The Spill With Paul M. Duck, Chief Strategy Officer at OPEN MINDS

Every industry reaches moments when the rules begin to change. Not overnight. Not with one headline or one piece of legislation. But gradually, through a series of shifts that, taken together, redefine how organizations succeed.

Behavioral health is in one of those moments now.

For this edition of The Spill, I sat down with Paul Duck, Chief Strategy Officer at OPEN MINDS, whose career has spanned provider organizations, health plans, and healthcare technology. That perspective gives him a unique vantage point into the challenges and opportunities emerging across our industry.

While our conversation covered everything from Medicaid policy to artificial intelligence, one theme surfaced repeatedly:

The organizations that prepare for change will outperform those waiting for certainty.

Financial Sustainability Has Become the Defining Leadership Challenge

Ask behavioral health executives what’s keeping them awake at night, and you’ll hear familiar concerns, workforce shortages, documentation burden, reimbursement pressures, and growing demand for services.

Paul believes those challenges ultimately point back to one issue.

Financial sustainability.

“The ones that are sleeping well and not worried are the ones that should be worried.”

For years, behavioral health has largely operated within a fee-for-service environment where reimbursement rewarded activity more than outcomes. But that model is steadily evolving.

Whether organizations are ready or not, value-based care and risk-based contracting continue to gain momentum. The question is no longer if organizations will need to demonstrate value, but how they’ll prove it.

As Paul put it:

“No one’s going to pay you a higher rate simply because people say you’re great. It needs evidence.”

That observation carries an important challenge for leadership teams. Most organizations possess years of clinical, operational, and outcomes data sitting inside their EHRs. Yet relatively few have transformed that information into meaningful evidence demonstrating where they consistently deliver superior outcomes.

In the years ahead, reputation alone won’t be enough. Organizations that understand their strengths, and can prove them with measurable outcomes, will be far better positioned as reimbursement models continue evolving.

HR1 Is Accelerating Conversations Leaders Can’t Ignore

Our conversation naturally turned toward HR1 and its potential impact across behavioral health.

While implementation will vary from state to state, Paul believes the legislation introduces a new level of uncertainty around Medicaid eligibility and funding that every executive team should be evaluating today, not after policies are finalized.

As states determine how to implement new requirements, behavioral health organizations may experience meaningful shifts in the populations they serve and the reimbursement models that support them.

At the same time, community need isn’t slowing.

“We have a growing need and we actually have fewer providers in the mix.”

Rather than waiting to see how these changes unfold, Paul encourages leaders to build multiple operational scenarios now.

What happens if eligibility changes?

How would referral patterns shift?

What would happen if reimbursement models evolve more quickly than expected?

Organizations that have already mapped those possibilities will be able to respond with confidence instead of reacting under pressure.

Technology Has Become a Strategic Advantage

One of the most noticeable shifts Paul has observed is how executive teams think about technology. Not long ago, conversations about software lived almost exclusively within IT departments.

Today, CEOs are asking about AI strategy, interoperability, data architecture, and technology stacks, not because they’re interested in technology itself, but because they understand technology has become inseparable from organizational strategy.

“The organizations that have that tech-first mindset… they’re less stressed because they have a plan.”

Technology is also beginning to address one of behavioral health’s longest-standing pain points: administrative burden. Documentation, intake, prior authorizations, scheduling, and countless manual processes consume valuable clinical resources every day.

When implemented thoughtfully, AI and automation aren’t replacing clinicians. They’re helping clinicians spend more time doing what only clinicians can do. For organizations facing workforce shortages and increasing demand, that distinction matters.

Culture Determines Whether Strategy Succeeds

Technology alone doesn’t create transformation.

People do.

Paul believes organizational culture has never been more important because the pace of change has never been faster.

Some resistance comes from fear.

Some comes from uncertainty.

Some simply comes from not understanding what new technologies actually do.

The organizations navigating this transition most effectively aren’t eliminating those concerns; they’re creating cultures where people feel informed, supported, and empowered to adapt.

As Paul shared:

“It’s better to be planning for change than it is to be sitting it out and waiting, because waiting won’t work.”

Leadership today isn’t about predicting every disruption.

It’s about building organizations capable of responding to whatever comes next.

The AI Governance Wake-Up Call

One story from our conversation perfectly captured why governance deserves as much attention as innovation.

While working with a large multi-state provider, Paul discovered that several clinicians had begun recording therapy sessions on their personal phones, uploading transcripts into ChatGPT, and using the summaries for documentation.

They weren’t trying to violate policy.

There simply wasn’t one.

In the absence of clear guidance, well-intentioned employees created their own workflows.

That story illustrates one of the most important leadership lessons surrounding AI.

Organizations don’t have the luxury of waiting to develop governance after AI adoption begins.

By then, adoption has already happened.

Policies, education, privacy standards, security requirements, and operational guardrails must evolve alongside the technology, not months afterward.

Innovation without governance creates unnecessary risk.

Governance without innovation creates stagnation.

The future requires both.

Final Pour

Throughout our conversation, Paul kept returning to a simple but powerful idea.

Preparation beats prediction.

No one knows exactly how reimbursement models will evolve.

No one knows precisely how each state will implement HR1.

No one can fully predict how artificial intelligence will reshape behavioral health over the next decade.

But leaders don’t need perfect certainty to begin preparing.

The organizations that thrive won’t necessarily be the largest or the first to adopt every new technology.

They’ll be the ones that understand their value, use data to demonstrate their impact, embrace technology with purpose, and establish the governance necessary to innovate responsibly.

Behavioral health is entering a new chapter.

The leaders who start preparing today won’t simply adapt to what’s coming.

They’ll help shape what comes next.

As our conversation concluded, one message stood above the rest. The future of behavioral health won’t be determined simply by policy changes, artificial intelligence, or new reimbursement models. It will be determined by leadership. Organizations that invest today in financial strength, measurable outcomes, technology strategy, governance, and organizational agility will be best positioned to thrive. That philosophy continues to shape the work Paul and the OPEN MINDS team do with organizations across the country every day.

Thanks to Paul M. Duck for spilling it with us. Until next time.