Crea%ng a Value Orienta%on & Ar%cula%ng the Impact. The Movement from Volume to Value

Transcription

1 Crea%ng a Value Orienta%on & Ar%cula%ng the Impact The Movement from Volume to Value

2 Ra2onale for Change to the Health Care System Be:er Care, Be:er Health, Lower Costs Ever rising health care costs are a na2onal challenge. The United States currently spends 16 percent of its GDP on health care which is nearly twice as much as any other na2on. At the same 2me, key health indicators suggest that we are not gemng our money s worth NYS DOH, Plan to Transform the Empire State s Medicaid Program

3 Current environment Transi2ons we are seeing in the behavioral healthcare field Greater reliance on Evidence Based Best Prac2ces Movement to Managed Care A road map to value based reimbursement models Outcomes, Outcomes, Outcomes Outcomes provides staff and clients with measures to determine ways to improve upon exis2ng work Outcomes answers ques2ons about the work we re doing and offers deeper insights about what is or isn't going on All agencies will have to collect and focus their efforts on data collec2on to be able to document the value they return to their community and the children, youth and families they serve

4 Measuring Quality the Na2onal Prospec2ve The Affordable Care Act charged the U.S. Department of Health and Human Services with developing a Na2onal Quality Strategy. As a result (SAMHSA) has developed the Na2onal Behavioral Health Quality Framework (NBHQF). The goals of the Na2onal Quality Strategy addresses the following goals: evidence- based prac2ces Family- driven and youth guided care coordinated care healthy living for communi2es reduc2on of adverse events, and cost reduc2ons

5 NYS Quality Vision The quality strategy for behavioral health is being developed by OMH and OASAS and will embrace NY State vision of a system that is: Family- driven Recovery and resiliency oriented Integrated and, Value Based/Outcome driven

6 NYS Quality Vision con2nued Quality outcome measures will support the following goals: Improve access to and engagement in community- based behavioral health services, including Services designed to improve and maintain independent func2oning and quality of life Increase provider implementa2on of evidence based prac2ces that integrate behavioral and physical health services

7 NYS Quality Vision con2nued Improved health care coordina2on and addresses con2nuity of care Reduced avoidable behavioral health and medical inpa2ent admissions and readmissions. Con2nuous quality improvement at the clinical, program, plan, and popula2on levels. Reduce dispari2es in health outcomes for people with behavioral health condi2ons as compared to the popula2on at large.

8 What does this mean for you? Your organiza2on will be evaluated based on the value equa2on: Value = Quality Cost Financial incen2ves and reimbursement models will closely align with value not volume

9 What does this mean for you? con2nued Crea2ng a value oriented organiza2onal environment and incen2ve systems that rewards value will be cri2cal to con2nued success. Access to good quality metrics that are then used to inform prac2ce and improve systems will be vital. Communica2ng your value to all stakeholders will be key.

10 What now: Step 1: Determine where you fit in Create your VALUE PROPOSITION Define the problems and goals that your organiza2on is best suited to address in the new behavioral health care environment Evaluate the processes, resources, and talents that will be necessary to be a successful and valued partner Measure your current effec2veness and efficiencies Clearly ar2culate how your agency will play a part in the triple aim of health care reform:» Improving the Experience of Care» Improving Health» Reducing Costs

11 Step 2: Determine what you are going to need Undertake a gap analysis to determine skill sets, processes, organiza2onal structures and technologies that will be necessary to achieve your value proposi2on. Focus on: Staffing and training Does your staff have the skills to interact effec2vely with the integrated physical and behavioral health treatment communi2es Do you have the data analy2c and financial modeling skills and tools necessary to move from Volume/Cost to Outcome/Cost monitoring Organiza%onal Structure Do you have organiza2onal silos the are barriers to effec2ve and efficient care Are your organiza2onal incen2ves suppor2ng volume over quality

12 Step 2: Determine what you are going to need (con2nued) Technologies Can you quan2fy and collect the outcome data you will need to evaluate your performance Can you electronically share clinical data with other service providers in a secure fashion Do you have tools and data sets necessary to shih to popula2on management and evaluate Outcome/Cost across agency episodes of care Processes Quality Assurance Program How do you use the informa2on gleaned from this process? Quality Improvement Process U2liza2on Management Process

13 Step 3: Develop a plan for managing outcomes and s2ck to it Design and implement a plan that will get you from where you are today to where you need to be tomorrow. Priori2ze and address low hanging fruit immediately Set benchmarks and 2melines and hold yourself accountable Look to secure resources where ever possible Solicit input from all levels of your organiza2on Embrace change for the value it will bring to the quality of your services and the value it will return to the clients, families, and communi2es you serve.

14 Develop your plan Plan Do Study Quality Improvement Planning Process Iden2fy where to focus first o Most Cri2cal Area? o Low Hanging Fruit o Biggest Barrier? What will be implemented to address the iden2fied area? Implement Measure Ar2culate change through data What were the results? Benchmarking Monitor o Crea2ng a Scorecard What do you do with the informa2on? Making it Ac2onable. Act Based on the findings, what next? Tools to use Logic Modeling Strategic Planning

15 Communicate your value Educate the board as your representa2ves in the community Evaluate your Mission and Vision statements to see if they align with the new emphasis on value Review your print and online branding to incorporate your value statement Devote a sec2on in your annual report, 990, and in- house newsle:er to value and quality

16 Communicate your value con2nued Provide value updates to your stakeholders including clients, families, funders and payers Do not forget to measure client and family sa2sfac2on and incorporate that into your value statement

17 Resources you may find helpful OMH: Online access to Sta2s2cal Data h:ps://

18 Resources (con2nue) Guidance and Direc2on Quality Strategy for the New York State Medicaid Managed Care Program h:ps:// Quality Assurance Repor2ng Requirements h:ps:// qarr_specifica2ons_manual.pdf SAMHSA Data, Outcomes, and Quality h:p:// data- outcomes- quality/samhsas- efforts Na2onal Commi:ee for Quality Assurance (NCQA) h:p:// Atlas of Integrated Behavioral Health Care Quality Measures h:p://integra2onacademy.ahrq.gov/atlas

19 Thank you for a:ending!