Value-Based Readiness Assessment (VBRA) Analysis

Transcription

1 Value-Based Readiness Assessment (VBRA) Analysis INTRODUCTION SUMMARY A results analysis aiming to help leaders translate the VBRA insights into an action plan September 2017

2 OVERVIEW BACKGROUND Health system leaders and care teams are overwhelmed by the pace and scope of effort required to transform the organization to new expectations of value and financial risk. Both Federal and commercial payers are rapidly moving towards valuebased payment models, and for many health systems the ability to perform under such models is questionable. Existing strategies won t successfully guide organizations through this immensely challenging volume-to-value transformation. Effective leadership will require a deep understanding of what is expected by all stakeholders personnel, payers, patients, partners and the local community and the ability to create a comprehensive, thoughtfully sequenced strategy that creates a demonstrable value proposition for consumer and purchases of health care services. The Value-Based Readiness Assessment (VBRA) was developed with and for health system leaders and providers to help health systems of all sizes address the volume-to-value transformation challenge. The unique VBRA design and proprietary analytic model gives leaders in-depth insight into the organization s current ability to perform value-oriented competencies and an understanding of the willingness of the workforce to adopt a change agenda for the competencies requiring improvement. The results are then used to identify what is going well and what might be improved, and to suggest a strategy that achieves measurable improvement at a pace that matches the workforce s readiness to change. 2

3 OVERVIEW VBRA ANALYTIC MODEL: Translating Perceptions to an Aligned Strategy An analytic model was created to enable leaders to incorporate the mindset of employees - executives to front-line staff - and subjective norms of the organization in their volume-tovalue transformation strategy (see Figure 1). The model was developed using a wide variety of organizational strategy (e.g., change management, leadership, etc.) and behavior change models, and evaluations of executive leadership cases from inside and outside of healthcare. FIGURE 1: Engaging the workforce to develop an aligned leadership and management strategy. Importance (perception of priority) Aligned Leadership & Management Strategy Ability (perception of proficiency) The model output is summarized in the grid to the right (see Figure 2). A proprietary method applied to the VBRA results assigns each competency (n=16) to one of four quadrants: Ready for Improvement (RFI), Focus on Continuous Improvement (FCI), Clarify Vision, Align and Motivate (CVAM) and Confirm or Redirect Resources (CIRR). The results are not intended to be prescriptive; rather, the model provides a guide for leaders to determine an optimal pathway to aligning the organization behind a value-based, patient-centered mindset, while simultaneously improving the organizational competencies required to meet current valuebased contractual agreements and achieve long-term system optimization aims. FIGURE 2: Transition to Value Model TM HIGH IMPORTANCE (perception of priority) READY FOR IMPROVEMENT Importance is perceived as high but it appears the organization has limited ability to perform COMMUNICATE VISION, ALIGN & MOTIVATE Importance isn t understood or adopted and the skills to improve are limited FOCUS ON CONTINUOUS IMPROVEMENT Importance is perceived as high and it appears the organization has the ability to continually innovate CLARIFY IMPORTANCE OR REDIRECT RESOURCES TO HIGH- PRIORITY AREAS Importance is perceived as low but the ability to perform is high ABILITY (perception of proficiency) LOW HIGH To use the interactive features in this report, please open the file using Adobe Acrobat reader. Click here to download the latest version. 3

4 OVERVIEW VBRA ONTOLOGY The VBRA content is outlined in the diagram below. To allow for hierarchical analysis, the VBRA content is grouped across three tiers: Domains, Capabilities and Competencies. Competencies are the most granular level, Domains the highest the relationship between the domains (orange), capabilities (maroon) and competencies (blue) is identified in the diagram. As shown below, there are four Domains, nine Capabilities, and 16 Competencies. There are a total of 42 questions (the number of questions for each competency is listed in parentheses next to the competency name). COMPETENCIES CAPABILITIES DOMAINS 4

