TO CARE A PERFORMANCE IMPROVEMENT PROJECT Vicki Sidrow MPA President and CEO Joseph Ume LCSW CCS DRCC Vice President Clinical Services What is rapid access Rapid access also known as open access or same day access is the process of implementing processes to allow for ID: 695355
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IMPLEMENTING RAPID ACCESS TO CARE
A PERFORMANCE IMPROVEMENT PROJECT
Vicki
Sidrow
, MPA
President and CEO
Joseph Ume, LCSW, CCS, DRCC
Vice President Clinical ServicesSlide2
What is rapid access?Rapid access, also known as open access or same day access, is the process of implementing processes to allow for quicker access to treatment to meet the immediate needs of individuals. Slide3
Why rapid access?Community Mental Health organizations have historically had too many no show or cancellations for first time appointments (as well as others). Scheduling out weeks, or in the case of psychiatrists, sometimes months. Literature reviews suggest that “wait times of up to 10 days from an initial contact to a formal assessment is fast becoming a thing of the past” ("Table of Contents," 2014) (Mental Health Weekly). Slide4
Why rapid access?Long wait period for services is not good customer service, good care or good business. “Therefore ,a fast ,effective and flexible response close to the point of initial contact should be an essential component of the fight against the major public health impact of mental health problems” (Gershon and Rider 1992) mental health Practice. Slide5
Why rapid access?Prevent decompensationReduce anxiety, Depression, Life Crisis.Maintain stabilityFavorable client outcomeReduce cost for careRapid access to care plays a role in keeping clients out of the jail or emergency room*.*"Overcrowding in ERs is a nationwide problem. With the (Affordable Care Act), more people have insurance but don't have doctors."(Bruce, 2015)Slide6
Access redesign PI projectSlide7
Access Redesign ProjectThe two basic
reasons for choosing to changing our access process at Vantage Health System were:
1. Client Centered: To provide timely availability of first time clinical assessments for those struggling with mental health crisis or chronic mental health issues.
2.
FFS:
To
prepare for the changing
funding model as
the State Division of Mental Health and Addiction Services (DMHAS) transitions funding from a grant
based funding
to a Fee For Service arena in the year 2017. Slide8
Planning the Project : Access RedesignPrimary goal was to get clients into first clinical assessments soonerData collection on number of assessments scheduled, days, time, etc.Data collection on number of no shows/cancellation of assessments36% no show/cancellation rate 11-24 days for first appointment. Slide9
Planning (continued)Researched literature on rapid access modelsInvolved some clinical staff at to help in-house design of a pilot for rapid access in one location, limited hours using data collected. Slide10
DO !Vantage Designed Pilot: April 20143 hour block one day a week in Englewood siteDid not exclude other scheduled assessment timesComplicated by our use of outsourced Access Call CenterSlide11
CHECK Results were promising but decided we could use some consultation help with full implementation agency wide as we realized the many processes that would need to change and we wanted more staff buy in. Slide12
ACT !September 2014 : Hired MTM Consultants through National Council on Behavioral Health On site kick off with all clinical staff for importance of project, buy in, etc.Monthly webinars with MTM consultant and internal team made up of CEO, VP Clinical Services, Access Liaison and Outpatient Clinical Coordinators through November 2015Tools to decide how many clinicians you would need to implement rapid access , how many hours, etc. Slide13
DO ! Access Call CenterApril 2015From contracted access to in house access: This involved moving away from outsourcing our access services to a contractor who utilized Masters level Clinician with licenses to using bachelor level staff with experience in mental health and providing close supervision on screening calls. Expectation is that calls be time limited to 15mimutes. Access: Wrote script for new clients (language is important)Brief Screening by telephoneCollect Demographics, verify benefitsOffer walk in access times (varied at our 2 locations)Face to Face Assessment with Licensed Professional
Case Management assistance with application for Health Care CoverageSlide14
Access ScriptFOR ENGLEWOOD/Dumont: Our entry point of care is through rapid access slots. We do assessments on Mondays 1:30 pm to 6:00 pm, Tuesdays 9:30 a.m. to 2:00 p.m. We tend to have more people come at the beginning of the time, and wait may be longer then. What time do you think you might be coming in? If you need a bilingual clinician I can offer you 2:00 pm or 5:00 p.m on a Monday, and/or Tuesday 10:00 a.m. You need to arrive half hour early to complete your paperwork. Rapid access in DumontWednesday 12:30 pm – 2:30 pm
