Community Balanced Scorecards to Make MAPP Partnerships ...

Community Balanced Scorecards to Make MAPP Partnerships More Effective

NACCHO (www.NACCHO.org)

Results That Matter Team (www.RTMteam.net)

http://www.naccho.org/�

http://www.rtmteam.org/�

Webinar Presenters

Paul Epstein, Leader, Results That Matter Team, Epstein & Fass Associates.

Belinda Johnson-Cornett, Administrator, Osceola County, Florida, Health Department, who has been leading Osceola County’s CBSC approach toimprove access to health care.

Karen van Caulil, Executive Director, Health Council of East Central Florida, a key participant in Osceola County’s MAPP planning process and CBSC efforts.

Mark Peters, Director of Community Health, St. Clair County, Illinois, Health Department, St. Clair County MAPP Coordinator, lead of CBSC efforts, and co-chair of the County’s Get Up & Go partnership for improving fitness and nutrition.

2Results That Matter Team (www.RTMteam.net)

http://www.rtmteam.net/�

About the RTM Team

Epstein & Fass Associates: Results That Matter Teamwww.RTMteam.net

• Measuring & improving public and nonprofit performance since 1985

• Public Health Foundation & ASTHO Consulting Teams

• Featured in The Public Health Quality Improvement Handbook

• Working with Insightformation, Inc. (www.insightformation.com) to bring Community Balanced Scorecards to Public Health Partnerships


http://www.insightformation.com/�


4

Execution Gap

Strategy Maps and Community Balanced Scorecards to improve the Alignment and Execution of Strategies

No Strategic Alignment

High Level Goals

Power of Strategic Alignment

Public Health

Outcomes

Other PublicAgencies

Hospitals

Schools CommunityGroups

FaithCommunities

NonprofitsHealth Dept

Families & Individuals

• Is an integrated strategic planning and management system traditionally focused on one organization

• Communicates vision, mission, and strategy to stakeholders and employees

• Maps strategies based on cause & effect assumptions across different perspectives or “views.”

• Aligns day-to-day work to the strategy

• Provides a disciplined framework for measuring strategic performance as viewed from those different perspectives.

The Balanced Scorecard (BSC) …



Community Balanced Scorecard (CBSC)

• Combines the community building power of effective collaborations with the strategy alignment of balanced scorecards

– Pulls the community together around common outcomes

– Leverages assets from all sectors

– Aligns key community collaborators behind a common strategy for faster, measurable results

– Creates mutual accountability for results

• Intended for the many important issues in communities and regions that cannot be resolved by one organization or sector.



Community Balanced Scorecard Components

Performance Measures, Targets, &

Initiatives

Perspectives

Community Vision, Overall or by Issue or

“Theme”Community

Priorities

Strategy MapStrategic Objectives

Could be a “Strategic Goal” or

“AIM Statement”



Perspectives in Current Practice for Public Health Community Balanced Scorecards

Community Health Status

Community Implementation

Community Process & Learning

Community Assets



Quick Guides to Relating Community Balanced Scorecards & MAPP at RTMteam.net



MAPP Phase

1. Organize/Partner-ship Development

2. MAPP Vision

3. Four Assessments

CBSC Element

• Building Community Assets

• CBSC Vision

• Four Perspectives



MAPP Phase

1. Organize/Partner-ship Development

2. MAPP Vision

3. Four Assessments

4. Identify Strategic Issues

5. Formulate Goals & Strategies

6. Action Cycle

CBSC Element

• Building Community Assets

• CBSC Vision

• Four Perspectives

• Select Issues for Strategy Mapping

• Strategic Objectives & Strategy Maps

• Initiatives, Performance Measures, & Targets



# 2Investigate, Respond to

Emergencies & Threats

Minimize Risks

# 6Enforce Laws & Regulations

Potential Public Health Community Balanced Scorecard Strategy MapBased on the Ten Essential Services of Public Health

STRATEGIC OBJECTIVESPerspectives

Improve Health

Outcomes & Eliminate

Disparities

# 3Inform, Educate,

& Empower People (Promote Health)

# 7Help People

Receive Services

# 4Engage & Develop

Community Members & PH

Partners

# 5Develop Policies &

Plans

# 1Monitor Health

Status

# 9Evaluate & Improve

Services & Interventions

# 10Support

Research & Innovation

# 8Assure

Competent Health

Workforces

Community Assets


Community Implemen-

tation


H2. Increase Active Living & Healthy Eating

STRATEGIC OBJECTIVESPerspective

Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

&

Lear

ning

Vision: A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.

