Post on 18-Jun-2020
NO MORE SLEEPLESS NIGHTS: ADAPTING TO MANAGED CARE IN OHIO
Presenters:David J. Bucciferro, Senior Advisor, Foothold TechnologyEd Carpenter, IT Manager, Mended Reeds Services
Presenter Introduction
Preview of Presentation
Your Questions to Be Answered
Introduction
• Improve the health of populations
• Lower per capita costs
• Improve the patient care experience
• Reform existing payment models and health care delivery systems, i.e. become an Accountable Care Organization (ACO)
• Share in “savings” that result from improving care quality and reducing cost for eligible Medicare populations
Healthy Start - Goals of the ACA
State andFederal Fiscal
Instability
ACOsStateInitiatives
ChangingExpectations
HCBSChanges
ChangingRegulationsYouFee For
ServiceHIPAA
HiTECH Implementation
MandatesPrivacy &Consent
HIEs andRHIOsOlmstead
Act
Every Changing – Every Complex
• Triple Aim: A Focus on improving outcomes, improving quality, reducing cost
• Medicaid/managed care expansion, Mental Hygiene parity
• Focus on better coordinated, accountable, and integrated physical, Intellectual, Developmental and behavioral health care
• Major emphasis on home and community based services and less reliance on institutional care
• Promoting wellness, preventing relapses upstream
• Person-centered individualized care
• Focus on Social Determinants of Health
What is a Healthy and Current Focus
• Diminishing Resources
• Integration of Care
• Ever-changing Regulations
• Increased Oversight Activity
• Shift from Volume to Value
• New Workforce Skills Needed
• From Budget to Business Model
• Performance based Contracting
Why We Need to Operate Differently
Depends upon your perspective….
• Control costs
• Control quality of service delivery
• Provide an evidence-based service delivery structure
• Improve treatment outcomes
• To make money
What does Managed Care do?
• We won’t be able to do business
• They don’t want to hear from us.
• Consumers will go without
• They want 1-stop shops
• They aren’t going to pay us timely/correctly
• Increased administrative burden
Fears of Managed Care
How Can My Agency Ever Do This?
LEADERSHIP+
DATA=
READINESS
Leadership Data Workforce• Leadership buy-in
and culture change management
• Data…obtain
• Skill Set – Staff need to be placed in situations that need their skills and they can be successful.
• Human Resources development
• Information…link the data
• Culture – Foster a culture of responsibility, mission and excellence.
• Quality Assurance protocols internal to the agency
• Knowledge…organize the information
• Data Accepting – Use data to inform, manage, operate and deliver services.
• Mission-driven strategy
• Wisdom…apply the knowledge
• Adaptability – Change will happen if staff are adaptable to change.
Key Elements ?
• Leadership buy-in and culture change management• What does your team know, and who is not “in the know”? • How is information managed? What is the tone/ expectation
of anticipated changes?
• Human Resources development for unifying expectations, implementing practice and training
• Quality Assurance protocols internal to the agency that complement state outcome goals and offer a strong feedback loop to quality improvement, Establish Benchmarks
• Mission-driven strategy to keep the focus on your personalized triple aim
Leadership Strategy
When Using Data In Your Agency:
• Know the Information You Need
• Understand Input and Outputs
• Establish Culture
• Continuously Evolve
• Use to Survive and Grow
• Use to be Effective and Efficient
5 Ways To Success
• Meet your obligations• You’re accountable to many people. Exceed those obligations
• Implement a dynamic management system with Informed decision-making by all agency personnel• Gut Decisions do not work• Continuously improve using your organizational memory.
• data, information, knowledge, wisdom
• Efficiencies in Service Delivery• Manage delivery and documentation
• Seek opportunities for collaboration and interoperability• Standalone agencies will struggle without collaboration.
• Market yourself• You’re a business and need to sell yourself.
Meeting Your Obligations
• External obligations• Government• Funders• Accreditation bodies, etc.
• Internal obligations• Individuals in service• Board of directors• Staff and others
Informed Decision-MakingDynamic Management
Efficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Name of Agency Staff
Agency Title Entity Accountable
To
Type of Measure
Specific Measurement
Frequency of Report
John Smith CEO Clients Outcomes Employment Quarterly
Hospitalization Daily
ECT.
Incidents Level 1 and 2 Daily
Other Levels Weekly
ETC.
B.O.D. Fiscal Annual Report Annually
Balance Sheet Quarterly
ETC.
Government Census Registrations Monthly
Utilization Attendance Annual Slide
Organizing Data
Informed Decision-Making
• Data-based decision-making• Data• Information• Knowledge • Wisdom
• Everyone’s job• Administrators• Supervisors• Clinicians• Oversight and support
Meet Your ObligationsDynamic
ManagementEfficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Managing With Data
• Data…obtain
• Information…link the data
• Knowledge….organize the information
• Wisdom…apply knowledge to issue
Creating organizational knowledge:
Organizational memory is the accumulated body of data, information, and knowledge created in the course of an individual organization’s existence.
Meet Your ObligationsDynamic
ManagementEfficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Accessibility To Decision Making Data
• Key staff have access and knowledge of the system• Regular use of the system• Tracking outside of the system• Reports from the system—client demographics/profile, client
outcomes, LOS• Staff training and re-training, new features• Ongoing review of data Meet Your Obligations
Dynamic Management
Efficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Dynamic Management
Interactive process of data feeding back into operations • Be Informed
• Be Flexible
• Be Able to Rapidly Adapt
Meet Your ObligationsDynamic
ManagementEfficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Efficiencies in Service Delivery
• Services
• Reduce No-shows
• Outcome Oriented
• Documentation
• Person Centered
• Collaborative
Meet Your ObligationsInformed Decision-Making/Dynamic
ManagementEfficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Collaboration And Interoperability
• Collaboration
• Need to work and
communicate with other
providers
• Integration
• Need to be able to
exchange Data HIE
Meet Your ObligationsInformed Decision-Making/Dynamic
ManagementEfficiencies in Service DeliveryCollaboration & Interoperability
Market Yourself
Market Yourself
• Value to Your Funder
• Value as a Partner
• Efficiency
• Effectiveness
• Person to Person Outreach
Meet Your ObligationsInformed Decision-Making/Dynamic
ManagementCollaboration & InteroperabilityEfficiencies in Service Delivery
Market Yourself
• Be proactive• Offer ideas/innovations• Attend Government and MCO sponsored
trainings/events/meetings. Be visible and introduce yourself (make your presence known)!
• Avoid getting sucked in by the negativity• Acknowledge the positive aspects of the change (EBPs,
accountability, etc.)• Direct questions to the right authority to give an answer• Don’t give up and don’t give in• USE DATA IN NEW WAYS
What Can we do?
How to use the data to advance your agency• Outcome-based information
• Value-based information
• Staff expertise
• Board influences
• Stories with data
• Create Internal Benchmarks
• Evaluate against External Benchmarks
Leveraging Your Data
Remember to…
Contact Information
David J. BucciferroSenior Advisor
Foothold TechnologyDavid@footholdtechnology.com
212.780.1450 x8037www.footholdtechnology.com
Ed CarpenterIT Manager
Mended Reeds Servicesecarpenter@mendedreeds.org
917.870.0805www.mendedreedsservices.com