Increasing access and retention: Wisconsin STAR-SI

The Strengthening Treatment Access and Retention-State Implementation (STAR-SI) project (2006–2009) showed that payer-provider partnerships focused on process improvement can increase access to and retention in treatment. NIATx provided technical support for this project, funded by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT).

Nine states participated: Florida, Illinois, Iowa, Maine, New York, Ohio, Oklahoma, South Carolina, and Wisconsin. Since the end of the funding period, many of the grantee states have sustained and spread their improvements. For example:

• Florida developed the Florida Learning System to support continuous process improvement for behavioral healthcare providers statewide. (See related story in this issue about Florida’s recent activity in the NIATx business practices learning collaborative.)
• The Iowa Division of Behavioral Health and most Iowa substance abuse treatment providers continue to use NIATx as their internal quality improvement process. The Iowa Department of Public Health and the Iowa Behavioral Health Association participated in the first round of the NIATx Business Practices for the Future Learning Collaborative, convening 13 treatment providers to increase their contracts with third-party payers.
• Ohio’s performance management system includes retention measures, and the state has deployed a data reporting and feedback cycle to encourage use of the NIATx model. The Ohio Council of Behavioral Health & Family Services Providers also participated in the first round of the NIATx Business Practices for the Future Learning Collaborative, convening several providers to improve their billing processes.

In Wisconsin, the STAR-SI project was so well received that the state Department of Health Services has funded it continuously since 2010.

Michael Quirke, Program Evaluation Coordinator, Bureau of Mental Health and Substance Abuse Services leads the Wisconsin STAR-SI Program, with Deanne Boss, University of Wisconsin Department of Family Medicine, serving as the Program Director.

With new providers joining in 2012, more than 50 Wisconsin treatment agencies will be participating in Wisconsin STAR-SI. “Many of the providers are NIATx veterans, having been part of the original STAR-SI or another NIATx project. They’re available to mentor and encourage the new agencies that come on each year,” says Deanne.

The Wisconsin STAR-SI program offers training on the NIATx model and monthly “Focus Area” teleconference calls to support change projects and promote peer networking. Change team leaders or senior managers are required to participate in a one-hour NIATx-STAR-SI teleconference call with Deanne and attend an annual daylong learning session. “We’ve built the internal capacity to provide NIATx training and coaching, based on our experience with the original STAR-SI and other NIATx projects,” explains Deanne, who is also a certified NIATx coach.

During a learning session in August 2012, Mike and Deanne conducted a Nominal Group Session so that provider agencies could select the areas they wanted to work in in the coming year. This helped identify the following focus areas for change projects: increasing third-party revenue, building a credentialed workforce, tracking clinical outcomes, healthcare integration, and improving customer service, along with improving treatment admissions and retention. Another focus area the group identified is NIATx training for agencies new to the project.

The Wisconsin STAR-SI project offers participating providers a stipend to offset costs of participating in the program. They are required to submit change project forms semi-annually.

Deanne continues to see enthusiasm for the NIATx model among the new agencies that join the project. As an example, she cites West Central Wisconsin Behavioral Health (WCWBH) in Black River Falls, Wisconsin.

“This organization worked on a change project to improve treatment completion,” says Deanne. “They conducted six rapid-change cycles over the year, testing simple changes like reminder calls and motivational incentives.”

WCWBH drew on the experience of the veteran providers in the collaborative to find out what had worked for other providers in the state of Wisconsin. A baseline treatment completion through the fourth session was 55%. By the end of the project, they’d increased that to 100%.

Having been with the project since its beginning, Deanne has observed a change in the process improvement culture for participating providers. “Leaders as well as team members have become more effective because they have a process and tools they’ve come to trust,” she says. “Providers that have built NIATx into their cultures appear to be in better shape to withstand the changes in behavioral health, and they approach challenges in a more responsive manner.”