Building Your Business Acumen - Washington … Your Business Acumen Beyond the Basics Yolanda...
Transcript of Building Your Business Acumen - Washington … Your Business Acumen Beyond the Basics Yolanda...
Building Your Business Acumen Beyond the Basics
Yolanda Lovato, Planning & Resource Director
John Beck, Business Administration Director
Pearl Bouchard, CLC Manager
1222 N. Post St. | Spokane, WA 99201 | TEL 509-458-2509 | FAX 509-458-2003
SERVING: Northern Ferry, Pend Oreille, Spokane, Stevens & Whitman counties
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Summary of Presentation
• ALTCEW’s Experience with Business Acumen • Marketing
– Network Development – Branding – Service Package
• IT Platform – Why it Matters – Selection Process – Challenges and Uses
• Quality Improvement – Measurement for Improvement – Tools to Support Improvement – Examples
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Support for Learning Collaborative
• Administration for Community Living/Office of Policy Analysis and Development
• The John A. Hartford Foundation
• The SCAN Foundation
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ALTCEW and Business Acumen
Goal: Improve integration between hospitals, insurers, health care providers and community-based organizations (CBOs)
• 11 Networks of varying expertise
• Training
• Sharing experiences
• Lessons learned and best practices from first cohort
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ALTCEW and Business Acumen
• Expanding opportunities for Area Agencies on Aging
– Managed Care Organizations (Apple Health Plans)
– ACO’s
– BPCI’s
– Care Coordination (Health Homes)
– Transitional Care Management (CCTP)
– Evidenced Based Programming (Varied models)
• Falls Risk Prevention
• Diabetes Prevention and Education
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ALTCEW’s Experience
• Network Development – Rural Resources
– Spokane County Meals on Wheels
– Centers for Independent Living (SCIL)
• Branding
• Service Package Development
• Culture Change
• Marketing
• Navigating New Territory – IT
– Quality Assurance/Data
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Key Considerations In Marketing
• What problem are we trying to solve?
• What are we going to do to solve the problem?
• What is unique about how we can solve the problem compared to others?
– Network Development
– Branding/Identity
– Service Package
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Key Considerations In Marketing (Network)
• Know your network market
• Identify strengths of each of the network partners
• Work on forming network identity separate from each individual partner identity
• Describe the benefits of the enhanced role of the partnership/network
• Develop an MOA (unique)
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Key Considerations In Marketing (Branding)
• Importance of branding
• Value Added Strategy/Representation
– Evolution of Conexus™
• Identity distinct from the AAA Social Service Model
– Trademark Registration
– One page overview
(See handouts)
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Key Considerations In Marketing (Service Package)
• Lead with a value proposition
• Establishing rates/pricing of services
• Return on Investment (ROI)
• Establish credibility
• “Buying It” is better than “Building It”
• Brokerage – One Contract, multiple services
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Marketing to Health Plans
• Look at the population through the health plans perspective
• Acknowledge the work that the plan is currently completing
• Understand the fiscal incentives driving the health plans
• Provide materials before hand
• Plan for a 30 minute pitch….be prepared for 1 hour
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Key Considerations in Marketing
• Be patient
• Understand the nature of the competitive market
• Understand what your organization can do as well or Better than anyone else in your area
• Align work with the priorities and fiscal imperatives of the payer source
• Redefine and if necessary, restyle your products and services to meet the payers needs
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Key Considerations In Marketing
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IT Platform: Why it Matters
*ACL Business Acumen heavily recommends having a medical reporting/billing system to be able to negotiate service contracts with various health network providers.
