Debra Rex, MA, MEd
President and CEO
To thrive in today’s healthcare system, leaders must be dynamic, according to Debra Rex, MA, MEd, president and CEO of Beech Brook in Cleveland. Rex says in her 23 years of leadership, Beech Brook has remained focused on strategic planning and innovation while maintaining its reputation for integrity—that is, following through on its promises for clients, the community and the payers it works with.
“We’ve stayed very close to our customers and very close to our clients,” she says. “We also stay close to best practices in the field.”
Rex says Beech Brook’s culture is designed to permit innovation, learning and subsequent improvement based on what was learned. Essentially, she says, the organization isn’t afraid to test new things and learn from failed initiatives. Some of her inspiration comes from the Fifth Discipline management philosophy, based on a 1990 business book, which outlines how to create a learning organization through group problem solving.
The reason why Rex drives innovation so hard is because the behavioral healthcare field is changing dramatically of its own volition and within the context of health reform overall. She says no organization can stand still, but rather, must take what it does well and apply it in new areas to grow and respond to the market.
“There’s a dynamic quality to financial sustainability, in addition to strategic planning and innovation and always looking for new revenue streams,” Rex says. “We also focus on strong financial management. Early on, we implemented monthly operational review meetings with our program managers as an opportunity to help them grow—most of them are social workers who don’t have business training. But we’ve increased their ability to think in a different way and manage their programs effectively.”
Specifically, the teams review budget forecasts, contract performance and any areas that might be underperforming so they can devise strategies for course correction as needed. She says the teams are always looking for ways to manage expenses and be more cost-efficient.
“We align cost reduction with strengthening our performance,” Rex says. “That has worked really well for us, taking an organizational approach.”
For example, as the service needs and performance needs change, staffing might need to change to ensure the right people with the right skills are in the right roles to advance care and sustainability. Rex says Beech Brook will reassign duties to team members to better leverage their strengths and allow them to put their skills to work in the most effective way possible. This includes management: Several years ago, Beech Brook reduced its management staff by 30 percent as part of an effort to shave $1 million off the budget, and the result was a more streamlined organization with improved performance measures, she says. And it clearly has paid off.
“I’ve been here 23 years, and we’ve balanced the budget 22 times,” Rex says.
She has guided the agency through steady growth and program expansion at a time when many not-for-profits have closed their doors or reduced their services. Beech Brook has grown from a budget of $6 million and four programs to $26 million and 45 programs, while nearly quadrupling the number of individuals receiving services.
Under Rex’s leadership Beech Brook has also been awarded several demonstration grants, including a recent grant to develop integrated care. She says the board of directors had supported a previous investment in a dedicated senior staff member to research and evaluate opportunities under the Affordable Care Act, and that investment translated to a unique readiness for the integrated care initiative, allowing Beech Brook to apply quickly when the grant became available. Even more so, the board approved an additional investment to lay the infrastructure needed to secure the grant.
The new pilot project integrates behavioral healthcare with social services and physical healthcare from a Federally Qualified Health Center in one location in a low-income neighborhood in Cleveland. There, clinicians and service staff can complete hot transfers of individuals who need assistance and intervention, while at the same time, the teams can provide education and prevention onsite. All the services, although funded separately, are seamless to the individuals.
Rex says the grant helped to fund the strategic planning and the upgrade of Beech Brook’s EHR system to manage the integrated care delivery. Ultimately, the experience will lead up to the organization qualifying as a health home with the state.
Rex is an advocate for integrated care. Beech Brook has transitioned from a primarily residential center to an agency that now provides more than 40 community-based programs to 24,000 children and families each year.
“Residential treatment is not the way to drive the future,” she says.
In fact, the organization’s more than 20 years of research shows that children who stay in residential settings benefit in the short-term but don’t necessarily benefit more from a long-term stay. Rather, Rex would like to see more mentoring, prevention and integrated care that involves the healthcare and local community support system.
Then and now
Rex says in the 23 years she’s been a leader at Beech Brook, the clinical specialty of behavioral health has changed but the business side has, too.