1. Costs: What You Found Out and What Did You Do With It? For Example: What are ways you have identified to bring down costs? How have you changed processes to still meet regulatory requirements but improve access to care? How have you shared this info across your organization? Pre-Work

2. Citizen Advocates, Inc. Costs: What You Found Out and What Did You Do With It? CAI participated in on site consultation 3 years ago with MTM staff to facilitate a change management process in clinic operations. Intent was to reduce costs, increase revenue and improve quality of care. This cost exercise affirmed the effectiveness of implementing the practices we put in place over the past several years, and the need to revisit/remain vigilant. We also need to prepare for how this will translate in an outcome driven Managed Care world. KEY COMPONENTS: 1. Concurrent/Collaborative Documentation!!!!!! 2. Use of Customer Support for all non-clinical functions, data collection, centralized scheduling, etc. 3. Use of Patient self-report Screening Tools while they wait. 4. Maintain focus of initial assessment visit on engagement, clinical formulation, level of care determination, immediate tx plan – (“name that tune” & “next step”) 5. Effective use of EMR and data tracking. - In our primary clinics; Therapist production expectations and the Open Access/Walk In model were other keys to cost reduction/revenue generation. We have not implemented Open Access in our GTAC sites yet. How have you shared this info across your organization? - The change process involved all staff, committees, etc. Results are shared on our Sharepoint site, in team mtg, etc. Part of an overall Quality improvement Process, Strategic Plan and KPI Dashboard.

3. Liberty Resources, Inc. Costs were initially based on hypothetical assumptions. We anticipate time/cost reductions as workflows become more efficient based on real time data. A process group was formed to develop policies, identify barriers, create new solutions, ensure accountability to internal customers and the continued monitoring of goals. A data monitoring and compliance plan is being developed. Redundancies were eliminated to ensure regulatory compliance while reducing time/costs. Information was shared with the PC/BH integration team, during all staff meetings and via emails to the team.

4. Odyssey House Costs: What You Found Out and What Did You Do With It? For Example:  What are ways you have identified to bring down costs? Utilized TA to determine reimbursable BH services under A28 license Currently delivering BH services as same day “ad-on” to medical E/M visits Scheduled grant-funded BH social work staff to work evenings with Psychiatrists Counting integrated BH services on HRSA application: documents need, justifies inclusion on scope of services  How have you changed processes to still meet regulatory requirements but improve access to care? Completed two DOH CoN’s to prepare for transition to FQHC Outreach to residents of supportive housing programs Outreach to residents of outpatient SUD clinic in primary care  How have you shared this info across your organization? Monthly communication meetings with BH managers Supervision sessions with Senior Managers, Clinical Sups and Direct Care Staff

5. Niagara Falls Costs: What You Found Out and What Did You Do With It? With the help of the National Council of Behavioral Health and MTM Services, we were able to analyze our processes and improve our efficiency. Our office staff now spend less time as a whole on the screening process. We have also been able to bill once annually for the PHQ-9 depression screen per patient, which has generated over $5,000 in extra revenue. To make the screening process more cost effective and efficient, we now use “SMART forms” for the PHQ-9 and AUDIT-C screens. “SMART forms” are electronic versions of the screens, built right into our EMR system. This improves our data tracking, reduces the cost of paper, and saves time from staff scanning and other inconveniences caused by hard copies. The “SMART forms” are now being used at all four of our organizations primary care offices and are a vital part of our Patient Centered Medical Home requirements.

6. Central Nassau Costs: What you found out and what did you do with it? Cost analysis done and submitted to MTM Services. MTM services provided information on data completion time in minutes as well as process cost by dollars. Non billable paperwork time was noted as taking 155 minutes at a cost of $162.59. Reviewed MTM Services minutes with key members of Team Identified eliminating the need to continue to write demographics on all forms in order to reduce time and cost. o Agency reviewing purchasing an ID Wedge – Form Auto Filler Application scans IDs, driver’s licenses, etc. It then fills any form on a PC that accepts keyboard input. Also will review with NMA if demographic data can be imported from CNG to NMA. o Doing above has the potential of reducing time by 20 minutes and reducing the cost by $15.49. A reduction in time from 155 minutes to 135 minutes and a reduction in cost from $162.59 to $147.10.

7. The main way we are bringing down costs are: switching to a nurse practitioner and moving administrative tasks to more cost effective staff. The main way we are improving access to care is switching provider hours from the evening to the day, something our clients have asked for since day one. Catholic Charities of Brooklyn and Queens

8. Glens Falls Hospital Costs: What You Found Out and What Did You Do With It? Post-clinical session paperwork identified as a target area for increased efficiency Established protocol for intake/assessment completed @ initial visit Next steps include shadowing with existing clinic staff to identify best practices and leveraging EMR data to reduce collection needs at point of encounter

9. Our focus has been on increasing billable activities. We Transitioned JBFCS effective June 1, 2015. Our operating hours have been changed. Transition: new processes and requirements to be determined by the new agency- access to care has not been effected. More insurance plans are expected to be accepted upon the transition, increasing the volume of admissions.

10. Equinox Costs