Today s Drivers Pushing EBP. Carol J. Reynolds, EVP Client Experience

Transcription

1 Today s Drivers Pushing EBP Carol J. Reynolds, EVP Client Experience

2 Deploying, monitoring and reporting on EBPs and related outcomes will be required This gradual, but absolute shift is happening HISTORICALLY A system that treats people mostly when they are sick or need treatment Revenue based on Volume = Quality Efficiency TODAY A system that proactively manages the health of populations Revenue based on Value Satisfaction = Clinical performance drives reimbursement

3 CREATING A LEARNING SYSTEM Value = Outcomes Cost Naturally Intuitive Efficiency Realized Practice Based Evidence Right information at the right time to make the best decisions Day in the Life of a Clinician Access UX Efficiency Mobility NTST Network Patient Level Analytics REAL Portability Ease of Access Research Entity Level Analytics Predictive Modeling Consumer Facilities Foundation Clinical Operational Workflow Coordinated Care Rehab Long-term Care Social Services INTEGRATED HEALTH Prim ary Care OUTCOMES: Clinical Financial Operational Cost Accounting Data Public Health Home Behavior al Health Health

4 From Discovery to Recovery Netsmart Client Base = 25M+ LIVES Public Health Long-Term Care Behavioral Health Analysis Data Center Data Analytics Real-time Services Assessments Acute/Primary Care Social Services Clinical Guidelines Benchmarking Foundations Entity Level Analytics Patient Level Analytics Research Evidence-based Workflows and Decision Support Predictive Modeling Advanced Analytics Practice-based Evidence Workflow Clinical Financial Operational Best Practice Outcomes Evidence-based Optimization

5 SAMHSA s Guidance Using EBP to implement EBP The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched an Evidence-Based Practices Resource Center (Resource Center) that aims to provide communities, clinicians, policy-makers and others in the field with the information and tools they need to incorporate evidence-based practices into their communities or clinical settings. The Resource Center, at contains a collection of science-based resources, including Treatment Improvement Protocols, toolkits, resource guides, and clinical practice guidelines, for a broad range of audiences.

6 Research on EBP shows Giving written education materials to practitioners alone does not change practice You need to educate beyond the practitioner Agency administrators and program leaders Practitioners Consumers Family Members Supporters

7 Measurement How do you measure outcomes today? Establishing the measurement system Taking a baseline Trending over time The ultimate goal Are we bringing value with these changes Value = Outcomes/Cost

8 Managing Change Planning for the impact of change

9 Kotters Change Management Model Current State People Process Technology Phase 1 Phase 2 Phase 3 Creating a climate for change Enabling and engaging Implementing and sustaining change Future State v Paper EHR Same Day Access

10 Virginia Satir s Change Management Model

11 Burden Reduction Collecting the data as part of the workflow Mobility

12 EHRA Usability Summit: Partnering to Reduce Documentation Burden Leveraging technology to reduce redundant documentation in the EHR (E.g. interop, NLP, audit logs, machine learning) Prioritizing EHR data for user consumption Improving ease of data access across systems (e.g. interop) Harmonization of documentation requirements across state, federal, drug license board, etc Improving ease of access to data within the same system (e.g. access to multiple screens: data prioritization) E&M guidelines do not reflect clinician workflows and contribute to documentation burden Government reporting programs requirements contributing to EHR documentation burden Improving prior authorization to reduce burden

13 Monitoring Fidelity

14 De-Mystifying Fidelity Implementation Strategies Process Evaluation Fidelity Outcome Evaluation Child & Family Outcomes Monitoring & Feedback

15 Good fidelity criteria Structure and process (Mowbray et al., 2008) Framework for service delivery Way in which services are delivered Integrity and differentiation (Bond et al., 2000) Adherence to defined activities/behaviors Competence of practitioners Dose of intervention (i.e., frequency, duration) Distinguishing feature of the intervention

16 Views of Three EBP Models Total Community involvement in I/DD employment Family-focused and community-based treatment program for chronically violent youth. Reaching Recovery a huge success story of Evidence Based Practice Practice Based Evidence

17 Training & Education as Part of your EBP plan

18 Building an Evidence-Based, Holistic Approach to Advancing Integrated Employment EBP Building an Evidence-Based, Holistic Approach to Advancing Integrated Employment, Allison Hall,Institute for Community Inclusion, University of Massachusetts Boston, 2018, retrieved from

