Just in Time Scheduling

Written by Mary Givens, CCBHC Program Manager and Laurie Kalmanson, Product Marketing Manager

We recently had the opportunity to speak with The Family Resource Center of Northwest Ohio (FRC), Inc., about their adoption of “Just in Time” (JIT) scheduling to medical provider appointments. The JIT scheduling model originated with Japanese manufacturing, and its adoption by healthcare brings its elements of productivity, transparency, and visibility to provider utilization. For new and continuing behavioral health clients, appointments with medical providers can have some of the longest waiting times, due to limited availability and high demand. How often do we all wait until we are out or almost out of medication to call the doctor for a refill? By using JIT scheduling, behavioral health and SUD agencies are able to get the client an appointment within 3-5 business days, decreasing the need for “bridge prescriptions” and effectively managing client adherence and provider scheduling.  

Challenge | No Show Rates and Waiting Lists 

The Family Resource Center of Northwest Ohio (FRC), Inc., was managing long waiting lists as demand for its services increased, while it struggled with a high no-show rate that left providers idle even as more and more people sought help. FRC was experiencing a no show rate of 41% for the appointments with medical providers which was completely unacceptable to them. They wanted to do better for their clients. After implementing the JIT scheduling, this no show rate dropped to 19% and they intend to improve that percentage even further.  

“Our model wasn’t working,” said Julie Yingling, Director of FRC. “Something had to give.” 

Solution | “Just in Time” Scheduling for Increased Access and Enhanced Productivity 

Working with the Chief Medical Officer, Dr. Valerie Westhead, a JIT trainer and MTM consultant and FRC’s providers, Yingling and her colleagues implemented a “Just in Time (JIT)” scheduling solution for medical appointments through the CareLogic EHR platform, supported by the Vital Interaction tool for workflow automation and patient communication. Having “buy in” from the top,  including FRC’s CEO, John Bindas, played a big part in the success of “JIT” for FRC.  

“We are fully implemented with JIT now, and it just makes sense,” Yingling said. “We have decreased no shows by more than 20%, and increased access to care, while gaining capacity and productivity.” 

“When done correctly, just in time scheduling has the potential to cut costs, increase productivity, improve medication compliance, improve access to care, and improve client satisfaction” said Mary Givens, Qualifacts CCBHC Program Manager. “Combined with the concurrent documentation that CareLogic facilitates, providers are handling caseloads more efficiently and more effectively, with better productivity while writing clinical notes in real time with active input from clients during their sessions for better communication and better buy in.” 

“We use JIT now to schedule medical appointments within 3 to 5 business days of when the client request or needs an appointment, including recurring appointments,” Yingling said.  “FRC uses CareLogic’s appointment reminder capabilities to call or text the client 5, 4, and 3 days before they are due to schedule their follow up appointment.” 

To ensure your EHR can support “JIT” scheduling, you will need a flexible scheduler that can support centralized scheduling, follow up notification functionality, and an integrated patient reminder application.  

Increased Client Engagement, and Enhanced Medication Adherence  

“Under JIT, when a client leaves their appointment, they do not leave with an appointment scheduled; they leave with a callback reminder card that says, your medical provider would like to see you, and they are asked to arrange that appointment within seven days before. This is supported by automated text and telephone reminders,” Yingling said. 

The emphasis on client engagement to drive compliance with follow up visits, supported by automated reminders generated in CareLogic has been successful in reducing no show rates and enhancing capacity and access, while empowering clients.  

“The responsibility now rests with the client, backed up by guard rails in the automated workflows,” Yingling said. “The people we serve have responded well to that, and it has enhanced their engagement. We maintain an outreach team to support people who aren’t able to keep their appointments, to understand how we can better engage them.”  

An emptying medication container is a powerful motivator for compliance: “Our clients are benefiting from the understanding that if what is in their prescription bottle is dwindling, they need to call for their next appointment,” Yingling said. “They come in on a regular cadence; the predictability works for them and for our providers.” 

Decreased No Show Rates, and Expanded Provider Utilization 

“For new clients, the productivity gains we have achieved with decreased no show rates has expanded the access we can offer, and we have improved the turnaround of scheduling when they can be seen,” Yingling said. “JIT has made a significant difference there — by using our resources more efficiently, and clearing out the no shows on our calendars, we have opened more time on our schedules.” Greater utilization is a value add for revenue.  

Call Center and Scheduling Success 

“We have so many accolades to award to our call center, for fielding phone calls across our six locations as to schedule face to face visits and the telehealth care that we also deliver,” Yingling said. “Anyone who calls to make a medical appointment goes through central scheduling, who books the time.” This increase in access has also led to a better client experience.  

Long Term JIT Success  

“The appointment reminder tools within CareLogic enable us to have visibility into who is keeping their appointments, and when there are misses under the JIT model, our outreach and engagement team can track and follow up to understand the barriers to care – maybe they couldn’t get a ride, or they had a family emergency – to help clients refocus so that their care becomes their priority,” Yingling said. “If you stay true to the model, the model will work. We are pleased with the strides we have made.”  

By being able to focus on those who do not show for their medical appointments, case management can reach out and work with the client to remove barriers to showing up for appointments. This can ultimately mean greater medication adherence, which is a win for the clients.  

In Closing 

If your agency is experiencing high “no show” rates for medication related appointments, consider trying JIT scheduling. When done well, “Just in time “scheduling can result in decreased no shows, greater provider utilization, greater medication compliance, and improved client experience. Each of these outcomes is an improvement to the quality of your services.  

About Family Resource Center of Northern Ohio, Inc. 

Prevention Works. Treatment is Effective. People Recover.

Family Resource Center of Northwest Ohio is licensed by the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and has received national accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF).  

We are about helping people find their path forward and seeing life through a hopeful lens. This is about more than programs, services and resources. This is about people who care deeply. People who have dedicated their lives to helping others. People who see not only see the challenges others face, but the person who faces them. 

The mission of Family Resource Center is to provide specialized behavioral health services to children, youth, adults, and families in our multicultural communities in order to strengthen family life and promote personal growth.