Practice Transformation Academy Mid-Year Meeting National Cohort Welcome!

Transcription

1 Practice Transformation Academy Mid-Year Meeting National Cohort Welcome! September 12, 2017

2 Today s Agenda Time Activity 9:00 AM Welcome and Overview of Agenda 9:35 AM Practice Assessment Tool Trends 9:50 AM Stretch Project Group Discussion 10:50 AM Break 11:00 AM Stretch Project Progress Report Out 12:15 PM Lunch 12:45 PM Root Cause Analysis Activity 2:25 PM Break 2:30 PM Root Cause Analysis Debrief 3:20 PM Break 3:30 PM Articulating Your Value Proposition 4:30 PM Wrap-Up and Next Steps

3 What are Value-Based Payments or Value Based Purchasing Models? Payment or Models that reward (pay) for improved quality, outcomes, and costs. A shift to value-based reimbursement models creates a new paradigm where care is delivered by an entire coordinated care community sharing in the responsibility and risk of outcomes and costs, touching almost every part of health care delivery operations Source: Kelley Grayson, Envolve, 9/5/17 for National Council s Practice Transformation Academy

4 What are Alternative Payment Models & Methodologies? Various reimbursement strategies that pay for Value as opposed to Volume.a shift away from FFS. Typically start with FFS + quality incentive and then RAMP to more risk-based models. Models that bundle reimbursement for multiple services as part of an episode of care. Example case rate or DRG. Models that pay an enhanced encounter rate or even capitated rate which is inclusive of services outside of the provider s normal scope of care...designed to promote integrated care approach. They encourage efficiency by allowing Provider more flexibility on how the $ s are spent to provide care. They always, always, always should include Quality and/or Efficiency Measures. Source: Kelley Grayson, Envolve, 9/5/17 for National Council s Practice Transformation Academy

5 . 5 Negotiations: What You Should Know QUALITY: Almost all value based models will require you to meet quality/efficiency metrics. You need to understand what these measures are and how you are performing on them today. FINANCIAL RISK: In an APM, you need to understand what if any risk is being agreed to on your part and whether or not your organization can tolerate that risk. Learn what terms like leakage, shared risk, full risk, upside only, capitation, partial cap, DOFR & downside risk mean. Understand what member attribution means and how that works. LEGAL: APMs that are bringing multiple providers together in order to participate in a shared reimbursement deal will require legal review. Be sure you understand how patient information will be protected; how your organization will be paid; what credentialing and/or contractual requirements need to be met; etc. REPORTING: Most if not all of these models will require some type of reporting. Be sure you understand how this requirement impacts you and your organization. Source: Kelley Grayson, Envolve, 9/5/17 for National Council s Practice Transformation Academy

6 Are You Ready For A Value- Based World? Develop Your Support Team: As utilization/care coordination moves from payer-led to provider-led, providers will need to structure how to manage a bundled payment and stay within financial allowances Invest in IT: Providers need to generate and monitor patient utilization reports, validation of encounter data submissions, financial utilization reports by member, quality performance targets Develop programs around payer needs: Most VBPs will ask for something extra clinically timely patient access, outcome accountability, process measures and providers should be building programs that a payer can then purchase Understand Risk Stratification: SUD is a big driver in today s health care landscape. Payers are using risk stratification tools to predict cost of care and promote pre-emptive treatment protocols. Networking/Marketing: Payments will be tied to providing more of a full array/continuum of services. You will potentially need to partner with other providers in order to take advantage of the new models. Source: Kelley Grayson, Envolve, 9/5/17 for National Council s Practice Transformation Academy

7 If a tree falls in the forest and no one collected the data, did it really happen?

8 How You re Getting There Sample Practice Transformation Academy Stretch Projects: Implement a risk stratification process targeting high-risk, highcost patients Develop a metrics based program scorecard integrating financial and clinical Develop care pathways for high risk populations Decrease wait times for patients/clients to get an appointment Reduce hospitalization and readmission to detoxification level of care by 25% for high risk patients Data driven decision-making and using data to improve service delivery and demonstrate value

9 Bridge: Destination Unknown Image source: Kelley Grayson, Envolve, 9/5/17 for National Council s Practice Transformation Academy

10 Types of Change Developmental Improvement of what is Transitional Movement towards welldefined new state Transformational New state is largely unknown

11 Transformational Change (a.k.a. Managing Chaos) 1. The future is unknown and only through forging ahead will it be discovered. 2. The future state is so different than the traditional state that a shift of mindset is required to invent it. 3. The process and the human dynamics are much more complex, partnership is critical!

