Client Engagement Support Webinar for CCBHCs. December 13, :00pm 3:30pm ET

Transcription

1 Client Engagement Support Webinar for CCBHCs December 13, :00pm 3:30pm ET

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4 Today s Presenter M.T.M. Services, LLC P. O. Box 1027, Holly Springs, NC Phone: Fax: david.lloyd@mtmservices.org Web Site: mtmservices.org 4

5 Objectives 1. Overview: Client engagement is both a clinical care philosophy and service delivery system shift from the historical scheduling a client as the solution to a client s presenting for her/his care needs to actually seeing the client based on using all of the available clinical and operational resources that the CCBHC has at that time 2. Institute for Healthcare Improvement s Triple Aim Approach to Population Management 3. Creating a Customer Service Action Plan 4. Developing a Person Centered Engagement Strategy 5. Using Data to Reduce Client Access Time 5

6 Institute for Healthcare Improvement - The Triple Aim With hospitals moving toward a value-based payment system there is more demand now than ever for strategies that will help healthcare systems hone in on population health. The Triple Aim, an initiative set forth by the Institute for Healthcare Improvement, covers three main checkpoints for all hospitals as they make this transition Population Health Focus Experience of Care Lower Per Capita Cost Source: Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; (Available on 6

7 Source: Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; (Available on 7

8 Customer Service Action Plan Service Area/Opportunity 1. Telephone Access: Number of Rings before answering Greeting/Friendliness Time On Hold/Re-Empowerment Background Music/Information Transfer Levels to Staff Protocol for Voice Mail Responsiveness 2. Physical Facility: Identification Signage Parking Adequate/Clean Landscaping/Flowers/Lawn Maintenance Entrance Clean, Easy to Locate, and ADA Accessible Ease of Opening Door(s) Lobby Area Appearance/Capacity Magazines, Artwork, Furniture & Carpeting Registration/Front Desk Accessibility & Hospitality Restrooms Availability/Cleanliness Signage Adequate, Clear & Positive Background Music 3. Reception/Intake Staff: Politeness/Attentiveness/Responsiveness Professionalism/Boundaries/Language Skills/Communication Skills Customer Service Empowerment Level Terminology/Acronyms Utilization Consumer Recognition Wait Time Re-Empowerment Wait Time Protocols Knowledge of Services/Staff Level of Client Wait Time in Lobby Typical Customer Service Concerns Solution Options/ Change Status 8

9 Customer Service Action Plan Service Area/Opportunity 4. Access to Care: Single Number for Access After Hours Clinical Triage Capacity Clinical Staff Availability Consistency of Screening/Triage 5. Intake Process: Wait Time from call/walk in to Intake Efficiency of Financial Intake Number of Client Signatures Required Number of Forms to be completed by Client Number of No Shows Satisfaction Surveys for Access/Intake Process for Shows and No Shows 5. Intake Process (continued): Access to Clinician Efficiency of Clinical Intake Number of Forms Utilized in Intake Number of Questions Asked of Client 6. General Customer Service: Efficiency of Scheduling Next Appointment Managing Customer/Consumer Service Complaint Protocols Information on Center-wide Services Confidentiality Concerns Meeting Special ADA, Language, & Cultural Diversity Needs Brochures, Newsletters & Information Bulletin Boards Information/Linkage to Community/Self-Help Supports Ability of Organization to Listen to Consumer/Customer and Change Organizational Behavior Timely and Accurate Client Billings Follow up Visit Customer Satisfaction Phone Calls Mystery Visitor Program Participation Customer Service Focus at All Staff Meetings Typical Customer Service Concerns Solution Options/ Change Status 9

10 Customer Service Focus Summary It s Not My Job Focus Client Focus Customer Focus 1. Individuals served are not the focus of my work 2. The needs of individuals served are not in my job description 3. Where will individuals served go if they don t go here. 4. Individuals served are here because they have to be hear 1. Individuals are not empowered 2. Individuals usually don t know what they need 3. Individuals have little or no choice 4. Individuals are here to receive treatment 1. Individuals are fully empowered 2. Individuals know what they want and need 3. Individuals have choices 4. Individuals are here to participate in their recovery 1. It is not my job! 2. They Need Us! 3. We Need Them! Customer Service Support Tools: 1. Secret Shopper Program Critically Important 2. Executive Walk Through Program 10

