Clinic Readiness, Preparation and Support

Transcription

1 ASSESSMENT 1 Clinic Readiness, Preparation and Support Laura Sisulak, Strategic Projects Senior Director Oregon Primary Care Association

2 ALTERNATIVE PAYMENT ADVANCED CARE MODEL 2 OPCA s GOAL FOR ALTERNATIVE PAYMENT ADVANCED CARE MODEL (APCM) Lead the development of and align payment with an efficient, effective, and emerging care model that achieves the Quadruple Aim in Oregon CHCs

3 CHC LEARNING COMMUNITY STRUCTURE 3 THE BIG PICTURE: TRANSFORMATION 3.0

4 ALTERNATIVE PAYMENT ADVANCED CARE MODEL 4 WHAT WE KNOW Do your clinic teams and partnerships address this truth? Infographic from bipartisanpolicy.org Data from: McGinnis et al The Case for More Active Policy Attention to Health Promotion. HealthAffairs

5 Accountability Plan Quality Seven* Quality Metrics aligned with Coordinated Care Organization (CCO) 2016 Incentive Metrics are required. Patient Satisfaction best practices. Cost In 2017, clinics and OHA will clearly define what data to track in cost/utilization, and determine how health centers will access such data. 5 *An additional metric (Dental Sealants) is optional and one to be added in 2018 (SBIRT). Access Report Care STEPs quarterly. OHA will remove patients from clinics APCM lists if they have not had a visit or Care STEP in eight quarters. Population Management Clinics will identify a population and use tool to learn and track bio-psychosocial needs. Improve quality through segmentation.

6 Care STEPS REDESIGNING CARE 6

7 HOW WE GOT HERE 7 WHAT WE LEARNED The health care system is very stable and does not change quickly or easily. Payment is a barrier to delivering care that improves outcomes and retains staff. Changing payment does not change the front lines of care delivery. To change care, you must have a clear vision that reflects the evidence regarding the causes of health and wellbeing in patients and staff. Keep payment and care aligned and evolving to support human-centric model.

8 Are you ready? 8

9 ASSESSMENT 9 CHC CONSIDERATIONS FOR APM Do you have a vision you can t reach under current payment structure? How will APM free up your clinic to provide more robust, patientcentered and team-based care? Is your leadership team stable? Have you considered workload to on-board?

10 ASSESSMENT 10 IS YOUR CLINIC READY? ORGANIZATIONAL AND CLINICAL READINESS Stable leadership team Compelling vision for transformation that includes SDoH interviewing and intervention Inclusion in Strategic Goals and priorities Capacity for and history of change management and PCMH quality reporting Commitment to resourcing APCM and facilitating organizational spread Full assessment of competing priorities, such as change in EHRs, new sites and services, number of initiatives Relatively well staffed to meet current medical demand

11 ASSESSMENT 11 IS YOUR CLINIC READY? DATA/IT READINESS APCM will increase demand for analytics/reporting and the clinic may need to expand current capacity Capacity to generate reports quarterly for submission to OHA on quality and access (visits and engagement encounters) Internal capacity to modify reports or work with EMR to generate relevant information as care and reporting requirements change Capacity to work with HCCN or non-hccn EMR vendors to support APCM reporting requirements Vision for using data to improve care:» Ideally, CHC has an analytics team with role of not only running reports, but also taking the data and engaging the rest of the clinic in using it to make the transformation vision come to life» Bi-directional process of using data to change care and then evaluate the impact of those changes

12 ASSESSMENT 12 IS YOUR CLINIC READY? FINANCIAL READINESS Cash on hand financial stability going in Payer mix» Consider challenge if the CHC serves less than 1,000 Medicaid patients» Consider how much visit-based revenue will continue at the clinic Average visits per patient, per year» Stability of historical utilization» Stability/predictability of patient population» Low visits per patient, per year Big investment of time for financial staff in the first year Billing process unchanged, but additional work to maintain patient lists may be a data/reporting function more than financial

13 CONVERSATIONS AROUND DATA OHA, OPCA, OCHIN, CLINICS, CCOs, BPHC BRIDGE TO VALUE-BASED PAY 13

14 ASSESSMENT 14 CLINIC READINESS TOOL Intended use:» Obtain baseline understanding for clinic and PCA» Assess strengths and opportunities for care model change» Facilitate generative conversations by identifying differing perspectives of various staff members» Identify success factors and/or cautions for clinic participation A Precursor to the Assessment Tool, intended to assess the developmental continuum of operational status for five strategies, similar to the PCMH-A, PCRS, QI tool

15 15 Example: Readiness Tool Phase 5 Readiness Guide Leadership What is your leadership team s vision under the Alternative Payment and Advanced Care Model? Please list your strategic goals and priorities for 2016 and Please describe activities your team participates in to Advance progress of goals Measure progress of goals Partner with patients to advance progress of goals Partner with community to advance progress of goals Partner with the board to advance progress of goals

16 16 Readiness Tool, Continued Data/IT Capacity/Empanelment Please describe your current data system: EMR: Data support team and functions: Relationship with your external IT support unit: What are you most interested in measuring? What are your current data-producing and delivery obligations? Describe customized reports you are interested in building and are not already provided within your EMR? What will they help you measure? What is your internal capacity to write reports? Monthly basis? Team level? What do you do with it? Knowing your Population How do you define and track your population? How do you note major shifts (Please describe in the context of utilization, complexity, and demographics) If any, please describe population changes you experienced during ACA expansion.

17 Model Implementation Timeline Assessment of CHC Readiness On-boarding process Policy/Leadership Secure golive funding Poll EDs Trainings Informational Sessions Individual assessments and recommendation Conceptual Deep Dives and policy review Technical Trainings and site visits to early adopters Rate Setting Pre Aug Sept Oct Nov Dec Jan Feb March April May June July Beyond

18 PCA CAPACITY FOR SUPPORTING APCM 18 PCA CAPACITY Core organizational capacity to facilitate a project of this size and complexity» Competing priorities» Stable leadership» Stable funding Significant staff resources required WHAT IT TAKES TO SUPPORT APCM» Internal expertise for technical, project management and administrative support in policy, payment, data and care transformation» Potential need for contractors to augment internal expertise Availability of additional funding for PCA to support APCM - OPCA budgets ~$500k for APCM Support» Government or Foundation grants» Membership dues» Charges to members to participate

19 APM Rate Setting Process 19