Most of us think we have a relatively healthy lifestyle—until we start looking at the metrics. And health apps make that easier (unfortunately). How many calories are in that Pad Thai I want to eat? How many steps did I walk today? The metrics give me some pretty clear direction. The message that I have 600 calories left in my daily allowance for dinner. Or the message that I need to walk “2000 more steps to your daily goal” at the end of the day—much to the delight of my two puppies.

The importance of data for driving actions has been underscored as never before by COVID-19. Government and public health leaders around the world have to make decisions and take action based on metrics—the number of positive virus tests (among consumers, among essential workers, and in the community), the number of people in a community testing positive for antibodies, the number of hospital admissions, the number of hospital admissions requiring ventilators, the mortality rate, and more. (My “go to” source is the COVID-19 Dashboard by the Center for Systems Science and Engineering at Johns Hopkins University & Medicine). Unfortunately, our public health data is incomplete for many of these factors for many reasons. And this lack of data makes decisions about the health crisis and the related economic crisis difficult at best.

And whether you are talking about policy for a country or management decisions for an organization, the point is that data is only as good as the action it inspires. I’d take the famous Peter Drucker adage of “If you can’t measure it, you can’t improve it” and expand it to “If you don’t know what to do with it, don’t measure it.” This was driven home by my colleague, OPEN MINDS Senior Associate Ken Carr in his web briefing, Short-Term Cash Management – To Assuring Continued Operations – An Overview. One of his key questions in the session was whether executive teams of health and human service provider organizations have the right data to make decisions. There are three questions executives should be asking:

• Do we know what data is needed to make good decisions—and have that data in meaningful dashboards?
• Are we mining all of our available data sources?
• Are we sharing the right data with the right people?

An organization that is making good use of data for decisionmaking in this crisis is Crossroads Health in Ohio. Our team spoke to their Controller, Jonathan Brown, to discuss how accessible, meaningful, and actionable data is of essence for staying afloat and preparing for the economic market upheaval that is likely to follow the pandemic. Crossroads provides a range of mental health, addiction treatment, and specialized services. The organization has more than 250 staff and annual revenue of about $17 million. Two years ago, the leadership team built a customized dashboard to support decisionmaking by their team. Labeled the “Performance Compass,” the dashboard includes four key categories—productivity, engagement, demographics, and finances. Mr. Brown describes it as a ‘data lake’ that consolidates data from multiple sources. Their executives review the performance data in the dashboard once a week and, in the meantime, the system sends relevant alerts to all managers and supervisors. We spoke with Mr. Brown about the three keys to optimizing available data for decisionmaking.

Do we know what data is needed to make good decisions—and have that data in meaningful dashboards? While the “Performance Compass” at Crossroads is a one-stop shop for data, it would have little value if the key points did not stand out at a glance. “Data should jump off the page for action,” says Mr. Brown. Visualization is critical—Mr. Brown refers to the ‘Rule of Fives.’ Can five people, standing five feet away from the screen, get the key takeaways in five seconds?

Of course, data is never useful in isolation—you always need historical context and future projections. Leaders need to have data dashboards programmed to reveal what’s normal and what’s not and to generate action alerts. “Our Performance Compass is the one place leaders go to see what needs attention,” explains Mr. Brown. And leaders have been coached to focus on the standard deviation above or below the mean for each dataset.

One example that Mr. Brown cited was using the “Performance Compass” to plan staffing during this crisis period. The data revealed a 50% drop in units of service because of COVID-19. But historically, there are also drops in services during holidays or spring breaks, which coincided with the lockdowns and increased coronavirus cases in the U.S. this year. But looking at the data in more detail, they found that after an increase in no-shows before and in the early days of COVID-19, there was actually a spike in kept appointments. In analyzing who was seeking services before and during COVID-19, Crossroads saw that people who needed medication refills were prone to keep up with appointments, especially through telehealth options as they learned how those worked.

