PracticeTransformationAcademyKick-offMeetingTheCareTransitionsNetwork

National Council for Behavioral HealthMontefiore Medical Center

Northwell HealthNew York State Office of Mental Health

Netsmart Technologies

Value inValue-BasedPayments

= Quality

Cost

Payments Continuum

Source: J. Rubin Principle Health Management Asso. 2016

ContractingwithaPayer

$Or…

Ifatreefallsintheforestandnoonecollectedthedata,itdidn’tmakeasound.

Value inValue-BasedPayments

= Quality

Cost

Value-BasedPaymentReadiness

Patient- andFamily-Centered

CareDesign

Data-drivenQuality

Improvement

SustainableBusinessOperations

PATScoresandTrendsPhaseofTransformation(Milestone13)

• 7/10organizationsinPhase1• 3/10inPhase2

PopulationManagement(Milestone7)• 5/10haveasystemforidentifyinghighriskpatients,buttheidentificationprocessforotherrisklevelsisinconsistentornotyetstandardized

QualityImprovementMilestones(14,15,16)• 5/10havenotyetidentifiedanorganizedQIapproach• 6/10havealimitednumberofstaffwhoaretrainedandparticipateinQIactivities• 8/10producereportsonprovider/careteamperformance,butdistributionislimited,theymaynotbesharedinafullytransparentmanner,andfollowupisinconsistent

AligningourTerms!

Value-basedPaymentsrequires…RiskStratificationwhichrequires…

PopulationHealthManagementtherefore…

theseconceptsarenotlooselylinkedbutarestructurallycontingentononeanother.

PopulationHealthManagement

• Asetofinterventionsdesignedtomaintainandimproveapatient’shealthacrossthefullcontinuumofcare—fromlow-risk,healthyindividualstohigh-riskindividualswithoneormorechroniccondition.(Felt-Lisk&Higgins,2011)

• Populationmanagementrequiresproviderstodevelopthecapacitytoutilizedatatoriskstratifypatientsintogroupsandthenrespondtotheneedsefficientlyandeffectively.

ThePromiseofPopulationHealthManagement

• Promotesacultureofmeasurement&problemsolving

• Bringstogetherutilizationreviewfocusoncostwithclinicalcarefocusonoutcomesinotherwordsit…providesmeanstoseehowqualitymetricsarelinkedtocost

PrinciplesofPopulationHealth

ComponentsofPopulationHealthManagement

1. Knowingwhattoaskaboutyourpopulation2. Dataregistrytodescribe/riskstratifyyourpopulations3. Proficiencywithqualityimprovementtoolstorespondtothefindings4. Continuousqualityimprovementpolicies/procedurestosustaindata

specificationtargets

CommonIndicatorsUsedtoStratifyRisk

• BehavioralHealthDiagnosis• Schizophrenia,Bipolar,Depression&Anxiety,PTSD&Stress,SUD

• HospitalizationUtilizationRates• Re-hospitalizationRates• EmergencyDepartmentUtilizationRates• MedicalCo-morbidities• SocialDeterminantsofHealth

OverviewofthePhasesofPlanning

ActivityDefinition

ActivitySequencing

ActivityResourceEstimating

ActivityDuration

ActivitySchedule:Calendar

Tool:WorkBreakdownStructure

Tool:NetworkDiagram

Tool:Gantt

StretchProjectPlanningGuidingQuestions

Throughoutthedaypleaseconsiderthefollowingquestions:1. Howmightyourstretchgoalchangefromyouroriginalproposal?2. Whowillyouincludeonyoutransformationteamandwhy?3. Whatmetricswillyouusetomeasureyoureffectivenesstoward

thisstretchgoal?4. Whatareyouranticipatedbarrierstomeetingyourstretchgoal?

LogFrameProcess• Usingalogframe (logicmodel)isonewaytodevelopaclearerunderstandingofthegoalsandobjectivesofaproject,withanemphasisonidentifyingmeasurableobjectives,bothshort-termandlong-term.NarrativeSummary Indicators DataSources Assumptions

Goal

Objectives/Outcomes

Outputs

ActivitiesProjectDeliverables

ProjectResultsIf thehorizontallogicisfollowedANDassumptionsholdtrue;Then theprojectwilllikely

succeed.

