Post on 30-Apr-2020
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
Medicaid Accelerated eXchange Series andMedicaid Accelerated eXchange New York (MAXny) Series
Program OverviewJune 12, 2018
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MAX and MAXny
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
The MAX Series Program is offered by the New York State Department of Health(NYS DOH) and facilitated by NYS DOH contracted facilitators as part of theDelivery System Reform Incentive Payment (DSRIP) program.
• As part of the Delivery System Reform Incentive Payment (DSRIP) program, the
NYS DOH launched the Medicaid Accelerated eXchange (MAX) Series Program, to
redesign the way care is delivered for New York State’s most vulnerable patients.
• The DSRIP program is designed to stabilize New York’s healthcare safety-net
system, and realign its delivery system by shifting the focus from service volume to
quality for its Medicaid population. Ultimately, the statewide goal is to reduce
avoidable hospital use by 25% over five years.
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MAX and MAXny
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
• The MAX Series is a rapid cycle continuous improvement (RCCI) program, which
aims to bridge the gap between “how-we’ve-always-done-it” traditional healthcare
and the provision of interdisciplinary services at the community level, by bringing
together frontline care providers from across the care continuum.
• Through highly structured and dynamic workshops and action periods, change is
implemented and results are driven at the local level.
• The MAX Series was launched in the summer of 2015
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MAX and MAXny
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
• The MAX Series was complemented by the Train-the-Trainer (TTT) program,
which was designed to scale and sustain process improvement work by training
participants in the same RCCI methodology used in the MAX Series.
• These TTT participants will continue to implement the RCCI methodology
throughout their respective PPS’s through the MAXny Series: MAX New York!
• The MAXny Series is offered by the PPS, and facilitated by qualified MAXny
facilitators as part of the DSRIP program.
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Train The Trainer Participant Role• To become experts in RCCI Methodology
• To enhance facilitation skills and techniques
• To develop a Sustainability Plan outlining the next RCCI Workshop Series (to be independently lead upon completion of the program)
See One Do One Lead One
MAX Series Roles and Responsibilities
• MAXny Series Executive Sponsor: Provides overall sponsorship and championing of the MAXny Series, including the development of new Sustainability Plans and ongoing reporting to the NYS DOH.
• Site Executive Sponsor: Provides leadership, sponsorship, and championing of the MAXny Series at the site enrolled into the program.
• Action Team Members: Frontline care providers directly involved in meeting the needs of the target population
• Action Team Lead: Provides leadership on the Action Team and serves as the MAXny Series Lead’s primary point of contact
HU Readmission Rate = 40%
Non-HU Readmission Rate = 8%Jiang et al. HCUP Statistical Brief #184 Nov 2014
Medicaid Members with 4 or more hospitalizations in 1 year
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The MAX & MAXny Series are rapid cycle continuous improvement (RCCI) program that brings together frontline providers to redesignthe way care is delivered to those who need it
MAXny Series Methodology Programs
Objectives6.2018▪ Leveraging a highly structured methodology,
approach and coaching
▪ Utilizing data to measure and drive
performance
▪ Facilitating system integration by breaking
down silos and bringing together multi-
disciplinary providers
▪ Focusing on sustainability
1) Decrease High Utilizer’s of ED and inpatient hospitalization
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
2) Improve provider quality of life
3) Increase integration across the care
delivery system
4) Develop and build rapid cycle continuous
improvement capability
June 2017© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
MAXny Series Medicaid Accelerated eXchange New York (MAXny) Series
Phase 1:
Assessment and Preparation
MA
Xn
y S
eri
es
Wo
rksh
op
s
Phase 2:
Workshops and Action Periods
Phase 3:
Reporting
MAXny
Workshop 1
Site and Participant
Enrollment
MAXny
Workshop 2
MAXny
Workshop 3Final Report
Note: Action Periods are rapid Plan Do Study Act continuous improvement cycles
30 day Action Period 60 day Action Period60 day Action Period
Data collection, analysis, evaluation, and reporting will be critical throughout the duration of the MAXny Series Workshops
Action Team
Members
Aug 1, 2017 – Sept 28, 2017 Sept 28, 2017 Oct 27, 2017 Jan 1, 2018 Mar 9, 2018
Phase 3:
Reporting
June 2017
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
Theory: PLAN-DO-STUDY-ACT
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Small, focused, measured changes can have significant positive impact on your daily processes.
It is important to:
1. Plan – Develop a plan
2. Do – Try it! Identify a specific action a specific person(s) will
take and how many time/how long to test.
3. Study – How did this change work and what did we learn
from it?
4. Act – Should we adapt, adopt or abandon the change?
What’s our next step?
NYS DOH MAX Series: Five Lessons Learned
About Improving Care for High Utilizers
• know who to focus on.
• view frequent utilization as a symptom of an unaddressed or unmet need.
• “do something different.” • successfully engage with and intensively serve patients after they leave
the hospital setting.
• actively collaborate with community providers and agencies.
Improving care for high utilizers requires we …
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February 26, 2016
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_workshops/docs/2017-jan-
jul_imp_care_for_high_utilizers.pdf
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MAX Series: E3 A-Team
• Mary Whalen, COO, Samaritan Medical Center
• Aaron Campbell, DO, Director of Hospitalist Program, Samaritan Medical Center
• Sarah Delaney-Rowland, MD, Emergency Department Physician, North Country Emergency Medical Consultants
• Jilayne Salisbury, RN, Clinical Director of Physician Practices, Samaritan Medical Center
• Kathy Hunter, RN, Manager of Case Management & Discharge Planning, Samaritan Medical Center
• Kim Thibert, RN, CNO, Samaritan Medical Center
• Tim Ruetten, Executive Director, Jefferson County Office for the Aging
• Jeri Fuller, LCSW, Medical Social Worker, Jefferson County Public Health Services
“E3 A Team”
• Our Goal Statement: To improve the quality of
life of high utilizers by collaboration across the
spectrums of the individual’s life including psychosocial, economic, and clinical factors.
