Ask the Expert Welcomes Kim Johnson

“Ask the Expert” features an interview with a leading expert on homelessness or co-occurring mental and substance use disorders. The following is an interview with Kim Johnson, the Deputy Director for operations of NIATx.

We are pleased to welcome Kim Johnson is the Deputy Director for operations of NIATx, a research center at the University of Wisconsin, Madison that focuses on systems improvement in behavioral health. She is also Director of the ACTION (Adopting Changes to Improve Outcomes Now) Campaign, a national campaign to improve access to and retention in treatment. Prior to her move to Wisconsin, Kim served for seven years as the Director of the Office of Substance Abuse in Maine. During her tenure as Maine’s SSA she focused on prevention of underage drinking and prescription drug abuse and improving availability to treatment through cross system efforts including developing a model treatment program for criminal justice clients, improved referral systems for child welfare clients and increased access to medication assisted treatment through work with Medicaid, primary care, and the public health system. Kim has a master’s degree in counselor education and an MBA and is a Ph.D. candidate in population health.

Question: What is NIATx?

Answer: Between patients and caring help lies a canyon of paperwork and burdensome processes. NIATx helps payers and behavioral health care providers remove those barriers to treatment and recovery. We serve people facing the challenge of addiction and mental illness by making improvements to the cost and effectiveness of the care delivery system. We developed a simple and easy to use model of process improvement. Designed specifically for behavioral health care, this model allows payers and providers to make small changes that substantially impact outcomes. As a learning collaborative within the University of Wisconsin-Madison's Center for Health Enhancement Systems Studies, we provide research, promising practices and innovative tools that encourage and support the use of the NIATx Model of process improvement. We're working to prepare the field for changes that will be required by influences such as parity, health care reform and technological advances

Question: What is the evidence that NIATx works?

Answer: The NIATx model of process improvement has been field-tested by treatment organizations throughout the United States. You can find out more by reviewing our list of peer-reviewed articles detailing outcomes from implementing process improvement.

In addition to the quantitative data, the NIATx web site features success stories from providers across the country that have fielded-tested the NIATx model.

Visit our story database to read about the wide range of benefits they’ve experienced, including increased client satisfaction, increased revenue, and improved staff morale and retention.

Question: What is a walk through? Who should participate in the walk-through?

Answer: The walk-through is an exercise to help the organization experience its services from the perspective of a client. It is a powerful tool to identify areas that need improvement. Select two people from your organization to play the roles of “client” and “family member.” The two of you will need to be detail-oriented and committed to making the most of this exercise. To ensure that your experiences will be as realistic and informative as possible, present yourselves as dealing with an addiction you are familiar with, and thus are able to consider the needs of people with that particular addiction issue. Start at the beginning of the process from a client’s perspective, trying to find out about services for example, and go through the intake/assessment process or the first service. A walkthrough is not mystery shopping. Staff needs to be aware and engaged in identifying processes that need to be improved.

Question: How can using NIATx principles and practices improve my bottom line?

Answer: Reimbursement generally falls into two categories: fee-for service or capitation which is essentially what grants are. In the experience of NIATx Founding Members, the business case for improving admissions and continuation is fairly clear-cut under a fee-for-service payment structure, since increased revenues have a positive impact on the bottom line. Long waiting times and high no-show rates represent wasted system capacity. Improvements in these areas eliminate waste and drive down unit costs, and benefit the bottom line no matter what reimbursement scheme is in place.

The business case for increasing continuation is clear, as long as the provider is reimbursed for every unit of service provided. A tie also exists between keeping people in treatment and the cost of admitting new clients; i.e., it’s generally cheaper to keep an existing client in treatment than to engage a new one. Under capitation, the business case for increasing continuation is not as easy to calculate; but high continuation rates can be a significant source of value in contract negotiations.

Mini-case example:
Perinatal Treatment Services (Seattle, WA) joined NIATx in September 2003 in a state of crisis. Their long-term residential treatment program for pregnant and parenting women was only four months into the fiscal year with a net loss of $140,000, a 60 percent continuation rate through the first four units of service, and occupancy rates below 50 percent. Kay Seim, the Executive Sponsor of Perinatal Treatment Services, engaged in a walk-through exercise to experience the treatment process through the eyes of the customer. The walk-through exercise exposed many opportunities to improve the customer experience, and a rapid-cycle change team was able to implement changes that led to an improvement from 60 percent to 85 percent continuation through the first four units of service. Now, occupancy is near 100 percent, and more women in the community are getting the help they need. Best of all, the link between continuation rates and revenues means that the program has improved from average monthly revenues of $60,000 in 2002 to more than $100,000 in Fiscal Year 2006, and the program is now squarely “in the black.”

Question: How do I choose a change project?

Answer: “We need to change everything right away!” is a typical reaction to the results of a walk-through. Many processes emerge as burdensome and confusing when viewed from the customer perspective. If you have completed a walk-through, chances are you have identified more than one process that you want to change immediately.

We recommend that you work on one change at a time. You’ll be applying the scientific method: changing one component of a complex process and measuring its impact on the larger system. By collecting and analyzing data, you will have a way to determine if the change is an improvement—before you move on to the next change project.

Consider the following as you make the decision on what to tackle first:

Guarantee success for your first change project: pick something easy to change and easy to implement. Think about a change that both staff members and clients will appreciate, such as reducing excess paperwork. The NIATx promising practices have a proven track record of success—try one at your organization. Remember, success begets success, so an early win will build support for additional changes.

What keeps the CEO awake at night? If asked that question, many leaders might comment on the financial health of the organization. If the project addresses problems that concern the executive director, she or he will actively support the project, helping to make it a success. Test a change that you anticipate will improve customer service and potentially increase revenue.

Make it a Change Team effort. Putting together a team with a variety of viewpoints can help identify what is the most immediate need, what will be the easiest early win, and what will have a great impact. Include a client who can provide the customer perspective, as well as people from all levels of staff. Click here for more information on how to form a Change Team. Collect data. Think about how you will measure the impact of your change. You will need to collect data before, during, and after your change to know if your change is an improvement. Pencil and paper are all you need. Click here for more information on collecting data.

Question: How does NIATx support SAMHSA's eight initiatives?

Answer: NIATx is involved in Health IT and Health Care Reform Initiatives that help move forward SAMHSA's agenda in those areas. Of most interest to CHAB participants is the way in which NIATx helps providers with quality, data and outcomes. The NIATx practices provide a solid foundation for a quality improvement plan for an organization. In particular for discretionary grantees, NIATx has helped organizations meet their GPRA requirements and helped SAMHSA programs better measure their impact on patients and the communities in which they live. Measurement does not have to be complicated. NIATx has worked with agencies to use existing data or simply collected new data elements to identify areas that need improvement and to tell the story of how their program has grown, improved and served the community.

Question: Anything you’d like to add?

Answer: Anyone interested in finding out more about NIATx programs can find descriptions and resources on the Web at http://www.niatx.net.

Publication Date: 
2010