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![Page 1: (Title) Name(s) of presenter(s) Organizational Affiliation Welcome Back Fee-for-Service Kentucky January 31, 2012 Project Funded by CSAT.](https://reader037.fdocuments.net/reader037/viewer/2022110304/551b6cfe550346d31b8b5e65/html5/thumbnails/1.jpg)
(Title)
Name(s) of presenter(s)Organizational Affiliation
Welcome BackFee-for-Service
KentuckyJanuary 31, 2012
Project Funded by CSAT
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"Never invest in any idea you can't illustrate with a crayon." –
Peter Lynch
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Executive Executive
SponsorSponsor
Change Change
LeaderLeader
Change Change
TeamTeam
People
Walk-throughWalk-through
FlowchartingFlowcharting
Nominal Group Nominal Group
TechniqueTechnique
PDSA CyclePDSA Cycle
ToolsTools
RulesRulesUse existing resourcesUse existing resources
Measure Measure
changechange
ImprovemenImprovemen
tt
ProcessProcess
ModelModel
ChangeChange
ProjectProject
aimaim
Sustain the gainsSustain the gains
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(Title)
Name(s) of presenter(s)Organizational Affiliation
Who’s Who in Process Improvement?
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Executive Sponsor
Authority to Allocate resources
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Executive SponsorResponsible for Communicating the Vision
Martin Luther King
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Executive SponsorSees change as a priority
Barack Obama, President
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Executive Sponsor Empowers the change
leader
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Change Leader
Reggie White
Someone who is comfortable providing day-to-day leadership, energy and enthusiasm
Has the power and prestige to influence people at all levels of the organization
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Change Leader
Oprah Winfrey
Michelle Obama
Focuses the team on the change team objective
Uses mandates
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Change Leader
Queen Rania of Jordan
Challenges the status quoReports directly to the Executive SponsorGets results mandated by data
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Change Team Members
Samaritan Village, Inc.Jamaica Outpatient Program
Staff and supervisors in the work area where changes will be made
Customers, family, caregivers
People with special knowledge
Others who are affected by the change
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Change Team Responsibilities
• Identify possible changes that could meet the objective
• Decide how to implement the change• Create and conduct rapid-cycle pilot tests until
goal is achieved• Collect data• Study results to see if the change should be
adopted, adapted or abandoned
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Key Roles:Change Team
Focus on
AIM
LOCATION
POPULATION
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What makes this approach to change different?
• Change is a big experiment
• No mistakes, no right or wrong
• Data tells you if the change was an improvement
• Customer guides change ideas
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Too often we design processes to meet the organization’s needs and not the needs of the customer.
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The Fee-for-Service project will help addiction treatment providers develop the capacity to bill third party payers
• Design a billing system (Level 1)
• Improve the billing process to increase collections (Level 2)
Our Mission
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• Use small scale, rapid cycles (PDSA cycles) to break change into manageable pieces
For example:– Create one bill– Eliminate the most common reason that
claims get denied
Applying the NIATx Way to Improve the Billing Process
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• Learn how to streamline the billing process for one third party payer.
• Then, do the same for another third party payer. • Apply what you learn with MCO’s.
Later:• Focus on attracting more clients with the desired
third party payer.
Applying the NIATx Way to Improve the Billing Process
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Model for ImprovementModel for Improvement
3. What changes can we make that will result in an improvement?
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
P
DS
A
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The Ball Pass ExerciseDiscussion Questions:• What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a
time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective?
Experience small scale, rapid cycles:The Ball Pass Exercise
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The Ball Pass Exercise
• AIM: to pass the ball from person to person as quickly as possible.
• RULES:– Only one person may touch the ball at a time; each
person must touch the ball with both hands. – The ball must be passed to a person who is not right
next to you.– The cycle begins when the Change Leader passes
the ball the first time and ends when the Change Leader has the ball at the end.
• Prepare a Change Project Form and document information about each PDSA cycle.
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The Ball Pass Exercise• Select a:
– Change Leader– Data Recorder
• Cycle #1 (baseline):– Stand in a circle.– The Change Leader passes the ball to another
person in the circle. – Each person passes the ball to another person who
is not right next to them; when everyone has touched the ball, pass it back to the Change Leader.
– The data recorder documents the time from the beginning to the end of the cycle (baseline data)
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The Ball Pass Exercise
• Conduct at least 3 PDSA cycles– PLAN: What can we do to reduce the time required?– DO: Implement the change and measure how long it
takes. – STUDY: Did we get the results we expected? Was the
change implemented as planned?– ACT: Adopt, adapt or abandon this change idea and
decide what the next cycle will be. – Repeat another PDSA cycle.
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The Ball Pass Exercise• Tell your story:
Create a graph to show the data for each PDSA cycle, noting the change that was made for each cycle.
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The Ball Pass ExerciseDiscussion Questions:• What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a
time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective?
Designing Change Projects
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Model for ImprovementModel for Improvement
3. What changes can we make that will result in an improvement?
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
P
DS
A
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Designing Change Projects
Unfocused improvement efforts are a waste of time and resources
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Sample Aim Statements
• Create a billing process to bill one new third party payer (Anthem) by June, 2012.
• Increase the collection rate from 60% to 70% by June, 2012. (Start with Anthem)
• Reduce the denial rate for invoices submitted to Anthem from 52% to 35% by June, 2012.
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Designing Change Projects
ONthe Change Project Form
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(Title)
Name(s) of presenter(s)Organizational Affiliation
Flowcharting
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Why Flowchart?
Flowcharts force an organizational
focus on process.
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Why Flowchart?
