Mark Cloutier Of Caminar On 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Jake Frankel

How will it be paid for? Legislatively, we need to modify benefit coverage requirements in public insurance systems such as Medicaid and Medicare to provide the types, levels, and duration of care to treat the population. This would require translating it into the financing infrastructure required to deliver the care.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement. In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System. As a part of this series, I had the pleasure to interview Mark Cloutier.

Mark Cloutier, MPP, MPH | Chief Executive Officer and Corporate Officer
Mark Cloutier became CEO of Caminar on January 31, 2019. Mark has dedicated his career to increasing access to quality health and supportive services for underserved communities and improving the overall health and well-being of individuals and families. He brings to Caminar extensive experience in organizational leadership, fundraising, financial and talent management, public policy, and strategy development. Prior to joining Caminar, Mark held leadership roles in major health organizations and foundations, including Horizons Services, the San Francisco Foundation, the Center for Youth Wellness, Kaiser Family Foundation, and San Francisco AIDS Foundation.

As CEO, Mark leads a $42M organization of close to 500 employees that served more than 18,000 people last year in the San Francisco Bay Area and Northern California.

A longstanding Bay Area resident, Mark is a graduate of Lewis and Clark College and earned his Master of Public Policy and Master of Public Health degrees at the University of California at Berkeley. He has authored a number of articles and recently co-authored “Prevent, Screen, Heal: Collective Action to Fight the Toxic Effects of Early Life Adversity.”

Mark also serves on the Board of Directors of Tenderloin Neighborhood Development Corporation.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

Early on in my career, I held leadership roles at Horizons Services, the San Francisco Foundation, the Center for Youth Wellness, the Kaiser Family Foundation, and San Francisco AIDS Foundation. I earned my Master of Public Policy and Master of Public Health degrees at the University of California at Berkeley.

In my current role as CEO of Caminar, I manage a $49M behavioral health organization in the Bay Area. I see firsthand the difficulties the healthcare system faces in staffing and patient care, as we have over 500 employees at Caminar. In addition, I serve as Board of Directors of Tenderloin Neighborhood Development Corporation.

Can you share the most interesting story that happened to you since you began your career?

I came into adulthood as a gay man at the beginning of the AIDS Epidemic. In 1981, I was 24 when AIDS was first identified and brought into the public attention. At the time, I was living in the Castro District in San Francisco, and it was like watching a hurricane reach closer to shore and eventually create destruction in our community. The stakes were high, and I was not, (no one was) psychologically prepared for a fatal disease that would strike populations that were marginalized. I was an activist and got incredibly involved in HIV prevention work and eventually worked for a Member of Congress on HIV and other health issues. I learned a lot about human nature: denial, compassion, courage, and resolve. I also learned that the root cause of outbreaks is not just infectious transmission, but discrimination, racism, and education facilitate outbreaks turning into epidemics. Living in and surviving an epidemic that literally wipes out your community instills a sense of focus, duty and appreciating what really matters. This early experience led me to want to study public health and public policy, which set the stage for my career.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Going back to the story I just explained, my mistake as a young person was not understanding the amount of time it takes large institutions to change. It takes an enormous amount of planning, resources and sheer willpower to move institutions through change processes. The lesson learned is making a good case, with data and personal stories is just a start. It means you have gotten people’s attention but then you need a plan, with stakeholders who can extend the persuasion of the argument, to organize and push a shared vision and plan forward.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“It is what it is.” I always come back to this quote, “It is what it is,” because it’s reorienting. I, like everyone, have illusions about how things could be. I used to be somewhat of a utopian thinker in my youth and I suppose elements of it still endure in my later adulthood. The wisdom of adulthood is accepting finitude, inertia, and comfort are often key motivators of resisting change and it is incumbent to work with these elements to bring people along in a change process. But that starts with a sober assessment of “what is.”

Are you working on any exciting new projects now? How do you think that will help people?

Currently, my team and I are working on a new strategic plan for my organization to begin contracting with managed care organizations and expanding the kinds of care we provide to new clients. We are also completing a rebranding process to position the organization and its identity to communicate a new way of providing our care to new clients.

Also, we are creating a new service line of treatment for kids, adolescents and families that is affordable for people who don’t have insurance in the Palo Alto area. We are excited to be providing mental health services at an affordable price for people who don’t have insurance coverage.

These initiatives will create more job opportunities for my staff, more revenue to invest in improving care, and better outcomes for our clients. More importantly, our communities will have access to the care they need.

How would you define an “excellent healthcare provider”?

A provider that provides care that is organized and delivered on the best operational and clinical science available. This type of care provides patients with specific information about benefits, side effects, and alternatives to various courses of treatment. This care should also address the income, housing, and employment dimensions of the client’s lives that, in the end, can determine if the mental health treatment can be successful and sustained by the client. That information is presented in a way that the patient can understand the options, can make informed decisions, and is supported by the care team to pursue that course, even when the care team disagrees with the choice. That is patient-centered care at the core.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

I think the enduring effects of COVID on the health system are the widespread burnout and disillusionment that it created among the healthcare workforce. We will continue to have widespread staffing gaps that lead to long waiting lists for care or needs to travel to get care. It is truer in medicine than in mental health, though mental health suffered from a workforce shortage before the pandemic. The solution is complex and is different for various levels of the system. For mental health professionals it includes low pay, persistent exposure to clients’ traumatic experiences, insufficient clinical supervision to process the trauma and economic factors that make living on the public sector mental health professionals’ salary so difficult.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

In essence, we flipped almost all of our clinical encounters to telehealth, and continued to see clients in our sites of care — obviously with all of the infection control systems in place. We also implemented home visits for people who could not get out. We have many clients who are treated with long-acting injectables and we brought them to their homes or shelters. I am proud of the work that our staff did. We went the extra mile to ensure everyone who needed care received it.