19 10 Critical Elements for Organizational Transformation The following 10 Critical Elements for Organizational transformation were taken from: Building an Evidence-Based, Holistic Approach to Advancing Integrated Employment To purchase a copy of the whitepaper:

20 1. Clear and Consistent goals An explicit commitment to increasing competitive integrated employment is essential. Goals must be measurable, compelling, easy to grasp, directly reflective of the core mission, modifiable, specific to an established time frame and reflect the needs of individuals Most EHR s have an Individual Service Plan or Treatment Plan. Documenting employment as a goal with a description of the desired employment, the skills required for that employment and a defined plan with objectives and time lines

21 2. An agency culture that values inclusion A culture must be established that values support individuals in the community rather than in facilities, positive thinking, learning, creativity, innovation and continuous quality improvement Adding a Key Performance Indicator to measure the percentage of clients your organization serves that live in the community vs. residential or institutional housing alternatives. Trended over time

22 3. An active, person-centered job placement process Proactive job-finding should occur one person at a time. This just do it approach creates momentum as successful employment outcomes are achieved and celebrated. An inventory of successful employers, matched to skills that were required for previous employment placements. A skills library that is attached to an individual, with the specific skills highlighted as part of the ISP. An approval process that involves the employer as part of the ISP so they are aware of the plan. Job shadowing, volunteering (service learning), work sampling, internships, community based work assessment, unpaid and paid work experiences.

23 4. A strong internal and external communications plan Successful organizations must communicate clear, authentic expectations for competitive integrated employment. Internally this includes all levels of staff, individuals, families, and board members and externally, this refers to marketing services Creation of poster boards that show the statistics on the walls trended. Trending shows your intention to improve. % of clients served that have a goal on their ISP that identifies an employment plan # of job placements in the past 30 days - trended

24 5. Reallocated and restructured resources Focus! Alignment of staff and resources required to put into place the supports and services needed for increasing competitive integrated employment. Community outreach and education on the needs of this population. Documented processes for internal inclusion and communication for job placement Staff training on your documented steps for planning for each consumer.

25 6. An ongoing investment in staff professional development Frequent and ongoing training, continuing education, conference participation and mentorship opportunities are needed to develop and maintain staff s core competencies and to implement best practices

26 7. A focus on customer engagement Organizations must engage with customer groups including individuals, families, funders, and other community partners, as well as with new and existing business partners, to meet both individual and market needs Local focus groups or employment boards that involve the community in job search/creation Communication within the community to highlight successes Outreach to employers to stay current on needs

27 8. Effective employment performance measurement, quality assurance, and program oversight combined with 9. A holistic approach A clear framework must be established for implementing and measuring administrative, management and program strategies over defined periods of time to determine the impact and success of efforts Once the individual is employed, a defined process could be treatment plan / ISP driven to generate reminders for check-ins with the employer. Check ins should be documented and follow up plans should be included as part of the ongoing clients treatment plan Consideration must be given to the whole person with wrap-around life supports and use of a career planning process that involves staff, parents and friends and includes any accommodations, including assistive technology

28 10. Multiple and diverse community partnerships.. A holistic approach School Districts State Agency Offices such as vital records Faith-Based and/or civic organizations Transportation Resources

29 Multisystemic Therapy

30 Multisystemic Therapy (MST) Why is this cool? For the first time this brings this Evidence Based Model into the digital world and now providers of this intensive family and community based treatment program can work solely within myevolv. This improves performance metrics by taking advantage of automatic workflows for reminders, increases data compliance, and provides inclusion of all MST players in the agency Early adopters Community Solutions Inc North American Family Institute (NAFI/NFI) 70% of youths in Justice System have a mental health diagnosis

31 Multisystemic Therapy (MST) Feedback life changing game changer

32 Reaching Recovery

33 Recovery Transformation Requires: Recovery is more than a treatment philosophy; it is a process of transformational change for organizations that involves many facets. From intake to service delivery and everywhere in between Symptom Control/Management: Focus on the symptoms Management is the objective Passive client model Recovery Process: Person and strength driven Holistic and integrates community Addresses trauma

34 A Focus on Well-Being Our work enables adults to live more fulfilling and productive lives, children to be more resilient, and families to be happier and healthier. $ Recovery & Resilience Treatment Works Strengthening Community Our Services Save Money We work to improve well-being in our community through a focus on recovery and resilience across the lifespan. People can and do recover from mental illness, treatment and prevention work and well-being is something everyone deserves. Our work is part of what makes our community strong and healthy families grow from a foundation of mental wellness. Our services save the community money and it a better place to live.

