SAME DAY ACCESS AND CUSTOMER

ENGAGEMENT

Noel Clark, CEOCarlsbad Mental Health

WHAT IS SAME DAY ACCESS?

Same Day Access is a both a philosophy and a practice management process. The philosophy dictates that the practice must

respond to the customer the same day services are requested. Then, all efforts must focus on customer engagement.

Four (4) points I hope you take from this session

Same Day Access will improve customer outcomes, increase capacity, improve productivity and enhance revenue

Same Day Access is both practice management and practice philosophy

Capacity is not a number – it exists when a practice is unable to offer services as defined in Episode of Care (EOC) standards or treatment plans

High No-shows and low productivity are not the problems – they are symptoms of an agency centered approach

When a customer walks into your practice for the first time and requests services – Does your practice say YES or NO?

AGENCY CENTERED•Evaluate how much of your intake process is focused on feeding the data monster.•Do you hand your customer an Intake Packet or review your Intake Packet with the Customer?•Do your customers see a clinician on their first visit?•Do you schedule Intakes?

CUSTOMER CENTERED PRACTICE

•Can a customers get an Intake an hour of any day you are open•Do you have Customer Engagement Standards?•Do you have a Customer Engagement Policy?•Do you discharge inactive customers?•Do you know the capacity of your practice?•Do you remind customers of their appointments

FIRST STEPS Leadership must embrace SDA and the

Premier Customer Service required to transform the practice

Define your practice – Agency Centered or Customer Centered

Re-define your practice to be prepared to respond and engage customers on their terms

Performance Expectations, job descriptions, standard operating procedures related to SDA

Ongoing monitoring of benchmarks that guide supervision and coaching

HOW DO I GET THERE? Discharge policy – Clean up your case loads Practice Expectations Customer Engagement Standards Establishing performance standards Monitoring performance Coaching Supervision

DISCHARGE POLICY Clean up your case loads Inactive customers – define inactive Establish standard Attempt to re-engage customers –

letters/calls If they decline – admin discharge First step in understanding your capacity

CLEAN UP CASELOADSCapacity exists when your practice is unable to schedule appointments to meet your Customer Engagement Standards

• Management Team defines “inactive”• Discharge customers who are inactive• Manager responsible for monthly clean up• Monitor the number of admits and discharges

monthly

Assignments Closed by Clinician, April 2012

Honor Medina (18)

Julie Nason(6)

Kathryn Lackner(2)

Cynthia Fossan(0)

Steve Meagher(2)

Rob Clements(20)

Liz Moore(2)

All Clinicians (50 Total)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

11%

0%

0%

0%

0%

10%

50%

10%

72%

0%

50%

0%

0%

85%

0%

62%

0%

0%

0%

0%

0%

0%

0%

0%

17%

100%

50%

0%

100%

5%

50%

28%

Treatment Completed Treatment Incomplete Discharged for Lack of Client AccountabilityAdministrative Discharge

Practice Expectations

• Access Goals – no appointments for intakes• Productivity – includes hours billed and

documentation compliance• No Shows – for 2nd appointments• Backfilling appointments• Standard Operation Procedures• Case Completion goals• Monthly reporting

CARLSBAD MENTAL HEALTH CENTERPractice Expectations

1st Quarter Revisions – FY 12

BUSINESS OPERATIONS  Department and corporate revenue will meet or exceed budgeted amounts on a quarterly basis.

Corrective action plans will be in place by January 31st where revenues shortfalls are noted during the first 2 quarters of operations. The CFO will provide the E-Team and DPM a quarterly report identifying revenue shortfalls by department.

Department and corporate expenses will be managed at 90% of revenue annually. Corrective action plans will be in place by January 31st each year where expenses exceed 90% of revenue in the first 6 months of operations. CFO will provide the E-Team and DPM a quarterly report identifying areas where expense overruns are identified

Department and corporate revenue and expense budgets will be reviewed quarterly and revised as necessary. Review and revisions must be completed and implemented by the 30th day of the month following the end of the quarter.

90% of client cancellations will be backfilled by the CSRs. Compliance will be reported to the E-Team monthly.

