By Monica E. Oss, Chief Executive Officer, OPEN MINDS
Technology and analytics are an important ingredient in almost every domain of health and human services—including crisis services. That was the focus of my remarks in the recent podcast episode—Being There For Youth—of the 988 Crisis Jam Podcast.
For organizations participating in a crisis continuum of care in their community, some of the keys to success are partnerships and flexible services delivery—and the technology to optimize them. In the podcast, I spoke to how organizations are leveraging their electronic health recordkeeping systems (EHRs) with data-sharing to knit together the continuum and provide better consumer services. There are new developments in consumer digital technologies and in smarter phone and texting systems. And, across these new tech capabilities, executive teams are using innovative analytics to track operations and improve performance.
The need for urgent care and crisis services in mental health and addiction treatment continues to increase. While suicide and overdose rates have declined slightly, the demand far outstrips system capacity. Almost three-quarters of people in crisis sought help. One in five of these people in crisis call 988. This has driven an increase in the number of new programs operating in this market space, such as:
- Children’s Minnesota & Washburn Center For Children Expand Partnership To Prevent Emergency Department Boarding For Youth In Mental Health Crisis
- Behavioral Health Urgent Care Opening In Canton, Ohio
- Trumbull County, Ohio, Cuts Ribbon On New Crisis Center, Supportive Housing Project
- UPMC Children’s Hospital Of Pittsburgh Opens Second Behavioral Health Walk-In Clinic
- Nebraska Partners With Central Wyoming Counseling Center On New Crisis Stabilization & Medically Monitored Detox Center
But despite the continued demand and increasing market activity, making crisis services “pencil out” financially is a challenge. I asked my OPEN MINDS colleagues their insights and recommendations for executive team operating (or considering opening) crisis services.
My colleague Paul M. Duck, OPEN MINDS chief strategy officer, was quick to point out that getting the reimbursement right is the greatest challenge. He noted that, “Crisis services usually rely on a mix of funding sources … and those dollars don’t always line up with the actual cost of running crisis programs.”
And, in her work, OPEN MINDS Senior Advisor Deanne Cornette has observed that fee-for-service reimbursement rarely covers idle time, travel, supervision, care coordination, or post-crisis outreach; per-diems/case rates often exclude transport and security; and authorization rules drive denials. “Funding is braided … and each stream pays for a slice of the continuum, not the whole readiness cost,” she added.
Dr. Stuart Buttlaire, OPEN MINDS vice president of clinical excellence and leadership, added that, “Financial viability remains one of the greatest pain points for crisis providers. Reimbursement rarely matches the true cost of operating a 24/7 program, especially when volumes fluctuate. Fixed staffing and facility expenses continue regardless of census, and payer fragmentation introduces administrative friction, denials, and inconsistent coverage for different crisis services. In addition, limited step-down capacity—in detox, inpatient, or respite availability—also drives up costs by prolonging stays.”
But even with identified payers, revenue cycle management and data discipline are key to financial sustainability. “Billing requirements are complicated,” Mr. Duck added, suggesting organizations track net collection percentage, especially as payers shift to value and demand outcomes.” Ms. Cornette added that “field documentation and mid-episode payer changes amplify leakage. Without service-line cost accounting, leaders can’t see true contribution margins and misallocate investment.”
Beyond reimbursement, Christy Dye, OPEN MINDS senior advisor, has observed firsthand the staffing challenges of crisis services. “Crisis staffing models must be engineered for 24/7 capacity with rapid field deployment—a different animal than 8-5 office-based models. Beginner crisis organizations often struggle to make these models efficient while absorbing premium overnight pay. Because crisis is a specialty, not everyone is cut out for it—burnout risk remains high, even in well-run teams. That 24/7 expectation is now table stakes. The organizations that thrive will treat staffing as an always-on capacity design problem, not a shift-by-shift scheduling exercise.”
OPEN MINDS Senior Advisor Sharon Hicks added that “The capacity issues are real. Staff safety and staff availability are related because of high turn and the difficulty in recruiting. And another is that, especially in rural areas, so many bed-based services have closed or shrunken. The concept of mobile crisis has been built around hospital and jail diversion; however, without more beds, either inpatient or crisis stabilization, there will be many people in crisis who simply have no place to go.”
To address this, OPEN MINDS Senior Advisor Rick Guitterez advised, “We had to develop creative bonus programs when I managed a crisis program due to the odd hours people were on call. This helped to incentivize the workforce to take holidays. But this can get expensive and needs to be included in the budget. The alternative is you have high turnover and are wasting money recruiting, hiring, and training.”