This month, Iris Telehealth hosted a webinar with community health leaders to discuss how they’re optimizing provider scheduling and driving operational improvements.
Julie Rayne, Behavioral Health Manager at Worcester County Health Department, and Cynthia McAfee, Director of Operations at Golden Valley Health Centers, lent their expertise and insights into how they’re creating sustainable workflows, assessing the benefits of virtual care to support this work, and driving operational improvements.
Patient no-shows and provider scheduling complexities are key challenges in healthcare operations
No-show rates are a consistent challenge in healthcare, with 37% of medical groups reporting increased rates in 2023.
While the reasons behind these rates vary, a 2017 report from the American Hospital Association found that 3.6 million people did not have a ride to their clinician’s office, citing transportation as the third leading cause of missed medical appointments.
Echoing these statistics, McAfee shared that patients at Golden Valley often miss appointments due to transportation, homelessness, or family situations.
In addition to mitigating no-shows, Golden Valley and Worcester Health must also manage provider schedules and workflows, ensuring full schedules, consistent support, and specialized treatment that enables momentum in care.
Fortunately, by leveraging evidence-based care models and data insights, Golden Valley and Worcester Health have made meaningful strides and improvements for behavioral health patients in their communities.
Leveraging evidence-based care models increased Worcester Health’s no-show rates by 12%
According to the National Alliance on Mental Illness (NAMI), 70% of patients who seek mental health care drop out after their first or second visit, underscoring the importance of engagement from the very beginning of treatment.
To improve engagement and no-show rates, Worcester Health leveraged multiple grants to increase their evidence-based practice models and ensure their providers had the right specializations and concentrations to best support their patients.
As a result of this focus on evidence-based clinical optimizations, Worcester Health’s show rates have increased by 12%.
Reflecting on this increase, Rayne shared that clients were more invested in Worcester’s services because of the increased access to the most in-demand specializations.
Julie Rayne, Behavioral Health Manager, Worcester County Health Department
Our show rates increased tremendously because clients were more engaged in the services and felt more invested. We focused on our community and the needs assessment and determined what was lacking in our evidence-based models. Then, we sent our therapists to get certified in those models.
Rayne shared that Worcester has also optimized caseloads, ensuring patients were getting seen at the frequency they needed to maintain momentum in their treatment. They were also mindful of creating a balance between caseload optimization and size, ensuring caseloads weren’t getting too big while also ensuring schedules were full.
Worcester analyzes this data monthly, looks at schedules daily, and works within their EHR to ensure confirmations and appointment reminders for patients.
Additionally, to help ensure consistent visits, Worcester asks patients to sign a treatment contract. If they miss three appointments in a row, they are discharged from services and must be readmitted.
Worcester also has a grant-funded program that enables them to send a social worker or case manager into patient homes to meet with them and explore their barriers to care.
This wrap-around care enables Worcester to learn if there are additional services patients might need without affecting their provider schedules or no-show rates.
Balancing patient convenience with operational efficiency is a core strategy for future success
Improving scheduling accuracy and being mindful of not overbooking providers is a critical component of an organization’s operations.
For Worcester, Rayne shared they run weekly no-show reports to identify patient patterns. They also look at the dynamics of a patient’s life and how that might impact their provider’s schedules.
For instance, if a young patient stays with their grandparents for the summer, they plan for that change in the provider’s scheduling, as it provides an opening for other patients to be seen during that time.
Golden Valley uses “MyChart” to allow patients to send messages to their provider rather than requiring the back and forth of a telephone call.
In the new year, Golden Valley is also investing in iPads to leverage in their waiting room to help improve delays and get patients seen more quickly, noting that check-in time matters to the psychiatrist experience.
Then, to help with check-ins and workflows, Golden Valley implemented, “reverse scheduling,” where a Medical Assistant meets with the patient out front, checks them in, and communicates with them at the end of their visit as well.
Start small, build on success, and center patients in your strategy
Patients are the heart of every organization and working with partners who put people first is a key part of any strategy.
Reflecting on their largest operational improvements, McAfee shared that working with Iris Telehealth has allowed Golden Valley to make improvements at the clinical level.
Cynthia McAfee, Director of Operations at Golden Valley Health Centers
Iris has been excellent in working through and putting together a dashboard that we couldn’t put together fast enough through EPIC reporting. We have great relationships with providers, center managers, and the clinical supervisor of the medical assistants.
For Rayne and her team at Worcester, a big operational improvement that has impacted show rates has been their target case management program. This approach helps Worcester learn and solve why a patient might be missing appointments.
Rayne also shared that the therapists Worcester has leveraged through Iris has been instrumental to their teams.
Julie Rayne, Behavioral Health Manager, Worcester County Health Department
I can’t say enough about our Iris therapists and the way they micromanage their own schedules and balance it. If they have a client they want to see, they reach out to them. If someone no-shows, they get the client in to ensure they’re getting the services they need.
Prioritizing communication and a deep knowledge of your patient population delivers results
McAfee shared that her top piece of advice for organizations tackling this work is to remember that it’s their obligation to do research to increase access, noting that research needs to include understanding of referral sources and identifying clinical locations based on that geography and access.
For Golden Valley, they looked at referral sources, geography, and where the patients were coming from. Then, they tried to make sure they had a 12-month run rate because of the calendar year and the summers.
Cynthia McAfee, Director of Operations at Golden Valley Health Centers
We brought in one provider at a time, and it allowed us to learn our processes, workflows, and what wasn’t going well. Then, we could adapt them before the second provider joined. Those are probably the biggest common denominators – keeping lines of communication open – with your care teams and vendor, Iris Telehealth.
If you don’t have those open lines of communication, the ability to take a criticism and turn it into an opportunity, there’s no way you can help patients.
At Worcester, they’ve found great partnership opportunities within their community. Whether that’s local social services, parole and probation, juvenile services, schools, or doctor’s offices, they ask for evaluations and recommendations from them twice a year.
Worcester consistently analyzes how things are going with their supervisors and clerical staff and reviews agency-wide client feedback annually.
Learn more about how virtual care can optimize scheduling
We are grateful for the time these leaders shared with us! Thank you for your partnership and for all the incredible work you are all doing to care for your community and support your clinicians!
Weren’t able to make it to the webinar? You can watch the full conversation here. If you’d like to learn more and figure out the next steps to integrating virtual care into your organization, you can contact us here.