11 What do you tell your customers? 11

12 Selection Criteria for Inclusion in Project Pilot Cohort Enhanced Access and Engagement Cohort Inclusion Criteria Each individual entering the pilot cohort must meet the following five criteria: 1. Open Case 2. Age 18 and older 3. Diagnoses including Schizophrenia Schizoaffective Disorder Major Depressive Disorder, Bipolar Disorders Psychotic Disorder NOS Delusional Disorder 4. Psychiatric Hospital/ ER utilization: In the most recent 12 months: One or more admissions of any duration to inpatient psychiatric treatment, and/or Two or more psychiatric emergency room visits and/or screenings for psychiatric inpatient hospitalization. 5. At least 2 SPMI Functional Criteria 12

13 Enhanced Access and Engagement Project Design All Organizations Subset (Half) of Organizations Measures (All Organizations) Core Access and Capacity Building Strategies 1. Intake Process Flow and Costing Analysis 2. Documentation Data Mapping 3. Intake Process Streamlining 4. Schedule Management 5. Productivity Measurement and Standards Development/ Management 6. Operational No Show/ Cancel Management (e.g. Medication Clinics) 7. Customer Service Improvement Strategies Subset A: (5 organizations ) Identify SMI Pilot Cohort and Add Person Centered Engagement Strategies 1. Collaborative Documentation 2. Person Centered Approaches 3. Addressing Specific Engagement Barriers 4. Relapse Prevention Strategies Subset B: (Remaining 5 Organizations) Identify SMI Pilot Cohort for Measurement Only At organizational level: 1. Access Measures as defined in previous Access and Retention Project At organizational and cohort level: 1. No / Show Cancellation Rates At Cohort Level Only: 1. Medication Adherence 2. Psychiatric Hospitalization / ER Utilization Rates (formula to be defined) 3. Lost to Service Rates (formula to be defined) 13

14 Person Centered Engagement Strategies A. Collaborative Documentation Implementation for the following documentation in Subset A Cohort: Assessment Service Planning Individual Therapy Group Therapy Case Management/ Community Support/ ACT 14

15 Collaborative Documentation National Client Survey Results Responses for All Participating Centers Collaborative Documentation Survey Thank you for taking a minute to answer a few questions about your session today. We re working on making the services you receive more open to you, giving you the chance to play a bigger part in the process of tracking the work we do, making sure our notes are accurate, and making sure that we re focused on your treatment goals. We value your opinion! 1. On a scale of 1 to 5, how helpful was it to you to have your provider review your note with you at the end of the session? Percentages Total Total % 1 Very Unhelpful 982 5% 2 Not helpful 283 1% 3 Neither helpful nor not helpful % 4 Helpful % 5 Very Helpful % NA No Answer/No Opinion 529 2% Total/Approval %: 21,378 94% 2. On a scale of 1 to 5, how involved did you feel in your care compared to past experiences (either with this or other agencies)? Total Total % 1 Very Uninvolved 510 2% 2 Not involved 203 1% 3 About the same % 4 Involved % 5 Very Involved % NA No Answer/No Opinion 577 3% Total/Approval %: 20,441 96% 3. On a scale of 1 to 5, how well do you think your provider did in introducing and using this new system? Total Total % 1 Very Poorly 91 0% 2 Poorly 47 0% 3 Average 859 4% 4 Good % 5 Very Good % NA No Answer/No Opinion 407 2% Total/Approval %: 20,371 99% 4. On a scale of 1 to 3, in the future, would you want your provider to continue to review your note with you? Total Total % 1 No % 2 Unsure % 3 Yes % NA No Answer/No Opinion % Total/Approval %: 19,580 94% 0 0% 0 0% 1. On a scale of 1 to 5, how helpful was it to you to have your provider review your note with you at the end of the session? Very Helpful, 52% Helpful, 31% No Answer/No Opinion, 2% Very Unhelpful, 5% Not helpful, 1% Neither helpful nor not helpful, 9% 2. On a scale of 1 to 5, how involved did you feel in your care compared to past experiences (either with this or other agencies)? Very Involved, 51% Involved, 29% No Answer/No Opinion, 3% Not involved, 1% Very Uninvolved, 2% About the same, 14% 3. On a scale of 1 to 5, how well do you think your provider did in introducing and using this new system? Very Good, 69% No Answer/No Opinion, 2% Very Poorly, 0% Poorly, 0% Good, 24% Average, 4% 4. On a scale of 1 to 3, in the future, would you want your provider to continue to review your note with you? No Answer/No Opinion, 5% Yes, 77% No, 6% Unsure, 12% 15