Another example is using dashboards to manage cash flow. By integrating a projection tool in the dashboard, Crossroads is able to project the potential annual impact for any number of factors (be it units, revenues, or productive hours) affecting cash flow. They looked at changes in utilization and revenue for three different programs—school-based, day treatment, and community services. What they found is that if the current drop in volume of these services due to the pandemic continues, the impact could be as large as a $2.1 million hit in revenue. Their projection tool helps their team narrow down the specific actions to take to maintain sustainability. They focus on where there may be pockets to improve performance within these programs to ask ‘What is helping us win?’

Cash flow management is of the essence in the current pandemic crisis and we need dashboards that will immediately point to how we can increase inflows and reduce outflows, says Mr. Carr. Data dashboards should support answering questions like “Can I cut expenses anywhere?” and “Is there more revenue anywhere?”

Are we mining all our data sources? Data doesn’t just come from revenue reports or the number of appointments scheduled or canceled, it comes from every part of your organization and from every member of your management team. The key is to gather all the data in one place.

I discussed how you can use the large volumes of data you report to payers for performance improvement (see Reducing The Cost Of Reporting 558 Unique Performance Measures) with integrated reporting and workflows and being flexible in the use of performance measures. And Mr. Carr points to obvious sources of data we may overlook, such as electronic health records (EHRs). “If you fully use your EHR functionality, you can identify multiple areas for improvement—billing, accuracy of documentation, no-show reduction, unit costs,” and much more, he says. Mr. Brown explains that Crossroads initially focused on EHR data to build its ‘Performance Compass’ because clinical professionals interact with EHRs daily and know the lingo, which makes it easy to translate the data into insights they can understand.

Are we sharing the right data with the right people? Transparency and trust are key when it comes to sharing data for action. The goals need to be made clear and staff should be encouraged to own the goals and to use all relevant data as a tool for improvement. Clinical professionals can’t ignore billing and collections data and finance professionals can’t say that data on consumer engagement is not relevant to them.

Alerts from the data should be customized and delivered to specific people for specific actions. “You can drown in the data lake unless you have buoys in the form of succinct and easy-to-understand alerts,” cautions Mr. Brown. “The alerts on Crossroads Health’s Performance Management Compass are by design intended to help focus on who to engage.”

At Crossroads, data has been a great conversation starter and pathway to better performance primarily because everyone from the frontlines to the top executive tiers is striving to speak the same language. With any data—whether it relates to no-shows, delivering trauma-informed care, or increasing revenue—staff and leaders ask two consistent questions, “What’s getting in our way?” and “What’s helping us win?” They aren’t losing track of these basics, even in an emergency. So when they asked these same two questions on seeing the influx of COVID-19 data, they heard that struggles with adapting to telehealth for both staff and consumers were getting in their way, but that rapid IT equipment setup, and training in virtual services provided by the IT team, as well as leadership’s ability to follow and maintain patterns (such as daily huddles), were helping them win.

Mr. Brown’s team has also focused on helping managers and executives see things they don’t see on other data platforms, on putting data in context, and keeping the spotlight on the impact. Mr. Brown offers a construction analogy—data is like 2x4s, the management process around the data is like a hammer—if used randomly and without focus or rhythm, much damage is possible. Alerts are like the nails—sharp and to the point where actions need to happen. Data is only as good as the actions it enables. “Remember, data is not the answer, it is only the start of the conversation,” sums up Mr. Brown.

For more on using data to make strategic cash and revenue management decisions in the face of crisis and long-term market disruption, join us for web briefings offered as part of the new OPEN MINDS Executive Blueprint For Crisis Management program. The program is designed to help our Elite-level OPEN MINDS Circle subscribers navigate the business, operational, and culture changes of a market in turbulence.

• May 21, 2020: How To Improve Your Cash Management Program – The Five Steps To Manage Cash More Aggressively
• June 25, 2020: Using Mergers, Acquisitions & Affiliations To Address ‘Urgent’ Cashflow Needs
• July 2, 2020: Executive Portfolio Management In Time Of A Market Shift – What Programs To Keep & Which To Close?
• August 27, 2020: Options For Managing Staffing Costs – Productivity Management, Outsourcing, Technology Solutions & More
• September 24, 2020: Process Reengineering – How To Streamline Your Operations While Maintaining A Great Consumer Experience
• October 1, 2020 : Assessing & Building Our Organization’s Financial Resiliency – The OPEN MINDS Approach To Non-Profit Financial Strength Assessment

I’ve heard a consistent comment in my recent conversations with executives of specialty provider organizations “we were always planning to do telehealth, but this forced us to do it…” In the space of three weeks, most health care services have been moved to telehealth. And, at the same, most organizational administrative functions have moved to virtual as well. Both are part of the broad social distancing mandate – don’t be in close contact with others unless you need to.