12 Practice Assessment Tool Progress Past trends and a look to the future

13 Celebrate the Big Successes Milestone 13 Practice has developed a vision and plan for transformation that includes specific clinical outcomes and utilization aims that are aligned with national TCPI aims and that are shared broadly within the practice. Average score Milestone 14 Practice uses an organized approach (e.g. use of PDSAs, Model for Improvement, Lean, Six Sigma) to identify and act on improvement opportunities. Average score

14 Celebrate the Small Successes Milestone 7 Practice has a reliable process in place for identifying risk level of each patient and providing care appropriate to the level of risk. Average score

15 Overcoming Obstacles Milestone 3 Practice has reduced unnecessary hospitalizations. Average score Milestone 11 Practice uses evidence -based protocols or care maps where appropriate to improve patient care and safety. Average score Milestone 15 Practice builds QI capability in the practice and empowers staff to innovate and improve. Average score

16 Looking to the Future Milestone 3 Practice has reduced unnecessary hospitalizations. Current average score 0.58 Milestone 18 Practice uses sound business practices, including budget management and return on investment calculations. Current average score 2.5 Milestone 19 Practice has effective strategies in place to cultivate joy in work and can document results. Current average score 1.67

17 Looking to the Future Milestone 21 Practice considers itself ready for migrating into an alternative based payment arrangement. Current average score 0.58 Milestone 22 Practice uses a formal approach to understanding its work processes and increasing the value of all processing steps. Current average score 1.75

18 PAT and Workplan Completion PAT Workplan Yes No

19 Stretch Project Group Discussion

20 Small Group Discussion Share your prepared presentation Ask questions and brainstorm ideas Nominate a presenter for large group report out Be prepared to report out on: Common themes across projects Success stories and innovative approaches Challenges and workarounds Nominate a stretch project deep-dive

21 Root Cause Analysis Understanding and overcoming challenges and inefficiencies

22 What if things aren t going as planned? Root cause analysis is a process for identifying the underlying causes of a problem Purpose: Understand what happened, why it happened, and determine how it can be avoided in the future (what changes need to be made) When to utilize root cause analysis: When designing an intervention, project or program To analyze adverse events or individual patient cases When projects or interventions aren t going as planned

23 How does this tie to VBPs? Value-based payments require quality improvements Root cause analysis addresses systemic problems making longlasting quality improvement attainable Root cause analysis should be a routine part of quality improvement efforts Eliminate or mitigate the cause Determine cause of problem Eliminate or mitigate the problem

24 Determining the Root Cause Tool: Fishbone Diagram Process: The 5 Whys 1. Identify the specific problem 2. Ask why the problem happens (potential causes) 3. Repeat continue to ask why until you come to the root cause of the problem

25 Common Cause Areas People Processes Materials Environment Management Problem (Effect)

26 Activity: Develop a Fishbone Diagram Working in your small group, determine a problem that one or all members are currently experiencing Using a flipchart and markers draw your fishbone Using the selected problem, walk through the 5 whys to determine root cases of problem Use sticky notes for the causes and sub-causes Note: This will be most useful if as a group you walk through one group member s experience of this problem and its causes

27 Root Cause Analysis Debrief What did you discover from the process? How would you facilitate this approach at your organization? How will you translate this into action/change? How are you tying the results to your metrics?

28 Turning Insight into Action Root cause analysis will give you insight into all potential causes of a problem Next, you need to identify actions and solutions based on the outcome of root cause analysis Process Brainstorm all potential solutions to the problem before selecting your approach Identify criteria that will guide the selection of solutions to the problem (cost, value, benefit to org) Evaluate potential solutions based on criteria Decide on a course of action Prioritize: You often won t be able to address all problems at once, identify your priorities, start with low-hanging fruit

29 Articulating your Value Proposition Bringing it all together

30 Value Proposition A positioning statement that explains what benefit you provide for who and how you do it uniquely well It describes your target buyer, the problem you solve and why you are distinctly better than the alternative Should show relevancy, quantified value, and unique differentiation

31 Value proposition should answer the following questions: What population(s) is your organization serving? What is the benefit of your services to the community? What makes your services unique and different? How does this solve a problem for your payer?

32 What population is your organization serving? Analysis through risk stratification Development of care pathways Costing your services Systemized approach to treating high, medium and low risk patient populations

33 What is the benefit of your services to the community? Identify the gaps in the system of care in your community Identify your partners in your community Assess for your primary referral sources

34 What makes your services unique and different? Benchmark progress toward improved clinical outcomes Benchmark progress toward driving down costs Incorporate a lean approach to operations Accessibility Responsiveness to social determinants of health

35 How does this solve a problem for your payer? Your value proposition should be in the language of your payer Assess your payer s pain points Research pilot projects your payer has contracted in the past

36 Measurement A perpetual question In Real Life: The Top Three Follow Up After Hospitalization for Mental Illness (31.5%) Readmission Rates (15%) Access (15%) Others

37 Next Steps Meeting evaluation via Survey Monkey Coaching calls scheduled with coaches Webinars Wednesday, October 18th, 12:00pm 1:00pm ET Wednesday, November 15th, 12:00pm 1:00pm ET Tuesday, January 23rd (2018), 11:30am - 1:30pm ET CEO Call December, date to be announced

38 Thank you! Nina Marshall, MSW Samantha Holcombe, MPH Kate Davidson, LCSW Elizabeth Arend, MPH Maura Gaswirth, LICSW Pam Pietruszewski, MA Kathy Dettling, MA Julia Schreiber, MPH Libbi Ethier