5 OVERVIEW VBRA QUESTION STRUCTURE The VBRA assesses workforce perceptions of proficiency and priority for value-oriented capabilities. Assessing Proficiency The purpose of each proficiency question (based on a 1-9 scale) is to capture the respondent s perception of the organization s current ability to perform a value-oriented competency. The structure of the proficiency questions is as follows: 1 3 Not at all or on a limited basis No work is being done or only on a limited basis, with highlevel plans to do more. 4 6 Implementing & Expanding Implemented in some healthcare services with plans to make the competency a standard across the health system. 7 9 Doing & Continuously Improving In operation across the entire health system with systematic evaluation and evidence of continuous improvement. Assessing Current and Future Priorities There are two types of priority questions: 1. An assessment of a competency s current priority. 2. An assessment of the top three priorities for the upcoming. Current Priority Upon completing the proficiency questions for each competency, respondents are asked to rate their perceived level of priority on a 1 5 scale. The structure of the priority questions is as follows: 1 Not a priority for future success 2 A low-level priority, some planning in place 3 A moderate priority with some action being taken 4 A high priority with planning in place 5 Of the highest priority for the organization requires immediate attention Priority for the Upcoming Twelve Months At the end of the VBRA, respondents are asked to rank the competencies they perceive to be the top three priorities for the upcoming twelve months. 5

6 OVERVIEW ANALYTICS PLATFORM The objective of the analytics platform is to provide leaders and their teams with the ability to analyze the data at a level of detail required to confidently produce or refine a strategic plan. The platform offers executive summary level views, as well as the opportunity to identify the key insights and blindspots by and across roles and across multiple levels of detail (competency and objective). The content below describes the purpose of each view (in red) on the analytics platorm, and the flow you might follow to produce an action plan. Respondents Overview Captures the number of respondents by role and position type. Insights to Action -> Step 1: Review Executive Dashboard Presents the average scores for priority, proficiency, alignment and an overall readiness summary score (a composite of these three scores). Insights to Action -> Step 2: Examine Analytic Model Results The VBRA analytic model results displaying the top three objectives (questions) by quadrant. Insights to Action -> Step 3: Identify Alignment Gaps Between Roles This view captures multiple insights required to understand the variation in perception - critical information leaders must take into account when creating a change strategy. Insights such as: The differences in average priority and proficiency across roles for each competency and objective. The differences in average proficiency perceptions between respondents classified as Executive Leaders and all other roles. Insights to Action -> Step 4: Evaluate Respondent Comments A downloadable PDF that captures the respondent s written comments. If additional detail is needed to confidently determine the action plan, other views provide further insights. Additional Analysis -> Table View of Results by Objective A complete table of the results that can be filter by several attributes. Additional Analysis -> Results Summary by Competency The VBRA analytics model results by competency. Additional Analysis -> Future Priority Ratings A table that captures the % of respondents that voted a competency as one of the top three priorities for the next twelve months. Additional Analysis ->Scenario Analysis by Objective This view provides the ability to examine the actions to consider - based on the quadrant assignment - when implementing the objective selected in the filter. 6

7 RESPONDENTS OVERVIEW The content below provides a summary of the VBRA respondents by role and position title. The organization had a 26% response rate (the average response rate across ~50 organizations is 45%). Note: xxx invited more than 900 employees. TOTAL NUMBER OF RESPONDENTS: 235 7

8 EXECUTIVE SUMMARY: KEY VALUE READINESS SCORES The dashboard view below (and presented here on the analytics platform) captures the proficiency (ability) and priority average scores, and a unique measure in the analytic model called the Alignment Score. The Alignment Score indicates the degree the Executive Leaders agree with the all other respondents regarding proficiency, current priority and future priority (on a 0 to 9 scale). Please note that a score of nine on proficiency is the aim for an organization; whereas, a score of zero for the Alignment score is the aim, which indicates all respondents are perfectly aligned in their perception of proficiency and priorities with Executive Leaders. The number in parantheses under the gauge is the overall average / benchmark. Priority Score (A higher score is better.) Five Highest Priority Scores by Competency* Proficiency Score (A higher score is better.) Five Lowest Proficiency Scores by Objective** Alignment Score (A lower score is better) Five Largest Alignment Gaps Between Executive Leaders & All Other Roles *Number of competencies=16; **Number of objectives=42 8

