Meta-Leadership In Action: Making Provider Organization ... · What is Meta-Leadership? II. ......

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www.openminds.com15 Lincoln Square, Gettysburg, Pennsylvania 17325

Phone: 717-334-1329 - Email: [email protected]

The 2017 OPEN MINDS Executive Leadership Retreat

September 28, 2017| 9:45 AM – 11:00 AM

Bob Dunbar, Senior Associate, OPEN MINDS

Meta-Leadership In Action: Making Provider Organization Collaborations Work


I. What is Meta-Leadership?

II. Meta-Leadership In Action: Spectrum Health Services

III. Meta-Leadership In Action: Adult and Child Health Services

IV. Questions & Discussion

Agenda


What Is Meta-Leadership?

“Meta”: Going beyond, higher, transcending.

Meta leader navigates a complex situation by pulling together collective resources of diverse stakeholders to accomplish what otherwise may not be attainable.

Meta-Leadership is framework for getting beyond silo-thinking to achieve cross-agency and/or cross-organizations coordinated strategy and effort.

Meta-Leader forges a strategic connectivity for a coordinated effort that reaches beyond the boundaries of isolated organizational thinking and functioning.

“Influence” more than “formal” authority.

Hurricane Harvey, strategic alliance, integration behavioral health/primary care.


Dimensions of Meta-Leadership

Person as Meta-Leader

Know self/self awareness.

Know impact have on others, those lead or seek to lead. How to others

view you?

High emotional intelligence.

Capacity to build and maintain trust.


Dimensions Of Meta-Leadership: Situational Awareness/Diagnosing The Challenge

Capacity to diagnose/generate a clear picture of what is happening;

what is known as well as what may be going on beneath the surface.

Capacity to communicate what is happening.

Intent to understand and integrate different perspectives and interests

into a cohesive view and effective action.


Dimensions Of Meta-Leadership: Connectivity

Meta-Leader forges strategic connectivity for coordinated effort.

Meta-Leader determines:

– What stakeholders need to be involved?

– How to assemble and link into a connected system in which each unit knows its

responsibilities.

– Benefits of connectivity.

– Shared aligned interests and problem solving.


Four Facets Of Connectivity

Leading

Down

Leading

Across

Leading

Up

Leading

Beyond


Connectivity: Leading Down/Your Silo

Your base of operations.

Support critical to influence larger system.

Quality leadership: effectively guide, direct, manage

Show commitment and trust.


Connectivity: Leading Your Boss/Up

Effective influence on those tow whom are accountable

Inform, educate, communicate.

Don’t promise what can’t deliver.

Meet Commitment

Truth to power.


Connectivity: Leading Across

Other departments within organization.

Influence and engage internal stakeholders to effectively link into a

shared effort.

Challenge: competing recognition, rewards, resources, interests.

Advantages of collaboration

Design cross system linkages.


Connectivity: Leading Beyond

Reach out for external expertise and capacity.

Influence, rather than power or authority.

Facilitate connectivity by building trust, identifying benefits that arise

uniquely from coordination, unity of mission, and by coordinating

effective action.

Spectrum Health Services

David Wawrzynek, MS, MBA, Chief Financial Officer,

Spectrum Health Services

Meta-Leadership In Action: Making Provider Organization Collaborations Work

A CASE STUDY BY:

DAVID E WAWRZYNEK MS, MBA SR. V.P. FINANCE SPECTRUM HEALTH AND HUMAN SERVICES

Spectrum Health and Human Services

• 18 million dollar Behavioral Health Not-For-Profit in up-state western New York

• Providing integrated outpatient mental health and substance use treatment services including:• Clinic

• Assertive Community Treatment Teams

• Targeted Case Management

• Rehabilitative Services

• Supported Housing

• 24/7 crisis outreach

• Spectrum has been designated as a Certified Community Behavioral Health Clinic

New York State – Disruptive innovation

◦ All Medicaid services (with a few temporary exceptions) are paid through Managed Care Organizations

◦ NYS is participating in the national Certified Community Behavioral Health Clinic initiative and has designated 16 Clinics throughout the state

◦ In 2014 NYS was awarded a Medicaid 1115 wavier that allows the state to reinvest over a five-year period $8 billion of the $17 billion that they anticipate savings through their Medicaid Redesign Team (MRT) reforms.

