There’s a huge disparity between community mental health centers and private practices. Providers are typically forced to choose between the higher salary afforded by private practices, or choose to work for a mental health center that provides a strong sense of community, rich culture and solid support system – though it probably isn’t able to pay as much.
Dr. Hutchinson has experienced both sides of mental health practice. She worked for a nonprofit full-time and loved the strong sense of purpose and meaning that went into everything she did.
“It made it feel really good to go to work, but it was hard to pay my basic bills,” she said. “I could work one and a half days in private practice and bring in almost as much as I was making full-time in my nonprofit role.”
John brought his consulting background to the table and identified there was an opportunity to combine the two models – providing a solid income for clinicians while maintaining a great mission, community connection and sense of purpose.
CARE Counseling opened in January 2014 and Dr. Hutchinson started seeing clients that September. John and Dr. Hutchinson also had a baby that same month. Perhaps that’s where they developed the value of work-hard, play-hard at CARE. In the months leading up to the clinic’s opening, the couple worked several full-time jobs to cover the cost of opening a practice and in all of their nights and weekends, they worked on renovating a beautiful Victorian home that became their first clinic location.
When they weren’t working at their jobs, skim coating walls, scraping wallpaper, painting, redoing floors, and changing out electrical – Dr. Hutchinson was working with business and ethics consultants to make sure the clinic had carefully written paperwork for clients, systems that were repeatable, and the company could be in-network with all the insurance panels. John was leveraging his business acumen to create a business model grounded in something meaningful and sustainable. He quickly recognized that many mental health professionals are undervalued, and the companies they work at follow clinicians’ lead and place most of their focus on clients, often at the expense of providers – this leads to extremely high burn-out. John envisioned a practice focused on the provider with the belief that a supported provider will be able to provide the best possible care to their clients.
The team quickly grew to 10 clinicians and Andrea & John identified the organization needed to double down on its mission, switching from a contractor-based model to an employment model and reinvesting every dollar they made back into the clinicians. Since then, the practice’s growth has been astronomical. They currently have over 84 team members scheduling over 1,500 clients weekly.
“Our mission is building a community to strengthen the community,” said Dr. Hutchinson. “Every decision we make filters through this lens.” Their mission informs everything from compensation, their response to COVID, internal and external communications, team gifting and events, and the incredibly sophisticated training and operation systems developed by Dr. Hutchinson’s team.
John points out the importance of offering great pay, a beautiful environment to work in, and providing opportunities for people to create deep relationships with one another. “There’s an average fifty percent turnover across agencies, and fifty-five to sixty percent of providers leave the profession within five years,” John said. “The people who are consolidating the industry don’t seem to care about the providers. We want to do it differently.”
CARE Counseling not only ensures strong pay for providers to have a good quality of life, but they invest heavily in training.
“A lot of mental health agencies have one or two trainings a year. Some of the best agencies might have twelve. We have twenty-four to thirty grand rounds (trainings), on average, every year for the entire team,” Dr. Hutchinson said. “In addition to this, the team also gets weekly training based on a monthly training topic, bringing the total up to around seventy trainings for our clinicians every year.” A minimum of a fourth of these trainings are focused on diversity, equity, and inclusion, meaning the team has about 15-20 hours of internal multicultural counseling training at their fingertips each year.
Each month, they cover a specific training theme, giving CARE’s clinicians the chance to do a deep dive into the research and apply it to their practice. “Our goal is to have the best practitioner-scholars in Minnesota,” Dr. Hutchinson said. The entire leadership team knows that when someone needs mental health support, they deserve to have a provider who is cared for and is highly trained.
“CARE Counseling has one-hour talk therapy experts,” said marketing director Nicole Dahl. “Because of our growth, we are able to offer same-week availability, which is great. When people are stressed out, they don’t want to wait three weeks, they want an appointment now.”
