Multi-Sector Collaboration: Internal and External Leadership Approaches and Capacities

P O P U L AT I O N H E A LT H I N N O VAT I O N L A B

October 11, 2017

Agenda

P O P U L AT I O N H E A LT H I N N O VAT I O N L A B

• Agenda, Objectives, Where are we in the Learning Lab Process?

• Speaker Introductions

• Internal Leadership Key Concepts Kevin Barnett

• Internal Leadership Personal Experiences Peter Roberts

• Q and A

Objectives

• Learn about strategies to align stakeholder resources where health inequities are

concentrated

• Applying a system approach to heath care governance, leadership, and operations

• Share examples of exemplary practices and emerging lessons from the field

• Uncover blind spots, power dynamics and other “invisible” influences in current structures

• Understand personal and collective actions needed for success

• Sharing personal stories and how they influenced leadership practices and decisions

•

P O P U L AT I O N H E A LT H I N N O VAT I O N L A B

SHARED INTENT SYSTEMS PERSPECTIVE MAKE MEANING PROTOTYPE SCALE

SHARED INTENTSYSTEMS PERSPECTIVE

MAKE MEANING PROTOTYPE SCALE

• Discover the need + shared purpose you are addressing

• Create a preliminary vision of the future you want to enact

• Build a strong core team to address the need

• Observe + engage the greater system - impacts, challenges, opportunities, leverage points, gaps and blind spots

• Engage stakeholders in the system to increase your understanding

• Map out the system and ask stakeholders "what's missing from my map"

• Reflect, individually and collectively

• Make meaning of what you are learning with your team + co-create

• Uncover blind spots, test your preliminary vision

• Integrate your current level of understanding

• Brainstorm or ideate potential solutions (services, products, processes)

• Build a prototype

• Test -> Feedback -> Test

• Go back to the drawing board if a prototype fails and repeat until you reach a scalable prototype

• Scale what is working

• Plan

• Implement

• Test

DEF

INIT

ION

AL

ELEM

ENT

KEY

STE

PS

Shared Vision and Goals Partnership and Leadership Backbone Organization and Data Analytics

Wellness Fund and Portfolio of Interventions

All

Learning Lab Process

Welcome and Introductions

P O P U L AT I O N H E A LT H I N N O VAT I O N L A B

Peter Roberts Kevin Barnett

Building a Foundation for Population Health: Inside the Hospital Walls

ACH Webinar Series

October 11, 2017

Kevin Barnett, DrPH, MCP

Senior Investigator

Public Health Institute

Hospital as“Total Health”

Anchor InstitutionWith shared ownership for

the health ofthe community

Shared RiskCommunityInfrastructure To Manage Shared ROI

Shared Savings

Bundled Payments

PCMHAlign

Resources With Diverse

Stakeholders

ID andAnalyze Common

Diagnoses

ID andAnalyze Factors

Influencing Panel

Pay forPerformance

PCCM

ReadmissionPenalty

Hospital asAcute Care

“Body Shop”Fee for Service

Improve

Health ofCommunity

Episodic

PatientCare

Global Payment Totally AccountableCare Organization

Health Care Transformation Continuum

ID and AnalyzeGeographic

ConcentrationsOf Inequities

Coming to Terms with Health Inequities

• Unhealthy housing

• Exposure to array of environmental hazards

• Limited access to healthy food sources & basic services

• Unsafe neighborhoods

• Lack of public space, sites for exercise

• Limited public transportation options

• Inflexible and/or poor working conditions

• Health impacts (e.g., allostatic load) of chronic stress

Population Health

Medical Model

Population Health

Assess patient health status

Ensure timely access to clinical services and

medications

Clinical case management through team-based

care

Patient education

Use EMR to ID and group risk populations,

monitor service utilization and patient outcomes

Lament persistent patient noncompliance

Place-Based

Population Health

Assess patient health status, social and environmental risk

factors

Ensure access to clinical services & link to social support

systems

Case management through clinical and community-based

teams

Community-based education, problem solving, and advocacy

Use EHR and GIS to identify geo conc. of

health disparities, target interventions, & monitor population

health outcomes

Leverage HC resources through strategic engagement of

diverse stakeholders

Moving from Innovative Projects to Institutional Policies

Mission / Organizational Culture

• Established and perpetuated through status as a faith-based institution, a long term safety net role, connections to specific populations, or other historical and demographic factors.

