Improving Efficiency and Effectiveness of Addiction Treatment Through Business Process Improvement

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Philippa Bruce
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1 The Network for the Improvement of Addiction Treatment (NIATx) Improving Efficiency and Effectiveness of Addiction Treatment Through Business Process Improvement David Gustafson PhD NIATx Director, University of Wisconsin-Madison Reduce Waiting & No-Shows Increase Admissions & Continuation

2 Representing a great team. Victor Cappocia Kimberly Johnson Todd Molfenter Thomas Mosgaller Andrew Quanbeck Alice Pulvermacher Jay Ford 2500 addiction treatment agencies

3 Must improve access & retention No Care Got needed care Leave Care

4 Process Improvement A key to success in many industries A movement across healthcare Essential to improve access & retention A simple, fast, effective approach

5 Statistics 17% offered medications known to be effective for alcohol/opiates 48 percent used proven psychosocial interventions (e.g. cognitive behavioral or motivational enhancement therapy) Roman, et al., Clinical Trials Network Steering Committee, 2002

6 My Walkthrough

7 Between patient & caring help lies a canyon of paperwork & burdensome processes A chronic disease where timing is everything Very dedicated staff Business processes keep patients & staff apart. They waste money. But they CAN be controlled!

9 A key to success in many industries. A movement across healthcare. An essential element in the strategy to improve access and retention. Ceci Connolly. Toyota Assembly Line Inspires Improvements at Hospital. Washington Post. 6/3/05

10 Five Evidence Based Principles Help the CEO sleep Influential change leader Ideas & pressure from outside. Personally experience the customer experience Rapid Cycle testing Customer Problem Change agent Look outside Quality

11 Key NIATx Strategies SIMPLICITY Very specific aims Very few simple measures Face-to-face learning sessions On-site and telephone coaching Website:

12 NIATx Aims Reduce delay: 1st request to 1st Tx Reduce % no-shows Increase number of admissions Increase continuation rate Improve bottom line Improve outcomes

13 Nine key Paths to Recovery First contact Intake and assessment Transitions through levels of care Paperwork Scheduling Engagement Social supports Outreach Maximizing revenue

14 Aim 1:Timeliness 50.48% improvement in 37 agencies Walk-in appointments Time to treatment 44% to 95% No-shows 27% to 66%

15 Aim 2: No Shows 41% reduction in 28 agencies Calls: no-shows 34% to 70% Ask why did not come Find/remove barriers (transport, childcare) Encourage clients to come back Remind of future appointments Contact key individuals (e.g., court liaison).

16 Aim 3: Continuation 38% improvement in 35 agencies Clients use Process Improvement to manage own changes: Tx completion 46%

17 Aim 4: Admissions Direct admits: 57% 21 agencies Transfer b/w LOC: 198%: 4 agencies Targeted Marketing (to Unions, EAPs) Referrals 300%, Outpatient admissions by 50% Outpatient revenues 260% Residential revenues $600,000.

18 Transfer Examples Detoxification to Out Patient: Joint meetings of residential & outpatient groups Start clients in outpatient group while in residential detoxification Continuation 247%

20 Takes NIATx to a higher level. Partner states and providers Improve both state and provider processes Promote wide dissemination of improvements Remove barriers Provide Incentives

21 Pilot Project Delaware Iowa North Carolina Oklahoma Texas

22 Activities Select a NIATx aim and measure Partner w 3-6 providers State & agencies pick process targets Quickly test changes to improve Plan how to spread effective changes.

23 Examples from Oklahoma Drop financial eligibility determination before scheduling an appointment Change state rules (ASI or bio-psychosocial) Cut 1 week from time to assessment Reduced agency assessment time by 45 min. Triggered agency reviews of own processes

25 Key Points Need to improve access & retention Process Improvement: proven effective Provinces: a key player in diffusing PI? Who can allocate resources to do so?

Network for the Improvement of Addiction Treatment (NIATx) http://www.niatx.net

Network for the Improvement of Addiction Treatment (NIATx) http://www.niatx.net Lynn M. Madden, MPA, CHE lmadden@emh.org Scott O. Farnum, LCPC, LADC, NCC sfarnum@emh.org Acadia Hospital Bangor, Maine MOVING