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1 Welcome! We will begin the webinar shortly. If you are joining us for the first time, please make sure to complete the Intent to Participate Information and Baseline Survey. Questions? us at

2 Performance Driven Bar graph Academy SESSION 4: EFFECTIVE MEASUREMENT PRACTICES

3 Brought to you by the Managed Care Technical Assistance Center Speaking: Briannon O Connor Associate Director CCSI s Center for Collaboration in Community Health

4 Reminders Please make sure everyone in your work group registers for one JUNE in-person session If you re joining us for the first time, complete the baseline survey and review Webinars 1-3 Webinars are recorded and you should have received materials ahead of this webinar Use for any questions, comments, etc. Chat in questions/comments to all panelists at any time

5 What is the PDA?

6 Goal of the PDA Elements of a Performance Driven Organization Developed by CCSI s Center for Collaboration in Community Health

7 Actively participating in the PDA will Position you to know your cost, know your quality, and know your impact within the broader system of care Generate a workplan for integrating knowledge gained and transfer knowledge within you organization Provide tools and resources to support effective collaboration, measurement, financial analytics, and leadership values to support continuous growth and improved efficiencies Document your agency s growth and improvement through the evaluation Demonstrate your agency s commitment to performance driven principles through a certificate of completion

8 Where we ve been Developing a culture that supports performance driven principles and prioritizes data-driven decision making Effective collaboration as a key to success and optimizing impact Best practices to support your human resources and heighten accountability for performance

9 4. Effective Measurement 6. Practice Development Semester 2: Finance and Leadership 5. Continuous Quality Improvement 7. In-person sessions

10 Effective Measurement Practices The Performance Driven Academy BRIANNON O CONNOR, PHD ASSOCIATE DIRECTOR, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.

11 Background of Today s Speaker Doctorate in Clinical Psychology Expertise in children s mental health, research methodology, statistical analysis, evaluation in real-world behavioral health settings, performance measurement CCSI Associate Director, Center for Collaboration in Community Health Supporting behavioral health providers and networks in meaningful data analytics and cross-system collaboration for improved outcomes

12 Today s Learning Objectives Provide far too much information for a brief webinar Define measurement and its value Review tips for measurement best practices Provide examples for productive information gathered from readily available data Discuss examples for moving beyond the basics Introduce tools to support measurement planning Hear a provider describe their approach to measurement

13 What s in a name?

14 What s in a name?

15 What s in a name? Measure: Using data to understand a process, comparison, outcome Data: Discrete (numbers) information collected systematically; ideally stored electronically Too simple?

16 Where can measurement bring value to your organization? Process Staff variables Outcomes / clinical progress Financial measures Streamline processes, become more efficient Enhance staff buy-in Improve quality of care Improve bottom line Marketing, position for successful VBP arrangements and network collaborations

17 Just get started.thoughtfully

18 Measurement as a new skill Perfect is the enemy of good Understand data limitations, but don t get hung up on them Make it part of the routine Practice, practice, practice Start easy; early success leads to continued efforts

19 Where to start or re-energize efforts Start with what you re good at What is the impact of your service? What do you do well? Why do individuals/families/youth seek out this service? What outcomes are you and your staff most proud of? What have other service providers told you about what you do well? Why do other providers refer to you? What are you known for? What do you consumers say about what you do well? What would the alternatives be if this service didn't exist? See Brainstorming Impact Tool

20 Where to start or re-energize efforts Focus on immediately actionable information that is meaningful and likely to show change soon Reducing ED visits vs. Mental Health Engagement in Care 30 Days (VBP Quality Measure) Rate of Potentially Preventable ED visits-agency January: % new clients engaged in care-30 days February: % new clients engaged in care-30 days March: % new clients engaged in care-30 days Clinical Team A Clinical Team B Clinical Team C

21 Where to start or re-energize efforts Focus on immediately actionable information that is meaningful Reducing ED visits vs. Mental Health Engagement in Care 30 Days (VBP Quality Measure) Staff Performance Appraisal Rating Scale 1) Rarely meets objective 2) Occasionally meets objective 3) Meet objective half of the time 4) Usually meets objective 5) Always meets objective Area of Responsibility Score 1-5 Client Engagement and Attendance: Based on show rate data as compared to target. Steps to improve: Uses engagement data to measure joining, tracks show rate for caseload, uses client attendance agreements, sends letters, documents follow-up, etc. Notes/Additional Detail 1= <64% Show Rate 2= 65-69% Show Rate 3= 70-74% Show Rate 4= 75-79% Show Rate 5= >80% Show Rate *Calculated monthly and year to date January: % new clients engaged in care-30 days February: % new clients engaged in care-30 days Celebrate successes! March: % new clients engaged in care-30 days Clinical Team A Clinical Team B