• Serves as an important substrate to underline and reinforce charitable purpose in decision making processes.

• Expressed primarily through CB-related activities, investments, and decisions around divestitures; less explicit in general operations.

• Optimally is infused into ongoing core business decisions – most effectively through institutional policies.

Institutional Policies

• Any action taken to formalize a function or structure at the individual, departmental, or organizational level.

• Purpose is to codify, scale, and sustain desired practices.

• Examples include, but are not limited to:

– Form board committees (e.g., population health)

– Create new positions

– Add competencies to job descriptions

– Change job responsibilities

– Integrate internal functions (e.g., align CB and pop health mgmt)

– Establish new functions (e.g., collect data on SDH)

– Establish new relationships (e.g., share data with FQHCs)

Integrating Community Benefit and Pop Health Management

• Optimize data collection/analysis– Focus on chronic diseases, PQIs

– Geocoding utilization data

– Addition of SDH indicators

– Overlay of demographics (e.g., race/ethnicity, HH income, etc)

– Data pooling with FQHCs, other hospitals

• Identify synergistic opportunities– Overlap between patient populations and place-based drivers

– Start with readmissions, move to PQIs across payer groups

– Facilitate links between care teams and CB activities

– Set Triple Aim targets for patients, populations, people

– Establish incentives across departments

Data Systems

EMR/EHRpiloting

EMR/EHRrollout

SDH selection and piloting

SDH/EHRintegration

Mobile techdata collection (Care redesign)

Data sharing with FQHCs

Data sharing with othersectors

Data sharing with competitors

Panelanalysis

GIS coding of panel

CB data sharing

Institutional PoliciesSelect EMR/EHR

Select pilot sites

Mandate rollout

Formalize accountabilities

Establish protocolsfor analysis/use

Mandate internal integration

Agreements for data sharing

Aligned strategy with CB (Care redesign)

Designate SL responsibilities

Hire staff Metrics/oversight

Internal AlignmentDevelop CB Charter

Review CB /CH Portfolio

Review/map utilization data

Assess internal CB/PH/CD capacity

Establish senior leader accountabilities

Hire/build staff capacity

ReallocateCB resources

ID/assess community assets

Review organizational investment portfolio

Establish internal/ external competency-based oversight structure(s)

ID / leverage opportunities with community and competitors

Establish formal criteria for CB resource allocations

Designate % of investment portfolio

Align investments, CB and Pop H strategies

Alignment for Excellence

Internal Integration

Integrate data systems, finance,

community benefit and clinical care

management

Develop and implement strategies that employ care redesign, predictive analytics, and geocoding to focus strategies where health inequities are concentrated

Internal/External

Alignment

Build Ethic of Shared Ownership for Health

Integrate data on the social determinants of health into electronic health records and establish protocols for enhancement of care coordination strategies.

Short TermEvidence-based comprehensive CHI strategies in place

Framework for regional risk stratification across providers and payers, alignment of service delivery and infrastructure investments, and pooling of stakeholder resources

Increased efficacy and accountability of local human service agencies

Focus of resources in neighborhoods where health inequities are concentrated

Long TermReduction in PQIs, acuity for defined panels, and readmissions

Cost savings in value-based reimbursement reallocated to address the SDH

Aggregate improvement in health status, social conditions, and economic vitality in neighborhoods where health inequities were previously concentrated

Establish protocols for data sharing and alignment of strategies among clinical and population/community health leadership and staff

Co-invest with other providers and payers in the establishment and funding of a shared infrastructure to support the alignment of services to address the social determinants of health.

Strategically allocate resources/expertise to mobilize the assets of diverse community stakeholders, with focus in geo areas with concentrated health inequities.

Engage the community development sector in strategies to align health improvement interventions with real estate investments (e.g., grocery stores, housing, childcare centers, FQHCs), including allocation of a portion of provider and payer investment portfolios.

