevention Partnership. When she recently referred a program participant to a “same-day access” clinic, “it took three trips so he could actually be seen.”

She likened the experience to going to the Department of Motor Vehicles without an appointment: “You need to show up early and be prepared to wait for several hours.”

But once the client was seen, Walton said he was able to obtain a telehealth therapy appointment within the same week and a medication evaluation three weeks out, which Walton said is considered “a great turnaround for a Medicaid patient.”

“Many of the people we see at Pikes Peak Suicide Prevention Partnership end up with us because they cannot see their assigned provider for several weeks after they have been referred to them,” she said. “They are desperate for support.”

Colorado Springs resident Rachel Berube said she hasn’t had trouble getting appointments for therapy as a Diversus patient since 2015, but she refuses to use Diversus for medication management because of problems she’s had with being accused of using drugs when she had not.

“Diversus isn’t providing the medications people need, so you end up with more people self-medicating, and many people go on the streets to get them,” Berube said.

Medicaid reform changes landscape

A phase of Medicaid reform in 2018 divided Colorado into seven geographic networks and designated overseers in each called Regional Accountable Entities or RAEs.

The restructuring predated Roberts’ tenure, as he took over Diversus as CEO in 2019.

But it represented a major shift for Diversus, he said, as the organization became one of many behavioral health providers in the new Medicaid network.

El Paso, Teller and Park counties have 1,237 other individual behavioral health providers, excluding Diversus, said Colleen B. Daywalt, director of corporate and public affairs for Physician Health Partners and spokesperson for Colorado Community Health Alliance, the regional coordinated care organization that oversees El Paso, Teller and Park counties.

In part, Roberts blames the new model that introduced increased competition for reducing Diversus’ revenue by 30% in 2018, which in turn led to a 30% decrease in staff. The organization’s annual budget took a hit, running a nearly $5 million shortfall that year. It’s since rebounded to average a 5% to 10% return, Roberts said.

Diversus remains important in the expanded market because of the volume of Medicaid patients the organization handles, compared with independent behavioral health providers and substance use disorder facilities, for example.

The number of unique Medicaid clients using Diversus decreased from 14,975 in fiscal year 2019 to 9,907 in fiscal year 2022, Light, the chief financial officer, said. The projection for the current fiscal year is 9,800 patients.

Diversus received $47.5 million in Medicaid reimbursements in fiscal year 2018, compared with $33 million in fiscal year 2023, according to Light. The organization’s projection for 2024 is $30 million.

Commercial payer clients also have decreased over the past several years, Roberts said.

“While these numbers are decreasing, they are trending in line with funding and staffing,” he said.

That’s not been the case for all providers, though, said Marc Williams, spokesman for the Colorado Department of Health Care Policy and Financing, which administers Health First Colorado, the state’s Medicaid program.

“There are other providers probably within RAE 7 who would say this model has worked out fine, and others who would say they’ve learned how to balance this,” he said.

The RAE system, launched five years ago with a seven-year contract, was intended to expand access and choice for both primary care and behavioral health patients, said Daywalt, spokesperson for Colorado Community Health Alliance.

“They were able to grow the number of providers now accepting Medicaid in Region 7,” she said.

About 13% of the state’s 1.34 million Medicaid recipients in fiscal year 2020-2021 used behavioral health services, according to the Department of Health Care Policy and Financing. Of those, 99% received outpatient treatment, 6% sought inpatient care and 2% underwent residential mental health treatment.

Medicaid enrollment is expected to decline as the federal mandate that enrollees could not be disqualified during the pandemic expired last month, and the state has started re-verifying eligibility, Williams said.

Telehealth brings ups and downs

Daywalt said she was impressed with Diversus’ ability to pivot during the pandemic to offer telehealth sessions with clients. In a 48-hour period, the organization transitioned to the new model of delivering services with minimal inter