Dec 18, 2018

Challenges Facing Behavioral Health & Human Services CFOs

While it is inevitable that CFOs at nonprofit behavioral health organizations will face many challenges in their day-to-day operations, what doesn’t have to be inevitable is facing those challenges alone. Knowing that collaboration is vital for success, we recently sought to provide a forum that would allow financial leaders to come together and discuss any topic important to their business.

11 CFOs from large Behavioral Health and Human Services (HHS) organizations in the Mid-Atlantic Region ventured to the Graham Building for a one-day meet-up to compare notes, share ideas and benchmark against one another.

While we proposed some potential topics for discussion, we felt it was important for participants to weigh in beforehand on any particular areas of interest or current pain points. That way, we aimed to foster an environment completely tailored to the attendees, with Graham serving as the facilitator and offering advice on certain topics fitting our expertise. Once the topics were agreed upon, it was entirely up to the CFOs to determine what happened after that.

Some of the topics of discussion included: (1) Hiring & Retaining Direct Service Workers; (2) Increasing Cost of Employee Benefits; (3) Impact of Benefits on Millennials; (4) Insurance and Risk Management; (5) Mergers & Acquisitions; (6) Reimbursement Models (e.g. value-based care); (7) Cyber Security and (8) Management Service Organizations (centralized and decentralized). These topics made for a great discussion – and included representatives from each organization sharing their respective expertise.

It was not a huge surprise to find out that a primary concern for the group of CFOs was how to manage hiring and retaining employees, followed closely by the increase in healthcare costs. We know that for most organizations, attracting and retaining talent is a top priority – after all, a successful company starts with assembling a team of smart, dedicated employees. But because HHS organizations are also dealing with the effects of a reduced labor market, designing a benefits package that successfully meets the needs of their target workforce is paramount – but it also makes the increasing cost a significant challenge.  As a result, you need a creative value-based design that includes consumerism and transparency tools.

From there, the conversation shifted to the next generation of workers.  Like most industries, HHS organizations may need to reevaluate their work rules and benefits strategy so that it appeals to millennials and increases their chances of acquiring talent. The primary question was – what exactly do millennials want? Is it flex time, working from home, pet insurance, student loan assistance and paid volunteer time? There was no conclusion drawn during the discussion, but the consensus was management needs to change their mindset and consider all things that might appeal to the next generation; however, accountability standards need to be maintained. Equally important, there was a thoughtful discussion on the importance of developing a strong management perpetuation plan and how to execute the strategy. Unfortunately, many HHS organizations don’t have next generation talent so perpetuation is a real problem. As a result, the group talked about the up-tick in M&A activities; and for the well-run organizations with depth, this is a real opportunity to scale their businesses.

When it comes to insurance and risk management, there was agreement that HHS is a high risk business, primarily because they are servicing very vulnerable individuals and when injuries occur, our litigious society says someone must be liable.

All in all, it was a spectacular day, and we wanted to thank several of our HHS partners who made it all possible including: Kevin Fee, CEO of Angler West, a mergers and acquisitions intermediary focused on transactions involving healthcare and human services companies; Bob Fesnak, Partner at RSM US LLP (CPAs), an accounting firm specializing in the behavioral health industry; and Diana Ramsey, President of The Ramsay Group, a leading executive search firm. These incredible individuals organized, sponsored and facilitated the session for the benefit of the group. In addition, they were happy to answer any questions that the CFOs had regarding their businesses’ unique challenges and provide insight on industry best practices, including a discussion on compliance and its associated impact on a nonprofit’s bottom line.

At Graham Company, we are truly passionate about thought leadership and the power of collaboration. We look forward to expanding these engaging forums with an event planned next year in New York City.

At the end of our session, the CFOs completed a survey which included the following positive feedback:

  • Great to share ideas because we are all facing similar challenges and hurdles.
  • I loved that you put an agenda together but facilitated and allowed conversation.
  • I liked the open format and discussion.
  • I enjoyed hearing the experiences/ideas of other CFO’s in the room.
  • It was the right-sized group.
  • Commonality of problems, some good potential solutions.
  • Helped having external experts to discuss best practices.
  • Knowledge and experience of the panel was great.
  • As a group, we will be a very helpful, future resource to one another.
Michael J. Mitchell, CPA, CPCU
Vice Chairman
The Graham Building
Philadelphia, PA, 19102
(215) 701-5214



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