Orientation to the Treat First Concept

Treat First is flexible: Your agency can tailor it to the services you provide and the needs of your clients. For example, while many providers have clients come in for scheduled Treat First appointments with therapists to begin the process, others have clients walk in at specified times, and after answering 4 questions, they meet with a Comprehensive Community Support Services (CCSS) worker to explore what brings them in to ask for help.

Those agencies have found that it is often the case that the CCSS worker is best suited to provide effective help – like helping to get the heating bill paid.

The client in this case will need to check in with a therapist to provide a provisional diagnosis. Unlike the historical intake process, Treat First services can be billed with a provisional diagnosis, or even a Z Code, although those diagnostic findings will still need to be documented by an appropriately licensed BH professional.

Of course the therapist may also provide support or another therapeutic intervention. Both the CCSS service and the therapeutic intervention can be billed with the Z Code, or other provisional diagnosis.

The full diagnostic assessment and Treatment Plan is only due at the conclusion of the 4^th Treat First session.

Treat First is not for ongoing patients, although you can define the length of time since a previous treatment episode that would open it up for them. Many agencies using Treat First define that as 90 days without a session with one of your behavioral health providers.

Resolving the issue

If the client’s goals are met within the 4 Treat First sessions, there is not an obligation to create a treatment plan or complete a full assessment.   16% of clients who have presented for Treat First thus far have had their issue resolved within those 4 sessions. While many agencies have operations staff enter the data on Treat First clients into a specific data collection website maintained by Falling Colors, resolution of the issue is a call to be made by the primary provider engaged with the client – whether that is a Therapist, a CCSS worker, or other provider.

Multiple encounters possible on Treat First days

Some implementing agencies have folded Treat First into an open access or Same Day Intake time, with multiple provider types available to respond to the needs clients bring. For example, if a client sees a CCSS worker, a MH Therapist, and a Substance Abuse counselor in the course of responding to the needs – in Treat First Day 1, 2, 3, or 4 – all of those encounters can be billed separately, using the Treat First Modifier on the same date of service.

Medicaid and State Funded Non-Medicaid

Currently, Treat First is designed for clients with Medicaid or covered by State Funded Non-Medicaid funds. There is not automatically anything in the Treat First process that would violate contracts with private payers, but it would always be wise to review your contracts and communicate with the private payers you work with about your desire to provide Treat first with their members.

Medicare is not currently compatible with the Treat First design.

Check in

Clients complete 4 questions at each check in to measure how they are doing that visit.

There are different questions for children and adolescents, and all Check In and Check Out questions for adults, as well as children and adolescents, are also available in Spanish. For adults the questions are:

• How would you rate how you are doing today?
• How would you rate how things are going in your personal life?
• How would you rate how things are going in your social/work life?
• How would you rate how things are going in your life overall?

Clients respond with a Likert type 10 point scale where 1 is “Very Low” and 10 is “Very High.”

Cumulative results of clients’ answers to those questions, statewide and by individual agencies, are reported through the BHSDStar website.

Check Out

When checking out, a client will answer another four questions to measure how well the client felt attended by their providers that visit. These answers can be used as a supervision tool to help clinicians focus on the quality of services they provide. These questions are also uploaded to the Falling Colors Treat First website and an analysis will be provided for assessing and demonstrating quality service for the agencies using Treat First.

Billing process

There is no need to significantly alter your current billing process with MCOs or Falling Colors for State Funded Non-Medicaid services. Once you have been certified as a Treat First Agency by BHSD, those payers will process the claims according to your appropriate fee schedule.

Auditors for those payers will also be informed about the different diagnostic, assessment, and treatment plan requirements for Treat First, so you need not fear a finding of noncompliance with the prior requirement of a full diagnostic assessment and treatment plan completed at first contact.

It takes courage for a person who is suffering to come and ask for help. In fact, the majority of  people who could benefit from professional behavioral health services don’t get that help.

While there are many reasons for that, the process of accessing those services too often leads to discouragement and further suffering, and can require resources that many people suffering don’t have access to.

Regulatory and administrative requirements for a full diagnostic assessment prior to being able to be paid have led many agencies to request new or returning clients to fill out long and often repetitive questionnaires designed to arrive at a clear and accurate diagnostic assessment. This has helped create a system that prioritizes the needs of the payors – a demonstration of medical necessity – over the needs of the people seeking help.

This can result in initial appointments that required clients to obtain transportation, time off from work, or other arrangements in their life, but that don’t actually provide much tangible assistance.

Treat First is a creative and flexible process that moves towards balancing those competing needs. By being able to start the process with a simple question like, “how can we help you today,” we can be more welcoming, responsive, and immediately helpful.

Results from the agencies involved in a Treat First learning community make clear that, while it can be a challenging transition for agencies and staff, patients and clients overwhelmingly appreciate that human connection, and feel heard, supported and cared for early on in their search for help. This appears to lead to a win-win: better outcomes for the clients, and more predictable attendance at subsequent appointments, supporting better productivity and higher quality services.

We are pleased you are interested in Treat First, and invite agency leaders – both clinical and administrative – to continue on to Talk #2, which goes into more detail on the critical elements of Treat First.