From Project Plan to Transformation Plan. Value-Based Payment Practice Transformation Academy

Transcription

1 From Project Plan to Transformation Plan Value-Based Payment Practice Transformation Academy

2 What is Practice Transformation? Developmental Improvement of what is Transitional Movement towards welldefined new state Transformational New state is largely unknown

3 Transformation to Value-based Payments From this To this

4 VBP Readiness Patient and Family-Centered Care Design Patient & family engagement Team-based relationships Population management Practice as a community partner Coordinated care delivery Organized, evidence-based care Enhanced access Continuous, Data- Driven Quality Improvement Engaged and committed leadership Quality improvement strategy support a culture of quality and safety Transparent measurement and monitoring Optimal use of HIT Sustainable Business Operations Strategic use of practice revenue Staff vitality and joy in work Capability to analyze and document value Efficiency of operation

5 Planning for Transformation Successful transformation requires having concrete goals and a plan for how you will achieve them. VBP Planning Guide Framework for strategic plan Identifying manageable objectives/tasks that build to long-term goal Aligning priorities with state/federal timelines Adapting for your organizational needs

6 Project Planning for Transformation

7 From Stretch Project to Transformation The first step in building momentum is to

8 Rapid Cycle Change Three Steps: Develop and execute the stretch project workplan Rapid-cycle change: Use PDSA to drive implementation Monitor and sustain improvement through Continuous Quality Improvement (CQI)

9 IHI s Collaborative Model for Achieving Breakthrough Improvement Ongoing Support: In-person workshop, webinars, assessments, resources and tools, phone conferences with faculty coaches, access to regional practice coaches

10 Planning Your Stretch Project

11 Turning Your Framework into An Action Plan Narrative Summary Indicators Data Sources Assumptions Goal Make the paradigm shift to population health management to improve patient outcomes Objectives/Outcomes Improved care coordination Outputs Established risk stratification approach to investigate client population Activities 1. Identify common indicators used to stratify risk 2. Design and implement data registry 3. Identify operational workflows to support risk stratification processes Reduced re-hospitalization rates Medicaid data Percent of high risk clients receiving care coordination/ care management 1. Percent of clients with established care pathways 2. Percent of high risk clients referred to care management 1. Indicators selected 2. Data registry protocol in place 3. Staff implementing workflows EHR EHR Organizational protocols Monthly staff meetings Coordinated/managed care will improve health outcomes Care pathways will be followed and patients will be referred Staff are given the tools and resources to effectively implement this approach

12 Targeted Projects Project 2A: Bi-Directional Integration of Care and Primary Care Transformation (Required) Project 2B: Community-Based Care Coordination (Optional) Project 2C: Transitional Care (Optional) Project 2D: Diversion Interventions (Optional) Project 3A: Addressing the Opioid Use Public Health Crisis (Required) Project 3D: Chronic Disease Prevention & Control (Optional)

13 Demonstration Toolkit Measures Follow-up After Discharge from Emergency Department for Alcohol or other Drug Dependence (2A) Follow-up After Discharge from Emergency Department for Mental Health (2A) Follow-up After Hospitalization for Mental Illness (2A) Inpatient Hospital Utilization (2A & 3A) Outpatient Emergency Department Visits per 1000 Member Months (2A & 3A) Patients on High-Dose Chronic Opioid Therapy by Varying Thresholds (3A) Substance Use Disorder Treatment Penetration (Opioid) (3A) Patients with Concurrent Sedatives Prescriptions (3A) Percent Arrested Percent Homeless (Narrow Definition)

14 Demonstration Toolkit Measures Child and Adolescents Access to Primary Care Practitioners (2A) Chlamydia Screening in Women Ages 16 to 24 Comprehensive Diabetes Care: Eye Exam (retinal) performed (2A) Comprehensive Diabetes Care: Hemoglobin A1c Testing (2A) Comprehensive Diabetes Care: Medical Attention for Nephropathy (2A) Contraceptive Care- Most & Moderately Effective Methods Contraceptive Care- Postpartum Dental Sealants for Children at Elevated Caries Risk, Periodontal Evaluation in Adults with Chronic Periodontitis Primary Care Prevention Intervention as Part of Well/Ill Child Care as Offered by Primary Care Medical Providers Statin Therapy for Patients with Cardiovascular Disease (Prescribed) Timeliness of Prenatal Care: Prenatal care in the first trimester of pregnancy Utilization of Dental Services by Medicaid Beneficiaries Well-Child Visits in the First 15 Months of Life

15 Phases of Planning Activity Definition Tool: Work Breakdown Structure Activity Sequencing Activity Resource Estimating Tool: Network Diagram Activity Duration Activity Schedule: Calendar Tool: Gantt

16 Phase 1: Activity Definition In Phase 1 we are: Identifying the key activities that need to happen for your stretch project Breaking down these activities into tasks Once broken down, the tasks can be: Clearly defined Analyzed for dependencies and risks Scheduled

17 Stretch Project Example Established risk stratification approach to investigate client population Logframe Output Identify common indicators Design and implement data registry Align organizational policies and procedures Train staff Data collection Identify current data points/processes Map all data points Review current workflows, policies and procedures Finalize all materials and protocols Develop project monitoring and evaluation plan Identify gaps Develop or adapt registry tool Revise workflows to include newly identified processes/procedures Contingency plan for training and lost productivity Collect and review data on a monthly basis Crosswalk and determine potential data collection approaches Mid-term review of progress Select final metrics

18 Phase 2: Activity Sequencing Mapping out the identified activities based on sequencing and dependencies Identify gaps Start Identify current data points/processes Crosswalk and determine potential data collection approaches Select final metrics Review current workflows, policies and procedures Revise and align workflows, policies and procedures Train staff Map all data points Develop or adapt registry tool

19 Phase 3: Resource Estimation What staff are available? What additional resources do I need? What skills do I need? Does any of this cost money? What support or buy in do I need? What constraints do I have?

20 Phase 4: Activity Duration Start Identify current data points/processes 5 days 1 day Identify gaps Crosswalk and determine potential data collection approaches Map all data points 3 days 5 days Select final metrics Review current workflows, policies and procedures 1 day 10 days Revise and align workflows, policies and procedures 30 days Develop or adapt registry tool 40 days 1 day Train staff

21 Phase 5: Activity Scheduling Using the results of your other planning phases, you are able to build out your activity schedule/workplan to monitor and track on progress Activity Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Wk 9 Wk1 0 Wk1 1 Wk1 2 Identify common indicators Design and implement data registry Align organizational policies and procedures Staff training Data collection

22 Next Steps Phase 2: Exercise: Identify the key high-level activities for your stretch project Come prepared to plan! In-person meeting Wednesday, February 28 th Radisson SeaTac Hotel

23 Thank you! Questions? Contact Joan Miller The project described was supported by Funding Opportunity Number CMS-1G from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.