Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI)
(Formerly known as STAR-SI)
Key DFM Personnel
Joyce Allen, Director, WI Bureau of Mental Health and Substance Abuse Services
Michael Quirke, Program Evaluation Coordinator, Bureau of Mental Health and Substance Abuse Services
Wisconsin Department of Health Services (DHS)
The Wisconsin STAR-QI Program began in October 2006 as a three-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the grant was to use the Network for the Improvement of Addiction Treatment (NIATx) Quality Improvement Model to improve organizational processes at the State and treatment agency level to impact client access to and retention in outpatient substance abuse treatment services. The STAR-QI Program has been so successful, that DHS has continued to fund it through September 2013.
The STAR-QI quality improvement projects aim to:
- Reduce the wait time between a client's first request for service and the first treatment session
- Reduce client no-shows
- Increase addiction treatment centers' admissions
- Increase the treatment continuation rate between the first and fourth treatment sessions
Collecting and reporting data is central to the NIATx model. Provider agencies collect baseline data before beginning a change. During the rapid-cycle quality improvement cycle, the agency continues to collect data, which they study to determine how the change impacted services. Change Teams at the provider agencies use their data to decide whether to adopt, adapt, or abandon their change project and to decide which quality improvement projects to pursue next.
Spread and sustainability are important concepts in the NIATx model. Initially ten Provider Organizations were participants in the first grant year. As we begin our seventh year, 50+ agencies are currently participating and outreach efforts are continuing.
In the Spotlight: Benedict Center
For the past two years, in an attempt to help Wisconsin STAR-QI providers diversify their revenue base, the STAR-QI program has offered Third Party Revenue as a Focus Area for providers to participate in. This year, the STAR-QI program has six providers focusing on increasing Third Party Revenue. The providers have found that the NIATx model, which provides structure and data to guide their process improvement, combined with the support of the STAR-QI program, and resources available through NIATx, have been a successful combination to assist Wisconsin agencies with the complex task of transitioning from block grant funding to third party reimbursement.
One of the agencies who have realized success in improving third party reimbursement is the Benedict Center. The Benedict Center is a non-profit agency serving women with the criminal justice system in Milwaukee addressing treatment for past trauma, stress and anger management, substance abuse, healthy lifestyles and employment. Jeanne Geraci is the Executive Sponsor and Janet Miller is the Change Team Leader for the STAR-QI Program.
With the support of the monthly STAR-QI Third Party Revenue Focus Area calls, the Benedict team began the project by deciding to increase Title 19 insurance by 5%. Following are the subsequent rapid cycle steps that the change team implemented using the NIATx model as their guide:
- In their first rapid cycle, the Benedict Center identified clients with Title 19 insurance.
- In their second rapid cycle, the Program Assistant learned how to utilize the Forward Health Portal to identify insurance for all incoming participants.
- In the third change cycle, the Program Assistant tracked the attendance on Title 19 AODA clients to understand billing capacity.
- In the fourth rapid cycle, the Benedict Center began the process of getting counselors approved for billing to increase the number of billable treatment hours in the program.
- In the fifth rapid cycle, the Program Assistant learned the online billing system for Title 19 and reviewed the NIATx prepared Third Party Billing Guide for applicable suggestions from other NIATx providers.
- In the final rapid cycle of the reporting period, the Benedict Center submitted bills for the last quarter of 2012.
When the Benedict Center began this project, they had not ever collected any revenue through Third Party Billing. Because they had identified what percentage of clients were insured through Forward Health and which HMOs were common among the participants, they knew which HMOs to approach first. Tracking attendance also allowed the Benedict center to identify which group times were the most heavily attended and allowed them to evaluate if two groups should be held at the same time, and when individuals are most likely to attend one-on-one sessions. Within two months, the counselor was approved for billing and a policy and procedure was developed for new counselors to become approved providers as soon as they started with the Benedict Center. Over $800 in revenue was obtained for the last quarter of 2012.
The transition that the Benedict Center has begun from block grant funding to third party reimbursement is to be congratulated. The team has experienced numerous barriers which they continue to handle with a balance of patience and persistence. The structure of the NIATx model, the support provided through the STAR-QI monthly teleconference calls, and helpful resources such as the NIATx Third Party Billing Guide, have been instrumental in the Benedict Center beginning this process and experiencing success.
Our current participants include:
- Adams County Health & Human Services Dept
- Aids Resource Center of Wisconsin
- AMRI Counseling
- Arbor Place
- ARC Community Svcs.
- Beacon House
- Behavioral Health Services of Racine County
- Bell Therapy
- Benedict Center
- Bridge Health Clinics
- Brown County
- Center Point Counseling
- Connections Counseling
- Coulee Youth
- Dane County DHS
- Door County
- Eau Claire Metro
- Family Service Madison
- Family Services of NE WI
- Fokus Family Services
- Ho-Chunk Nation, Department of Health
- Holy Family Memorial Behavioral Health
- Horizon Health
- Human Development Center
- Jackie Nitschke
- Jefferson County
- Journey Mental Health Center
- Kewaunee County Human Services
- LaCasa de Esperanza
- La Crosse County
- LSS Women's Way
- Mayo Clinic Health System La Crosse
- Meta House
- North Central Health Care
- Omni Enrichment, Inc
- Open Door Center for Change
- Polk County HHS
- Rock Valley Community
- Rock County
- St. Croix County HHS
- St. Joseph's Hospital
- Theda Care
- Waukesha County HHS
- Wausau Health Services
- West Central WI Behavioral Health
- William S. Middleton Veteran's Hospital
- Wood County
To promote sustainability, the staff members at participating Treatment Agencies are trained in the principles of the NIATx Improvement Process through an annual face-to-face learning session. They also participate in monthly group provider teleconference calls to support and promote continued rapid cycling quality improvement projects and network with other providers. 1:1 coaching calls are an additional option in an effort to support the quality improvement practices providers are implementing.
For more information, please visit:
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Deanne Boss, M.S.
STAR-QI Program Director
UW Department of Family Medicine
1100 Delaplaine Court
Madison, WI 53715