How to ensure organizational sustainability with uncertain funding: Customer focus fuels change at ADANTA Group

The Adanta Group provides behavioral health care services to 10 counties in the Lake Cumberland area of Kentucky. Its 10 outpatient clinics serve between 12,000 and 15,000 clients each year.

Adanta has been using NIATx process improvement methods since 2009, when Jamie Burton, CEO, and Beverly Loy, Clinical Director, attended a NIATx training offered by the Kentucky Department for Behavioral Health, Developmental, and Intellectual Disabilities.

The Adanta Group is also participating in the NIATx learning collaborative on business practices, NIATx-SI: Business Practices for the Future.

"The NIATx model offers a way to make changes quickly, which is exactly what we were looking for," says Jamie.

Jamie, Beverly, and Dan Luchtefeld, Adanta's Performance Improvement Director, described how they used the NIATx method to meet a financial crisis in "How to ensure organizational sustainability with uncertain funding," a how-to workshop they gave at the 2012 SAAS Annual Conference and NIATx Summit in June.

In 2010, the state passed legislation requiring agencies across the state participating in the Kentucky Employee Retirement System to increase the employer rate of contribution. (Kentucky allows private sector organizations to participate in the state retirement system.) Contribution rates increased from 12% to 17% in 2011 and to 20% in 2012.

Retirement contributions are funded solely by the agency, with no contributions from state government. Adanta’s revenue comes mainly from grants and Medicaid billing. With Medicaid rates from 2009, and no increases expected in the near future, the Adanta management team knew it would have to examine services and staffing to keep the retirement system contributions from adversely affecting the clients and staff. Their solution was a four-pronged approach: reduce no-shows and time to treatment, increase admissions, improve staff productivity, and improve collections.

Communicating the need for change was an important first step, as was looking at Adanta as a system. Explains Jamie, "We went to our staff and our Board and explained that we needed to figure out how our system works, from the time a client walks in the door to the time we receive payment for services staff provide."

To reduce no-shows, Adanta began to make "in-person" reminder calls, a change from the less personal computer-generated reminders. "We really worked on building a team spirit at every site,' explains Beverly. "Support staff and clinicians made reminder calls in their down time Increasing evening hours for substance abuse treatment sessions improved the show rate and also increased admissions."

Data helped the Adanta team make changes to improve productivity. An analysis of productivity data showed that the daily average of kept appointments at each of the 10 outpatient sites was 22.2, with a daily average of 2.6 per clinician.

"We discovered some clinicians were scheduling appointments as far out as a year ahead—and that many turned out to be no-shows. Having time blocked meant that staff was not available to accommodate walk-ins, emergencies, or new admissions," says Dan.

Productivity increased when clinicians were allowed to schedule just one appointment at a time. Another new policy required that clinicians spend 60% of their time each week providing services either directly (the majority of time) or as an adjunct to client services. An improved system for tracking time and documenting services allowed clinicians to get timely feedback on their productivity.

"A key element in this change project was sharing information with staff—where the agency was and where the agency needed to be—and explaining the need for improved productivity that first and foremost benefitted the client, as well as the staff and the agency,” says Jamie. “While we lost a few staff, this also inspired many to work smarter and spend their time more effectively."

To increase new clients and reduce time to treatment, the Adanta change team developed a new process for screening. "We've reduced time between a client's first contact with the agency and time to treatment from an average of 14 days before the changes were made to an average of 7 days," says Beverly. Sites now offer same-day service for emergencies.

Adanta also increased its marketing efforts to attract new clients. This involved creating brochures for all services, advertising in local media, sending thank-you letters to referral sources, and attending local conferences and job and health fairs. These efforts doubled the number of new clients coming to the agency for services.

To improve collections, the Adanta team examined its billing audit process. "We were losing revenue because of billing errors," explains Jamie. A new system was developed to reduce errors. Better documentation by staff who provide services and by those who collect payments has increased accountability, reduced errors significantly, and improved the bottom line.

As a result of this system-wide change effort, The Adanta Group was able to meet the new retirement system contribution increases—and offer salary increases.

"The agency-wide effort of staff education, improved and focused processes, increased monitoring on the items that were affecting collections, and timely reporting back to the clinicians are the huge contributors to the success of the project. Staff were excited and appreciative of the pay increase," says Dan.

"The solutions for change were based on a focus on customer service. Not only did the change projects improve our systems—they also served to remind staff of our agency's mission," adds Beverly.

Adanta's advice to other organizations that face budget cuts and increased costs?

For Jamie, the NIATx focus on data was key. "Take time to drill down to the data that really matter, and organize it into a presentation for staff." She encourages organizations with multiple sites to provide site-specific data.

Other essential ingredients in the Adanta Group's success included:

• Educating everyone in the agency, including the board
• Improving or creating processes to address problems
• Monitoring staff and providing timely feedback

This system-wide change effort also helped The Adanta Group prepare for managed care, which arrived in November 2011. "A similar approach, with a focus on customer service, helped us create a positive working relationship with the managed care organizations from the get-go," says Jamie.

To view the Adanta Group's Powerpoint presentation, "How to ensure organizational sustainability with uncertain funding," visit www.saasniatx.net