Lessons from Healthcare Leaders on Optimizing Provider Scheduling and Show Rates

This month, Iris Telehealth hosted a webinar with community health leaders to discuss how they’re optimizing provider scheduling and driving operational improvements.

Julie Rayne, Behavioral Health Manager at Worcester County Health Department, and Cynthia McAfee, Director of Operations at Golden Valley Health Centers, lent their expertise and insights into how they’re creating sustainable workflows, assessing the benefits of virtual care to support this work, and driving operational improvements.

Patient no-shows and provider scheduling complexities are key challenges in healthcare operations

No-show rates are a consistent challenge in healthcare, with 37% of medical groups reporting increased rates in 2023.

While the reasons behind these rates vary, a 2017 report from the American Hospital Association found that 3.6 million people did not have a ride to their clinician’s office, citing transportation as the third leading cause of missed medical appointments.

Echoing these statistics, McAfee shared that patients at Golden Valley often miss appointments due to transportation, homelessness, or family situations.

In addition to mitigating no-shows, Golden Valley and Worcester Health must also manage provider schedules and workflows, ensuring full schedules, consistent support, and specialized treatment that enables momentum in care.  

Fortunately, by leveraging evidence-based care models and data insights, Golden Valley and Worcester Health have made meaningful strides and improvements for behavioral health patients in their communities.

Leveraging evidence-based care models increased Worcester Health’s no-show rates by 12%

According to the National Alliance on Mental Illness (NAMI), 70% of patients who seek mental health care drop out after their first or second visit, underscoring the importance of engagement from the very beginning of treatment.

To improve engagement and no-show rates, Worcester Health leveraged multiple grants to increase their evidence-based practice models and ensure their providers had the right specializations and concentrations to best support their patients.

As a result of this focus on evidence-based clinical optimizations, Worcester Health’s show rates have increased by 12%.

Reflecting on this increase, Rayne shared that clients were more invested in Worcester’s services because of the increased access to the most in-demand specializations. 

 “Our show rates increased tremendously because clients were more engaged in the services and felt more invested. We focused on our community and the needs assessment and determined what was lacking in our evidence-based models. Then, we sent our therapists to get certified in those models.”
Julie Rayne, Behavioral Health Manager, Worcester County Health Department

 

Rayne shared that Worcester has also optimized caseloads, ensuring patients were getting seen at the frequency they needed to maintain momentum in their treatment. They were also mindful of creating a balance between caseload optimization and size, ensuring caseloads weren’t getting too big while also ensuring schedules were full.

Worcester analyzes this data monthly, looks at schedules daily, and works within their EHR to ensure confirmations and appointment reminders for patients.

Additionally, to help ensure consistent visits, Worcester asks patients to sign a treatment contract. If they miss three appointments in a row, they are discharged from services and must be readmitted.

Worcester also has a grant-funded program that enables them to send a social worker or case manager into patient homes to meet with them and explore their barriers to care.

This wrap-around care enables Worcester to learn if there are additional services patients might need without affecting their provider schedules or no-show rates.

Balancing patient convenience with operational efficiency is a core strategy for future success  

Improving scheduling accuracy and being mindful of not overbooking providers is a critical component of an organization’s operations.

For Worcester, Rayne shared they run weekly no-show reports to identify patient patterns. They also look at the dynamics of a patient’s life and how that might impact their provider’s schedules.

For instance, if a young patient stays with their grandparents for the summer, they plan for that change in the provider’s scheduling, as it provides an opening for other patients to be seen during that time.

Golden Valley uses “MyChart” to allow patients to send messages to their provider rather than requiring the back and forth of a telephone call.

In the new year, Golden Valley is also investing in iPads to leverage in their waiting room to help improve delays and get patients seen more quickly, noting that check-in time matters to the psychiatrist experience.

Then, to help with check-ins and workflows, Golden Valley implemented, “reverse scheduling,” where a Medical Assistant meets with the patient out front, checks them in, and communicates with them at the end of their visit as well.

Start small, build on success, and center patients in your strategy

Patients are the heart of every organization and working with partners who put people first is a key part of any strategy.  

Reflecting on their largest operational improvements, McAfee shared that working with Iris Telehealth has allowed Golden Valley to make improvements at the clinical level.

 “Iris has been excellent in working through and putting together a dashboard that we couldn’t put together fast enough through EPIC reporting. We have great relationships with providers, center managers, and the clinical supervisor of the medical assistants.”
Cynthia McAfee, Director of Operations at Golden Valley Health Centers

 

For Rayne and her team at Worcester, a big operational improvement that has impacted show rates has been their target case management program. This approach helps Worcester learn and solve why a patient might be missing appointments.

Rayne also shared that the therapists Worcester has leveraged through Iris has been instrumental to their teams.

“I can’t say enough about our Iris therapists and the way they micromanage their own schedules and balance it. If they have a client they want to see, they reach out to them. If someone no-shows, they get the client in to ensure they’re getting the services they need.”
Julie Rayne, Behavioral Health Manager, Worcester County Health Department

 

Prioritizing communication and a deep knowledge of your patient population delivers results

McAfee shared that her top piece of advice for organizations tackling this work is to remember that it’s their obligation to do research to increase access, noting that research needs to include understanding of referral sources and identifying clinical locations based on that geography and access.