So what services have moved to telehealth? My primary care physician is not seeing anyone in person—all appointments are over Skype and by telephone. I read that in hospitals, workers are wheeling carts with video cameras into patients’ rooms so doctors can talk to them from outside the room and evaluate them using electronic stethoscopes. Video visits are being used to screen people for COVID-19 as well as for therapy sessions and addiction treatment.

The team at the Hazelden Betty Ford Foundation pivoted so quickly to a virtual workforce and services that executive team members had to turn in laptops to ensure all team members who could work from home had the equipment to do so. “Going virtual was something we talked about for years,” said Mark G. Mishek, the nonprofit’s president and chief executive officer, “and now we’re finally doing it” (see Hazelden Betty Ford Foundation: An OPEN MINDS Organizational Profile). Virtual care delivery was included in the organization’s strategic plan with a three-year time frame that included a pilot out of San Diego and interviews with vendors. The team was prepared for daily registrations of 100 patients, which was an underestimation, says Mr. Mishek. “My advice? Having a good strategic plan really does help you when catastrophe hits. Parts of the plan help guide you and help you hold true to what you’re doing.”

But going virtual is not as simple as it might seem. In my briefing on Tuesday, The OPEN MINDS Executive Blueprint For Crisis Management: Building Resiliency In The Face Of Adversity, I reviewed some of the key issues in moving to be a virtual service organization. On the health care service delivery side, there are technology, contracting and billing, risk management, and supervision issues to address. And these services now need to operate within a remote management context.

Making the transition to virtual care work was the focus of a recent session, COVID-19: Adapting To Virtual Care Delivery and Implementing New Approaches and Technology featuring Netsmart Chief Clinical Advisor, Denny Morrison, Ph.D., Netsmart Vice President of Interoperability, A.J. Peterson, and Livongo Vice President of Behavioral Health Strategy, Julia Hoffman, Psy.D. They suggested a three-prong approach to the transition—infrastructure, logistics, and best practices.

Ensure the proper infrastructure is in place—It’s not enough to have an electronic health record (EHR). You have to ensure that EHRs can be securely accessed by staff who are remote, even when they don’t have Internet access. Can telehealth appointments be routed through centralized scheduling? How will documentation of progress notes, billing, and reimbursement be handled. Do you have the right codes, and policies and procedures in place?

Consider the logistics— There is no “one-size-fits-all” approach. Define which practices are best suited to your organization and ensure consistent implementation with consumers and clinical professionals. An example: After ensuring consumers can set up their phones or desktop computer access, consider how long a session should run as it might be uncomfortable to hold a phone for an extended period of time (see Digital Health Still ‘The Exception’ But Get Your Plan Ready for more recommendations). Staff need sufficient Internet bandwidth, good lighting, and training in good on-camera practices to make virtual care delivery effective. In addition, care teams need assessment tools that are connected to EHRs to keep data flowing.

Take a best practice approach—With the right infrastructure and a plan for operations, the final question is how to conduct clinical service online. Dr. Hoffman recommended using guidelines and resources from the American Psychological Association (see Guidelines for the Practice of Telepsychology and Telehealth Continuing Education Resources) along with how-to resources on vetting mental health applications and online tools from the American Psychiatric Association (see App Evaluation Model). For those starting out, consider the Telehealth Start-up And Resource Guide from the Substance Abuse and Mental Health Services Administration, and Best Practices For Telehealth During COVID-19 Public Health Emergency from the National Council for Behavioral Health.

