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