9 EXECUTIVE SUMMARY: PROFICIENCY ALIGNMENT ANALYSIS A unique aspect of the VBRA is the ability to detemine alignment within and across roles. The alignment score on page 5 is a measure determining the degree of alignment - in proficiency & priority - between respondents classified as Executive Leaders and all other roles. The intent is to highlight whether the workforce agrees with the perspectives of Executive Leaders. For the five objectives with the largest alignment score (noted on the previous page)*, the arrows in the table below indicate if the average proficiency rating for each role is above or below the average of all Executve Leaders. The column titled # of Executive Leader Outliers displays the % of Executive Leaders with a proficiency rating larger than a 34% difference from the average rating of all Executive Leaders. Average % Rating Difference From Executive Leaders** # of Executive Leader Outliers*** Objective Senior Leader Business / Clinical Leader Direct Care Provider Executive Leader BCP1: The organization has the ability to calculate per capita spending. 48% BCP1: The organization has access to the capital required to support the transition to value-based 39% payment models. IPHN1: The organization can anticipate the needs of the entire population. 26% CG2: Care teams use decision aids to help patients make informed choices concerning their healthcare 22% options. BL3: Providers are appropriately represented on steering committees. 13% *The larger the alignment score, the less agreement between roles. **A green up arrow indicates the average response for the role is higher than the overall average response for all Executive Leaders. ***Indicates the % of Executive Leaders with a rating for the objective that is more than 34% different than the overall average score for all Executive Leaders. A smaller number is better. 9

10 EXECUTIVE SUMMARY: PRIORITY ALIGNMENT ANALYSIS A unique aspect of the VBRA is the ability to detemine alignment within and across roles. The alignment score on page 5 is a measure determining the degree of alignment - in proficiency & priority - between respondents classified as Executive Leaders and all other roles. The intent is to highlight whether the workforce agrees with the perspectives of Executive Leaders. For the competencies with the largest priority alignment score*, the arrows in the table below indicate if the average priority rating for each role is above or below the average of all Executve Leaders. The column titled # of Executive Leader Outliers displays the % of Executive Leaders with a priority rating larger than a 34% difference from the average rating of all Executive Leaders. Average % Rating Difference From Executive Leaders** # of Executive Leader Outliers*** Competency Senior Leader Business / Clinical Leader Direct Care Provider Executive Leader Budgeting & Capital Planning (BCP) 30% Identification of Patient Health Needs (IPHN) 60% Care Guidelines (CG) 22% Balanced Leadership (BL) 26% *The larger the alignment score, the less agreement between roles. **A green up arrow indicates the average response for the role is higher than the overall average response for all Executive Leaders. ***Indicates the % of Executive Leaders with a rating for the objective that is more than 34% different than the overall average score for all Executive Leaders. A smaller number is better. 10

11 EXECUTIVE SUMMARY: COMMENTS OVERVIEW Respondents submitted a total of 461 comments, or 1.9 comments per respondent compared to the overall average number of comments per respondent of 1.4. The competencies with the highest number of comments and the comments by role are below. All comments are available in the web-based analytic platform (found here) - click on the header Insights to Action then Step 3: Evaluate Respondent Comments. TOP FIVE COMPETENCIES WITH THE MOST COMMENTS (RANKED FROM TOP TO BOTTOM) Competency Total % of Total Benchmark % Benchmark Rank* Future Priorities (FP) 54 12% 14% 1 Balanced Leadership (BL) 42 9% 6% 2 Clarity of Mission (CM) 38 8% 9% 3 Provider Education (PED) 34 8% 6% 7 Practice Pattern Analysis (PPA) 19 7% 6% 5 COMMENTS BY ROLE Role Total % of Total Benchmark % Executive Leader 60 13% 11% Senior Leader 51 11% 14% Business of Clinical Leader % 40% Direct Care Provider % 29% Total 461 *Out of the 16 competencies 11

12 EXECUTIVE SUMMARY: SENTIMENT ANALYSIS BASED ON COMMENTS Sentiment analysis software was applied to the 461 comments. Sentiment analysis analyzes text to determine the underlying emotion or attitude of a comment and assigns the comment a rating of positive, negative or neutral, along with a score to indicate the strength of the rating. The charts below outline key findings from the sentiment analysis program. Overall Average % OF POSITIVE & NEGATIVE COMMENTS BY COMPETENCY 47% 53% Provider Engagement (PEN) Provider Education (PED) Practice Pattern Analysis (PPA) 43% 42% 41% 57% 58% 59% Patient Self-Management (PSM) 73% 27% Patient Education (PE) Patient Activation (PA) Identification of Patient Health Needs (IPHN) 52% 49% 53% 48% 51% 47% Future Priorities (FP) Contracting (C) 60% 60% 40% 40% Compensation Alignment (CA) 44% 56% Clinical Quality and Health Outcomes Measurement (CQHM) 55% 45% Clarity of Mission (CM) Care Guidelines (CG) Care Decision Support (CDS) Budgeting and Capital Planning (BCP) Balanced Leadership (BL) Appropriate Mix of Providers and Care Settings (APCS) 45% 47% 41% 40% 36% 43% 55% 53% 59% 60% 64% 57% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Positive Negative 12