SampleStretchProject

Supportmyorganizationtomaketheparadigmshifttopopulationhealthmanagement.Determinewhatmetricsareneededtocapturenewcarepathwaysforourhighrisk/highcostpopulations.Increasereliabilityoffinancial,clinicalandpatientexperiencedata.

Exercise:DevelopYourStretchProjectLogFrameNarrativeSummary Indicators DataSources Assumptions

GoalMaketheparadigmshifttopopulationhealthmanagementtoimprovepatientoutcomes

Reducedre-hospitalizationrates Medicaiddata

Objectives/OutcomesImprovedcarecoordination

Percentofhighriskclientsreceivingcarecoordination/caremanagement

EHR Coordinated/managedcarewillimprovehealthoutcomes

OutputsEstablishedriskstratificationapproachtoinvestigateclientpopulation

1.Percentofclientswithestablishedcarepathways2.Percentofhighriskclientsreferredtocaremanagement

EHR Carepathways willbefollowedandpatientswillbereferred

Activities1.Identifycommonindicatorsusedtostratifyrisk2.Designandimplementdataregistry3.Identifyoperationalworkflowstosupportriskstratificationprocesses

1. Indicatorsselected2. Dataregistryprotocolinplace3. Staffimplementingworkflows

Organizationalprotocols

Monthlystaffmeetings

Staff aregiventhetoolsandresourcestoeffectivelyimplementthisapproach

OverviewofthePhasesofPlanning

ActivityDefinition

ActivitySequencing

ActivityResourceEstimating

ActivityDuration

ActivitySchedule:Calendar

Tool:WorkBreakdownStructure

Tool:NetworkDiagram

Tool:Gantt

Phase1:ActivityDefinition

• InPhase1weare:• Identifyingthekeyactivitiesthatneedtohappenforyourstretchproject• Breakingdowntheseactivitiesintotasks

• Oncebrokendown,thetaskscanbe:• Clearlydefined• Analyzedfordependenciesandrisks• Scheduled

StretchProjectExampleEstablishpopulationhealthmanagement

approach

Identifymetrics

Identifycurrentdatapoints/processes

Identifygaps

Crosswork anddeterminepotential

datacollectionapproaches

Selectfinalmetrics

Establishriskstratificationapproach

Identifytools Implementapproach

Establishteamworkflows

Trainstaff

EstablishQIapproachDesignand

implementdataregistry

Mapalldatapoints

Developoradaptregistrytool

Trainstaff

Finalizeallmaterialsandprotocols

Contingencyplanfortrainingandlostproductivity

StretchProjectExampleEstablishQIApproach

EstablishQIteam

Developmonitoringandevaluationplan

Datacollection

Developdatacollectiontoolsandprotocol

Monthlydatacollection

Quarterlydatacollection

Developpoliciesandprocedures

Workflowrevisions Stafftraining

Materialsfordistribution

Culturalreinforcement

Accommodatelossin

productivity

Exercise:IdentifyYourStretchProjectActivities• Identifythekeyactivitiesforyourstretchprojectandbreakthemdownintodetailedleveloftasks

• Keyquestion:Whatiseverythingthatneedstohappeninorderforthisactivitytobecompleted?

• Useonecolorofstickynoteandoneactivity/taskperstickynote

Phase2:ActivitySequencing• Mappingouttheidentifiedactivitiesbasedonsequencinganddependencies

EstablishQIApproach EstablishQIteam

DevelopM&Eplan

Developdatacollectiontoolsandprocesses

Reviseworkflows

StafftrainingRevisepoliciesandprocedures

Traininglogistics

Reviewcurrentworkflows

Reviewcurrentpolicies/procedu

res

Exercise:SequencetheActivitiesforYourStretchProject• Keyquestions:

• Whatcanhappenconcurrently?• Wherearethedependencies?

• Makesureyouareincludingallactivities• Usethestickynotesyoujustdevelopedandrearrangethemintoanetworkdiagram

Phase3:ActivityResourceEstimating

Whatstaffare

available?

Whatadditional

resourcesdoIneed?

WhatskillsdoIneed?

WhatconstraintsdoIhave?Whatbuyin

doIneed?

Doesanyofthiscostmoney?

Exercise:IdentifyingYourStretchProjectResources• Keyquestions

• Whoneedstobeinvolvedinthisactivity?• WhatresourcesdoIneedtocompletethisactivity?• Arethereanybudgetimplicationsfortheseactivities?

