Noel Clark, CEO Carlsbad Mental Health

Same Day Access is a both a philosophy and a practice management process. The philosophy dictates that the practice must respond to the customer the same day services are requested. Then, all efforts must focus on customer engagement.

 Same Day Access will improve customer outcomes, increase capacity, improve productivity and enhance revenue  Same Day Access is both practice management and practice philosophy  Capacity is not a number – it exists when a practice is unable to offer services as defined in Episode of Care (EOC) standards or treatment plans  High No-shows and low productivity are not the problems – they are symptoms of an agency centered approach

When a customer walks into your practice for the first time and requests services – Does your practice say YES or NO?

Evaluate how much of your intake process is focused on feeding the data monster. Do you hand your customer an Intake Packet or review your Intake Packet with the Customer? Do your customers see a clinician on their first visit? Do you schedule Intakes?

Can a customers get an Intake an hour of any day you are open Do you have Customer Engagement Standards? Do you have a Customer Engagement Policy? Do you discharge inactive customers? Do you know the capacity of your practice? Do you remind customers of their appointments

 Leadership must embrace SDA and the Premier Customer Service required to transform the practice  Define your practice – Agency Centered or Customer Centered  Re-define your practice to be prepared to respond and engage customers on their terms  Performance Expectations, job descriptions, standard operating procedures related to SDA  Ongoing monitoring of benchmarks that guide supervision and coaching

 Discharge policy – Clean up your case loads  Practice Expectations  Customer Engagement Standards  Establishing performance standards  Monitoring performance  Coaching  Supervision

 Clean up your case loads  Inactive customers – define inactive  Establish standard  Attempt to re-engage customers – letters/calls  If they decline – admin discharge  First step in understanding your capacity

Capacity exists when your practice is unable to schedule appointments to meet your Customer Engagement Standards Management Team defines “inactive” Discharge customers who are inactive Manager responsible for monthly clean up Monitor the number of admits and discharges monthly

Access Goals – no appointments for intakes Productivity – includes hours billed and documentation compliance No Shows – for 2 nd appointments Backfilling appointments Standard Operation Procedures Case Completion goals Monthly reporting

 BUSINESS OPERATIONS  Department and corporate revenue will meet or exceed budgeted amounts on a quarterly basis. Corrective action plans will be in place by January 31 st where revenues shortfalls are noted during the first 2 quarters of operations. The CFO will provide the E-Team and DPM a quarterly report identifying revenue shortfalls by department.  Department and corporate expenses will be managed at 90% of revenue annually. Corrective action plans will be in place by January 31 st each year where expenses exceed 90% of revenue in the first 6 months of operations. CFO will provide the E-Team and DPM a quarterly report identifying areas where expense overruns are identified  Department and corporate revenue and expense budgets will be reviewed quarterly and revised as necessary. Review and revisions must be completed and implemented by the 30 th day of the month following the end of the quarter.  90% of client cancellations will be backfilled by the CSRs. Compliance will be reported to the E-Team monthly.  All appointments will be confirmed 48 hours in advance. All client cancels with less than 24 hours notice will be considered and documented as a No Show. Customers will be advised of this at the 48 hour confirmation and appointment cards  CSR Manager will provide a scheduled monthly update to E-Team on customer fees to include comparison to goal  No revenue lost due to authorization or credentialing problems. New direct service staff must be credentialed to provide services prior to beginning employment  Medical Loss Ratio (MLR) will be managed and the DPM will report these figures to the E-Team monthly.  Suspense Reports will be monitored and reported by the DPM. Corrective action plans will be in place for staff where suspended billing is deemed a problematic issue

Second clinical appointment First medical appointment Treatment plan development Tentative diagnosis Episode of Care Performance goals define what is monitored Monthly reporting Supervision & Coaching to standards

Define No Shows & cancellations Define number of No Shows per EOC How many center cancellations should a customer allow before firing you? Revise policy to incorporate standards Revise Customer Rights and Responsibilities Monitor performance and provide coaching & supervision

Build around clinicians with solid diagnostic skills and who are widely credentialed Realistic productivity expectations – 3 intakes a day Define the elements of an Intake Define roles and responsibilities (insurance verification, confirmation, prior authorizations) Incorporate data gathering, fee assignment, fee collection and centralized scheduling Monitor Intakes monthly and compliance at each step – customer service, clinical, documentation Know in advance when to add FTEs. Adjust FTEs quarterly

 Carlsbad MHC produced data that demonstrate the following about the relationship between initial contact for help, Same Day Access, second appointments and no- shows. Sample size new customers.  Approximately 95 percent of the customers who have their second appointment scheduled within 12.2 days of their Intake show for that appointment. Therefore the 10 day access standard that is recommended is valid for the second counseling service and medical appointment.  Approximately 70 percent of customers who have the second appointment scheduled 22 days or more after their intake did not show.  100 percent of the customers whose second appointment was canceled by the Center – never came back. 19

 No shows at intake can and should be eliminated  Low productivity and high no-shows are symptoms of poor customer service  Customers don’t stop coming because they aren’t motivated – they stop because we fail to engage them  Episodes of Care make providers accountable to our customers  Outlining the cost, frequency of appointments and duration of the process improves engagement  Capacity has nothing to do with caseloads and everything to do with compliance with EOC guidelines

 If a practice expectation is important enough to be identified, Leadership must define it, incorporate it into into training, job descriptions, standard operating procedures, performance evaluations and performance incentives.