Kennebec Behavioral Health-Maine STAR-SI

We believe that time to service can be a barrier for people seeking substance abuse treatment, and by reducing time to service, we help patients to over come a potentially damaging obstacle to recovery.  

Live scheduling of appointments for clients calling to seek substance abuse treatment.

There are systemic & personal barriers to treatment and even initial engagement that can be better managed to ease entry into service.

Abstract

The Rapid Cycle Change process (RCC) was first brought to the Access Center by Bob Long as a way to improve upon the accessibility of the continuum of care starting with entry into service, and extending into engagement and retention of patients.  The model was initially applied to substance abuse treatment models and is used here for improving access to substance abuse treatment as well as a variety of services at Kennebec Behavioral Health (KBH).  The model has also been applied to technology transfer of the workforce at KBH with an eye on improving overall access to services through improving work efficiency.

Rationale

Technology transfer is something that KBH has had to deal with in the context of automatic (electronic) health records, and that has impacted our Access Center greatly.  In addition to an electronic health record, the skill sets of Access Center clinicians has had to expand to include being adept at web navigation (for resources), automated insurance systems, advanced phone systems, and electronic communication such as email, and electronic address books to maintain current community resource and contact information.  As insurance coverage rules and managing payor mix has become more pedantic, some artificial barriers are inadvertently created or exacerbated and thus, interfere with access to services.  We have attempted to apply the RCC to mitigate and eliminate these barriers, while concurrently maintaining the efficiency designs intended by the introduction of the technology in the first place.  The RCC begins with taking the point of view of a client and doing a “walk through” – to more fully appreciate the client’s experience.

Conducting the Walk-Through

Bob Long, Mickey Sirota, and myself conducted the walk-through with Julie Grant providing us the service of the pre-intake paperwork and orientation interviews.  During the walk-through, we realized that, prior to treatment initiation, our patients were experiencing lots of data collection related more to demographics than to addressing their reasons for seeking treatment.  With the help of our advisor, Scott Farnum, LCPC, LADC, MPA, we looked at how we were capturing information from the initial point of contact, from a patient’s first phone call to our agency and up to the pre-intake interview.

Concurrent with the Walk-through, implementation of the Beta version of our ACD (Automatic Call Distribution) system occurred between our Augusta and Waterville sites.  Ideally, this system will be expanded to all KBH offices (including our Winthrop and Skowhegan clinics).  All calls are routed to our Access Center clinicians, for screening and some initial level of care determination.

What we learned:

Systemic Barriers include:

Inefficient Phone Systems

Payor verification

Show rate rules

The “Pedantic Experience” of service entry

With the “technology transfer” of our ACD system implantation, the Access Center moved to a “live scheduling” mind set.  Live scheduling means: Ideally a caller would be transferred to a live person, capable of speaking with the caller directly and avoid having to call back to get information, and again, ideally being scheduled at the time of the initial call.  ACD routes calls from our receptionist to the next available Access Center clinician who can gather the information, preliminarily assess level of care needs, verify insurance, match the referred client’s needs, payor, and demographics to the appropriately credentialed clinician with availability conducive to the client’s need for scheduling (there was a previously established automated system called Qualifax, in which clinicians enter their availability to do intakes for new clients, and would have access to those schedules for this purpose).

The largest barrier to live scheduling is the verification of insurance.  During the initial (pre walk-through, done by Scott Farnum, our RCC advisor) – the live scheduling process was interrupted when Scott was asked to call us back for with his insurance number.  Ideally, we would schedule based on the information we do have with the understanding that the schedule is pending insurance verification.  Client would then be called back if insurance coverage was unverified (i.e. negative for coverage during our verification process).

Other barriers to live scheduling would include competing interests on the time and demands placed on Access Center Clinicians, i.e. intake interviews, case reviews, clerical duties, etc.  This observation would become a smaller area of an RCC focus (if we can reduce tasks, more time would be devoted to live scheduling).

Figure 1