22 What question are you trying to answer AKA Why I cringe at the question What does the data show?

23 Parallel Process: Measures should be SMART S M A R T Specific The who, what, when, where, why without jargon or ambiguous language Measurable How will you know you ve met the goal? What data will be used? Achievable Within reach Relevant Meaningful to the organization, staff, bigger picture Time limited When will we review? When do we expect change?

24 Good idea Improve access to services ER visits for behavioral health crises will be reduced Services provided will reflect cultural/social identity awareness Better measures Families who initiate contact will be given an appointment within 2 weeks At least 75% of referrals will be proactively contacted within 48 hours Crisis services will be available within 30 minutes of all zip codes in the county At least 90% of individuals at risk on Questionnaire at Intake will be provided with targeted crisis management plans and peer support contact information Treatment educational materials will be translated into Spanish and Chinese Providers will document engaging in shared decision making with families and important others for at least 80% of new clients in Q3 2018

25 Focus and prioritize

26 Consider How does your impact and question you have for your data fit within the big picture of state goals, VBP metrics, MCO priorities, etc.?

27 Fitting into the Big Picture What we do well Our Impact???? State Goals What services are provided VBP Quality Measures Start on the right Ask the question how. How would this occur? How would you know? End on the left What do we do that contributes to this?

28 Example Attend family group sessions Awareness of available community resources Crisis plan in place Family selfmanagement wellness tools Education about relapse prevention, identifying triggers Foster supportive relationships Skill building Identify barriers Advocacy Access Mobile Crisis Services Support use of deescalation strategies Connections with social supports Access Benefits -Social services -Healthcare -Stable housing Crises Supports (natural/ community) State Goals Reduce avoidable ER/ inpatient use State Outcomes Reduce avoidable ER/ inpatient use Improve Outcomes Improve Outcomes

29 Prioritize measurement efforts Focus on a few measures only Enhance buy-in Staff input on where to start Consumer feedback

30 Master the basics

31 Make the most of readily available data Who is served? Understanding the basic characteristics of your consumer population How are they served? Utilization data, quantifying the services you provide How well are they served? Clinical progress, outcomes, defining the impact of your service What is the cost of serving them? How effectively are you using your resources in support of your mission Stay tuned for Semester 2 See also Dashboard Tool Version 1

32 Who is served? Demographic snapshot of your population Identify potential disparities in access to services Identify if the population you serve is representative of your community Help identify subgroups of interest or niche populations Identify targets for new markets or outreach Being able to easily summarize the population served is the foundation of measurement Understanding your denominator

33 Are there disparities in population served within my community? Race Distribution-Served in my Agency Race Distribution-Community (Census) African American Caucasian African American Caucasian Asian Multi-racial Asian Multi-racial

34 Are we using information we collect? Why are there no PTSD diagnoses? 60% of current clients have a trauma history. Are we trauma informed?

35 Sample questions to answer with basic demographic data What is our gender/racial/diagnostic/primary substance distribution? Does it make sense? Are there disparities? Are staff adequately trained to engage and meet the needs? What do we know about unmet needs in social determinants of health? Transportation, housing status, childcare, food security, etc. Do we effectively link patients with services to meet these needs?

36 How are they served? Identify the services you provide and to whom Quantify how many services you provide and how those services are distributed across your population When collected, can identify who is providing the service and how often Productivity How am I using my resources? Identify if the service delivery pattern is consistent across services

37 Are we using evidence-based best practices? Evidence-based practice for children with ADHD is parent training. Are we providing the most effective treatment?

38 Are we engaging patients quickly? Are we balancing caseload effectively? Population that needs therapeutic interventions May be more difficult to engage Many assessments at one time tough on staff

39 What can we learn by comparing results?

40 Sample questions to answer with basic utilization data Do we have the right training for our staff? Are we using best practice for modality of treatment? Is our staff distribution appropriate? How do our productivity targets look? Are certain services under- or over-utilized? How many clients receive 1 visit, 2-4 visits, 5-10 visits, visits, more than 25 visits? In a month, quarter, year, episode of care Are some service lines showing higher rates of no show/low engagement?

