BH Business Learning Network Participants: “Results were immediate—enrollments began increasing right away”

Participating in SAMHSA’s BHBusiness Plus learning network on Eligibility & Enrollment helped Deb Freed and Ty Curtis of Northern Lakes Community Mental Health Center in Traverse City, Michigan increase enrollment in the agency’s new Health Home program for people with co-occurring disorders. They share some insights from that experience in the interview that follows.

Deb Freed, MBA, Managing Director, Freed Communications Inc., is responsible for Marketing and Public Relations at Northern Lakes CMH, including health promotion, consumer outreach and engagement, and social media. She has a strong interest and assists with grants, project management, change management and strategic planning.

Ty Curtis, LLMSW, Case Manager/Health Home Team Lead, has worked as a case manager serving adults with serious mental illness since 2007. He has worked on the development and implementation of Northern Lakes CMH's healthcare integration projects since 2012, including on-site primary care services and the Michigan Medicaid Behavioral Health Home pilot.

Why did Northern Lakes Community Mental Health want to join SAMHSA’s  BHBusiness Plus learning network on Eligibility & Enrollment? 

Deb Freed: We are a Health Home pilot site for the State of Michigan and a recent grantee of SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) program. We have contracted with a Federally Qualified Health Center to provide primary care services on site in the Northern Lakes CMH Traverse City office. We are particularly interested in ways to increase enrollment into the new Health Home program and clinic.

(The Health Home is an option under the Affordable Care Act that offers financial incentives to states to develop and implement a medical home for people with chronic health conditions, including serious mental illness.)

Ty Curtis: There have been such significant changes to health care eligibility and enrollment over the past few years. This learning network seemed like an opportunity to bring ourselves up to speed on what these changes were and how they affected the people we serve. In addition, the projects Deb mentions are primarily grant funded at this time. We realized that, in order to ensure financial viability and sustainability long-term, we must first ensure that we are able to link the people we serve with health care coverage they are eligible for.

Describe NLCMH and the pilot Health Home project.

DF: Northern Lakes CMH is a community mental health service program serving adults with mental illness, children with serious emotional disorders, individuals with intellectual and developmental disabilities, and people with substance use disorders, in six counties in Northern Michigan. The Health Home pilot is for people who live in Grand Traverse County only. The state of Michigan provides a list of people eligible for the program. These are people who have a serious mental illness, with Medicaid, who also have co-occurring chronic medical conditions along with high rates of inpatient hospitalization or emergency department use. The Health Home program provides six new services: comprehensive care management, care coordination, health promotion, comprehensive transitional care (from inpatient to other settings, including follow up), individual and family support (which includes authorized representatives), and referral to community and social support services (if relevant). The goals of Michigan’s Health Home benefit are aligned with those of CMH: Reduce avoidable hospital inpatient and emergency department admissions, improve self-management of mental illness and chronic physical health conditions, improve adherence to prescription medications, and improve the consumer’s experience of care.

TC: Michigan’s Health Home Pilot is an effort by the state to change the way we address the multi-morbid chronic health conditions and poor health outcomes of individuals who also struggle with serious mental illness. This is group of people who we have long known struggle with access to adequate and appropriate care, experience higher than average rates of chronic disease, and have a life expectancies decades shorter than the general population. In addition, this is a group of people who are historically difficult to treat in the traditional primary care model. The Health Home is an attempt at leveraging the skills and success that Michigan’s Community Mental Health system has had in fostering positive engagement and recovery from these serious mental health conditions, and use them to address the physical health needs of this population as well.

What was your role in the BhBusiness Plus Learning Network and/or the HH project?

DF: I am involved in health promotion, consumer outreach and engagement, and social media and communications. I also have a strong interest in strategic planning and change management.

TC: I am a case manager for adults with mental illness, and the Health Home Team Lead. I have been involved in the planning, development, and implementation of all of NLCMH’s integrated health projects since 2012. I brought the clinical perspective to the learning network, looking at how best to translate the information from the course into our current work practice.

What did you team find most helpful/inspiring/instructive about the learning network? Can you comment on specific resources that your team found particularly useful?

DF: We particularly liked the unit on starting a change project. The learning network provided a great change management form that lays out a process for creating or changing a business practice. This tool includes a Project Charter that guides you to very concisely lay out your goals, target client population, change leaders and team members, and expected financial impact of the project. It also has a work plan template with Plan, Do, Study, Act rapid change cycles, which we found very helpful.

We were also thrilled to discover the Promising Practices section on the NIATx website where we found a treasure trove of information, organized by AIM, including Increasing Admissions. These two sources of information – the change management tool and the promising practices repository – significantly reduced our research time and jumpstarted our work, so that within a week’s time we were able to make a plan to ramp up our enrollment processes. The results were immediate in that enrollments began increasing right away.

TC: Having access to a knowledgeable and supportive coach was fantastic, and it was also great to have the opportunity to talk with other organizations from around the country, to hear what their successes and failures, and to brainstorm new ideas. I agree that the rapid change cycle template and promising practices have been invaluable in jump starting our efforts to increase our projects enrollment. We found concise, step-by- step directions on ways to tackle the issue, and a clear overall document that helps communicate the goals, objectives and timeline of the project.

Did you or your team have an “Aha!” moment?

DF: In Michigan we have had major budget cuts that have significantly impacted services. For me, an “AhA!” moment came in completing the change management tool and very clearly defining the goals and the impact of our success. This helped us see the benefits of increasing enrollment. Success will generate new revenue for the organization, save unnecessary health care costs, and free up dollars in NLCMH General Fund. From a non-financial standpoint, success for the people served will mean additional support, greater convenience, and, ultimately, better and longer quality of life. For case managers and other clinical workers, success will mean work load relief, more support, and greater satisfaction in seeing the people they serve doing well. Having this kind of shared vision has helped inspire our team.

TC: My “Aha!” moment came when I was looking through the Promising Practices documents and realizing that the struggles we are having were not new or impossible to fix. Finding this resource was great for reminding me that we don’t need to reinvent the wheel and create a solution out of whole cloth. Instead, we can take what has worked for others and find a way to fit it into our particular situation.

What did your team accomplish in the BH Business Plus learning network?  

DF: We accomplished making a change management plan and learning about what works in increasing enrollments. We immediately began implementing the new strategies.

TC: We started our first Rapid Change Cycle in January 2014, looking at ways to increase enrollment in the Health Home program and targeting 16 new enrollments per month. In spite of a rolling start to these efforts over the course of the month, we enrolled 12 new members into the Health Home program—75% of our monthly goal, which was over a 33% increase from our total enrollment in the first 6 months of the pilot project.

Will any of the NIATx  practices you learned about become standard procedure at NLCMH? 

DF: The promising practices we have found most effective so far are: Collaborating with referrers to streamline the process, encouraging referrers to make the first appointment while the client is present, guiding people on how to make a referral and orient clients. We also did a walk-through of the referral process, which was instructive. In the future we plan to explore using motivational incentives. We also plan to revisit the NIATx website to learn more about promising practices to reduce no-shows. That will likely be another area in which we will apply change management principles.

We very much appreciated the great guidance from our BH Business coach Bruce Emery. He was very accessible, helpful and encouraging.

For more information about SAMHSA’s BHBusiness Plus, contact Amy McIlvaine, NIATx Educational Services Director: amy.mcilvaine@chess.wisc.edu