This crisis will redefine how health and human services are delivered, and executives who move quickly to find creative ways to meet the needs of their consumers in this new environment will be poised for future success. As Dr. Morrison noted, “Right now is an excellent opportunity to rethink how we deliver care. While it won’t replace our former idea of care, now is the time to find new opportunities to best support those consumers who need it the most.” Despite the uncertainty we face, we have the tools to overcome these challenges—and now is the time to use them.

For even more on adapting to virtual care, check out these resources in the OPEN MINDS Industry Library:

1. Netsmart Telehealth By The Numbers For Post-Acute
2. Netsmart Keys To Choosing Your Technology Partner
3. Netsmart Building A Virtual Health Network For Post-Acute
4. The Definitive Guide To Leveraging Telehealth
5. Go Virtual To Keep Your Consumers (& Your Revenue) – Resources You Can Use
6. A Guide To Building A Sustainable Telehealth Program: From Billing & Scheduling To Staffing & Training
7. Your Digital Tech Integration Checklist
8. The Uphill Climb To Virtual Care
9. Using Technology To Personalize Consumer Care & Expand Access
10. Virtual Mental Health Delivery Systems Evolve

For even more, join us on April 14 for the Web Briefing: Developing The Consumer & Staff Training & Guidelines Needed To Expand Your Telehealth Services Quickly with OPEN MINDS Senior Associate Deb Adler and on April 23 for the executive web briefing, Going “Virtual Service” – Reaching Consumers Where They Are At With Telehealth And More –An Overview, with OPEN MINDS Senior Associate Steve Remillard.

The use of telehealth in the delivery of services by health and human services has been growing in the last several years. This has increased dramatically as a result of the COVID-19 pandemic.

To learn more about best practices in telehealth, we interviewed Jaye Williams, MBA, Chief Administrative Officer at Open Hearts Family Wellness. Ms. Williams has been with Open Hearts for eleven years and she oversees all non-clinical departments and functions, including information technology, finance, billing, human resources, compliance, quality, data collection and reporting.

Founded in 1974 and formerly known as Youth Evaluation and Treatment Centers in Phoenix, Arizona, Open Hearts began with a dream to develop a new model of community-based services for youth. The organization rebranded five years ago as Open Hearts and now has offices in Phoenix and Tempe and along with “traditional” office-based services, is one of the largest providers of intensive home-based coaching services for youth and families who need extra support in the state. Open Hearts works with youth, families, and adults in vulnerable situations in their communities in order to build on their strengths, expand their opportunity to cope, and empower them to strive toward a better future.

Each year, Open Hearts utilizes a team-based approach to serve over 4500 individuals and family members to integrate the mind and body towards greater quality of life. The organization’s primary funding source is Medicaid, along with some commercial insurance and it is accredited by the Council on Accreditation (COA). 

The organization introduced telepsychiatry in 2017, to meet the immense demands for psychiatry in community-based mental health. Faced with significant nationwide recruitment and retention challenges in board certified Psychiatrists, Open Hearts Leadership made the strategic decision to work with a licensed psychiatrist who worked remotely. This provided Open Hearts the opportunity to both expand access to psychiatric services and begin to develop and modify, as needed, a telehealth program on a manageable scale.

In the beginning, Open Hearts used a telepsychiatry platform that some other providers were using, but found this too cumbersome, so they switched to the ZOOM HIPAA healthcare version, which was HIPAA compliant and much more user-friendly than the previous telepsychiatry platform. Leadership at Open Hearts conducted several surveys of clinical staff and clients to develop workflows that were effective for both clients and staff.  The model included the following:

• Phased Implementation: Telepsychiatry services first began in the Phoenix office, and then expanded to the Tempe office.
• Compliance & Regulatory Affairs: Research to identify all necessary releases.
• Triage: A Medical Assistant (MA) first met with the clients to obtain vitals and to provide triage if needed prior to the psychiatrist.
• Reassurance: Since most clients were unfamiliar with telepsychiatry, a member of the Care Team was available upon request to accompany the client during the session.
• Language Translation: Translation services, were provided by the MA, both of whom were bilingual.
• Real Time Chart Entry: The psychiatrist and other team members as appropriate, did all documentation directly into the Open Hearts EHR, which is cloud-based (Credible).
• Billable Services: Billing for services was done using the Medicaid telehealth psychiatric billing codes and commercial billing codes as appropriate.

