Improve the Payer Mix

Problem:

Funding from current payer sources is saturated.

Solution:

Attract clients that will improve the payer mix.

Featured Stories

Daybreak Youth Services in Spokane, Washington increased private bed days and revenue by 30 percent by managing admissions so that clients with different funding sources were admitted more evenly throughout the year. They also referred adolescents covered by state funding to Perinatal Treatment Services (PTS), another NIATx agency, and PTS referred clients covered by private payers to Daybreak. For more information see the PTS/Daybreak report from the field.

Prairie Ridge Addiction Treatment Services in Mason City, Iowa increased fee-for-service revenues (third party, Medicaid, and client-fee receipts) from $627,193 to $1,008,367 in two years by targeting their marketing on the 40 percent of their business that was fee-for-service, including third party insurance, Medicaid, and self-pay clients. The accounts supervisor put small Change Teams together within her department to increase collections of third party, Medicaid, and client-fee receipts using PDSA Cycles. For more information, see the Prairie Ridge business case.

Lessons Learned

• Manage referrals and admissions so that you are meeting contractual obligations and also leaving room to admit clients from other payer sources that will increase your revenue.
• Follow the the Ten Steps to Increase Targeted Admissions.

Tracking Measures

Cycle Measure

Number of admissions

Data Collection Form

None

ActionSteps

Follow the Ten Steps to Increase Targeted Admissions.