Maximizing Opportunities – and Results – with Same Day Access
As more organizations adjust to meet timely access requirements, many are striving to go one step further – to provide true Same Day Access (SDA). By definition, SDA utilizes unscheduled assessments; clients are seen when they show up and staffing schedules are designed to make it work.
The benefits of SDA - sometimes referred to as Open Access - are clear. By not scheduling assessments, organizations eliminate no shows and engage clients more quickly while improving clinician productivity and revenue.
Compass Health Network serves 45 counties in Missouri with a focus on behavioral health and substance use disorder services. In 2016, Compass began implementing changes necessary to become a Certified Community Behavioral Health Clinic (CCBHC), including the Medicaid requirement that an initial assessment be delivered within 10 days. At the time, less than a quarter of initial assessments were completed within 10 days and the average time to first evaluation was nearly three months. The Compass management team knew they would have to change both process and culture in order to meet – and ultimately exceed – the initial assessment requirements.
Change Process
Prior to becoming a CCBHC, Compass had been part of a statewide access redesign project led by MTM Services, which included design and implementation of SDA. Building on that work, Compass implemented a comprehensive training program to not only help staff understand why a shift to SDA was so essential, but also empower them with the clinical and diagnostic skills necessary to make it work.
Key elements of change included:
Mindset - Every clinician was trained to do an initial assessment and diagnosis, regardless of professional specialty. This meant that staff needed to be prepared to respond to needs of any and every client that walked in the door.
Data Analysis - Long-held assumptions regarding service mix and peak hours were knocked down using data analysis.
Scheduling - New workflows were created utilizing a block schedule that allowed for maximum availability and flexibility.
Reporting Requirements - Paperwork requirements had to change to ensure alignment with the assessment process while still meeting Medicaid requirements.
The transition to full SDA did not happen overnight, with planning beginning in 2016. In their first year as a CCBHC (July 2017–June 2018), Compass implemented centralized scheduling and began an enhanced data gathering effort to identify challenges and develop new, responsive training and operational strategies. Compass began implementation of SDA in their second year as a CCBHC (July 2018–June 2019), which required a multistep training process and, initially, increased staffing as well as enhanced IT infrastructure and workflows.
Results
Compass implemented Same Day Access across all 47 locations. In doing so, they doubled the number of first-time clients served and eliminated no-shows while also increasing licensed staff and implementing telehealth capabilities for initial assessments.
“We knew we could not meet CCBHC requirements to conduct an initial assessment within 10 days without full implementation of Same Day Access. But it was always about more than meeting the standard. We wanted to be able to respond to people when they show up, when they are ready to get help. When people have to wait for care, they drop out of the system and we lose the opportunity to help them. That was totally unacceptable. It took time and a lot of work, but the results speak for themselves.
We are serving more people, getting them into care quickly, and eliminating no-shows. Same day access is truly a win-win-win.”
“Offering Same Day Access may seem impossible at first, but fortunately, these challenges are solvable,” said Joy Fruth, MSW and Lead Process Change Consultant at MTM Services. “As Compass makes clear, when you shift both culture and operations, the results translate into amazing long-term value – for clients, for clinicians and for the bottom line.”
For more information on Same Day Access and the MTM Consultation Team, please visit www.mtmservices.org or to schedule a free planning meeting, please email MTM director of operations Jodie Giboney or call (919) 387-9892.