13 EXECUTIVE SUMMARY: SENTIMENT ANALYSIS BASED ON COMMENTS Sentiment analysis software was applied to the 461 comments. Sentiment analysis analyzes text to determine the underlying emotion or attitude of a comment and assigns the comment a rating of positive, negative or neutral, along with a score to indicate the strength of the rating. The charts below outline key findings from the sentiment analysis program. % OF POSITIVE, NEGATIVE & NEUTRAL COMMENTS BY ROLE 70% 63% 60% 59% 57% 50% 51% 49% 47% 53% 41% 43% 40% 37% 30% 20% 10% 0% Business or Clinical Leader Direct Care Provider Executive Leader Senior Leader Overall Average Positive Negative 13

14 OBJECTIVES BY QUADRANT: BE A GREAT PLACE TO WORK, LEARN & DISCOVER The results below and on the following two pages capture the insights most closely related to xxx s strategic goal Be a great place to work, learn & discover. The purpose of the content is only to start the conversation, not indicate these are the only objectives (12 out of the 42) leaders should consider when determining how the results might help the organization achieve the strategic goal. HIGH RFI: Motivated to act, limited ability (N=1) PEN1: Providers are adequately assigned as champions of strategic technology implementations. FCI: Motivated and able (N=1) CM1: The mission of the health system is consistent with Triple Aim. CVAM: Not motivated or able (N=6) CIRR: Capable but not a high priority (N=4) IMPORTANCE (perception of priority) CA1: Providers compensation policies are aligned with performance measures. CA2: Care teams receive feedback on performance measures that are outlined in compensation agreements. C1: The organization has contracts with providers that align with the aims of a value-based health system. PED3: Providers receive adequate education concerning the aims and core characteristics of a value-based delivery system. PED1: Providers on multidisciplinary teams receive sufficient training on team-based care. BL3: Providers are appropriately represented on steering committees. PEN2: Providers are adequately assigned to leadership roles for strategic quality improvement initiatives. PA2: Providers and staff receive adequate patient experience training. PEN1: Providers are adequately assigned as champions of strategic technology implementations. PED2: Providers assigned to leadership roles receive adequate leadership training. LOW ABILITY (perception of proficiency) HIGH PED: Provider Education CA: Compensation Alignment PEN: Provider Engagement; PA: Patient Activation C: Contracting CM: Clarity of Mission BL: Balanced Leadership 14

15 COMMENTS: BE A GREAT PLACE TO WORK, LEARN & DISCOVER Respondents submitted a total of 461 comments, or 1.9 comments per respondent compared to the overall average number of comments per respondent of 1.4. Below are direct quotes from respondents captured in the comments sections of the VBRA that are related to the objectives captured on the previous page. All comments are available in the web-based analytic platform (found here). PROVIDER EDUCATION Direct Care Provider: Current xxx culture is way behind curve on volume to value transition and the word value is never discussed. Team based care seems to be an alien concept. Provider education discouraged. Education committee disbanded for years. Attempts to resuscitate it were stopped. Senior Leader: Provider education is effectively a punitive model that reminds us that we will be adversely rewarded if we don t adhere to the prescribed value propositions, which appear to be dubious or inconsistent. PROVIDER ENGAGEMENT Direct Care Provider: Many docs alienated, demoralized, not attending quarterly meetings to get caught up. WRMC quarterly physician meetings seem devoid of substance regarding upcoming changes. Executive Leader: Lots of issues around provider/admin structure. I have never worked in a system with such a lack of providers in the admin process at the ops level. Direct Care Provider: Providers at the front-lines do not feel engaged by the health system. There is a feeling of isolation. BALANCED LEADERSHIP Busines / Clinical Leader: I feel the organizational model should coincide with the IOM s suggestion to include nursing to operate to it s full extent and include nursing leadership on the forefront of more decisions to positively impact population health. Direct Care Provider: One of our areas of weakness is having patients and community partners involved in xxx steering committees. Business / Clinical Leader: Strategic priorities are established without input or vetting from the chairs, service line leadership and those who should be leading and strategies. COMPENSATION ALIGNMENT Direct Care Provider: Seems like providers take all the risk not administrators. Direct Care Provider: I don t think that my compensation as a provider is currently aligned with performance measures. Executive Leader: This strategic priority is currently receiving relatively little attention, but it should be receiving more attention! Direct Care Provider: We receive press ganey scores but I don t know how that will be tied into VB care, but we don t receive information on the health of our patients (A1Cs, mammogram rates, etc). 15