◦ The cornerstone of MRT is the creation of a Delivery System Reform Incentive Payment (DSRIP) program.

◦ Safety net providers will be required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement.

◦ In 2015 as part of MRT published their VBP Roadmap which outlines the goal that 80-90% of all MCO payments to providers will be made under a value based payment methodology.

New York State - continued◦ Recently NY announced the NYS Behavioral Health (BH) Value Based Payment (VBP) Readiness

Program. The program will fund BH providers to come together in Behavioral Health Care Collaborative (BHCC). $60 million dollars will be available over 3 years for planning and implementation, to support the development of shared infrastructure. BHCCs will share clinical quality standards, data collection, analytics, and reporting, to improve care quality and enhance their value in VBP arrangements.

◦ It is expected that all Behavioral Health and Community Based organizations will become members of at least one Behavioral Health Collaborative.

◦ It is anticipated that each BHCC that is formed as an IPA or ACO will negotiate VBP based contracts with the MCO that will involve both upside and downside risk.

Meta-LeadershipBehavioral Health Leaders in NY will be challenged in ways they have never been before and will need to amend their leadership styles and embrace the Meta-leadership concepts of:

Leading Down the formal

chain of command to subordinates

creating a cohesive high-performance team with a

unified mission

Leading up to superiors, inspiring

confidence and delivering on expectations

Leading Across to peers and

intra-organizational units to foster collaboration

and coordination

Leading Beyond by engaging external

entities to create unity of purpose and

effort in large-scale response

to complex events

Meta-Leadership in action – a case studyIn 2011 NYS announced that they were going to restructure and expand their targeted case management services and create Health Homes.

Health Homes Leads would create organizations that would contract with Case Management Services providers and be responsible for the coordination, quality, billing, and finance of case management services for those Medicaid clients attributed to the Health Home.

Spectrum Health and Human Services had been a targeted case management service providers for a number of years and faced with the decision to apply to be a lead health home or to not apply and wait to contract with the lead health home as a care management provider

Leading down

Executive Leadership:◦ Created a Health Home workgroup comprised to key management staff to:

◦ Evaluate the fundamental question of potential loss of autonomy

◦ Create fiscal models to evaluate potential financial ramifications of either decision

◦ Evaluate current capacity to meet the application and operational requirements

◦ Evaluate the regulatory, compliance and financial risks to the agency

◦ Once the decision was made to move forward with the application the communication plan was implemented to help case management staff understand:

The choice the organizations was facing

The rational for the decision that was made

The real world affect on them (doubling of caseloads), and

The long term benefits to themselves, their clients, and the organization

Leading upOnce Executive leadership became aware of the opportunity they engaged the Board of Directors in the conversation by:

◦ Making them aware immediately and keeping them regularly informed as to the decision making process

◦ Laying out a clear and concise presentation of our evaluation including potential risks and rewards

◦ Demonstrating the due diligence that went into the decision process to inspire confidence

◦ Kept them regularly informed during the application, selection and implementation process through the board report and board discussion

◦ Provide them with monthly reports on the financial ramifications and results

◦ Continue to keep them informed – in July the Health Home/Care Management team presented to the board as part of our continuing update on the project and its impact on the staff, clients, and organization.

Leading AcrossOnce Health Home Partners was finalized Executive leadership formed an inter-departmental implementation team that was charged with designing and putting in practice the organizational changes necessary to meet the program requirements. Tasks included:

◦ Identifying staff training needs and assuring that these needs were meet

◦ Creating and implementing a new fiscal model that included transitioning caseloads from 20 to 40 over 12 months

◦ Reconfiguring billing software to included expanded billing codes

◦ Redesigning program outcome metric and workflows related to data collection

◦ Evaluating risks related to new documentation and billing requirements and designing and implementing new audit controls designed to mitigate these risks

◦ Redesigning existing space to accommodate an expanded workforce

Leading beyond

Once the state reviewed the application they “suggested” that we collaborate with two other applicants, a billion dollar hospital system and a local organization that historically provided services to community members with HIV/AIDS◦ A short period of dating ensued between the three executive leadership teams to see if we

were compatible and shared similar missions, visions, and commitment to our consumers and the project

◦ A LLC was formed (Health Home Partners of Western NY) with a clearly articulated governance structure, bi-laws, and operating requirements

◦ Operational workgroups were created and staffed by each organizations Clinical Leadership, Financial Leadership, Compliance Leadership, and Executive Leadership

◦ Differences were addressed until consensus was met, responsibilities were shared, successes were celebrated as a group.

