Cases of eating disorders are on the rise nationally, bringing about an influx of providers in recent years. Within the last year, the industry began to see eating disorder providers shutter or scale back their programming.
The fall of some eating disorder providers may come down to an over-prioritization of margins rather than the mission, Allan Benham, CEO of eating disorder treatment provider Alsana, said in the latest episode of Behavioral Health Business Perspectives podcast.
Westlake Village, California-based Alsana offers residential, partial hospitalization (PHP) and intensive outpatient (IOP) programs in Alabama, California and Missouri. Alsana also provides virtual PHP and IOP nationwide.
Benham was appointed CEO in April. He previously served as chief operating officer at trauma, mental health and addiction provider Meadows Behavioral Healthcare.
Despite the challenges leading to some notable closures, eating disorder providers are also experiencing tailwinds including decreased stigma and increased acceptance of the chronic nature of the disease.
Behavioral Health Business sat down with Benham to discuss Alsana’s “backpedaling” of some of its aggressive growth, reimbursement challenges and staffing strategies.
Below are highlights from the conversation, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.
BHB: What is the current landscape of the eating disorder treatment industry? Feel free to tap into your behavioral health knowledge as well.
Benham: During COVID we saw a lot of people come into the industry. As with any time when you get an influx of people in, the quality companies stay around and the ones who were just here for a quick profit disappear. We are reverting to the people who really care about the patients, who care more about the patients than they do about the dollar. The whole industry is shifting back toward the mission rather than the margin, specifically with eating disorders.
There’s a shift of catching eating disorders early, treating adolescents and trying to change the behavior before it’s fully ingrained in a lifestyle choice.
There’s an underreporting of men; men who suffer from eating disorders have a deeper shame about it and they struggle more to ask for help. I’m very proud to say that at Alsana we take men at every level of care and reach out to them and find them before they reach that crisis stage where men typically find help.
Another key trend is diabulimia, a complicated disease that requires a skilled clinician and a skilled physician to treat that. Again, I’m very proud to say that we are able to do that at Alsana.
I wish I could say that I was seeing the incidence of eating disorders go down, but unfortunately, I am not. We haven’t been able to find the cure for it yet, but we are working on it one person at a time.
We saw some notable closures in the eating disorder treatment space earlier this year and in 2023. Refresh Mental Health, Odyssey Behavioral Health and Discovery Behavioral Health all shuttered or scaled back their eating disorder treatment programs. What does this tell us about the temperature of the eating disorder market? How are you keeping this information in mind for Alsana?
We saw a lot of people dive into the eating disorder market in 2020 to 2022 who weren’t committed to it and who were more opportunistic than a long-term commitment. Alsana wasn’t immune to that. We really tried to capitalize on that, and we did some aggressive growth that we’ve had backpedal on.
That was a real lesson in very sustained, intentional growth in solid areas. Our approach now is, instead of looking at a trigger point of 70% occupancy or 80% occupancy, it’s asking, ‘What is the demand coming in? What’s the pipeline coming in?’
The whole industry had to adjust in 2023. We saw attrition in some quality providers and some quality programs closed. I look at it from two points of view. First of all, do those closures represent an opportunity for us? Is that something that we may be able to capitalize on? Or is it a lesson for Alsana? Do we need to learn from somebody else’s difficulties?
What are some of the biggest challenges eating disorder providers are facing right now?
The two biggest challenges are staffing and insurance. If you ask any provider in the mental health space, that’s the two.
The entire treatment world, since COVID in 2020, has been struggling to keep qualified staff and we’re no different. There’s a big lure to go to the virtual world with some of the other providers. And there’s a big lure to go to private practice. A lot of states dropped the requirements for private practice to allow for greater access to mental health during COVID times, and that hasn’t gone back to what it was prior.
Our commitment is not only to attract quality staff but to provide them with training to make them better. They’re providing for our clients better, but not only that, we’re changing the treatment world. Any training that we provide to a therapist, nurse, or dietitian while they are in our world, they take with them. We’re not only changing Alsana, we’re changing our patients’ lives, and the treatment world because we’re sending better therapists out into the world.
The other one is of course insurance payers. Insurance has typically been reluctant to pay for the length of time that some eating disorder patients need. I don’t want to create an antagonistic relationship with the insurance provider. I don’t think we need to fight about it. We just need to come alongside and make sure that we both have the patient’s best interests in mind.
Some of those disreputable people who came into the industry in 2020, ‘21 and ‘22 gave a black eye to good providers because of the shady business practices that were out there.
Being able to show them what quality treatment looks like and treatment with integrity, where we’re not going to keep a patient for 300 days because we can, it’s really about ‘Are they progressing? Are they making progress?’
What tailwinds do you see in the eating disorder treatment industry right now?
The industry as a whole is recognizing that this is a lifelong disorder that people are going to struggle with. Nobody’s been able to find a cure for this yet. It’s about learning how to have a healthy relationship with food. It’s about learning how to have a healthy relationship with movement. It recognizes that all food can be good food, and that movement isn’t bad just because you’re below a certain threshold of weight.
There’s a level of acceptance coming into the world that eating disorders or even mental health in general is truly a disease and it’s truly a disorder of the mind that people can’t control.
There’s a level of acceptance about the surrender that’s needed to get and find treatment. That warms my heart. Families are more open to it. Men are increasingly accepting the fact that they may have an eating disorder. That acceptance is a tailwind.
