Coordination is an executive problem

I have spent the last several months in rooms, physical and virtual, with behavioral health executives, and there is a moment that repeats in almost every conversation. I ask about their no-show rate and get a precise answer. Then I ask who owns fixing it, and the room goes quiet.

That silence is the subject of this post.

In many organizations, missed appointments are filed under front-desk noise: something the schedulers manage, one reminder call at a time. Leadership sees the aggregate on a monthly report, winces, and moves to the next slide. But add up what a missed appointment actually costs and it stops being noise. The empty clinical hour that revenue never fills. The staff afternoon spent working a call list of people who did not pick up. The compliance exposure when follow-up care slips. And the critical but quietest cost of all: for many patients, the missed appointment is the first step out of care entirely.

Across behavioral health, appointments fail 25 to 40 percent of the time.¹ Variance depends on the type of care. This is not a front-desk problem. This is a financial problem, a care problem, an operations problem.

The cost of unplanned work

Between every scheduled appointment and every delivered visit sits a layer of invisible work: confirming, reminding, rescheduling, chasing paperwork, refilling the slot when someone cancels, noticing which patients are drifting and pulling them back. Call it coordination.

Every organization pays for this work. Few budget for it, staff for it, or measure it. It lands on whoever has a free hand, which means it competes with the patient standing at the front desk, and it loses.

Consider a question: if the person who unofficially owns your coordination work took two weeks off, what would happen to your schedule? If that question makes you uncomfortable, coordination is already an executive problem in your organization. It is just an unmanaged one.

Why hindsight tools have not fixed it

The industry's answer has been visibility: dashboards and reports that show last month's no-show rate, last week's utilization, and yesterday's gaps. I have built some of those tools in my career, and visibility genuinely matters. It is a start, but it does not solve the problem. A report describes what already went wrong. It does not reach the patient.

Meanwhile, the information needed to prevent most of these failures already exists inside your systems. Which patients have missed before? Who never confirmed? Who has an outstanding balance, a transportation barrier, a screener that never came back? The signals are all there. What has been missing is something that reads them ahead of the day and acts while the appointment can still be saved.

Since 2014, Mend has supported more than 40 million appointments evaluated and 160 million patient interactions. That history is what lets Mend predict which appointments are at risk instead of reporting which ones were already missed. It is what allows you to act before the appointment gets missed.

This is the key difference between reporting and coordination. One describes your morning. The other has already started resolving it.

What coordination could look like

This week our team launched Coordinate™, and I want to share some of the design decisions behind it. My hope is that this gives a picture of what managed coordination looks like, whether or not you ever use our product.

We decided it had to work ahead of the schedule, not behind it, so risk gets handled before the slot goes dark instead of explained afterward.
We decided appointments could not be treated identically. A first-time patient who never confirms is not the same risk as a regular who always shows.
We decided refilling an opening from the waitlist should be a reflex, not a scramble.
We decided, most importantly, that you set where automation stops and judgment begins. The routine runs under your team's standing direction, and a human approves the decisions that matter, with the reasoning in front of them. That line is a dial, not a default. If you want it to, Coordinate can run the whole loop automatically. If you would rather your team touch more of it, dial the automation back and keep people in as many steps as your organization sees fit.

This is an operating decision. Which is why I believe coordination is a critical opportunity for the executive team to own. Handoffs are where organizations either compound their excellence or quietly bleed it.

The decision on the table

The argument of this post stands with or without Coordinate. Coordination is where behavioral health organizations are leaking revenue, capacity, and continuity of care, and it will keep leaking until someone at the leadership table owns it.

If you want to feel the difference rather than read about it, we built a hands-on test drive: step into a morning with Coordinate, watch it work, and ask it your own questions. Take the test drive — no form required to start.

Automation where you need it. Humans when it matters most. I look forward to partnering in these efforts.

Croy Bosch is Chief Product Officer at Mend.

Reference

Pippen, P.E. University of Louisville Doctor of Nursing Practice Papers. 2022.