Who are high utilizers?
• Four (4) or more inpatient admissions within the last year (131)
• Combination of medical, behavioral health, and social needs – Social isolation
– Lack of family support
– Lack of engagement with preventative care
– Behavioral health
– Social determinants
– Lack of advanced care planning
SMC Super-Utilizers in the last 12 Months
Baseline Data 11/15/2015 – 11/14/2016
PATIENTS 131
ADMISSIONS 641
Average ADMISSIONS/PATIENT 4.9
0
2
4
6
8
10
12
14
16
0 20 40 60 80 100 120 140
Count of Admissions
Number of
Admissions
Number of Patients
What can be done?
• Identify the “drivers of utilization” – do not
over medicalize.
• What is the root cause?
– Ask “why”– Assess for clinical – behavioral – social needs
Getting Started
• Electronic notification of all members of the
action team
• Provider engagement plan
• Expanding care coordination meeting
• Interview patients with consistent tool to
identify the drivers of utilization
Collaborate Across the Care Continuum….
• Case conferencing
• Definitive linkage to outpatient services
• Develop “Intensive Care Transition Team”• Increase the number of HU interviews
• Identify the HU in multidisciplinary rounds and discuss the
drivers of utilization
3030
E3 A-Team | NCI, Samaritan Medical Center
* Denotes workshop action plan
Inpatient High Utilizer Care Pathway
Identify
• Send dynamic twice daily high utilizer report to Samaritan Medical Center, Jefferson County Public Health, Jefferson County Office for the Aging (automatic via Meditech)
Assess
• Identify Drivers of Utilization through discharge planning assessment Monday through Friday; conducted by discharge planners
• Share identified DOUs with care team
• Identify HUs in interdisciplinary rounds and discuss DOUs*
• Identify advanced directives
Link
• Hold monthly advanced care coordination meeting with CBOs, Primary Care Practices and the hospital
• Create linkages to Jefferson County Public Health, Northern Regional Center for Independent Living, Health Home, PCP Care Managers
Manage
• Conduct interagency case conferencing
• Develop intensive care transitions process/team* to ensure long-term follow up in the community
-85
-78
-71
-59-57
-29
-21
8
-29 -33
-100
-80
-60
-40
-20
0
20
Feb 17 Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sept 17 Oct 17 Nov 17
Percent Change in HU IP Hospitalization
45% Decrease in HU IP Hospitalizations
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Lessons Learned# Topic Description
1 There is no single solution
• A majority of this population engage in behaviors that are difficult to change overnight. We recognize we must take an individualized approach and look at DOU differently than we have in the past, but also be mindful that ultimately the patient/family have to be willing to make a change.
2 Competing priorities and incentives
• There are competing priorities and incentives in the healthcare system that can impede process improvement.
3 This isn’t a project- it is a process change
• It is important to have caregivers understand this is a long-term and on-going process improvement.
CBOs have unrealistic expectations of the role of the hospital
• There is still a need to change CBOs expectation of care provided in the hospital vs. outside the hospital.4
© 2017 New York State, Department Of Health, Office of Health Insurance Programs. All rights reserved.
Medicaid Accelerated eXchange New York (MAXny) Series
The Next MAX……..
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MAXny Series: E3 A-Team
• Mario Victoria, MD, Chief Medical Officer, Samaritan Medical Center
• Sarah Delaney-Rowland, MD, Emergency Department Physician, North Country Emergency Medical Consultants
• Kathy Hunter, RN, Manager of Case
Management & Discharge Planning, Samaritan Medical Center
• Kim Thibert, RN, CNO, Samaritan Medical Center
• Aileen Martin, Executive Director, NRCIL
• Christen Norris, ED Nurse Manager, Samaritan Medical Center
• Michelle Treadwell, ED Clinical Discharge Planner, Samaritan Medical Center
• Linda Hayes, LPN, Family Practice Administrator, North Country Family Health Center
• Anne Hodkinson, Patient Relations Manager, Samaritan Medical Center
• Lisa Hedger, Community Outreach Specialist, Children’s Home of Jefferson County
ED Stats 7/1/2016 - 6/30/2017
• 48,589 Visits
• 28,580 Patients
• 81% Discharged to Home
• 15.6% Admitted as Inpatients
• 3.8% LWBS/AMA
▪ Needs assessment to identify social and behavioral needs
▪ ED resources mobilized for initialpatient engagement
PATIENT IDENTIFICATION
PLANNING MANAGEMENT FOLLOW UP
Target population: Patients with 10+ ED visits in a 12 month period
Samaritan Medical Center: Overview
▪ Flag in EMR
▪ Real time alert to hospital and community care team
▪ Care managementengages with patients after discharge
▪ Community SocialWorker/Care Manager connects patient to services
▪ Definitively connectpatients to critical social services
▪ Bi-weeklyinterdisciplinary care plan meetings
Process improvements:
=189
Patients2741
ED Visits275
IP Admissions
Final Thoughts
• Challenges with sustainability: it seems like more work, takes
resources, new things eventually become old
• The definition of insanity : making the same discharge plan for
the patient every time they come to the hospital even though
it clearly doesn’t work.
• This is a journey with lots of exits and detours
Final Thoughts (cont.)
• It’s about improving quality of life, helping our patients and families to be safer, reducing suffering while at the same time
being fiscally responsible
• It’s not a project, its about doing something different, rethinking, revamping, trying something new
• Focus on patients that are impactable
Any change, even a change for the better, is
always accompanied by drawbacks and
discomforts. – Arnold Bennett