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IT Platform: Why it Matters
*The Electronic Health Records (EHR) system should provide the following:
MEANINGFUL USE is using certified electronic health records technology (EHR) to:
– Improve quality, safety, efficiency, and reduce health disparities
– Engage patients and families
– Improve care coordination and population and public health
– Maintain privacy and security of patient health information
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IT Platform: Why it Matters
Ultimately, it is hoped that the meaningful use compliance will result in:
• Better clinical outcomes
• Improved population health outcomes
• Increased transparency and efficiency
• Empowered individuals
• More robust research data on health systems
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Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs
IT Platform: Key Considerations
National Committee for Quality Assurance (NCQA) has a Patient-Centered Medical Home Recognition (PCMH) NCQA Vendor Contact List
• List has “Pre-validated Product Names” of EHR Vendors
• Interactive with health technology
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IT Platform: Selection
• Contacted all vendors on NCQA list
• Had a task force of staff and Planning and Management Council members which: – Screened initial RFQ submittals
– Selected 3 finalists for full RFP
– Rated the responses
– Contacted current user references
– Negotiated initial rates
– Recommended to PMC and Governing Board for approval to contract
• Full RFQ is available upon request
• Panel selected NextGen Healthcare Ambulatory EHR
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IT Platform: Challenges
• Getting DSHS IT to allow us to use state system to access NextGen
• Staff time commitment to implement
• Modifying a medical practice system to our model
• Need a Medicare provider number to get ultimate billing capabilities
• System is expensive and will need consulting support
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IT Platform: Initial Uses
• Consolidated data for 5 Health Homes contracted services
• Tracking of Matter of Balance class participants
• Development of Care Transition pilot program with CHPW
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IT Platform: Ultimate Uses
• Person centered database to track all non-OAA
& ALTSA services • Full communications with paying sources • Platform for private pay services • Always current to Meaningful Use, HIPAA, and
medical billing
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IT Platform
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Quality Improvement: Why?
• Our current interventions can affect outcomes for health plans, hospitals, ACOs and provider groups
• Helps define the conversation with Plans
• A new culture must come about—better/faster/accelerate change
• We have to measure and improve constantly
• Communicate outcomes with Plans
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Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs
Quality Improvement: Performance Measurement
Three faces of measurement:
Accountability
Research
Improvement
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Quality Improvement: Setting Up a Successful
Project
• Involve senior leadership
• Move through rapidly
• Transparency*
• Resources
• Motivate others
*Importance of Documentation:
Reflection, capture knowledge, create organizational memory, transfer learning
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Quality Improvement: Tools to Support Improvement
– Project Charter Form (in packet)
– Run Charts (or line graphs)
• 12 points to add median
• 20 points to add mean
• 5 or more data points/consecutive up or down = trend
• 6 points consecutive = shift
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Quality Improvement Tools: PDSA
Quality Improvement Tools: Driver Diagrams
Quality Improvement: Making Measurement Useful
Do one improvement at a time
Make it important to staff
Collection of data easy and frequent enough
Not a measure of accountability or research
Gather baseline data
Important to contracting with MCOs, ACOs, BPCIs, etc.
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Quality Improvement: Sources
• PH55X: “Practical Improvement Science in Health Care”; Harvard X, Harvard University. https://courses.ed.org
• Taylor, MJ, et al. BMJ Qual Saf 2013; 0: 1-9
• Bennett, B and Provost, L. “What’s Your Theory?” www.qualityprogress.com
• “Defining and Using Aims and Drivers for Improvement: A How to Guide”, CMS https://innovation.cms.gov/files/x/hciatwoaimsdrvrs.pdf
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Quality Improvement
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Lessons Learned
• I thought I knew more than I could ever know about ACA having done work with the Exchange.
• There is an entirely new vocabulary and list of acronyms.
• Working in the medical field is complex and decisions take much more time than imagined.
• Change is challenging, particularly when talking culture change within an organization
• Social service agencies have to begin framing from a business perspective
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Lessons Learned
• The need to consistently reinforce what relationship this work has to our overall mission
• It is NEVER too soon to talk about sustainability
• Time is of the essence
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Next Steps
• Change our approach from reporting to performance based
• Secure multiple contracts
• Continue environmental scan for partners and payers
• Strengthen relationships with medical partners
• Broaden work by developing business plan
– Private pay market
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Any Further Questions?
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