◦ Some feelings were hurt along the way but they were never allowed to significantly affect the process

Leading beyond (continued)Once HHP of Western NY was formed executive leadership had the task of communicating and coordinating with an array of community stakeholders, health care systems, and payers. Tasks included:

◦ Coordinating workflows with the other two Health Homes to eliminate duplication of services.

◦ Negotiate with hospitals to allow Health Home staff access to hospitalized patients in support of a warm hand off prior to discharge

◦ Engage contracted care management agencies in the development of shared workflow, quality standards, reporting requirements

◦ Initiation of a media campaign to inform the community of the availability of enhance case management services

◦ Engage local and state government partners in support of an efficient and effective system of care

ResultHealth Home Partners of WNY was recently recognized as one of the highest performing Health Homes in New York State.

My Meta-Leadership keys to success:

◦ Have a clear mission and vision and be able to articulate it effectively

◦ Be transparent and understand the constraints and capacity of those individuals and groups you work with

◦ Instill confidence in others through your command of the issues, your understanding of others’ concerns, and your ability to listen

◦ Leverage you other success and have command of the data to support your position

◦ Communicate – keep governance, staff, and community partners informed every step of the way

◦ Meet challenges head on and celebrate successes

Adult and Child Health Services

Allen Brown, Chief Executive Officer, Adult and Child

Health Services

Meta-Leadership: Making Provider Organization Collaborations Work

Adult and Child Health Services Case Study

Allen Brown, CEO, Adult and Child

Open Minds Executive Leadership Retreat

September 28, 2017

• JC accredited

CMHC and Licensed Child Placement Agency

• Comprehensive BH and child welfare services

• On-site primary care services since 2010

• 700 FTE

• Majority of staff work in schools, homes, etc.

• $48m annual revenue

• Top payors are Medicaid, state grants, and child welfare

The A&C Tradition

• Longstanding success and reputation as high quality mental health and child welfare provider

• Stable, effective, highly networked leadership

• Nationally known for best practices in ACT

• Early adopter and strong commitment to primary and behavioral health care integration

• Champion for evidence-based practice

• Quality over quantity

A&C In 2014 • Leadership

– Proven, experienced

• Strategy– Niche provider strategy

– Refer out routine, non-acute cases

– Create strategic affiliations for revenue sharing

– Leverage partnerships to achieve growth, up to and including merger potential merger

• Org Structure– Divisions led by highly

specialized subject matter experts

• 6 of 8 member of Exec. Team at retirement age– No internal successors

• Large gaps in service continuum– Minimal counseling– Little to no SUD services

• Strategic Affiliations and Partnerships often one-sided

• Silos – Adult division and Child division

operated as 2 separate companies• Quality• Growth• Reputation

Status In 2014

• Infrastructure

– Very low administrative overhead costs (IT, HR, QI, etc)

– Operational autonomy

– Decentralized decision-making

• Growth

• Under-resourced corporate administration

• Reliance on manual paper processes

• Problematic EMR and unreliable IT network

• Lack of standardized best practices

• Not enough persons served• High cost per client• Access to care barriers• Low morale• Adult programs flat to

shrinking • Slowing revenue growth

Adult And Child Today

5,101

5,698

6,273

6,610

8,963

11,029

4,000

5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

FY12 FY13 FY14 FY15 FY16 FY17

Unduplicated Client Count

1,953

2,4042,656 2,635

3,793

4,937

1,900

2,400

2,900

3,400

3,900

4,400

4,900

5,400


Intakes & Evals

8,380 8,3348,049

9,717

10,573

12,861

8,000

9,000

10,000

11,000

12,000

13,000

14,000


Prescriber Services

81,687

104,293

152,122

172,491180,999

197,731

80,000

100,000

120,000

140,000

160,000

180,000

200,000

220,000


ADL Skills Sessions

3,0192,458

1,965 2,259

3,271

8,355

1,900

2,900

3,900

4,900

5,900

6,900

7,900

8,900


Job Services

Change Initiatives Driving Growth And Success

• Executive Leadership Team

• Board of Directors

• Mission and Vision

• Corporate Restructure

• Leadership Development

• Staff Engagement

• Infrastructure Investment

• Strategic Plan

– PC/BH Integration

– Collaboration

• Balanced Scorecard

To Collaborate Or Compete? Collaborations Aren’t Easy….