16 Percent Medication Adherence Client Report 100 Medication Adherence Client Report Subset B % Subset A % Linear (Subset B %) Linear (Subset A %)

17 Percent Medication Adherence Clinician Report 100 Medication Adherence Clinician Report Subset B % Subset A % Linear (Subset B %) Linear (Subset A %)

18 Percent Kept Appointment Rates Individual, Group, Medication Management Subset A vs. Subset B Cohort Kept Rates Total Sub A Cohort Kept Rate Total Sub B Cohort Kept Rate Linear (Total Sub A Cohort Kept Rate) Linear (Total Sub B Cohort Kept Rate)

19 Access to Treatment Is a Leadership Requirement 1. Primary Access Time to provide client face to face initial intake/assessment after call for help Same Day/Open Access Model implemented at over 550 CBHCs nationally 2. Secondary Access Time to provide client face to face service with his/her treating clinician following intake/assessment date 3 to 5 days but not later than 8 days after same day assessment provided 3. Tertiary Access Time to first face to face service with Psychiatrist/APRN following the intake/assessment date - 3 to 5 days but not later than 8 days after the same day assessment provided. NOTE: New 72 hour Just in Time Medical Services Scheduling Models have been implemented by CBHCs in 15 states By: 19

20 MTM Services Access to Care Data Since 2003, MTM Services has provided access to treatment consultation measurement support for over 700 community MH/SUD/IDD centers. The average center has 15 different access to treatment process flows (Loosely-held federation model that is hard to explain in a business case ) The MTM Team has completed over 9,000 GAP Analysis Processes 20

21 Access Redesign Initiatives First Call to Assessment Kept vs. No Show/Cancelled Presented David By: David Lloyd, Lloyd, Founder, MTM Services 21 21

22 Client Definition of Access What we have found is The False Reality of Full 75% Drop Out Before Treatment Avg. 31 to 48 Days Wait 1 out of 4 Receive Treatment Client Calls for Help Wait Time # 1 Assessment Appointment Wait Time # 2 Treatment Planning Appointment Wait Time # 3 Client Arrives for an Open Session Avg. 45 Days Wait from Initial Assess. to Psych Eval. 22

23 Enhanced Access Grant Cohort Example #1 Copyright Demographic Information Practice/Engagement Information Financial Information 23 # Location Division State Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Beachwood Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- Cleveland Heights Connections (NE Ohio)- West 25th Connections (NE Ohio) - West 25th Connections (NE Ohio) - West 25th Connections (NE Ohio) - West 25th Connections (NE Ohio) - West 25th Connections (NE Ohio) - West 25th Total Staff Time (Hrs) Total Client Time without Wait-time (Hrs) # of Intakes Completed Per Month Total Wait-time (Days) Cost for Intake Process Revenue for Intake Process Gain/Loss per Intake Monthly Margin Annual Margin SCALES OH $ $0.00 ($489.90) $0.00 $0.00 Counseling Only OH $ $0.00 ($377.46) $0.00 $0.00 Counseling + Meds OH $ $0.00 ($639.38) $0.00 $0.00 Meds Only OH $ $0.00 ($514.38) $0.00 $0.00 Case Management Only OH $ $0.00 ($329.54) $0.00 $0.00 MH/Meds/CM OH $ $0.00 ($717.02) $0.00 $0.00 Perinatal OH $ $0.00 ($539.08) $0.00 $0.00 Forensic OH $ $0.00 ($539.08) $0.00 $0.00 SCALES OH $ $0.00 ($489.90) $0.00 $0.00 Counseling Only OH $ $0.00 ($377.46) $0.00 $0.00 Counseling + Meds OH $ $0.00 ($639.38) $0.00 $0.00 Meds Only OH $ $0.00 ($514.38) $0.00 $0.00 Case Management Only OH $ $0.00 ($329.54) $0.00 $0.00 MH/Meds/CM OH $ $0.00 ($717.02) $0.00 $0.00 Perinatal OH $ $0.00 ($539.08) $0.00 $0.00 SCALES OH $ $0.00 ($489.90) $0.00 $0.00 SCALES-Spanish- Speaking OH $ $0.00 ($594.06) $0.00 $0.00 Counseling Only OH $ $0.00 ($377.46) $0.00 $0.00 Counseling + Meds OH $ $0.00 ($639.38) $0.00 $0.00 Case Management Only OH $ $0.00 ($329.54) $0.00 $0.00 MH/Meds/CM OH $ $0.00 ($717.02) $0.00 $0.00 Average Average Average ($519.04) $0.00 $0.00 $0.00 $0.00 Total Total Total , $10, $0.00 ######### $0.00 $0.00 Total Number of Intakes Per Month 0 Total Monthly Margin: Total Annual Margin: 23 $0.00 $0.00

24 Copyright Demographic Information Practice/Engagement Information Financial Information # Location Division State Total Staff Time (Hrs) Total Client Time without Wait-time (Hrs) # of Intakes Completed Per Month Total Wait-time (Days) Cost for Intake Process Revenue for Intake Process Gain/Loss per Intake Monthly Margin Annual Margin 1 Centennial- Akron Mental Health CO $ $0.00 ($357.14) $0.00 $ Centennial- Akron Psychiatry CO $ $0.00 ($577.02) $0.00 $ Centennial- Akron SA CO $ $0.00 ($631.13) $0.00 $ Centennial- Burlington Mental Health CO $ $0.00 ($338.25) $0.00 $0.00 Enhanced Access Grant Cohort Example #2 5 Centennial- Burlington Psychiatry CO $ $0.00 ($558.13) $0.00 $ Centennial- Burlington SA CO $ $0.00 ($253.31) $0.00 $ Centennial- Elizabeth Mental Health CO $ $0.00 ($338.25) $0.00 $ Centennial- Elizabeth Psychiatry CO $ $0.00 ($558.13) $0.00 $ Centennial- Elizabeth SA CO $ $0.00 ($253.31) $0.00 $ Centennial- Fort Morgan Mental Health CO $ $0.00 ($342.00) $0.00 $ Centennial- Fort Morgan Psychiatry CO $ $0.00 ($561.88) $0.00 $ Centennial- Fort Morgan SA CO $ $0.00 ($253.31) $0.00 $ Centennial-Holyoke Mental Health CO $ $0.00 ($345.13) $0.00 $ Centennial-Holyoke Psychiatry CO $ $0.00 ($565.00) $0.00 $ Centennial-Holyoke SA CO $ $0.00 ($270.50) $0.00 $ Centennial- Limon Mental Health CO $ $0.00 ($338.25) $0.00 $ Centennial- Limon Psychiatry CO $ $0.00 ($558.13) $0.00 $ Centennial- Limon SA CO $ $0.00 ($253.31) $0.00 $ Centennial- Sterling Mental Health CO $ $0.00 ($341.06) $0.00 $ Centennial- Sterling Psychiatry CO $ $0.00 ($579.69) $0.00 $ Centennial- Sterling SA CO $ $0.00 ($183.56) $0.00 $ Centennial- Wray Mental Health CO $ $0.00 ($353.88) $0.00 $ Centennial- Wray Psychiatry CO $ $0.00 ($573.75) $0.00 $ Centennial- Wray SA CO $ $0.00 ($272.20) $0.00 $ Centennial- Yuma Mental Health CO $ $0.00 ($353.88) $0.00 $ Centennial- Yuma Psychiatry CO $ $0.00 ($573.75) $0.00 $ Centennial- Yuma SA CO $ $0.00 ($272.21) $0.00 $ Centennial- Elizabeth CSP CO $ $0.00 ($408.08) $0.00 $ Centennial- Fort Morgan CSP CO $ $0.00 ($408.08) $0.00 $ Centennial- Sterling CSP CO $ $0.00 ($407.15) $0.00 $ Average Average Average ($402.65) $0.00 $0.00 $0.00 $0.00 Total Total Total $12, $0.00 ######### $0.00 $0.00 Total Number of Intakes Per Month 0 Total Monthly Margin: Total Annual Margin: $0.00 $

25 Data Mapping to Reduce Access Time Case Study of Exhaustive Data Collection Model: M.T.M. Services provides project management and consultation services for the Access and Retention Grant. In their work with CBHOs they provide data mapping of the number of data elements each center collects from the first call for services through the completion of the diagnostic assessment/intake. A recent data mapping effort for a community provider produced the following outcomes: 1. Total number of data elements collected in the process = 1, Total number of redundant data elements collected in the process = Total number of data elements really required for access to treatment planning processes = Total staff time required to administer the original flow process = Four hours ten minutes 5. Total staff time required to administer the revised flow process = One hours twenty minutes 25 25

