Alli Center, LLC, An Alliance for Behavioral Health

Alli Center, a mental health practice in Coralville, Iowa, had just celebrated its two-year anniversary when COVID-19 struck. Suddenly, like practices across the country, it faced multiple threats including emotional havoc to their patients, financial impact to its 20 employees and an uncertain future for this young clinic.
Simultaneously, Alli Center was launching Kareo as its EMR to automate the practice. Its first EMR had been a total fiasco. “They had the worst customer support I’ve ever experienced,” says Zara Wanlass, MBA, co-founder and CEO of Alli Center.
“I did my homework, and researched the top 10 systems on the market,” she continues. “I picked Kareo because it would help us eliminate paper, was robust, had an attractive user interface, and a solid infrastructure for future development.”
It also helped when she noticed where Kareo was based, and that the CEO was a University of California alum, like Wanlass herself. “I tend to trust software that comes out of California,” she says.

Wanlass was in the process of implementing Kareo throughout the office to streamline administrative functions when the coronavirus hit. Her plan had been to roll out telemedicine sometime in the future. All at once, shelter-in-place orders bumped telemedicine to the front burner.
“Our patients were suffering and needed help,” she explains. “Our therapists wanted to be there for them, and to keep their jobs. Telemedicine became an instant priority. Luckily for us, we had exactly what we needed in Kareo, and were able to shift all appointments to the virtual platform right away.”

Wanlass initially worried about adopting telemedicine, due to the nature of Alli Center’s client base. “We serve both Medicaid and Medicare patients, many of whom lack sophisticated computers or access to high-speed Internet at home. During shelter-in-place, they couldn’t even use a public library or community hotspot for a counseling session,” she says.
“However, we discovered that most people are comfortable with smart phones. They can easily click on a text or email to download the Kareo app. Within minutes they can be up and running.”
For patients who prefer to use a computer rather than a phone, getting connected is equally simple. Less than five percent need to resort to an old-school telephone session, usually because they lack a smart phone or strong wifi signal.

Privacy, an important concern in mental health, proved to be a nonissue. “One of the greatest things about Kareo’s telemedicine is the built-in security, with full HIPAA approval. It’s great that we don’t have to worry about compliance, hacking, or zoom-bombing,” says Wanlass.
Equally important to Wanlass was signal reliability. “We have Doxy.me, a free telemedicine platform, which we keep as a backup,” she notes. “But its reception tends to be problematic.Kareo’s telemedicine service gives us very clear connections, for a superior client interaction.”

Many patients are finding that their insurance copays are waived for telehealth during the coronavirus pandemic, Wanlass explains. “This means that we’re getting more payments directly from insurance companies, a very pleasant side effect. For those who must still make copays, we are able to securely store credit card information in Kareo, and easily run patients’ cards at the time of service. The Kareo statements are beautiful, easy to read, and provide a URL for the patient to make a secure payment online, for anyone who chooses to have a statement mailed to them.”
A large percentage of Alli Center’s patients are on Medicaid and thus do not make payments. So Wanlass opted to disable the functionality of Kareo requiring a credit card prior to a telehealth session. “If we were a self-pay-only service, we would definitely use this feature,” she says.

In addition to the benefits of telemedicine, Alli Center began experiencing improvements throughout the clinic when it adopted the new system. “Kareo’s automated notes function saves practitioners an hour or two a day,” says Jason Knight, LISW, co-founder and clinical director. “The type-aheads and shortcuts mean that we can leave the office at night with our notes all done – a wonderful thing!”
He adds that the automated notes suggest what to record, and help with consistency, while reducing the risk of insurance audits.

Similar benefits have come in training. “Live training is expensive and exhausting. With our previous software provider, it cost hundreds of dollars to train each new staff member, not including paying for employee hours,” says Wanlass.
“In contrast, Kareo University is fantastic. A therapist can get up to speed quickly and easily, choosing the modules they want. I can upload our own clinic-specific training documentation to our company intranet, or modify the Kareo offerings to meet our needs. Kareo University has cut our training costs by about 75% and saved immense amounts of management time.”

Alli Center discovered yet another an unexpected benefit from the switch to Kareo. “Our no-show rate has dropped dramatically, by about 35 percent,” Wanlass says. “We don’t get paid for Medicaid no-shows, and receive only a partial payment from other patients. So, each one represents lost revenue to both the practice and our providers.
“Now, we use Kareo to send a reminder text several days in advance of an appointment, and another two hours before,” she continues. “Not only are more patients showing up, but they’re also more timely. We attribute this to both the Kareo reminders, and to the flexibility and convenience of telemedicine.”

Alli Center’s patients have been grateful for the uninterrupted service they receive from the clinic, thanks to telemedicine. “People have so much on their minds right now in the midst of this pandemic,” says Knight. “They’re confused, frightened, and feeling alone. At the same time, they have very limited human interaction. Now more than ever, they need to talk to someone.”
Knight sees telemedicine as the beginning of a new horizon for the clinic. “We have vast unmet needs for mental health services in our area. Potential patients have difficulty travelling from rural areas for an appointment. Some are homebound. And there just aren’t enough in-person therapists in general. Telemedicine lets us reach out to people, whatever their behavioral needs. It gives us a tremendous potential for growth.”