Same Day Access Presented by: ScottLloyd Lloyd, President
Audio and Control Panel Opening Your Line 1. Make sure Telephone is the option selected 2. Dial your Access Code 3. Enter your two digit Audio PIN (unique to you, the picture is a sample!) Didn t work? Try putting # on either side of the PIN Have a question? Just ask by raising Have a question? Just ask by raising your hand or texting in your question via the control panel!
Experience Improving Quality in the Face of Healthcare Reform MTM Services has delivered consultation to over 800 providers (MH/SA/DD/Residential) in46 states, Washington, DC, and 2 foreign countries since 1995. 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
Access Redesign Experience Improving Quality in the Face of Healthcare Reform David Lloyd, Founder of MTM Services and Senior Consultant for the National Council Scott Lloyd, President of MTM Services and Senior Consultant for the National Council Randy Love, Chief Information Officer for SPQM Data Reporting Services Willa Presmanes, M.Ed., M. A., Medical Necessity/Utilization Management Expert and Co Author of the DLA 20 (Daily Living Activities) functionality scale Bill Schmelter, Ph.D., Lead Clinical & Collaborative Documentation Consultant for MTM Services and Consultant for the National Council Michael Flora, M.B.A., M.A.Ed., L.P.C.C., C L.S.W., LeadOperationsConsultantforMTM Services, CEO ofthe Ben Gordon Center in DeKalb, IL, and Consultant for the National Council David Swann, MA, LCAS, CCS, LPC, NCC M.T.M. Services Senior Integrated Healthcare Consultant, CEO of a public Local Management Entity in North Carolina, and Consultant for the National Council Joy Fruth, M.S.W., Lead Process Change Consultant for M.T.M. Services and Consultant for the National Council Katherine Hirsch,, MSW, LCSW, Collaborative Documentation Consultant Specializing in Collaborative Documentation with Children and Consultant for the National Council John Kern, MD Collaborative Documentation Consultant for M.T.M. Services and Consultant for the National Council Annie Jensen, MSW, LCSW Process Change Consultant for MTM Services, Vice President of Operations/ Burrell Behavioral Health, and Consultant for the National Council Jennifer Hibbard Operations Consultant for MTM Services, CEO View Point Health in Georgia, and Consultant for the National Council Jennifer Senechal Financial Controller and Cost & Revenue Analyst for M.T.M. Services
Same Day Access
A Few Questions to Start Off 1. Do you know how long it takes for a Consumers to make it to your first treatment appointment from their first phone call for help? 2. If you know how long it takes for number 1 above, would you wait that long? 3. What information does the consumer receive during their first onsite visit with ih your team (Orientation, i Assessment, Screening?), and is it enough to answer their 5 key questions? 4. How long and/or how many sessions does your Assessment take? 5. What is your drop out rate from first call to first treatment appointment?
TheFalse Reality of Full! The Client s Definition of Access Client Calls for Help WitTi Wait Time # 1 Assessment Appointment Wait Time # 2 Treatment Planning Appointment Wait Time # 3 Client Arrives for an Open Session
The Values that Community BH Clinics Now Need Community Behavioral Health Clinics (CBHCs) have an excellent opportunity to be helpful partners in the new integrated healthcare system if they can display the following specific values: 1. Be Accessible (Provide fast access to all needed services). 2. Be Efficient (Provide high quality services at lowest possible cost). 3. Be Connected (Have the ability to share core clinical information electronically). 4. Be Accountable (Produce information about the clinical outcomes achieved). 5. Be Resilient (Have ability or willingness to use alternative payment arrangements).
Same Day Access Defined Same Day Access MTM has move more than 400 teams through this process that allows teams to offer assessments on the same day they are requested, without a scheduling delay or waitlist. Thisprocess greatly improves consumer satisfaction and engagement, while also eradicating no shows in the assessment process. JIT Prescriber Scheduling An offshoot of Same Day Access now implemented with teams in 10 different states. This process allows teams to move a consumer from their diagnostic assessment to a psychiatric evaluation within 3 to 5 days, greatly increasing engagement and reducing no shows and cancellations.
Same Day Access Supports Teams who focus solely ll on Same Day Access alone often run into trouble within about 6 months, Changes must be more complete: Collaborative Documentation Same Day Access JIT Prescriber Scheduling Centralized Scheduling No Show Management Utilization Review/Utilization Management Episode of Care (EOC) / Level of Care (LOC)
Why Same Day Access Implementations often Fail
Why Same Day Access Implementations often Fail Team members with various levels of anxiety and differing opinions clash, but neither side has data to back their points is a key roadblock to successful changes!
Walk In Intake/Assessments a 0% No Show Model Why Same Day Access? It makes Sense! When looking at Access Models, you should first ask yourself, Whatdo 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. ReduceSystem Waste Inseveral cases CBHOshave determined that due to the Reduce System Waste In several cases, CBHOs have determined that due to the high rate of initial no shows experienced, there would be less clinician time utilized to move to a non scheduled walk in intake process.