For Golden Valley, they looked at referral sources, geography, and where the patients were coming from. Then, they tried to make sure they had a 12-month run rate because of the calendar year and the summers.

“We brought in one provider at a time, and it allowed us to learn our processes, workflows, and what wasn’t going well. Then, we could adapt them before the second provider joined. Those are probably the biggest common denominators – keeping lines of communication open – with your care teams and vendor, Iris Telehealth.
 If you don’t have those open lines of communication, the ability to take a criticism and turn it into an opportunity, there’s no way you can help patients.”
Cynthia McAfee, Director of Operations at Golden Valley Health Centers

At Worcester, they’ve found great partnership opportunities within their community. Whether that’s local social services, parole and probation, juvenile services, schools, or doctor’s offices, they ask for evaluations and recommendations from them twice a year.

Worcester consistently analyzes how things are going with their supervisors and clerical staff and reviews agency-wide client feedback annually.

Learn more about how virtual care can optimize scheduling

We are grateful for the time these leaders shared with us! Thank you for your partnership and for all the incredible work you are all doing to care for your community and support your clinicians!

Weren’t able to make it to the webinar? You can watch the full conversation here. If you’d like to learn more and figure out the next steps to integrating virtual care into your organization, you can contact us here.

The Transformative Impact of Virtual Behavioral Health Integration: A Specialist’s Perspective

Over the past decade and a half, the field of behavioral health has undergone significant changes. However, one transformation stands out among the rest: the integration of virtual behavioral health services into primary care settings. This groundbreaking shift is not only changing the way we provide care, but it is also fundamentally altering patient outcomes and reshaping the structure of our entire healthcare system.

 

Virtual care breaks down traditional barriers to behavioral health access

The traditional model of separate physical and behavioral healthcare has long created unnecessary obstacles for patients. Consider this: when a primary care physician identifies signs of depression during a routine visit, the traditional referral process often results in only 50% of patients actually following through with behavioral health appointments. The reasons are numerous: stigma, transportation issues, wait times, and the challenge of navigating multiple healthcare systems.

Virtual behavioral health integration dissolves these barriers. By embedding behavioral health services within primary care settings and leveraging technology for delivery, we’re seeing remarkable improvements in both access and outcomes.

 

Virtual care enables timely intervention and improved outcomes

Virtual behavioral health integration brings several key advantages:

Immediate Access

The integration of virtual care into primary care services allows for immediate access to behavioral health specialists during a virtual visit when mental health concerns are identified. This timely intervention not only prevents conditions from worsening but also reduces the risk of patients falling through the cracks. 

Additionally, for organizations without local access to behavioral health specialists, the use of virtual care can address these gaps and provide long-term strategic benefits for both providers and patients. By utilizing virtual care, primary care providers have a seamless connection to behavioral health specialists for patient referrals, enabling them to collaborate on medication dosages and facilitate referrals to higher levels of care.

Increased Engagement

Virtual care removes geographical constraints and time barriers. Patients can connect with specialists from their homes, workplaces, or any private space. This convenience has led to a marked decrease in no-show rates—clinics have experienced a 29% reduction in missed appointments after implementing virtual integrated services. 

Enhanced Collaboration

Virtual platforms enable seamless communication between primary care providers and behavioral health specialists. Doc-to-doc consults and referrals lead to more coordinated care plans and better management of complex conditions, creating a more holistic patient experience and increasing patient satisfaction.

 

Behavioral health integration creates significant cost savings for health systems

The benefits of virtual behavioral health integration extend beyond individual patient care to affect entire health systems:

Cost Reduction

By addressing behavioral health issues early and in conjunction with physical health, health systems see significant cost savings. Studies show that patients with untreated behavioral health conditions typically incur 2-3 times higher medical costs than those receiving appropriate care.

Resource Optimization

Virtual integration allows health systems to maximize their behavioral health resources. Specialists can serve multiple primary care locations without travel time, increasing their availability and effectiveness. 

Improved Population Health Management 

The data collected through virtual platforms enables better tracking of population health trends and outcomes. This information helps health systems allocate resources more effectively and develop targeted interventions for high-risk populations. 

 

Effective behavioral health integration drives real-world outcomes like decreased LOS and wait times

 At Iris, our own experience driving virtual behavioral health integration with our partners has shown: 

  • 96% reduction in patient wait times  
  • 38% improvement in depression symptoms over eight weeks of care 
  • 80% decrease in emergency department length of stay  

Additionally, emergency department visits for behavioral health crises decrease by up to 14.2% when virtual integrated care is available. 

Perhaps most significantly, virtual behavioral health integration is catalyzing a cultural shift in how we think about healthcare delivery. The artificial separation between physical and mental health is dissolving, replaced by a more holistic, patient-centered approach.

As we continue to evolve our healthcare delivery models, virtual behavioral health integration will play an increasingly central role. The future likely holds even greater integration of digital tools, artificial intelligence for risk prediction, and expanded capabilities for remote monitoring and intervention.