Flowcharting is useful for:
1. Providing a starting point to understand the process as it is today.
2. Identifying key problems/bottlenecks
3. Showing where to test ideas for most impact
4. Adding interactivity & fun - gets the team together
5. Creating a simple & succinct visual process overview
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Setting up a flowchart
Where does the
process begin?
Where does the
process end?
START
END
Verifying Coverage.
Document
authorization
limits
Client makes first contact
Title the process
you are
flowcharting.
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Key Symbols for Flowcharts
?
No
Yes
A square identifies a step in the process
A diamond is a decision point in the process and asks a “yes or no” question or offers a choice of direction in the process.
Action
Post-It Notes are great for flowcharting.
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Sample FlowchartProcess name: Billing Process
Ask a
bout ins.
at fi
rst c
ontact
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Before You Start
1. Identify a Change Leader to lead the flowchart
discussion.
2. Choose one person’s organization and
complete the flowchart exercise.
Change Team Assignment
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Change Team AssignmentFlowchart the billing process.
Remember the steps to follow:
1. Define where the process begins and ends2. Give your flowchart a title: e.g., “First Contact to Document
authorization limits”3. Define process steps 4. Review/refine flowchart5. Identify problems and bottlenecks
• Are there steps on the “Who does what chart” that no one is assigned to?
6. Customer barriers
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Large Group Discussion
1. Useful?
2. How could you use your flowchart to
help engage your organization in the
change process?
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The Ball Pass ExerciseDiscussion Questions:• What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a
time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective?
How to Measure the Impact of Change
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Learning Objectives
• The importance of data in a change project.
• A six-step process for the effective measurement of the impact of change.
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Model for ImprovementModel for Improvement
3. What changes can we make that will result in an improvement?
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide
P
DS
A
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Data answers three common change project questions…..
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DataData directs the action steps toward directs the action steps toward a change project improvement goal.a change project improvement goal.
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Keep data collection and reporting as simple as possible, but be specific.
Keep data collection and reporting as simple as possible, but be specific.
Denial tracking for Anthem
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A Step Process
for Measuring the
Impact of Change
66
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6 Steps for Measuring the Impact of Change
Always ask why.
1DEFINE YOUR
AIM & MEASURES
1DEFINE YOUR
AIM & MEASURES
2COLLECT
BASELINE DATA
2COLLECT
BASELINE DATA
3ESTABLISH A CLEAR GOAL
3ESTABLISH A CLEAR GOAL
4CONSISTENTLY COLLECT DATA
4CONSISTENTLY COLLECT DATA
5CHART YOUR PROGRESS
5CHART YOUR PROGRESS
6ASK
QUESTIONS
6ASK
QUESTIONS
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1. Define your measures.
This ensures that the results are interpretable and accepted within the organization.
Clear definitions of your measures should:- Clarify project objectives- Be agreed upon by stakeholders
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2. Collect baseline data.
QUESTIONS TO ASK:A. Was the data defined to ensure that we collect exactly the information needed?B. How accurate is the data? Does accuracy matter?C. Does the process ensure that the measures will be collected consistently?D. Do trade-offs exist? Is quality more important than the time required to collect data?
Never start a change project without it.
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3. Establish a clear goal.
This ensures that the results are interpretable and accepted within the organization.This ensures that the results are interpretable and accepted within the organization.
A goal should:- Be realistic yet ambitious- Be linked to project objectives- Avoid confusion
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4. Consistently collect data.
Regular data collection is a crucial part of the change process.
Regular data collection is a crucial part of the change process.
As a team, decide:Who will collect the data?How will they collect it?Where will the data be stored?
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5. Chart your progress.
Use visual aids forsharing the data.Use visual aids forsharing the data.
Share pre-change (baseline)and post-change data with:
- Change Team- Executive Sponsor- Others in the organization
Line graphLine graph
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A simple line graph example
Remember: One graph, one message.
Goal
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6. Ask questions.What is the information telling me about change in my organization?
Why was one change successful and another unsuccessful?
Always ask why.
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Possible AIM Measures(from the Dashboard)
• Denial Rate
• Collection Rate
Focus on one payer
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Possible Cycle Measures
• To focus on reducing the # of denials for a specific reason
– # of clients matched with a clinician with appropriate license (if bills are denied because service was provided by clinician without appropriate license)
– # of days between service and sending bill (if bills are denied because they weren’t submitted in a timely manner)
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Begin to fill out
How to Measure the Impact of Change Worksheet
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(Title)
Name(s) of presenter(s)Organizational Affiliation
CollaborationWhy?
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• Capture the wisdom of the Change Team and participants in the Collaborative
• Be willing to share and exchange ideas
• Participate actively and dialogue
• Share and copy best practices
• Divide work tasks and empower others to help
5 Steps to ensure a successful Collaborative:
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"If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple.
But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.“
George Bernard Shaw
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(Title)
Name(s) of presenter(s)Organizational Affiliation
Review and
Next Steps
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Review
How-to Steps for the NIATx Process Improvement Model
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Review
Use The NIATx Third-Party Billing Guide to identify steps in the process that
need to be implemented.
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Review
Are you likely to reach your wildest dreams for the outcome of this
collaborative?
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Call to Action
Monthly:• Send Lynn and Elizabeth your updated Change Project Form
• Attend monthly NIATx webinars:Level 1 – 2nd Tues. at 3 pm ESTLevel 2 – 2nd Wed. at 3 pm EST
• Attend monthly KY provider calls
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Contact InformationLynn Posze, Convener [email protected]
Elizabeth Strauss, NIATx [email protected]
Jeanne Pulvermacher, [email protected] 608-265-5087
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Thank you!
Celebrate