Outpatient Triage: Targeted Treatment Approaches

Outpatient Triage: Targeted Treatment Approaches Safe Harbor Behavioral Health Jonathan Evans, MA; President & CEO Mandy Fauble, PhD, LCSW; Vice President of Clinical Operations Lee Penman, RN; Clinic Coordinator

Safe Harbor Behavioral Health • Founded in 1993 in response to initial CHIPP. • Intensive outpatient & implementation of comprehensive crisis services. • Significant growth with outpatient census approaching 7,000. • Average of 200 new consumers each month with 80% in need of psychiatric care.

Changing Environment • Implementation of HealthChoices • Downsizing and closure of state hospitals. • Affordable Care Act. • Overall increased recognition of the importance of behavioral healthcare. • Increasing demand for outpatient services.

Strategic Planning • Systematic response to increase in demand for services • MTM Services • Concurrent Documentation. • Open Access. • “What level of service would we want for our family members?” • Results= average of 200 new clients per month with an active census of 7,000.

Beginning the Process • MTM • Open Access Presentations • Intake • Psychiatry • Collaborative Documentation • Good outcomes with No Show work group • The Waiting Game & The Telephone Tag Game • Inability to schedule because we can’t talk! • Waiting for appointments/blocking schedules

Prepping the Clinic and Staff • Reorganization of ‘intake’ • Reduction in phone triage and up front clinical triage • Prep for the unexpected • Increase in staff for financial intake • Increased focus on payment info during intake • Clear telephone message/info • Those scheduled? • Preparing for the WAVE of people who had called and/or scheduled prior to Open Access starting • Therapy and Flexibility • All hands on deck • Referral out • Scheduling

Related concepts and projects • Collaborative documentation • 3 hour webinar training • Therapy • Peer • BCM • Advantages and Disadvantages • Challenges with new E&M codes • Conceptualization of Nurse Liaison • Eventual hire of Nurse Liaison in 2013 • Availability of New Client Blocks for therapy

Care Levels for triage

What We Learned About Triage • Prepping people to refer out • Who walks in the door? How do they walk out? • People interpret the care levels differently • Hx vs. Current orientation • Medical factors • Awareness of meds/systems • There is no rhyme or reason • Very hard to predict timing of entry • Payer mix is a huge issue • Credentialing and scheduling

Data on Intake • Since February of 2013, 88% wait less than an hour from the financial to the start of assessment • Average is 30 minutes • Average total from sign in to end of intake1:35 • Represents 3,109 walk in intakes • 72% are done by intake staff • This year about 19% of adults have Medicare • 664 intakes were scheduled • Largely satellites and interpreter/major medical, dc • Age of Intakes

Data on Triage • 9/1/13 > 3/23/14 • Level 1 • 48 • Level 2 • 202 • Level 3 • 512 • Level 4 • 151 • Total 913

Resource Demands • Psych Evaluations/Diagnostics 2014: 715 as of 8/20/14 • Payer Mix/Scheduling • Adjustment of times for intake • Need for additional financial intake staff • Staffing the intake line as needed • Overwhelmed nurse liaison with referrals • Alternatives • CSANDS and CRU • BCM • PCPs

Therapy • New client blocks • Payer • Improved productivity for no shows

Outcomes/Uses • Nurse Liaison acuity changes • Nursing Assessments • Evaluation of therapy acuity and frequency • ID of potential referrals out • Better ID of potential high risk clients • Better ability to quantify desired time slots • Evaluation of therapy caseloads vs. prescriber

Lessons Learned • Resource Management • Team Integration • DEMAND and volume • Attention to payer and scheduling

Future Work • Referral to PCP? • Templates based on triage? • Revisions based on standardized measures? • Evaluating past versus current risk factors

Outpatient Triage: Targeted Treatment Approaches