16 KEY OBSERVATIONS: BE A GREAT PLACE TO WORK, LEARN & DISCOVER The content below captures what might be improved for a selected number of results related to xxx s strategic goal Be a great place to work, learn & discover. The purpose of the content is only to start the conversation, not indicate these are the only insights leaders should consider when evaluating the results. Results in the web-based analytic platform (here) might highlight other key insights. WHAT MIGHT BE IMPROVED 1. Insights: All three objectives within the Compensation Alignment (CA) competency are assigned to the CVAM quadrant, and have the 6th, 7th and 8th lowest proficiency ratings out of the 42 objectives. Other key insights include: 1. All roles rated the proficiency for the CA1 objective Provider compensation policies are aligned with performance measures higher than Executive Leaders (ELs), with Business / Clinical Leaders rating CA1 36% higher ELs; 2. Direct Care Providers rated the proficiency for the CA3 objective Executive compensation policies are aligned with performance measures 30% lower than Executive Leaders; 3. Executive Leaders rated the priorioty for the CA competency higher than all other roles. Possible Actions: Investigate whether there is an explicit policy to match provider and executive compensation with performance measures, work with cross-functional teams to confirm the objectives / aims for doing so and to document existing gaps, and communicate the improvement plan and ongoing improvements across the workforce. 2. Insights: Two of the three Provider Education (PED) objectives ( Providers receive adequate education concerning the aims and core characteristics of a value-based delivery system (PED3) and Providers on multidisciplinary teams receive sufficient training on teambased care (PED1) ) have the 4th and 5th lowest proficiency ratings out of all 42 objectives. Possible Action: Verify the scope and type of training offered to care staff provides the timely and relevant training they need to achieve optimal performance and work satisfaction. RELATIONSHIP TO PERFORMANCE MEASURES The majority of xxx HCAHPS measures ending in Q are at or below the national average. The proficency and priority rating for the 12 objectives listed on page 11 should potentially be evaluated and considered in an improvement plan. For example, confirm the mission is understood and adopted by all (CM1), providers / care staff receive adequate education concerning the aims and core characteristics of a value-based delivery system (PED3), providers / care staff are appropriately represented in an improvement plan (BL3), and providers receive the training they need to lead the change (PEN2), compensation is aligned with performance expectations / measures (CA1) and providers / care staff receive timely feedback on such measures (CA2) to continuously monitor and improve peformance. The codes listed with an objective are unique codes assigned to each objective (question) in the VBRA.. The quadrant abbreviations are: Focus on Continuous Improvement (FCI), Clarify Importance or Redirect Resources to High-Priority Areas (CIRR); Communicate Vision, Align & Motivate (CVAM) and Ready for Improvement (RFI). 16

17 EXECUTIVE SUMMARY: FUTURE PRIORITY RATINGS At the end of the VBRA, respondents are asking to force rank their top three priorites among the 16 competencies for the upcoming twelve months. The table below captures the five competencies that received the most votes for one of the top three priorities. Competency* Overall % Executive Leader % All Other Roles % Workforce Difference from Executive Leaders** Clinical Quality & Health Outcomes Measurement (CQHM) 40% 39% 40% Budgeting & Capital Planning (BCP) 32% 26% 33% Contracting (C) 22% 13% 23% Provider Engagement (PEN) 20% 26% 20% Clarity of Mission (CM) 17% 39% 15% *Four of the five competencies with the highest number of votes for a future priority are also rated as a top five current priority. **A green up arrow indicates the number of votes for the objective as a top three priority by all non-executive Leader roles is higher than the number of votes for the objective as a top three priority by all Executive Leaders. 17