The State of Iowa is currently experiencing a significant access problem for outpatient psychiatric care. New patients are often waiting several months before being seen for an initial psychiatric assessment. This delay contributes to patient dissatisfaction, referral source dissatisfaction, and symptom worsening. Delays of this nature directly contribute to increased health care costs.
The practice of health care delivery, including psychiatry, must change as medicine switches from an acute care model focused on inpatient care to a chronic care, health maintenance model focused on outpatient care.
To address the difficulty of accessing outpatient psychiatric care, the Iowa Psychiatric Society partnered with the Iowa Department of Human Services through its contract with Magellan Behavioral Care of Iowa to offer training in the open access model. The program is led by Dr. Robert Smith, IPS President and national coach for Advanced Clinic Access, an open access model within the Veterans Administration system.
The principles of open access that can be utilized in a mental health setting:
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Know, understand and measure demand and supply.
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Work down the backlog.
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Reduce appointment types and duration.
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Develop contingency plans.
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Reduce demand for visits.
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Increase supply.
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Know, understand, measure and balance demand and supply.
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Predict and anticipate patient needs.
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Manage the constraint.
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Optimize the care team.
Training workshops began in the spring of 2008 and included psychiatrists and staff from five mental health clinics in Central Iowa. By utilizing the principles for achieving open access, participating clinics were able to apply changes in their clinics to improve patient wait times. One clinic was able to reduce the wait time for an appointment from an average of 103 days to an average of 41 days – a great success story.
Training workshops for the second phase of the program will begin in March 2009 with a focus of training providers in community mental health centers across the state.
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