Practice Transformation Academy Kick-off Meeting · Practice Transformation Academy Kick-off...
Transcript of Practice Transformation Academy Kick-off Meeting · Practice Transformation Academy Kick-off...
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:[email protected]
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
Theproject describedwassupportedbyFundingOpportunityNumberCMS-1L1-15-003fromtheU.S.DepartmentofHealth&HumanServices,Centersfor Medicare&MedicaidServices.Disclaimer:The contentsprovidedaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresent theofficialviewsofHHSoranyofitsagencies.