Alignment of Governance and Leadership

Legacy Board Dynamics

• Central focus on fiduciary responsibilities

– Focus on individuals with investment, accounting, legal, and fundraising expertise

• Given limited competencies, disinclination to seek input on issues outside board competencies

• Historical language limits roles to “set” standards, “approve” proposals, and “monitor” performance.

• Limited attention to “inform” and “provide input”

Governance in the Transformation Era

• Growing number of decisions are strategic, with major implications for financial viability.

– Data systems development

– Care re-design

– Intersectoral engagement

– Public policy advocacy

• Consolidation, subsidiarity, and movement towards operating model removes direct fiduciary responsibility for many boards

• Increased pressure to meet financial targets, implement new delivery models, establish new working relationships, etc.

Expanded Oversight for Quality of Care

• New

– Sites for delivery of services

– Roles for more diverse teams

– Relationships involving less direct control

• Broader

– Scope of services

– Metrics to take into consideration (e.g., SDH)

– Context (e.g., geo) in which to assess performance

Emerging Board Competencies

• Public policy

• Epidemiology

• Community and economic development

• Social policy

• Education

• Information technology

• Scenario planning

• Collaboration with CBOs

Board Engagement

Establish/Assess Competencies

PH/SDHEducation

Recruit to fill gaps

Review/SetProtocols

Form PHCTE

Set/MonitorMetrics

(For LGR Systems)ApplySystemwide

Examples:Boston Children’s Board Committee on Community Service

Trinity Health Person-Centered Care Committee

Emerging Board Competencies

• Public policy

• Epidemiology

• Community and economic development

• Social policy

• Education

• Information technology

• Scenario planning

• Collaboration with CBOs

Roles of Board Members

• Serve as a “think tank” to support leadership, raising questions such as

– What is our organizational vision of population health?

– Is there strategic coordination between CB, finance, quality, and care coordination?

– What are the efforts to build partnerships with other stakeholders to align and leverage our resources?

– What is our population health capacity? (e.g., Internal FTEs, competencies, reporting relationships, oversight structures, leadership accountability)

– Do we have measurable objectives for CB programming, and are we monitoring progress?

– How are we providing leadership in the public policy arena?

Key Drivers

• Internal

• Senior leader champion(s)

• Mission centrality

• Board champion(s)

• Financial status

• Payer mix

• Hospital location

• Market concentration

• System capacity

• Links w/safety net (e.g., FQHCs)

• External

• State Medicaid policy

• Demographics

• Payer configuration and behaviors

• State investments in population health

• Local/state health philanthropy patterns

• State/local sector alignment efforts

Contact Information

• Kevin Barnett, Dr.P.H., M.C.P.

Public Health Institute

555 12th Street, 10th Floor

Oakland, CA 94607

Tel: 510-917-0820

Email: kevinpb@pacbell.net

Internal Leadership:Embedding Community Health in the Organization’s DNA

Peter Roberts, President, Roberts Health SolutionsOctober 3, 2017

Embedding Community Health in the Organization’s DNA

Organizational Authority and Support

• Authority is necessary, but not sufficient!– Organizational support – influencing both heads and hearts!

• Executive leadership support– Co-creation of community goals, strategies and metrics

– Committee leadership

– Regular reporting – formal metrics and storytelling

– Design studio participation

Embedding Community Health in the Organization’s DNA

Organizational Authority and Support (cont.)

• Middle management– Co-creation of community goals, strategies and metrics

– Committee participation

– Design studio participation

• Clinical staff– Potentially strongest allies

– Clinical perspective in work

– Design studio participation

Embedding Community Health in the Organization’s DNA

Creating Policies and Structures

• How is community health reflected in mission, vision and strategic plan?

• Board committee on community health

• Incentive compensation for employees

• How is community health represented in organizational scorecard?

• Voluntary annual review (audit) of community health

External Leadership: The Servant Leader Role

QUESTIONS?

Contact Information:Peter Roberts

peter@robertshealthsolutions.com

214-771-1208