National Council for Behavioral Health

Transcription

1 National Council for Behavioral Health Open Access: A Competitive Advantage for Your Organization September 3, 2014

2 Before we begin Join audio: Choose Mic & Speakers to use VoIP Choose Telephone and dial using the information provided Submit questions and comments via the Questions panel Note: Today s presentation is being recorded and will be provided within 48 hours.

3 Open Access: A Competitive Advantage for Your Organization Presented by: Scott C. Lloyd, President P. O. Box 1027, Holly Springs, NC Phone: Fax: Scott.Lloyd@mtmservices.org Web Site: wwww.mtmservices.org 2

4 Open Access: A Competitive Advantage for Your Organization Experience Improving Quality in the Face of Healthcare Reform MTM Services has delivered consultation to over 700 providers (MH/SA/DD/Residential) in 45 states, Washington, DC, and 2 foreign countries since MTM Services Access Redesign Experience (Excluding individual clients): 5 National Council Funded Access Redesign grants with 200 organizations across 25 states 7 Statewide efforts with 176 organizations Over 1,500 individualized flow charts created Over $20,000,000 in Annual Savings generated thus far A lot of happy staff and consumers 3

5 Open Access: A Competitive Advantage for Your Organization What is Open Access? Client Calls for Help Wait Time # 1 Assessment Appointment Wait Time # 2 Treatment Planning Appointment Wait Time # 3 Client Arrives for an Open Session 4

6 Open Access: A Competitive Advantage for Your Organization Why Open Access? It makes Sense! When looking at Access Models, you should first ask yourself, What do I expect when seeking medical care? Client Satisfaction/Engagement Clients who are offered a same day appointment show up 91% of the time, those schedule one day later show up 75% of the time. Teams who move to Same Day Access see a 10% increase in the kept rate of their follow up appointments on average. Competitive Advantage As CBHOs have moved to Open Access, they are seeing increases 5

7 Open Access: A Competitive Advantage for Your Organization NCQA has published accreditation standards for PCMHs Primary Care Development Corporation has developed a standard version of the Baseline PCMH Self-Assessment Tool that will guide PCMHs in their need to obtain accreditation 6

8 Open Access: A Competitive Advantage for Your Organization 7

9 Open Access: A Competitive Advantage for Your Organization Open Access Systems One of Management s key functions is to make sure that what they are asking is actually possible! 8

10 Open Access: A Competitive Advantage for Your Organization Most organizations perform costing efforts preparing for Integrated Care, Open Access, etc. to answer the question, Do we need to adjust our staffing/have a workforce expansion? Here are the questions you need to ask before hiring anyone! Steps to Reduce Wait Time or Clear a Waiting List Productivity = Service Capacity ACTUAL FACE-TO-FACE Billable Time Collaborative documentation 250 hours per year. No show rates how much capacity is lost to no shows? EOC/LOC Management Appropriately cleaning caseloads. Adjust episodes of care expectations. Hire new staff or turn away clients 9

11 Open Access: A Competitive Advantage for Your Organization Open Access System Changes Collaborative Documentation Same Day Access JIT Prescriber Scheduling No Show Management Utilization Review/Utilization Management Episode of Care (EOC) / Level of Care (LOC) 10

12 Open Access: A Competitive Advantage for Your Organization 11

13 Open Access: A Competitive Advantage for Your Organization 12

14 Open Access: A Competitive Advantage for Your Organization DATA/ RESULTS 13

15 Open Access: A Competitive Advantage for Your Organization 14

16 Open Access: A Competitive Advantage for Your Organization 15

17 Open Access: A Competitive Advantage for Your Organization Rosecrance Berry Campus Rockford, IL Open Access Case Study Richard Jaconette M.D. Child/Adolescent Psychiatrist 16

18 Open Access: A Competitive Advantage for Your Organization The False Reality of Full! Dr. Jaconette: Med Monitoring and Evaluation Events Prior to Open Access 17

19 Open Access: A Competitive Advantage for Your Organization The False Reality of Full! Dr. Jaconette: Med Monitoring and Evaluation Events After Open Access 18

20 Open Access: A Competitive Advantage for Your Organization The False Reality of Full! Dr. Jaconette: Med Monitoring and Evaluation Through the Open Access Implementation 19

21 Open Access: A Competitive Advantage for Your Organization Christine McCollister, Director MIS Topher Hansen, J.D., CEO Lincoln, NE 20