With the advent of the COVID-19 pandemic, the leadership team developed initial plans to keep clients and staff safe. Open Hearts leadership moved to a virtual service delivery model on March 16, 2020, and within 48 hours 95% of services were virtual. There were several things that allowed Open Hearts to make the transition quickly, and ultimately less stressful, especially when Arizona moved to a lockdown:

• Open Hearts had already developed telepsychiatry workflows
• The ZOOM platform was HIPAA compliant
• A number of staff were already familiar with using ZOOM for telepsychiatry
• Several staff had been using ZOOM for meetings
• Since Open Hearts provided a large number of community services, many staff already had laptops or iPads
• A metrics-driven culture, where the organization tracked current revenues against budget targets to help inform decision-making
• An agile organizational culture

Open Hearts transition to a virtual service delivery model has produced many positive results, such as:

• Reduced Transportation Barriers: For clients, especially in Maricopa County, transportation as a barrier to accessing services has been eliminated.
• Adolescents are Thriving: They are generally very comfortable with technology. In virtual sessions, adolescents are sharing more, and engaging in group sessions more than ever as the virtual platform affords them more therapeutic space.
• Increased Family Involvement: This has allowed for more family involvement, if family members are at home, the provider can quickly switch from a one-to-one session to a family session.
• Workforce Efficiency: For staff, there is no lost time and stress from travel, especially for community-based services.
• Increased Variety of Therapeutic Groups: Open Hearts developed several new virtual groups for clients to choose to participate in based on their individual treatment plan and goals. The development of these virtual groups tapped into staff creativity and professional growth and helped offset some of the financial losses due to shortened visit times.
• Workforce Retention: No staff were laid off (Some staff were hired during this time). This model has allowed Open Hearts to continue providing services in a safe environment, leading to no furloughs, or reductions in force. Open Hearts has continued to hire and fill positions throughout the pandemic.

Challenges that Open Hearts has experienced include:

• Length of Sessions: Virtual services have proven to be more difficult for young children, who may not be able to maintain an attention span for as long as they would have for in-person services
• Lack of Privacy: For clients, both for those in their own homes and those in group homes, access to a private space can be limited.
• Access to Technology: Many families do not have the technologies to access virtual care: computers, tablets, smart phones, and connectivity. Open Hearts is working to address this with funding to support technological needs.
• Delivery of Intensive Services: It is difficult to do all of components of the intensive two-to-three-hour home-based coaching services virtually. Key components of the program had to be done in the home, guided by a trained provider. A virtual model has been developed to support the virtual service delivery, however, Open Hearts notes that this is still a challenge in treatment.
• Staff Virtual Office Space: The staff do not have access to their own office “space” and juggle dual roles in the home while they have more individuals in the home due to the pandemic.
• Increased Need and Decreased Comfort: The pandemic has led to a significant increase in need for behavioral health services, however, many families are noting a different comfort level with services at this time. While more traditional office-based services could be provided virtually, the overall number of these services declined, with a significant financial impact. Some families have asked to take a break in services and know that Open Hearts is here when they are ready.

We asked Ms. Williams how Open Hearts is planning to navigate from a virtual delivery model to “in-person” services. She stated that is unclear because of a recent “spike” in COVID-19 cases in Arizona, which could slow down the transition. Open Hearts wants to ensure the safety of staff and clients and is committed to maintaining virtual care for as long as needed. She also stated that Open Hearts’ experience and capabilities with telehealth should help with whatever the blend of virtual and “in-person” care will be in the future.

We also asked what advice she would give to other health and human services providers. She stated that it is critical to be agile – as much as possible. She stated that much of Open Hearts’ successes come from their ability to view challenges as opportunities. Additionally, it is critical to listen to staff to hear both their ideas and concerns. Virtual care is a change for staff as they may not be able to experience the same level of satisfaction in their work virtually. Staff will need the support from their supervisors and leadership to adapt to this change.

Listen to the interview here: