When we refer to patient management, we are specifically referring to how clinics manage the flow pf patients through a clinic. Managing the flow of new and existing patients is essential to a well-functioning clinic. When a clinic has more patient than its pool of providers can manage, it can lead to numerous problems. Providers and clinic managers can quickly feel overwhelmed, especially as provider caseloads grow in size and wait times for follow-up appointment sessions move beyond two weeks or more. Large caseloads and long wait times for follow-up appointments can adversely affect provider morale and may lead to more staff turnover, especially in locations where wait times are so extreme that most patients don’t make therapeutic progress. Long wait times and overwhelmed providers can also lead to slower recoveries in patients and a higher rate of early drop-outs from treatment.
Most often, when a clinic has an issue in the area of patient management, it centers on there being a mismatch between supply of provider appointments and the demand for appointments. Clinic can choose to do one or both of the following actions:
• 1) control the influx of new cases into the clinic
• 2) ensure efficient care for patients who are already in the system
Clinic managers may be able to reduce the influx of new cases by screening out referrals for mild cases, working with primary care to manage more cases themselves, or starting a process where the majority of patients attend groups (e.g., psychoeducation groups, evidence-based psychotherapy groups) instead of being seen for only individual psychotherapy appointments.
By taking on too many mild cases or keeping cases that are not showing any signs of progress, provider caseloads can grow to the point where wait times for follow-up appointments are exceedingly long. As a result, patients can have slower recoveries requiring more time to treat. The number of individual therapy slots are limited and therefore a valuable commodity. Patient management focuses on identifying cases that need to be seen in the mental health clinic and those that will benefit from treatment.
Start by reviewing the Managing Patient Throughput training deck, which covers best practices for managing the influx of new patients and how patients move through a clinic’s system.
You can also encourage providers to review the Treatment Planning training deck. This training will provide information on using treatment plans, with additional emphasis on special groups of patients: those who are subclinical, under-engaged, or seeking administrative outcomes.
Together, these trainings highlight some examples of the steps to be taken to improve patient throughput and associated toolkit items including:
• Educating referral sources and screening incoming patients for the appropriate venue of care. Engage in targeted outreach to common referral sources (e.g., Primary care) to encourage the providers at these sites to retain mild/non-complex cases. You can use the Clinic Services Handout and Clinic Outreach Handout to help with this process.
Begin to screen or improve screening of referrals and triage cases to ensure they are treated at the most appropriate level of care for their needs.
• Utilize treatment teams to more efficiently manage mild cases. Treatment team meetings can help clinic providers identify and triage patients who no longer meet clinical thresholds or are not improving after a significant amount of therapy. These patients can be transferred to another level of care: group treatment, more infrequent individual treatment, or transitioned out of the clinic. This can help providers to have more availability to implement EBPs and see high-acuity patients more frequently. There is a template for an SOP/OI for Managing Subclinical Patients you can modify and use to set a policy on how the clinic addresses these types of cases. You can share the handout on Best Practices for Changing Levels of Care with providers, giving them templates for handling difficult conversations with patients.
• Managing patients who wish to be separated from service. We recommend that providers make attempts to retain service members who are appropriate for retention. For patients who are adamant about separation or are not able to be retained, establish a track to manage them. We have a brief Patient Treatment Expectations and Beliefs Scale you can add to your intake paperwork to help identify patients seeking separation. Once it’s determined that the service members will be separated, we recommend setting up specialized groups to provide ongoing weekly treatment (for administrative separations and MEBs). Another best practice is to assign one or more behavioral health technicians (BHTs) to assist with this population, where they perform a case manager role for these patients, ensuring regular check-ins, that paperwork for separations is moving along, and worsening of symptoms is identified early. This can dramatically reduce the workload for providers within the clinic.
Relevant Toolkit Items: General
These toolkit items will help you to manage patients in your clinic. It is best to start with the initial training deck, Managing Patient Throughput. From there, you will be introduced to some of the other toolkit items and can explore which would be most applicable to your clinic’s situation.
| Item Name | Description | Audience |
|---|---|---|
| Managing Patient Throughput Training Deck: Slides (PDF) Slides (PDF with notes) |
Training presentation on how to manage patients from referral source, through treatment and termination. Offers strategies for dealing with inappropriate referrals and patients who desire ongoing therapy when it is no longer clinically indicated | Clinic Managers |
| Treatment Planning Training Deck: Slides (PDF) Slides (PDF with notes) |
Training presentation on how to develop effective treatment goals incorporating outcome measures and plan for termination once treatment is no longer clinically indicated. Includes strategies for successful treatment planning with special populations | Providers |
| SOP/OI for Managing Subclinical Patients | Template for clinic managers to use in order to ensure providers set treatment expectations and terminate treatment when it is no longer clinically indicated | Clinic Managers |
| Clinic Outreach Handout | Customizable handout to distribute to referral sources outlining clinic policies and indicating availability/non-availability of services in your clinic | Clinic Managers |
| Clinic Services Handout | Customizable handout to distribute to patients and referral sources listing specific EBP groups and other services available within the clinic | Clinic Managers |
| FAQs: What to Expect When You Start Psychotherapy | Fact sheet that answers frequently asked questions regarding types of therapy, treatment duration, symptom reduction timeframe, etc. | Patients |
| Starting an Evidence-Based Psychotherapy | Fact sheet covering what to expect in terms of the structure of an EBP session | Patients |
| FAQs: Therapy Continuation Groups | Handout that answers frequently asked questions regarding therapy continuation groups including session structure, topics, and treatment duration. | Patients |
| Planning for Termination of Treatment | Fact sheet explaining the reasons to plan for termination, how to address with patients, and options for terminating treatment when no longer clinically indicated | Providers |
| Therapy Continuation Groups | Handout that answers frequently asked questions regarding therapy continuation groups including process, format, patient selection, and benefits to the provider, clinic, and patient. | Providers |
| Why Write a Treatment Plan | Fact sheet explaining the benefits of writing a treatment plan | Providers |
| 20/20 Treatment Team Review Form | Template for completing a thorough treatment team review after a patient has completed 20 therapy sessions and desires continued treatment | Providers |
| Best Practices for Changing Levels of Care | Example scripts and templates for changing the treatment plan of a patient who may not wish for/understand the need for change. It includes specific templates for memoranda explaining termination of care, changing the treatment plans of those who miss/cancel appointments regularly, and for those who fail to regularly complete homework assignments | Providers |
| Introducing Prolonged Exposure Therapy to Patients | Example script for introducing a patient to PE to help improve patient willingness to try the therapy | Providers |
| Patient Input into Treatment Team Review Form | Form soliciting patient feedback for the treatment team review process – including satisfaction and progress towards treatment goals | Patients |
| Patient Treatment Expectations and Beliefs Scale | Scale to solicit patient’s initial reason for seeking treatment and desire for improvement | Patients |
To return to the Clinic Optimization Toolkit, click here.