In the past few years, many of central New Jersey’s healthcare providers have merged with larger systems: Princeton Hospital joined Penn Medicine, RWJ Health System merged with Barnabas Health, and St. Francis Medical Center joined Trinity Health, which was itself nearly merged with Cooper Health in 2018 before the deal fell through.
But the most recent merger, in which the Carrier Clinic joined Hackensack Meridian, was unique: Hackensack Meridian is a North Jersey-based healthcare network with 17 hospitals, and Carrier Clinic, based in Belle Mead, has only one. However, Carrier Clinic is unique in that it is a behavioral health system. Since 1910 Carrier has operated an addiction clinic in Belle Mead. On its campus it operates an inpatient psychiatric hospital, a drug and alcohol rehab center, an adolescent and teen residential unit, and a middle and high school for emotionally disturbed students. It employs about 1,100 people.
Frequently, mergers like this result in staff reductions as redundant positions are eliminated. But according to Carrier President Don Parker, the merger is likely to result in Carrier Clinic hiring more staff as it seeks to take on patients that currently present themselves at Hackensack’s various emergency rooms.
“There have been multiple mergers in New Jersey creating several very large systems,” Parker said. “Now the larger systems are recognizing they need to have behavioral health covered.” He said many hospital emergency rooms are sometimes overloaded by psychiatric patients. “Now you multiply that by 17 and you can imagine the scope of the issue,” he said.
Before announcing the merger, Hackensack and Carrier cooperated on several projects to make sure the two healthcare providers were a good fit. One was the purchase of a substance abuse facility in North Jersey, the name of which has yet to be announced. The other was a bid to manage a mental health facility at Bergen Regional Medical Center in Paramus. “It worked for both of us, and we used these experiences to craft, along with significant negotiations, an agreement that allow both of us to merge with each other and for us to take on the responsibility of managing behavioral health in all 17 hospitals.”
One major reason for the merger is that medical systems are shifting from a fee-for-service approach to one of “population management,” in which health outcomes are emphasized. (The Affordable Care Act provided financial incentives to make this shift.) This change in approach means that hospitals are now considering factors that impact patients’ health even if they are far beyond the control of a traditional hospital visit. For example, living in poverty or a rough neighborhood will impact health in a variety of ways. Resolving these situations is currently beyond the scope of any healthcare system, but Parker says insurance companies are “moving in that direction.”
Healthcare systems also now recognize that mental health and substance abuse problems are a big part of overall health, so systems will need a strategy to deal with these issues in addition to medical problems. “Health systems need to have behavioral health and social services at a different level of intensity than they currently do,” Parker said.
To help Hackensack Meridian offer these services, Carrier Clinic is turning to an idea from the medical world: urgent care centers. Parker says behavioral urgent care centers will soon be opening throughout Meridian’s coverage area. The first one will be in Neptune.
Parker said some of them will share space and staff with traditional urgent care centers. Behavioral health patients will first see a nurse practitioner, who will connect them with a telepsychiatry network. Patients will videoconference with a psychiatrist.
A new technological twist on this service is the addition of emotion recognition software provided by a company called New Future, which currently contracts with the Veterans Administration. New Future’s software claims to help identify PTSD and other traumas by analyzing fleeting “micro-expressions” that cross the faces of the patients as an unconscious reaction.
Does this technology work as advertised? The company is currently partnering with American University to conduct a clinical trial of patients with arachnophobia (fear of spiders) to see if microexpression analysis can be helpful even if subjects are trying to conceal their fear. It is also conducting a proof-of-concept study with the VA to test its ability to identify PTSD sufferers.
Carrier is already known for its use of ElectroConvulsive Therapy to treat depression and other psychiatric conditions. ECT works by running a current through the brain to deliberately induce a seizure. The modern version of ECT is far from the barbaric “shock therapy” practice depicted in the book and movie “One Flew Over the Cuckoo’s Nest.” Modern ECT uses far lower levels of electricity than the old Electroshock Therapy and is only done to one brain hemisphere at a time. Studies have shown that it is highly effective against depression. However, it does have major side effects, including memory loss.
Carrier Clinic is studying an even more precise version of this idea for substance abuse patients. In a new program, patients sit in a chair and listen to music while low-voltage current stimulates the hypothalamus of the brain. This specific area of the brain controls endorphin production. The idea is that the electrical stimulation will help the brain activate functions, such as going to sleep and concentrating, that have been disrupted by the drug withdrawal. The University of Arizona is currently studying Carrier’s program to see if it is effective. “It’s like a lower voltage form of ECT with almost no side effects,” Parker says.
Another high-tech innovation ties in with the population health approach and helping patients avoid repeat hospitalizations. Carrier patients are being fitted with MIT-designed devices that track vital signs, much like a fitness tracker. These vital signs can provide early warning that a potential relapse is about to occur, so the patient can come in and have the potential relapse treated — an approach that is theoretically much cheaper and safer than waiting until the patient suffers a full relapse.
Other Carrier programs are lower-tech. It has a longstanding equine therapy program, in which recovery is aided by taking care of horses.
Carrier Clinic patients are also treated to live harp music every night, which helps them relax and go to sleep. “The patients love it,” Parker says.
Parker, a licensed clinical social work with a master’s degree from Rutgers, held management positions at St. Joseph’s and AtlantiCare health systems prior to joining Carrier Clinic in 2013. He is also enthusiastic about integrative medicine, which includes practices that are not supported by scientific evidence. For example, Carrier provides acoustical therapy from Theracoustics. The company says its sound systems stimulate the vagus nerve in the brain, which is associated with the fight-or-flight response, in order to help calm patients down. Speakers in a chair also allegedly stimulate “chakras,” a concept from new-age medicine. There is no scientific evidence that chakras exist.
“The acoustical stimulation coming through the chair focuses on chakras,” Parker says. “It unblocks energy points called meridians.”
Parker is aware that the scientific community does not generally believe in chakras or meridians, which alternative medicine practitioners say conduct a form of “life energy” that has never been measured or adequately described in scientific terms.
“I’m responsible for integrative medicine,” Parker says. “I’m looking at how to integrate medicine from other systems and other worlds into what we do.”
Parker aims to train more medical students in Carrier Clinic approaches. The merger will give Carrier access to Hackensack’s medical school, which has a psychiatric residency program. Carrier expects to have 30 new psychiatric residents by the end of 2020, which will produce more doctors trained in Carrier’s systems.
Carrier also expects to hire more social workers and counselors, as it now has a much larger patient population to manage.
“Our referrals are off the charts,” Parker said. “Since the merger was announced, we have been at full capacity. I have 53 people waiting to get into the hospital today.”
Carrier Clinic, 252 County Road 601, Belle Mead 08502; 800-933-3579. Don Parker, CEO. www.carrierclinic.org.