The clinic serves clients across the state using a combination of in-office and telehealth visits. CARE’s current clients range in age from two to eighty seven, and have myriad mental health needs. The clinic especially serves the “Working Well” – people who may appear be able to keep up with the demands of life seamlessly and perhaps with a smile but underneath the surface, they are feeling the weight of endless worries, hopelessness, sadness, grief, trauma, and/or other mental health concerns.
“We want to be the first and last touchpoint in mental health,” said John. “We want to keep people from needing higher level of care and support people as they step down from more acute services so they can continue their progress.”
Today, CARE accepts all major Minnesota health insurance companies. It’s also important to CARE that they’re available throughout the state. “We want to make sure that anybody can access our services, no matter whether they’re in the Twin Cities area or rural Minnesota,” said John.
CARE connected with 21st Century Bank a few years ago, thanks to a referral from the mental health practice’s real estate broker. They’ve worked closely with Blair Oklobzija, market president at 21st Century Bank’s Blaine location, ever since.
“They were early in their lifecycle with their business when they came to us, still trying to figure a few things out,” said Blair. “They’re an awesome team. I got the feeling that they knew what they were doing and trusted that they would figure it out, and they did.”
“21st Century Bank just gets it,” said John. “And Blair is comfortable with being aggressive but is also biased toward safety and pretty realistic. A lot of lenders might give you more funding than you need or are so conservative that you’re not going to hit your growth goals. With Blair and 21st, that wasn’t a problem.”
As part of their strategy, CARE hasn’t taken out many loans for their business. After switching to an employer model with rolling hiring (which helps them hit 70% growth year after year), CARE has been stable and supported their own growth from a cash flow perspective.
While CARE sought to establish a foothold in Minnesota communities, however, the group turned to 21st Century Bank for real estate lending. Currently, CARE has two buildings they’ve secured with the help of 21st Century Bank as part of the Small Business Administration (SBA) 504 loan program. And two buildings secured through conventional loans including a new site in Mendota Heights closed this fall.
CARE is passionate about maintaining a presence in the communities they serve. “People choose mental health in the same way they choose a dentist or a grocery store — they look for proximity first. Even with telehealth, people still want the agency to be in their community, just in case,” John said.
Being able to buy the buildings out of which CARE operates makes it a lot easier to invest money in those spaces – especially since they know they’ll be able to keep it long-term and won’t need to renegotiate their leases every five years.
21st Century Bank has been an ongoing partner in this venture. “It’s amazing how wonderful the small business loan programs have been and how much we’ve been able to do for the community and for our organization simply because we don’t have to put a twenty-five or thirty percent downstroke on a piece of commercial real estate,” John said.
It’s important for an organization like CARE to have the kind of community-focused support 21st Century Bank can provide. CARE has focused on doubling the size of its organization every 16 months, no small feat in the healthcare industry.
“We know we’re going to get paid by the insurance companies, but we don’t know if it will be next week or next month,” John said. “It’s a good risk, but the timing isn’t always ideal. 21st Century Bank has done a good job of managing what’s important.”
“Just talking to John and Andrea, and developing a relationship with them, it’s clear they know what they were doing. We are happy to partner with them,” said Blair. “They know their strengths and weaknesses better than most and know how to leverage or work around them.”
One of their strengths, according to John, is the fact that the organization is predominantly run by Dr. Hutchinson and other women leaders. “Aside from me, the leadership team is entirely women,” said John. “That’s such a powerful thing. It’s representative of the industry and it’s important for young professionals to see themselves reflected in leadership.”
CARE Counseling is excited for their future in Minnesota and here at 21st Century Bank, we’re happy to be by their side as they add to their existing locations, which currently include Uptown, Loring Park, Minneapolis, Mendota Heights and St. Louis Park.
As far as CARE is concerned, they’re in it to make a lasting difference and continuously reinvest in their people.
“We don’t really care about being the biggest,” said John. “We want to be the best. We want to make it really hard to compete without going that extra mile. The bigger we get, the more market influence we have, and at the end of the day, that’s how we change the world.”
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