26 Data Mapping Sample 26

27 SAMPLE New York State Specific Compliance Grid: Each State s Grid Will Vary 27

28 Are Your Clients Receiving Help in Your Access to Treatment Process? 1. Engagement Gold Standard Access to Treatment process will provide a clinical diagnostic assessment and initial treatment plan (e.g., one goal and two objectives) with a 1.25 hour target time frame with the clinician 2. Support staff (Customer Service Representatives- CSRs)will need to collect and record all non-clinical information in the intake process before the client goes back to the clinician. This support includes financial, consent, etc. information for the client. 3. FQHCs One of the engagement techniques that the FQHCs in Arkansas use is to make sure after the assessment and initial plan of care are completed to spend 5 to 10 minutes providing a therapeutic intervention so that the client leaves feeling like she/he has been helped. 4. NOTE: When the CCBHC only asks questions during the assessment/intake process, the client feels like they are helping us, when we identify the treatment needs through the assessment, design an initial treatment plan to address the needs with the client and share a therapeutic intervention that start the process of addressing the client s assessed needs, then the client feels like we are helping him/her. This approach supports early engagement in treatment that support ongoing engagement. 28

29 Secondary and Tertiary Access Challenges to Minimize Medical Loss Ratio Secondary Access - KPI Standard: Total days wait to treatment for therapist/case manager is preferred in 3 to 5 days but not more than 8 calendar days or less from Intake/Assessment date Challenge to Compliance: Level of nonengagement in ongoing therapy and case management services which creates a sense of caseloads being full. 29

30 Distributive Justice Ethical Leadership Challenge Distributive Justice Ethical Dilemma: 1. How do providers ensure that it is providing the greatest good to the greatest number of people based on the limited resources available 2. How do providers shift the primary service delivery focus from its current caseloads to an equal focus between current caseloads and persons presenting to access services? 3. Providers will need to establish key performance standards to ensure that the needs of ALL of the people in the catchment area are responded to timely and effectively 30

31 CCBHC Population Management Model To support minimizing clinical risk a significant qualitative and outcome shift will be needed from primarily treating consumers that present for care and consumers currently in caseloads to a re-focus on consumers in caseloads that are not engaged in services and the number of consumers that are eligible for services (i.e., Medicaid Eligible) that are not currently in service. What are the total population healthcare/ wellness needs for BH/SUD services and the physical health needs of the consumers CCBHCs must use their care coordination capacity to address high risk/high utilization consumers that are not engaged in services 31

32 Treatment Plan Goal/Objective Attainment Qualitative Review 32

33 Level of Care-Benefit Package Design Purpose is to establish Group Practice Clinical Guidelines to Facilitate Integration of all services into one service plan Provide an awareness to consumers at entry to services the types of services and duration of services the practice has found most helpful to meet their treatment needs so that the consumer will know and the staff will know what services are needed to complete that level of care Moves consumers to a more recovery/ resiliency based service planning and service delivery approach Facilitates being able to use centralized scheduling using the actual service plan of each consumer 33

34 Same Day Access/Treatment Plan Model Using Benefit Design/Level of Care Criteria 34

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36 Treat to Target Attainment Levels: 1. Most of our clinicians use a treat to target approach to planning, service delivery, and adjusting the care plan if it s not working including brief therapy models that incorporate Motivational Interviewing techniques. 2. The majority of clinicians and supervisors have studied the treat to target literature and develop care plans that include measureable targets (e.g. 25% improvement in DLA-20 aggregate score, 50% reduction in PHQ-9 scores within 12 weeks), measure progress at least monthly, and work with consumers to adjust the care plan if targets are not being met. 3. Part of this process includes the use of clinical tools that measure improvement in symptomology, functional status, and recovery and resilience-building for the children, families and adults we serve. 36

37 DLA-20 Functional Results Baseline and at 90 Days 37

38 Secondary and Tertiary Access Challenges to Minimize Medical Loss Ratio Tertiary Access - KPI Standard: total wait time to MD/APRN is 3 to 5 days but no more than 8 total calendar days from Intake/Assessment date Challenge to Compliance: Level of nonengagement in ongoing med follow up services which requires a high level of system noise to provide bridge medications by phone that creates a sense of being overwhelmed.. 38

39 Case Study: Just In Time Medical Scheduling Outcomes InterCommunity, E. Harford, CT Year Medical Team FTEs * * 39

40 Case Study: Just in Time Medical Scheduling Outcomes Source: St Joseph Orphanage, Cincinnati, OH Wait Time to Prescriber Services Before JIT and Medical Walk-In After JIT and Medical Walk-In Average wait time to access to Prescriber Services from First Contact with Client Days 7 10 Days Average no show percentage: 20% 8% *Of note, between two of our sites, Medical Walk In to see a prescriber is available Monday thru Friday (weekend hours are our next goal). Clients have opportunities to see a prescriber the same day as their assessment in Open Access (However, this opportunity goes away when our State implements Medicaid Redesign, as mental health assessment and e/m code are not allowed to be rendered to the same client on the same day). 40