• Trust

• Risk

• Difficult to execute

• Tribalism

• “Opportunity” Cost

• Internal vs Externally Focused Leadership

• CMHC’s relationship with Payers, Hospitals, Managed Care Entities

• Baggage of prior failed attempts

• Is the Strategic Vision strong enough to link different organizations together?

A&C Chooses Collaboration

• iHost Project: Homeless outreach agreement with Eskenazi Midtown MHC merging efforts and embedding services with homeless provider agencies

• Blue Triangle Project: value-based contract with City of Indianapolis, Anthem BCBS, and Partners in Housing bringing homeless persons off the streets into supportive housing and services

• Circle City Clubhouse: risk-sharing agreement for enhanced rehabilitation and recovery services to clubhouse consumers

• Jane Pauley Community Health: Risk-sharing agreement embedding FQHC services inside MHC

MHC And FQHC Reimbursement

Adult and Child

• Traditional Medicaid FFS Rate inadequate to cover costs for most services

• Minimal grant support for infrastructure or operations

• Traditional Medicaid Rate

– 99214 (MD): $76.88

– 99214 (APN): $57.66

– 90834 (LCSW): $50.39

Indiana Community Health Clinics

• HRSA building/infrastructure grants

• 330b grant funding

• 340b pharmacy program

• Enhanced Medicaid Rate

– FQHC PPS rate ranges from $170 to $280 per unit of service, regardless of service duration

Integration Approach 1: Partner With FQHC

• A&C partnered with FQHC in a 6 year PBHCI grant, with limited success

• Some MHC clients benefited, but the program was inefficient, costly and too few served

• Workflow, data, and service integration never evolved beyond a low level, co-location relationship

• A&C overall lost money, never gained sustainability

• Mid-grant, extensive merger discussions occurred but eventually broke down. A&C and FQHC parted ways after grant ended

Approach 2: Partner Again For Primary Care

But this time differently…

• No PBHCI grant dollars involved

• A&C required shared risk/shared reward

• Agreement balanced and structured to leverage highest possible reimbursement

• A&C needed a stronger partner willing to embrace risk to do this…

A&C/JP Operating Agreement

A&C approved by HRSA

to be a JP health clinic location

• JP leases office space

• BH staff are leased to JP

• JP provides primary and behavioral care services

• Services documented and billed through JP EMR

• Expenses shared for support functions like front desk, IT, BH supervision, QI, etc.

• JP reimburses A&C for full cost, plus overhead

Approach 2 Outcome:

• Victory! Financially viable for

both sides

• Whole health care being delivered to vulnerable, underserved SPMI populations

• BH providers delivering services through FQHC at higher level of reimbursement

• Project gaining attention from payors and press.

• Won 2016 Indianapolis Business Journal Innovation in Healthcare Award

Approach 3: Becoming An FQHC Look Alike(Collaboration And Competing)

• A&C has opened 2 new health clinics

• Submitted FQHC LAL application

• As a LAL, A&C will receive

enhanced Medicaid rate (Jan 2018)

• LAL applicants are required to seek letters of support from other FQHCs.

• 5 of 7 Indianapolis FQHCs (competitors) wrote letters of support for A&C’s application

• A&C now being approached by 2 hospitals interested to explore partnership

Tips For Successful Provider Organization Collaborations

“Collaboration is the new performance advantage for community behavioral health organizations”

• Be direct

• Don’t accept unfair terms

• Have a short memory

• Executive sponsorship is critical

• Don’t sweat the small stuff

• Speed of change can be as important the change itself

Questions & Discussion

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Meta-Leadership In Action: Making Provider Organization ... · What is Meta-Leadership? II. ......

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