• Comparethistowhatandwhoyouhaveavailabletoyouforthisproject– youmakecomeawayfromthisactivitywithsome“asks”youwillneedtobemaking

• Usinganothercolorstickynote– writedowntheresourcesforcertaintasksinyournetworkdiagramandattachthemtothattask

EstablishQIApproach EstablishQIteam

DevelopM&Eplan

Developdatacollectiontoolsandprocesses

Reviseworkflows

StafftrainingRevisepoliciesandprocedures

Traininglogistics

Reviewcurrentworkflows

Reviewcurrentpolicies/procedu

res

Phase4:ActivityDuration

1day

5days

5days

10days

3days

10days

5days

2days

1day

Exercise:EstimateDurationofActivitiesforYourStretchProject• Foreachactivity,makerealistic assumptionsaroundthedurationneededtocompleteit

• Youcanuseanotherstickynoteorwriteonthecurrentones

Phase5:ActivityScheduling• Usingtheresultsofyourotherplanningphases,youareabletobuildoutyouractivityschedule/workplan tomonitorandtrackonprogress

Activity Week1 Week2 Week3 Week4 Week5 Week6 Week7 Week8

EstablishQIteam

Identifymetrics

DevelopM&Eplan

Establishriskstratificationapproach

EstablishQIapproach

Developdataregistry

Trainstaff

Rolloutintervention

Monthlydatareview

Exercise:CreateYourProjectGANTT/Workplan

Activity Week1 Week2 Week3 Week4 Week5 Week6 Week7 Week8

RapidCycleChangeFourSteps:• LeverageyourTransformationPlan• DevelopandexecutethePracticeTransformationPlan

• Rapid-cyclechange:UsePDSAtodrivepopulationhealthmanagement

• SustainimprovementthroughContinuousQualityImprovement(CQI)

RapidCycleChange

Rapidcyclechangeisasystematicproblem-solvingapproachtounderstandclientneeds,restructureprocesses,andmakethemostefficientuseofavailableresources.

CQIRoles

Leadership’sRoleinPracticeTransformation

• Communicatehowtheorganizationwilltransforminthenext1-3years• Definenewterms(e.g.,PopulationHealthManagement)• Setorganizationalgoalswithtargetsandkeyperformanceindicators(objectives/tasksaredevelopedbysub-committeestaff)

• SupportandempowerthePracticeTransformationLead,whowilldrivechangeefforts

• Settimelines&authorizeanytimelinemodifications• Provideresourcesandthemeansforacquisition,riskidentification/contingencies,proceduresforconflictresolution

RootCauseAnalysis• Rootcauseanalysis (RCA)isastructuredmethodusedto analyzeproblemsandlearnfromadverseevents.

• RCAidentifiesunderlyingproblemsthatincreasethelikelihoodoferrors,whileavoidingthetrapoffocusingonmistakesbyindividuals. Example:Fishbonediagramtemplate

StretchGoalPresentationsandPeerFeedback

1. Whowillyouincludeonyoutransformationteamandwhy?2. Whatisyourstretchgoal?3. Whatmetricswillyouusetomeasureyoureffectivenesstoward

thisstretchgoal?4. Whatareyouranticipatedbarrierstomeetingyourstretchgoal?

Pleaseemailyourslidesto:JuliaS@thenationalcouncil.org

NextSteps• WebinarDates

• Communicatingthe“why”• Wednesday,May3,201712-1pm

• WorkflowMapping• Wednesday,June21,201712-1pm

• Identifystaff/teammembersusingtheRACI

• Tuesday,July25,201712-1pm• CultivatingaCultureofQualityImprovement

• Wednesday,October18,201712-1pm• IncorporatingPatientsandFamiliesinTransformation

• Wednesday,November15,201712-1pm• Wrap-upWebinar

• Tuesday,January23,201811:30-1:30pm

• Coachingcalls• CEOcalls• Mid-yearmeeting

• ThursdaySeptember21st 9am-5pm

Evaluationhttps://www.surveymonkey.com/r/7PHMZYP

Thankyou!www.CareTransitionsNetwork.org

CareTransitions@TheNationalCouncil.org

Theproject describedwassupportedbyFundingOpportunityNumberCMS-1L1-15-003fromtheU.S.DepartmentofHealth&HumanServices,Centersfor Medicare&MedicaidServices.Disclaimer:The contentsprovidedaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresent theofficialviewsofHHSoranyofitsagencies.