The integration of virtual behavioral health services into primary care isn’t just a temporary solution or a pandemic-driven necessity—it’s a fundamental reimagining of how we deliver comprehensive healthcare. By breaking down traditional barriers, improving access, and enabling true collaboration between providers, we’re moving toward a more effective, efficient, and equitable healthcare system.

For health systems considering implementation of virtual behavioral health integration services, the evidence is clear: this approach not only improves patient outcomes but also strengthens the entire healthcare ecosystem. The initial investment in technology and workflow redesign is far outweighed by the long-term benefits in terms of both patient health and system efficiency.

Our challenge now is not whether to implement these changes, but how to accelerate their adoption and ensure they reach all populations who could benefit from them. 

If you’d like to learn more about Virtual Clinic and how you can integrate behavioral health into your organization’s primary care service line, please reach out today.

The Time is Now to Sustainably Scale Behavioral Health Integration

Behavioral health integration is not a new idea. It started to garner mainstream traction in the 1970s, and in 2024, nobody disputes the impact of integrating mental and physical health.

It is unquestionably the right thing for patients and total cost of care.

The last fifty years have brought innovative ideas, pilots, and learnings — but as an industry, we have yet to drive widespread adoption and success. At Iris Telehealth, we believe that’s going to change. The data, care models, and technology have evolved to make driving scalable and sustainable clinical and financial outcomes possible. 

Let’s talk about what we’ve learned as an industry, where we’re going, and why the time is now to drive widespread adoption of behavioral health integration. 

 

Why hasn’t behavioral health integration lived up to the hype yet?

In entrepreneurship, there is a maxim that the success of any business comes down to 5% having the right strategy and 95% having great execution.

With behavioral health integration (BHI), the strategy needed to find success is no different. By integrating the right resources into a patient’s care team, we can drive better outcomes and total cost of care. 

However, the biggest challenge to date is scalability. There are no doubt great experiences, data, and outcomes. But results have been difficult to scale across patients of higher acuities, within rural geographies, and with financials that incentivize their organizations to invest over the long haul.

From our conversations with customers, too many have given up, or have stopped scaling their programs because they run into operational or financial roadblocks that prevent them from achieving their ultimate mission. 

 

So, how can we overcome this challenge to solve behavioral health integration?

There are a few key evolutions in the market that have changed the game: the ability to integrate virtual care locally, to algorithmically identify the patients that need care the most, and the development of care models that are financially sustainable.

Virtual care in behavioral health is a game changer. The unfortunate reality is that 70% of counties in our country do not have a licensed child psychiatrist and 60% do not have a licensed psychiatrist.

Additionally, virtual care allows you to leverage resources across geographies to ensure they’re being used efficiently so smaller populations can still receive great care. 

Virtual care has to be part of the story, but it comes down to the “how.”  

The answer is dedicated virtual care teams with local integration. There must be trust between virtual and in-person teams with shared goals, technology platforms, and communication mechanisms.  

The on-site teams must truly see the virtual providers as an extension of their teams – something that can only be established if the virtual providers know the local culture, are operating on the same technology platforms, communicate constantly, and have aligned goals.  

The second critical ingredient is utilization of data to measure and drive success. Data has unlocked our ability to determine “who should receive care” and “when.”

The reality is some patients are at higher risk of escalating than others, and the data exists within EMRs to intelligently prioritize who should get care first.

This process could mean prioritizing the referral queue to ensure patients in highest need care first or it could mean proactively identifying patients that need care, even if they have not been referred.

The data, algorithms, and technology are all there, we just have to do the work.

Finally, we have decades of learning around the optimal care model that we should apply going forward. Navigation assessments must be part of the story to ensure each patient is getting clinically appropriate care from a provider working top-of-license.

We need to incorporate short-term care models as clinically appropriate.

There must be a care team approach to ensure patients of all acuities can receive the best care for their specific needs. And, a need to collaborate with the broader team, and community providers, to ensure patients are receiving continuous, quality, whole-person care. 

If we do all these things, the financials follow – both on a fee-for-service basis and from a total cost of care perspective. We have proven that it is possible to deliver great clinical care while delivering a positive operating margin for our partner health systems. 

 

So, what’s next for behavioral health integration?

We cannot give up on the idea of behavioral health integration.

If we take the learnings we’ve had as an industry over the last few decades and apply them, we can absolutely scale BHI across entire populations in a way that delivers sustainable financials and fantastic clinical outcomes — all while increasing patient and provider satisfaction. 

We believe Virtual Clinic is the answer to behavioral health integration.

Our Virtual Clinic approach leverages a cross-functional care team to ensure patients who need help first, get seen first. They’re able to get the appropriate care plan for their needs and are supported throughout their care journey. Virtual Clinic integrates behavioral health services into unique patient journeys to ensure their mental health is always supported.

If you want to learn more about this service and how we can help your organization address behavioral health needs in a financially sustainable way, feel free to contact us today.

You can also learn more about our services here and read our case study to see them in action.