35 The Solution The Four Measures of Recovery Recovery Needs Level (RNL) Staff assigns appropriate level of care Recovery Markers Inventory (RMI) Staff rating of consumer progress Consumer Recovery Measure (CRM) Individual s rating of his or her recovery Promoting Recovery in Organizations (PRO Survey) Individual s rating of the organization s recovery culture

36 Reliability The only statistically valid recovery outcomes tools developed. Used for The Joint Commission s Outcome Requirements Recovery Marker Inventory IRT reliability: Person =.75, Item = 1.00 CTT reliability =.78 Consumer Recovery Measure IRT Reliability: Person = 0.83, Item = 0.96 CTT Reliability = 0.86 Recovery Needs Level IRT reliability: Person =.75 CTT reliability =.78 PRO Survey IRT reliability: Person = All subscales at or above.76 CTT reliability = all subscales at or above.91

37 The Benefits It s about well-being and recovery Individual Increased likelihood of sustained mental health recovery Integration of own perception into treatment planning Improved matching of services to individual needs Clinician Clinically significant information readily available Greater recovery improvements for time invested Improved allocation of caseload balance Tools to aid in identifying appropriate services for a consumer Program Management Evaluation and Fidelity Assessing how well your treatment and services are working Effective Program Components Community Identifying specific indicators that point to high performance Cost-Benefit Analysis Exploring the most efficient allocation of time and resources with the most successful results Communicating Your Success Demonstrates and communicates concrete outputs regarding recovery services to your whole community and stakeholder

38 Clinical Success This data is pulled from the Recovery Marker Inventory Fiscal Success Over a 3 year period, individuals receiving services in ACT level services had a: 73% Of individuals improved or sustained their overall level of recovery factors 70% Decrease in emergency room visits 81% Of individuals improved or sustained their level of symptom management 50% Fewer hospital admissions 69% Of individuals improved or sustained their level of service participation 80% Decrease in psychiatric hospitalizations 74% Of individuals improved or sustained their level of active growth orientation 97% Reduction in bed days

39 Cost-Benefit Analysis $ Total number of adult individuals served with at least 6 months mental health treatment Average annual savings per individual served 7078 $10, Estimate overall annual cost savings $76,899,808.00

40 Recovery Marker Inventory (RMI) Data An Employment Study The following are the outcomes for 36 consumers Understand how employment may be affected and improve outcomes within an ACT team. An ACT team utilized data from the Recovery Markers to create new initiatives and interventions to dramatically increase recovery outcomes in employment. Employment Topic Sep 2007 May 2008 No Interest in Work 14 7 Interest, No Action 7 9 Job Exploring 7 4 Active Job Searching 0 7 Part-Time Employment 2 1 Full-Time Employment 1 4

41 Evaluation and Fidelity Example Ensuring standards of a program are met with recovery outcomes. Below is the average recovery among all woman in the Growth and Recovery Opportunities for Women (GROW) Program at the Mental Health Center of Denver. By reviewing these outcomes in conjunction with the fidelity level of the program, we are able to determine the overall effectiveness of the program and identify areas where service improvements can be made.

42 Conducting Process Outcome Assessments

43 Evidence-based Practices Clinical Analytics Needs EBP integration within EMR workflow Daily or real-time updates available to clinical team Output of EBP needs to be visualized in a manner that allows for clinical utility and both operational and clinical improvement Benefits Drives fidelity and application Can t improve what you don t measure Can t improve what you don t measure and see! Provides meaningful and contextually relevant information to the user by role

44 The Power of integrating EBP and Analytics Trending of a defined populations outcomes on your selected EBP over time Analytics and Business Intelligence becomes very robust when you link your EBP to your total data set and have the ability to incorporate to your value story.

45 The Power of integrating EBP and Analytics Trending of a defined populations outcomes on your selected EBP over time

46 The Power of integrating EBP and Analytics Trending of a defined populations outcomes on your selected EBP over time

47 Enactus

48 PopCorn for the People

49 Questions