HUTCHINSON—Staff at Horizons Mental Health Center thought they could improve access to care at their clinic, but they were shocked by just how much.
Horizons recently gathered feedback as part of the clinic’s patient and family engagement efforts and through meetings with community partners, said Vikki Mader, Health Information Management Director and Risk Manager at Horizons.
“One of the major complaints was that it took too long to get in to be seen for an initial visit,” Mader said. “Often the next day is just too long for someone struggling with a mental health issue. And we were only able to schedule about 77 percent of initial visits on the same day.”
So, in November, Horizons fundamentally changed their workflow.
“The clinicians used to start the initial visit by gathering all the health history with the patient—so appointments were taking two hours,” she said. Now, that information is gathered a care coordinator at the beginning of the appointment.”
“That enabled them to see more patients and dramatically decrease our turnaways,” Mader said. “We saw a huge drop in turnaways—we went from 23% same-day turnaways to less than 3%. In May, out of 160 new patients, we only had to turn away five.
That improvement is among the many reasons that Horizons Mental Health Center has been recognized as a “Pinnacle Practice,” one of just five physician organizations in Kansas to receive the distinction in 2019, which comes with a $12,000 award.
Among other things, Pinnacle Practices have employed person and family engagement, encouraging the patient and their family to partner with the medical staff in their care. Pinnacle Practices also have incorporated additional quality metrics and utilization metrics for national comparison and evaluation.
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Horizons has also expanded access to care by putting clinicians into community settings. For example, they have a therapist in the county jail and recently added a case manager to help with reintegration with in the community once they are released. Using telemedicine, Horizons is also integrated with their local emergency department to reduce throughput times with patients who have a mental or behavioral health issue.
Currently they are working to increase access via nearby schools.
“Last year we started a pilot that put a therapist and case manager directly in a school so that they’re available through the whole school day,” Mader said. “So, if they’re having a rough day they can just walk down the hall and see a clinician, or they can schedule their formal appointments during the school day so they're not being taken out of school.”
"That program has been extremely successful, and we are expanding it into additional schools in that district as well as into another school district in the area, and we have a third school district that is interested,” she said.
Horizons staff hope that the $12,000 Pinnacle Practice award might also kick start a program to increase access to care—specifically to primary care.
“One of the things we want to do is somehow incorporate primary care for our patients. Often the symptoms of the mental illness make it difficult for our patients to be compliant in the primary care setting, therefore they don’t have a primary care provider. So, we have been exploring ways to incorporate those services,” she said.
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Horizons is among 180 practices in the Kansas Practice Transformation Network (PTN), which is administered by KHC and awarded the distinction.
Mader said working with her KHC Quality Improvement Advisor as part of the Kansas PTN has helped the clinic determine where to place its focus for improvement.
“In our discussions of the aims (of the PTN) and trying to find ways to improve our care, we identified access to access to care. It all started with talking about the different aims,” she said. "It's been extremely helpful to work through the aims (of the PTN) to see where we are doing ok and where we need to focus our energy."
The Pinnacle Practices exemplify—each in their way—scalable successes in improving health care quality, safety, and value, said Rosanne Rutkowski, Program Director at KHC.
“Horizons and our state’s other Pinnacle Practices are among the leaders in Kansas working on patient-centered initiatives that improve quality, safety, and value,” Rutkowski said. “Their experience is scalable and worth emulating.”
The Kansas PTN is part of a regional network called Compass PTN, which is one of 29 regional PTNs nationwide. Together they are part of the Transforming Clinical Practice initiative (TCPi), a program of the federal Centers for Medicare & Medicaid Services aimed at:
- Promoting broad payment and practice reform in primary care and specialty care;
- Promoting care coordination between providers of services and suppliers;
- Establishing community-based health teams to support chronic care management; and
- Promoting improved quality and reduced cost by developing a collaborative of institutions that support practice transformation.
PTNs are peer-based learning networks designed to mentor and assist practices in improvement in the broad areas. A “Pinnacle Practice” is among the top 5% of enrolled practices based on reporting and phase progression.
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Founded in 2008 by the Kansas Hospital Association and the Kansas Medical Society, KHC embodies the commitment of these two provider groups to act as a resource and continuously enhance the quality of care provided to Kansans. For more information visit KHConline.org/clinical-quality-improvement.