22 CenterPointe, Inc Lincoln, Nebraska Continuum of services for persons with Co-Occurring Disorders Focus of Open Access: Outpatient Counseling 4 FTE Masters Therapists, 1 Director Over 70 people on a wait list for services on GO LIVE date 12/3/2012 Set aside 2 assessments 4 days per week for 8 admission/week =

23 Concerns From Staff Ethics of opening admissions Anxiety over being over-run with requests for services Resulting in enormous caseloads Change in culture around missed appointments 22

24 Carefully Manage the Front Door To ensure people are in the right level of care That capacity is adequate for the overall flow week to week Plan B if requests in excess of resources Worked with Hospital and Crisis Center to have will call type appointments 23

25 Aggressively Manage the Back Door Not actively engaged Need medication only Not receiving active treatment Move toward episodic outpatient care 24

26 Education and Management Persons served educated about new attendance policies for missed appointments and alternative scheduling Clinical staff continuously identify people in need of alternative scheduling Aggressively back filling cancelled appointments, up to the time of the appt Making calls not to remind but to confirm - more than 24 hours in advance. 25

27 Before and After Admissions to Counseling Services Open Access Open Access Admissions Projected Wait List

28 Before and After Calculate Not Filled and No Show as missed appointments Staff have KPIs for their kept appointments Prior to open access Missed Appt Rates consistently 30% or more For July staff below 20%; All <= 25% 27

29 Value Increased competition in the community Effective, efficient, quality care = Value for persons served and payers 28

30 Final Thoughts Try it! 29

31 Open Access: A Competitive Advantage for Your Organization Benjamin Neal Millsap Senior Clinical Director Albemarle, N.C. 30

32 Monarch Open Access Monarch-Why Open Access? Best Practice and nationally recognized Without timely access people get lost No shows for first appointments are virtually Zero! Better outcomes for the people you support Better engagement (less no shows) for your programs Funders want and need access!!! Open Access can and should be part of a crisis continuum 31

33 Monarch Open Access Monarch-Our Model Comprehensive Clinical Assessment A treatment plan will be completed Same Day Psychiatric Eval if clinically appropriate If medically appropriate a script will be provided Next appointment(s) scheduled Door to Door 3 hours or less 32

34 Monarch Open Access Hub concept Purpose staffing Use of Telemedicine Connectivity Hardware Open access across our outpatient programs 19 outpatient sites 33

35 Open Access--Growth Growth!!! April 2012 took over services for an MCO (beginning of our move toward open access) June 2013 took over services from another MCO specifically to bring open access July 2013 Awarded more capacity from an MCO to increase services Oct 2013 Awarded services in a new 3 county area to bring open access to the area Aug 2014 asked to enter an MCO network to add open access concept 34

36 Open Access Growth cont From January 2012 to August 2014 Awarded 6 additional service contracts from MCO s Asked to speak at multiple different statewide engagements Multiple providers requesting us to teach them how to do open access 35

37 Open Access Growth Cont From Jan 2012-Aug 2014 cont.. Many providers have shifted their access model based on what they see Monarch doing, in order not to be left behind. $20 Million dollar increase in total Behavioral Health budget. 36

38 More individuals supported! Total Walk-Ins Total

39 Feedback Wanted! We collect feedback! Surveys completed Used for internal improvement and as info for our funders In July 23% of individuals completed our surveys Some of our most useful info 38

40 I received services in a reasonable amount of time from the time I walked in today. Agree Disagree March 82% 18% April 84% 16% May 83% 17% June 82% 18%

41 I would recommend Monarch to a friend or family member. Agree Disagree March 97% 3% April 97% 3% May 98% 2% June 97% 3%

42 I was treated with courtesy and respect today. Agree Disagree March 99% 1% April 97% 3% May 98% 2% June 98% 2%

43 If Monarch did not have a walk in open access center, I would have received my services from: Waited weeks/mo Gone to Gone to another Gone to my Gone to the nths to get services an urgent agency to get primary hospital Not gotten from care services care emergency services another center today physician department anywhere company March 6% 15% 11% 21% 33% 14% April 5% 10% 10% 24% 38% 13% May 6% 11% 8% 25% 33% 17% June 3% 12% 12% 29% 33% 12%

44 Lesson s Learned Good informed consent makes a world of difference! Look at your processes, anything you can do to streamline, reduce repeated steps, etc. the better it works. Develop good processes about what happens when someone cannot be seen and triaging individuals 43

45 Lessons Learned Cont Put the right staff in these positions. Staff need to be efficient and good at paperwork. Concurrent documentation is a must people are waiting Staff in these positions need to be comfortable with a wide range of populations Plan Do Study Act 44

46 Thank You! Any Questions? 45