Would you prefer walk-in time on Monday or Tuesday in Englewood or Wednesday in Dumont? What time do you think you will be coming in?FOR ALL CALLERS:You need to bring with you your insurance card whether private insurance, Medicare or Medicaid. If you do not have insurance please bring 2 pay stubs and your last income tax and proof of address. We must have this information to determine the cost of your service. At this first appointment you will be required to pay any co-pay or co-insurance required. We accept cash, checks, and credit cards
.Slide15
DO ! GO LIVE DEDICATED SLOT TIME FOR RAPID ACCESS VS CALL VOLUMECONTINGENCY STAFFING Slide16
DO !Simultaneous process changes: Collaborative DocumentationRemoved scheduled assessment times from all clinician’s schedules and Implemented Centralized Scheduling Slide17
COLLABORATIVE DOCUMENTATION: SETUP"Create a script to properly introduce the process of collaborative documentation.Treatment Planning/Individual Session” Sample: We are going to utilize a new note taking strategy during our session today. Instead of me taking notes after the session by myself, we will take notes together at the end of the session which will allow us to focus and agree on what was accomplished.“ In doing so I will allow you to read the notes I take to actively participate in the reflection process.” Everything is done within the clinical hour. When this
client is done you are ready for your next client.Slide18
centralized schedulingInitial removal of all scheduled assessments from clinician schedules.Over time , given the number of ongoing clients and missed therapy appointments, we allowed ACCESS to schedule an assessment in any open slot by Wednesday of each week for Thursday or Friday. Slide19
CENTRALIZED SCHEDULINGNeeds constant monitoring as clinicians were still plugging clients into open slots, not alerting front desk, causing double bookings as Access or front desk staff may be booking another client for same time slot = client dissatisfaction, confusionAdded new “Scheduler position” Slide20
CHECKResistance by clinical staff to maintain new processesOur finding indicated that clinical staff had to be flexible in dealing with the uncertainty of the volume that might walk through the door ( Mental Healthy WeeklySlide21
CHECKApril 1, 2015 – March 30, 2016April 1, 2014 – March 30, 2015
Number
of scheduled assessmentsTotal No. completed assessments%MissedAppts.679
435
36%
Number of hours available
Total No. completed assessments
%
Missed
Appts
.
656*
611
9.3%
176
new assessments
Missed
Appts
. 26.7%
Avg. *12 hrs week Rapid Access Time
Remainder: Backfill of open timeSlide22
PROJECT TIMELINE
Access RedesignPI Project1/2014
Rapid Access Pilot 4/2014
MTM Services
Consultation
9/2014
In-House
Access Center &
Rapid Access
4/1/2015
Scheduler Hired
12/2015
Evaluation
4/2016
Centralized
Scheduling
Collaborative Documentation
Training
11/2014
Rapid Access Pilot
12/2014Slide23
Lessons LearnedRapid Access model crucial process in new FFS worldStaff training and buy in needed On going monitoring and reinforcement of processBe flexible and make changes as neededSlide24
NEXT STEPSRecently moved to Clinical Assessments for all first time appointments except individuals coming from hospitals.This is allowing for quicker access to Psychiatric Evaluations after assessments. Psychiatric appointments were 1-3 months out for first time appointments with a 50% no show /cancellation rateImplementation of Just In Time Scheduling for Psychiatric Medication Visits to reduce no shows and cancellations for that serviceSlide25
ReferenceBruce, G. (2015).
New Gary mental health facility provides 'rapid access'. Retrieved from https://login.proxy.libraries.rutgers.edu/login?url=http://
search.ebscohost.com/login.aspx?direct=true&db=pwh&AN=2W6368427343&site=eds-liveRussell
, J., Rafferty, J., &
Joice
, A. (2010). Stepped care: developing a service for people with mild symptoms.
Mental Health Practice, 13
(8), 25-27 23p.
Stanhope, V.,
Ingoglia
, C.,
Schmelter
, B., & Marcus, S. C. (2013). Impact of person-centered planning and collaborative documentation on treatment adherence.
Psychiatric Services, 64
(1), 76-79 74p.
doi:10.1176/appi.ps.201100489
Table of Contents. (2014).
Mental Health Weekly, 24
(9), 1-8. doi:10.1002/mhw.20415
Williams, E., Sands, N.,
Elsom
, S., &
Prematunga
, R. K. (2015). Mental health consumers' perceptions of quality of life and mental health care.
Nursing & Health Sciences, 17
(3), 299-306.
doi:10.1111/nhs.12189
MTM Services Slide26
THANK YOU ! Vicki Sidrow, MPA CEO 201-385-4400 x 3058vsidrow@vantagenj.org Joseph Ume, LCSW ,CCS, DRCCVP Clinical Services201-385-4400 x 3020jume@vanrtagenj.org