41 National No Show/ Cancel Engagement KPIs National Standard for Appointment Types: Appointment Kept No Show (less than 24 hours notice) Appointment Canceled by Client (more than 24 hours notice) Appointment Canceled by Staff 41

42 No Show Definition Clarification: 1. No Show definition is not based solely on clients behavior as much as the impact of this behavior on service capacity of each direct care staff that day (i.e., Late cancellation results in a potential no show to schedule) 2. Cancellations count as No Shows IF the team is not backfilling 90% of pre-cancelled appointments Therefore, no shows and cancellations carry the same weight of reduced service capacity if the backfilling process is not happening 42

43 National No Show/ Cancel Key Performance Indicators 1. Initial Intake/Diagnostic Assessment Services = 0% No Show/Cancel rate based on Same Day access models 2. Ongoing Therapy Services = 8% - 12% No Show/Late Cancelled 3. Initial Psychiatric Evaluations = 4% to 6% No Show/Late Cancelled using the Just In Time Medical Scheduling Model 4. Ongoing Medication Follow Up Services 4% - 6% No Show/Late Cancelled - NOTE: Using the Just In Time Medical Scheduling Model including NO Medications provided by phone to clients that missed their appointments will have to be addressed to positively impact ongoing no show rates. 43

44 Individual Scheduling Template and Productivity Calculator 44

45 Clinic Level Scheduling Template and Productivity Calculator 45

46 Community Based Staff Plan Based Scheduling 46

47 Centralized Scheduling Standing Appointment Standards Have clinicians and community based staff turn in their standing appointments at least three months in advance? Supervision times PTO Lunch Breaks Dinner Breaks Required Training/Meetings/Committee work 47

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49 Components of Centralized Schedule Management 1. Awareness of all available clinical time/resources in the group practice 2. Filling in available clinical time with just in time services 3. Schedule all in clinic and in community appointments 4. Call and confirm appointments 36 to 48 hours in advance You have an appointment with on at p.m.. Do you still plan to see or would it be better if I reschedule you? 5. Back fill 90% of all cancelled appointments 6. Maintain Will Call lists from all clinicians and community support staff 49

50 Appointment Back-Fill Protocol 1. Whenever an appointment is cancelled by consumer, the Customer Service Representative (CSR) or his/her designee shall be responsible for offering the appointment time to new consumers or existing consumers needing an earlier appointment. 2. All new consumers with regular intake appointments scheduled beyond the same day criterion specified by Agency policy and funder requirements shall automatically be placed on a Will Call List for earliest availability. 3. To ensure optimal productivity, each Clinician shall provide, for Area Business Manager s use, a Will Call List of consumers who should be given priority consideration for earlier appointment based on ISP and level of care needed. 4. This list should be reviewed and updated by the Clinician as needed and at least weekly. 50

51 Will Call List to Support BACK FILL Strategies On a specific day of the week each clinician will submit their will call list Schedule Manager staffs call clients on the list to back fill client cancels 51

52 Measurement of Case Loads The Answer Measurement of specific caseload members no showing/canceling is critical part of the ability to reduce rates Need information in clinical staffings and supervision in order to change our behavior Need agency protocol when staff are to begin action on no show/cancellation challenge that is case level specific 52

53 NOTE: 20% of Clients will create 80% of the low engagement/no show/late cancellation challenge 53

54 Qualitative Dilemma With Quantitative Based No Show Policies Typical No Show Policies (i.e., Miss two appointments in three months and center will not reschedule client, etc.) are quantitative based which creates risk management concerns by clinical staff SOLUTION: Use Engagement Specialist Model 54

55 Qualitative Dilemma With Quantitative Based No Show Policies Engagement Specialist Model: 1. When client misses two appointments, the centralized scheduler turns the client over to the engagement specialists (LPN, Case Manager) 2. Engagement Specialist contacts the client to confirm if they want services Identifies barriers to client attending and addressing them (i.e., different day, time, etc.) Drops clients into med clinics, group therapy, etc. to reengage client Begins Discharge/Transfer Planning if the client cannot be reengaged in treatment 55

56 Questions and Feedback Questions? Feedback? Next Steps? 56

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61 Still have Questions? Sherronda Anderson Project Manager