All appointments will be confirmed 48 hours in advance. All client cancels with less than 24 hours notice will be considered and documented as a No Show. Customers will be advised of this at the 48 hour confirmation and appointment cards

CSR Manager will provide a scheduled monthly update to E-Team on customer fees to include comparison to goal  

No revenue lost due to authorization or credentialing problems. New direct service staff must be credentialed to provide services prior to beginning employment

Medical Loss Ratio (MLR) will be managed and the DPM will report these figures to the E-Team monthly. Suspense Reports will be monitored and reported by the DPM. Corrective action plans will be in place for

staff where suspended billing is deemed a problematic issue

Customer Engagement Standards

• Second clinical appointment• First medical appointment• Treatment plan development• Tentative diagnosis• Episode of Care• Performance goals define what is monitored• Monthly reporting• Supervision & Coaching to standards

DAYS TO ACCESS

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11Dec-11 Jan-12 Feb-12 Mar-12 Apr-120.0

5.0

10.0

15.0

20.0

25.0

30.0

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

12.710.8 10.8 11.6 11.1 11.1

12.29.9 10.7 11.5 12.1

16.013.9

24.7

10.4

13.912.9 13.3 14.2

18.7

10.8

20.0

11.7

7.68.7 8.1

4.1

15.2 13.8

17.5

11.911.9

AVERAGE DAYS TO INTAKE AVERAGE DAYS TO 1ST THERAPY AVERAGE DAYS TO 1ST MEDICAL

INTAKE SERVICE REPORT

Mar-11

Apr-1

1May

-11Jun

-11 Jul-11

Aug-1

1Sep

-11Oct-

11Nov

-11Dec-

11Jan

-12Feb

-12Mar-

12Ap

r-12

0

20

40

60

80

100

120

140

160

180

INTAKE CALLS WALK-INS PERFORMED DEFERRED WALK-OUTS

NU

MB

ER

No Show Management

• Define No Shows & cancellations • Define number of No Shows per EOC• How many center cancellations should

a customer allow before firing you?• Revise policy to incorporate standards• Revise Customer Rights and

Responsibilities• Monitor performance and provide

coaching & supervision

Develop an Intake Team

• Build around clinicians with solid diagnostic skills and who are widely credentialed

• Realistic productivity expectations – 3 intakes a day• Define the elements of an Intake• Define roles and responsibilities (insurance

verification, confirmation, prior authorizations)• Incorporate data gathering, fee assignment, fee

collection and centralized scheduling • Monitor Intakes monthly and compliance at each step

– customer service, clinical, documentation• Know in advance when to add FTEs.• Adjust FTEs quarterly

Carlsbad’s Timeliness Case Study

Carlsbad MHC produced data that demonstrate the following about the relationship between initial contact for help, Same Day Access, second appointments and no-shows.  Sample size - 599 new customers. Approximately 95 percent of the customers who have their

second appointment scheduled within 12.2 days of their Intake show for that appointment.  Therefore the 10 day access standard that is recommended is valid for  the second counseling service and medical appointment. 

Approximately 70 percent of customers who have the second appointment scheduled 22 days or more after their intake did not show.

100 percent of the customers whose second appointment was canceled by the Center – never came back.

19

Lessons Learned No shows at intake can and should be eliminated Low productivity and high no-shows are symptoms of

poor customer service Customers don’t stop coming because they aren’t

motivated – they stop because we fail to engage them

Episodes of Care make providers accountable to our customers

Outlining the cost, frequency of appointments and duration of the process improves engagement

Capacity has nothing to do with caseloads and everything to do with compliance with EOC guidelines

Final Thought If a practice expectation is

important enough to be identified, Leadership must

define it, incorporate it into into training, job descriptions,

standard operating procedures, performance evaluations and

performance incentives.

26%

18%

17%

8%

8%

5%

5%

4%3%3%2%2%

Referrals April 2012SelfJudicialFamily/FriendNo ResponseOtherSocial Service AgencyPhysician/CNS/PCPSchoolsOther MH/DD ProviderInpatient Institu-tionEmployerCYFD Juvenile Jus-tice

28%

24%7%

5%

8%

5%

5%

2% 5%7%

1%4%

Referrals Through May 24, 2012

Self

Judicial

Family/Friend

No Response

Other

Social Service Agency

Physician/CNS/PCP

Schools

Other MH/DD Provider

Inpatient Institution

Employer

CYFD Juvenile Justice

Coaching & Supervision

0

50

100

150

200

250

300

350

80 7893 99

75 7444

30 35 39 43 3952

29 22 20

169154

171189

219206

131104 111

125109 114

92

58

120108

249

232

264288

194

280

175

134 146164 152 153 144

87

142 128

BACK FILLED NOT FILLED TOTAL NS-CX

NUMBERS OF MISSED APPOINTMENTS BACKFILL STATUS