Silos to CirclesA New Continuum Conversation

How Do We Go From Here… …To Here?

Silos

Acute/Ambulatory

Public Health

Home and Community

Based Services

Long-Term Care

+ ++ +++

Develop draft vision and identify and invite/recruit key stakeholders

Affirm draft vision, outline priority barriers that compromise that vision

Select priority focus areas for collaboration (shared agenda); Articulate governing structure and process for supporting design teams; Recruit key stakeholders

Convene design teams to outline specific goals, set success measures and implementation plans (e.g., demonstrations, development of tools, education, etc.) Convene initial learning collaborative based on objectives identified by Silos to Circles participants.

© 1996-2009

Brokenness to wholeness

Statement for invitation:

We will work collaboratively on shared priorities that will foster

wholeness for our currently fragmented continuum.

Our opportunity is to collectively promote health at all life stages

with services that are integrated, culturally appropriate, equitable, sustainable and that honor our

shared humanity.

Core Group Vision for invitation – drafted 1.5.2015

Silos to Circles

Promote health with upstream stability

Capacity for our shared humanity

Measuring health and well-being at all life stages

Collaborative, integrated, respectful and culturally appropriate

• New map of health

• Brokenness to wholeness to thriving to living to being

• Fragments to continuum

• Household

• Person Centered Thinking

• Value health as people define health

• Sustainable reward for those providing care

• Prioritizes and supports preventive practices

• Consider social determinants, transportation, food, education and impact on 1 or others

• Daily living needs are met

• Economic stressors

• Defining measurable outcomes

• Maximizing life at all life stages

• Well-being is redefined and central to work (measurement too)

• Healthy body, mind, soul

• Treated with respect

• Community that is collective, active, and sustainable

• Collaborative, holistic solutions

• Integrated, culturally meaningful system of wellness

• Seamless network that makes a continuum

• New map of health care

• Working together on important priorities

• Choose areas with greatest opportunity to create something new

4

Cause And Effect: Where to Channel Our Efforts to Realize Our VisionCause And Effect: Where to Channel Our Efforts to Realize Our Vision

Promote health at all life stages with services that are

integrated, culturally appropriate, equitable,

sustainable and that honor our shared humanity.

Promote health at all life stages with services that are

integrated, culturally appropriate, equitable,

sustainable and that honor our shared humanity.

Value: Cost/Quality

Value: Cost/Quality

Transparency/Info/

Data/Technology/ Interoperability

Transparency/Info/

Data/Technology/ Interoperability

Shared Language / Culture / Fear

Shared Language / Culture / Fear

Navigation/ Coordination/

Trusted Advisor

Navigation/ Coordination/

Trusted Advisor

SharedPriorities

SharedPriorities

RegulationsRegulations Reimbursement / Funding

Reimbursement / Funding

Communication Across

Communication Across

Trust / Control / Choice

Trust / Control / Choice

We will work collaboratively on shared priorities that will foster

wholeness for our currently fragmented continuum, so that

we can collectively:

5

How We Utilize the Cause And Effect DiagramHow We Utilize the Cause And Effect Diagram

Hypothetical

Focus Areas

6

QuestionsQuestions

7

Community Health DataCommunity Health Data

MDH CHNAs1

MHACHNAs2

HealthEast Community

Conversations3

Mental Health

Obesity

Alcohol/S

ub

Abuse Patient Edu /

Welln

ess / N

utrition

Tobacco U

se

Chronic

Disease

Prevention

Access

to

Healthy F

oods

Domestic V

iolence

Transporta

tion

Financia

l

Vulnerability

✔✔ ✔✔✔

✔ ✔ ✔✔

✔✔ ✔ ✔ ✔

Access

to Care &

Resource

s

✔

1 MDH data includes 25 CHBs (8 Metro, 7 SE, 2 SC, 3 Central, 2 NE, 3 NW.2 MHA data includes CHNAs from 84 hospitals spanning the state3 HealthEast data includes a synthesis from East Metro Health and Well-being Community Conversations

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Shared Prioritization CriteriaShared Prioritization Criteria

• Greatest opportunity to collaborate• Greatest potential to empower consumer• Siloed-ness• Readiness for change• Greatest ability to impact• Builds collective infrastructure• Screens out that which supports the status quo• Environmental – Threats or Opportunities• Gap area—not overly duplicative of existing measures• Prohibited by public policy• Easy versus hard• Impact/reach largest population

SHIPStatewide Health

Improvement Plan

Cross-Continuum ActivitiesMinnesota Senior Health Options (MSHO)

Hennepin HealthGeneration Next

Southern Prairie Community CareEast Metro Mental Health Roundtable

Integrative Health / Catalyst

SIM (State Innovation Model grant) vision •Integrated Health Partnerships RFP (DHS)

• Accountable Health Communities RFP (MDH)

Center for Community Health

Back Yard Initiative

Healthy Communities Partnerships

Diabetes Collective Impact project

Healthy Minnesota Partnership

Health Care Delivery System demos

(e.g., NW Alliance)

Pioneer ACOs

NCQA ACOs

Health Care Homes

Aligned Incentive Contracts

ICSI

MN Community Measurement

Community ProjectsRAREHonoring ChoicesChoosing WiselyACT on Alzheimer’sCitizen Engagement ICSI/Citizens League / TPT

MN 2020

Long Term Care Imperative

Aging Services & Stratis Futures work

LSS “My Life My Choices”

Altair Social Services ACO

Policy IdeasHealth Outcome TrustsCommunity Health Business Models

Many change initiatives underway—could they be better connected and leveraged? How can successful models be taken to scale faster?

A Partial View:

Public Health Acute / Ambulatory Long-term Care Social Services

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What’s NextWhat’s Next

• Populate design teams• Share more information about what is going on in each focus area• Using data and considering existing initiatives, design collaborative

initiative in focus area (6-12 month duration) and set measures of success

• Track and evaluate progress in PDSA format• Report on progress and identify implications of learnings (e.g.,

policy implications arising from initiative)

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Leadership and Supporting Structure: Questions to ExploreLeadership and Supporting Structure: Questions to Explore

• Core Group:– What is the responsibility of this Core Group?

• i.e.: Provide direction for the overall project. Communicate with key stakeholders. Identify and help to secure human and financial resources for on-going work.

– How are new members added to the Core Group? – Do they make a formal commitment to participate and is there an agreed upon term?– Is it OK to have more than one person from an organization on the Core Group?

• Do we need one person to chair or have a distinct role in connection with the Lab?• What is the relationship of the Core Group and design groups?• Do we need any rules regarding conflicts or boundaries (off-limit topics/areas, e.g.,

lobbying)?• Are there any specific terms of engagement we have not addressed? (confidentiality,

interaction, decision making)• Do we need to set any guidelines regarding competition vs. collaboration?