As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system?

The issues that we experience at Caminar can be part of the larger healthcare system gaps. These require larger fixes and it’s important that this is more openly talked about to derive solutions and create a larger change. Our organization is becoming more involved with organizations that do health policy work, and organizations that have an advocacy arm, and we are actively becoming members of these organizations.

In order to facilitate change, specifically in the mental health sector, I pose these 5 questions to our healthcare system.

1. Who has what kind of behavioral health issues, what stage are they and where do they exist geographically? The first change would be to conduct a nationwide behavioral health epidemiology assessment to comprehensively measure, describe, and stage the prevalence of mental health and substance use disorders. We do this often for physical health conditions for health services planning. We could use much of the same approach with mental health.
2. How do we organize getting care to people that need it? We need to develop a comprehensive, population-based framework for interventions that take into account prevention, early intervention, acute, chronic, and recovery support services to be based on the distribution of mental health and substance use conditions in the population. Again, this is done in physical health to plan for disease staging and health care utilization projections.
3. How will it be paid for? Legislatively, we need to modify benefit coverage requirements in public insurance systems such as Medicaid and Medicare to provide the types, levels, and duration of care to treat the population. This would require translating it into the financing infrastructure required to deliver the care.
4. What do we need to get better at? We need to improve medical education to prepare physicians for practice, and ensure they understand the relationship between physical health conditions and the neurological, endocrinological, psychological and behavioral issues of their patient to dramatically enhance physician competencies to deliver truly integrated care. “Integration” is just a patient management buzzword of what we don’t do in the clinical back-end training to make co-treating patients with physical and mental health conditions clinically meaningful.
5. What do we need to do to make sure everyone gets what they need? It starts with closing the gap to achieve universal coverage of health care insurance. We still have about 7.9 percent of the population uninsured. We need to amend the Affordable Care Act to have provisions for subsidies for anyone currently categorically excluded from coverage. In a nation with the wealth we have, no one should be denied care.

Let’s zoom in on this a bit deeper. Let’s zoom in on this a bit deeper. How do you think we can address the problem of behavioral health provider shortages?

The system needs to provide grants or low-interest loans to reduce the post-graduation debt that occurs when you go to graduate school and then try to pay your loans on a $140,000 salary in a urban area with expensive housing. The ideal would be an approach to loan forgiveness in exchange for a stint of employment working in a setting that serves low-income or underserved populations. Raising reimbursements to increase salaries could also improve the situation.

How do you think we can address the issue of mental health provider diversity?

We need to better understand and address cultural issues that stigmatize mental health that prevent people from marginalized racial and cultural communities from considering the profession in addition to seeking care. There are a number of trust issues that communities of color have because of a historic mistreatment in the healthcare system — that extends to mental health.

How do you think we can address the issue of mental health provider burnout?

We also need to provide them with richer mental health benefits in their employer-sponsored health benefits. We need to consider increased paid time off benefits and encourage frequent breaks for renewal for our mental health providers. And, ensure that there is frequent clinical supervision to support dealing with countertransference and vicarious trauma. It would also be beneficial to build in sabbaticals at time thresholds to encourage professional and intellectual development.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

It starts with putting mental health on the same par with physical health. There still is a lot of stigma about both mental health and the profession that robs the profession of respect and standing in our culture. What everyone can do is demand that mental health be treated in true parity with physical health. We should be talking about this in our communities and governmental settings to raise the profile of mental health in a field of issues where it has a lot of competition for attention. We need public policy solutions to many of these issues to create rules and an even playing field.

We need to understand better root causes of mental health issues and how to intervene earlier in the process. It would be beneficial for the education system to implement stronger screening techniques for early intervention. A lot of good research exists about early intervention for psychosis, but, in general, the evidentiary basis of causation of most mental health conditions is poorly documented from a scientific perspective. A more precise understanding of causation is critical in doing prevention and early intervention work.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I would participate in a movement that would inspire people to reaffirm, preserve and expand democracy accompanied using reason and science. I would want that movement to rekindle an aspiration that using science, reason and a commitment to equity is the best way to support human flourishment. I know this is not a new idea, but the core tenets and practices of democracy are under threat throughout the world. As we have seen with COVID, the loss of belief in science hampered vaccination and infection control efforts.

The belief that all humans have dignity and have a right to participate in their self- determination through public institutions is a critical foundation for human health. Increasingly, politics are rooted in resentment and we are weaponizing hate to divide us further and cause violence and harm. We still have institutions that can mitigate these harms and we need a movement-level re-engagement to protect and enlarge democracy and its intellectual and institutional foundations. The project of democracy needs our help.

How can our readers further follow your work online?

Please visit our website caminar.org to learn more about our services and the work we do in the Bay Area.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.