Assessment Appointment Trends by Days of Wait for all Centers (Over 22,000 Events) Days Wait
NCQA Accreditation Standardsfor Patient Centered Medical Homes (PCMH) NCQA has published accreditation standards for PCMHs PrimaryCareDevelopment Corporation has developed 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
Source: Primary Care y Corporation PCMH Self- Assessment Tool
Walk In Intake/Assessments a 0% No Show Model The Anxiety that can proceed this change is 10 times worse than the change itself! Same Day Access does NOT look klike this; as long as you plan it out correctly! Photo Credits: Matador Records & The Simpsons
Walk In Intake/Assessments a 0% No Show Model The Set Up Steps for Success! 1. Determine your Organization s Demand andoptimal Hoursofof Operation 2. Select Your Staffing / Team Model / Back Up Contingency Staff 3. Set a Plan to handle your Existing Appointments 4. Choreograph hyour Wait time 5. Communicate and Go!
Walk In Intake/Assessments a 0% No Show Model Set Up Steps: 1. Determine your Organization s Demand and Optimal Hours of Operation Full Open Access (Recommended if demand is sufficient) Open Access Days Hybrid Model Call Ahead Times
Walk In Intake/Assessments a 0% No Show Model Set Up Steps: 2. Select Your Staffing / Team Model / Back Up Contingency Staff Set Team Intake/Assessment clinicians are assigned full or part time to specifically provide all intake/assessments on a walk in basis. After assessment, consumer is referred to other clinicians for treatment. Negative to this model is that the consumer must tell their story at least two times, UNLESS, the treating clinician will trust and utilized the assessment provided at intake Rotating Team Regular unit clinicians are scheduled in two hour blocks beginning each morning and throughout the day (fourblocks) to provide intakes. The number ofclinicians assigned to eachblock is based on historical intake calls received and intakes provided.
Walk In Intake/Assessments a 0% No Show Model Set Up Steps: 3. Set a Plan to handle your Existing intake / assessment Appointments Smooth Transition Kick Off Date End of Transition Existing Appointments Walk-In Appointments
WlkI Walk In Intake/Assessments t a 0% No Show Model Set Up Steps: 4. Choreograph your Wait time Pre session: What are the pre session activities that you will utilize? Session goals: Master s Level assessment provided the same day of call or walk in for help (If the consumer calls after 3:00 p.m. they will be asked to come in the next morning unless in crisis or urgent need) Initial diagnosis determined Level of Care and Benefit Design Identified with consumer Initial treatment plan Developed based on Benefit Design Package Follow Up Goals: 2nd clinical appointment for TREATMENT within 8 days of Initial Intake 1st medical appointment within 10 days of Initial Intake
Walk In Intake/Assessments a 0% No Show Model Set Up Steps: 5. Communicate and Go! Traditional Script Elements (3 5 min) Basic Demographics (Name, Phone) Confirm Crisis Status Confirm what services they desire Confirm their funding source (Script B?) Give them hours of operation & what to bring Ask them what time they plan to come in
Walk In Intake/Assessments a 0% No Show Model Successfully Running Now What? 1. Utilize Data to Confirm Planning Assumptions. 2. Monitor and Ensure Sustainability!! Review Capacity and Adjust accordingly 1. No Show Management 2. EOC / LOC Reviews
Process Redesign Review DATA/ RESULTS
Walk In Intake/Assessments a 0% No Show Model
Walk In Intake/Assessments a 0% No Show Model Although the group average was a 50% reduction in wait time, that means different things g g p g, g for different teams based upon their starting point. In the results above from the National Council s most recent Access Redesign grant, you can see that two teams actually reduced their wait time by 90% or more during our 8 months work time!
Tracking your Transition Our Projections were for a Maximum of 21 Intakes per day, and to achieve an average of 7 Intakes per day with in 16 days.
Tracking your True Impact!
JIT To a Prescriber in 3 Days
Access to Care Timeliness Case Study Using data that demonstrate the following about the relationship between initial contact for help, Open access (same day assessments), second appointments and no shows. Sample size is 561 new customers who received an intake between January 1, 2009 and May 31, 2009. The summary of outcomes identified are outlined below: a. Approximately 95 percent of the customers who have their second appointment scheduled within 12.2 days of their Intake show for that appointment. Therefore the10 day access standard dthat is recommended is valid for the second counseling service and medical appointment. b. Approximately 70 percent of customers who have the second appointment scheduled 22 days or more after their intake did not show. c. 100 percent of the customers whose second appointment was canceled by the Center never came back.
Access to Care Timeliness Case Study
Access Redesign Grant Results Assessment Appointment Impacts