41 How well are they served? Determine if consumers are satisfied with the services Assess if consumers are able to access services in a timely manner and engage effectively How long does someone wait from first contact to first assessment? First therapeutic visit? What is the average/median wait time? Does it differ by season, program, clinician, client demographics, referral source etc. Identify if consumers are reaching their goals and/or making progress toward those goals Tip: Avoid yes/no goals

42 What can we learn from regular progress monitoring that we can t wait until discharge to know? More than 40% of current clients show no improvement or increased frequency of use of primary substance within the first 3 months of treatment

43 Sample questions to answer with basic clinical progress data What percent of our current clients are improving in symptoms/functioning/substance use from assessment to first 90 day review? Are there differences in rate of improvement by demographics? Clinician? Type of service received? Are staff adequately trained in writing clear, measurable objectives? Is the information we need documented?

44 Moving beyond the basics

45 Use a lot of the same data to answer more complicated questions Predictive analytics without the complex data modeling Complex questions don t usually need a high-level analyst How do I know who is going to use a lot of inpatient and ED services before they are a high utilizer? In many cases, you already do Look at the empirical literature, state reports, clinical experience Stratify outcomes by patterns of interest Pivot tables in excel to describe differences in outcome for multiple characteristics How does this outcome differ for women of different ages across several racial backgrounds?

46 Use a lot of the same data to answer more complicated questions What can you learn from outliers? How many do you have? What s different about them than most others? Can you define episodes of care? Can you attribute cost per episode of care within subgroups of patients? Set up meaningful comparisons Comparisons are critical Within agency, across programs Across network, county, region, state benchmarks Variable of interest

47 Break some bad habits

48 Data that isn t actionable (or required) is a waste of time and resources Annual meeting show and tell File drawer Someday this might be useful

49 Tools to Support Measurement

50 Brainstorming Impact Series of questions to guide discussion within your workgroup What is the impact of your services? How do you know? What do you do with that information?

51 Data Availability and Use Checklist Examples of typically available data Consider what you already collect, what s done with it

52 Dashboard Templates: Version 1 Two tools (OMH/OASAS focused) available from previous Performance Driven Organization overview Excel workbooks that auto-populate pivot tables and visualizations Updated/upgraded version coming soon in Semester 1

53 Agency Experience

54 We are pleased to welcome: Frankie Tangredi & Liz Schreiber Rochester Regional Health

55 Rochester Regional Health 2018 Data Strategy Frankie Tangredi 4/11/

56 RRH BEHAVIORAL HEALTH SERVICES 14 Behavioral Health Locations; 4 Counties 370,000 Annual Outpatient Clinic Visits 2,000+ Individuals Enrolled in Home Health Care Management $ 75M+ Annual Revenue 4 Emergency Department Access Points (includes CPEP) 4,300 Inpatient Discharges 2 DSRIP - Mental Health Embedded in 13 Primary Care Practices 75 Active Psychiatric Inpatient Beds 86 Addiction Beds Staff Members Chemical Dependency Residential Programs 24 Woman s Beds & 18 Young Men s Beds 5 School Based Health Centers 56

57 Data Roadmap Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Justification Data Collection Reporting Rudimentary data analysis Distributed Efforts Measurement Standardization Metrics defined Formulate HR Dashboards Improvements Acknowledged Effectiveness Key Performance Indicators 1 Tracked Process Improvements Defined Expanded Organizational Accountability Sophisticated Analytical Tools Developed Value Creation Insights Decision Making based on data Investments between people and business outcomes realized Predictive Analysis Cultural Transformation Impact Strategic Goals achieved Change Processes created

58 RRH Strategic Areas: Quality and Data 58

59 What do I do next?

60 Take-aways: How Can I Get Started? Meet with your workgroup Set aside some time to think about the Brainstorming Impact Tool questions Gather (or have someone gather) information listed on the Data Availability Tool Have some informal discussion with staff about what they think would be helpful to measure using readily available data Select 1-2 areas to target for one quarter Just get started

61 Mark your calendars and register Webinars (Wednesdays, 12-1pm): Continuous Quality Improvement, 5/2/18 Practice Development and Management, 5/23/18 In-person events in late June (10am-2pm) Register individually (not by agency) Albany, Date TBD Rochester, Date TBD NYC, Date TBD

62 Send us any questions or feedback Use the chat box or us at: