1. Business Practices for the Future Learning Collaborative Fee-for-Service, Cohort II This Learning Collaborative was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the University of Wisconsin through JBS International, Inc., under contract numbers HHSS283200700003I/HHSS28300002T, with SAMHSA, U.S. Department of Health and Human Services (HHS). “The contents of this presentation do not necessarily reflect the views or policies of SAMHSA, or DHHS.” Kim Plavsic served as the Government Project Officer.

2. (Title) Name(s) of presenter(s) Organizational Affiliation A Collaborative Effort to Effect Change The Center for Prevention and Counseling Newton, NJ 07860 Change Team Members: Executive Sponsor, Barbara Adolphe, Executive Director Rachel Wallace, Clinical Supervisor Mary Ann St. John, Certified Public Accountant Change Leader, Gia Leo Start Date: February 1, 2012 – End Date : August 10, 2012

3.  The AIM of the project was to increase the amount of revenue collected from clients who pay for treatment at the self-pay rate and/or those who have copayments by 50%, or (first party payers).  Baseline: We gathered the number of appointments provided in October, November, and December, 2011 with corresponding co-pays and self-pays collected.  “Increase counseling revenue by 50% from baseline units $2,313 to $3,470 by August 10, 2012”

4.  PDSA # 1 – Complete a walkthrough and map with change team and integral change team members.  PDSA # 2 – Create and implement a sliding fee scale for new clients and current clients.  PDSA # 3 – Transition existing clients to the Sliding Fee Scale.  PDSA # 4 – Increase the lowest co-payment for services from $5.00 to $20.00  PDSA# 5 – Develop relationship with third party payer through a single case agreement

5. Baseline = $2,313 Outcome after NIATx = $3,068 Increased by 33% Annual increase of $9,060 Self-Pay Baseline Co-pay = $766.00 Outcome after NIATx = $2,037 Increased by 165% Annual increase of $15,252 Co- payments

6.  The co-payments and self-payments affected clients differently depending on their financial circumstances prior to entering treatment.  The impact on the organization was monumental – lots of CHANGE! Increase in profits for a time being, but loss of clients as an outcome. Currently-Loss of revenue /loss of clients after increasing sliding fee scale Still, not enough revenue  Ongoing assessment must be a constant rather than last minute.  Communication between interagency departments is critical.  Other sources of revenue must be created in order to develop and sustain the counseling department.  Marketing is necessary!  PDSA’s should not take as long as they did this first time!  Continuation of the sliding fee scale will be crucial, but modifications can be made.  Developing a relationship with third party payers will be critical.

7. HOW IT IMPACTED CUSTOMERS – BEFORE HOW IT HAS IMPACTED CUSTOMERS - AFTER  Customers were provided with high quality services for an extremely low cost.  Customers co-pay and self-pay rates were subjective rather than objective.  Customers were not terminated from treatment due to inability to pay – or carrying extremely high balances.  Customers were not signing a financial statement that was meaningful.  Communication regarding fees or fee changes were not addressed regularly.  Clients were being discharged and given letters of termination prior to paying balances.  We have fewer clients due to increased rates during initial phone calls.  We are collecting co-pays and self-payment costs during session, or have at minimum improved the collection rate, so customers are paying for their services.  Customers are treated with the same respect and dignity, however, due to co-pay and self-pay increases, treatment is solution focused and brief.  Customers are not challenging this as counselors thought that they might.  Organizational changes are necessary, and counselors must understand that treatment cannot happen for free.  Clients are building financial responsibilities!