Get Up & Go: Top LevelStrategy Map

H1. Minimize Obesity & Eliminate Disparities



Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

&

Lear

ning




I1. Promote Nutrition & Fitness

I1. Improve the Environment

I3. Enhance School & Community Nutrition &

Fitness Activities

P1. Develop & Advocate for Better Policies, Plans &

Programs


Fitness Activities




Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

&

Lear

ning


P4. Create Toolkits &Online Resources for

Community Use

P2. Provide Incentives & Support to

Stimulate Change

P3. Increase Health Status Assessment


16



P5. Encourage School -centered

Health & Wellness

A2. Keep Increasing Partnerships & Volunteerism

P1. Develop & Advocate for Better Policies, Plans &

Programs


Fitness Activities




Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

& L

earn

ing


P4. Create Toolkits &On-Line Resources for

Community Use

A1. Leverage funding opportunities

P2. Provide Incentives & Support to

Stimulate ChangeP3. Increase Health Status Assessment


17


P5. Encourage School -centered

Health & Wellness


St. Clair County Healthcare Commission Strategic Goals and IssuesSTRATEGIC GOALS and ISSUESPerspectives

Improve outcomes for priority health status issues selected by the Health Care Commission

Cardiovascular Diseases

Maternal & Child Health

RespiratoryDisease

STD Disparities

Get Up & Go!

Campaign

Address the Needs of those who

require Behavioral Health Services

Improve Health Services to the

Aging Community

Improve Access to

Care

Strengthen the Public Health Workforce

Create a Broader Sense of Community

Connectedness

Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

&

Lear

ning

Behavioral Health

Continually Advance Health Care Commission Processes (e.g., MAPP, QI, Policy Advocacy)

St Clair County MAPP Chronology

• 2006: Phases IV & V:– 6 Strategic Issues

– 13 Overarching Goals

– 47 Strategies

• 2007: Phase VI (Action Cycle) begins:– 35 Action Items for the 6 Strategic Issues

– Get Up & Go! conceived as a countywide Health & Wellness Campaign



St Clair Co MAPP Action Cycle Continues• 2008:

– 7th Strategic issue added– Recognized as a Pioneering Healthier Community

• 2009:– QI Mini-collaborative– Health Policy Summit

• 2010:– Selected by State for CPPW grant application– Piloting Community Balanced Scorecard

20 20Results That Matter Team (www.RTMteam.net)


MAPP in Osceola

Started the process in 1999; updated in 2004 and again in 2009.

MAPP has yielded impressive returns to the community

Data and information on the greatest needs in the county which have been communicated successfully to community partners and to local and national funders

Osceola’s MAPP Process…

Six priority areas were identified: (1) affordable prescriptions (2) specialty physician referral system for

the uninsured(3) inappropriate ER utilization(4) growing numbers of uninsured (5) lack of primary care services in outlying

areas(6) lack of chronic care services.

Tangible Results!

Pharmacy Co-op Developed a voluntary provider network Expanded safety net for uninsured to

include a federally qualified health center and a mobile medical van

Case management forum Cultural competency training

Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need. (A systemic issue.)


Community Assets


Community Implemen-

tation


Improve outcomes of people with, or at risk of, Diabetes Mellitus and Cardiovascular disease

Target our initiatives to

areas of most need

Increase access to specialty care

Measure our success

Improve the delivery and quality of care by

using evidenced-based best practices

Ensure access to comprehensive

health care

Sustain best practice

programs

Maximize resources and engage new & existing partners in developing solutions

Ensure the public health workforce is skilled to address

health issues

Increase enrollment in a medical home

24

25

You often need to “zoom in” from:• a “top level” strategy map• to maps with more details.



CommunityAssets

“Healthy Living” Themes from Communities of HOPE

Community HealthStatus

Pers

pect

ives

Strategic Themes

CommunityImplementation

CommunityProcess& Learning

Reduce Smoking &

Substance Abuse

Chronic Disease Prevention,

Early Detection, &

Managem

ent

Healthy Eating

Better Exercise

H e a l t h y L i v i n g

26

St. Clair County Healthcare Commission Strategic Goals and IssuesSTRATEGIC GOALS and ISSUESPerspectives

Improve outcomes for priority health status issues selected by the Health Care Commission

Cardiovascular Diseases

Maternal & Child Health

RespiratoryDisease

STD Disparities

Address the Needs of those who

require Behavioral Health Services

Improve Health Services to the

Aging Community

Improve Access to

Care

Strengthen the Public Health Workforce

Create a Broader Sense of Community

Connectedness

Com

mun

ity

Ass

ets

Com

mun

ity

Hea

lth

Stat

us

Com

mun

ity

Impl

emen

-ta

tion

Com

mun

ity

Proc

ess

&

Lear

ning

Behavioral Health

Continually Advance Health Care Commission Processes (e.g., MAPP, QI, Policy Advocacy)

Get Up & Go!Campaign

Theme: Expand with Education & Engagement

Theme: Fitness

Theme: School-based Strategies

Theme: Nutrition

CommunityAssets

“Get Up and Go” Themes from St. Clair County

Community HealthStatus

Pers

pect

ives

Strategic Themes

CommunityImplementation

CommunityProcess& Learning

Engagement and Education

Nutrition

Fitness

GET UP & GO!

28

School-based Efforts

Built Theme Objectives from Processes Many Contributed to

From Nov 2009 Health Policy Summit

From the CPPW Grant Application

And from other grant applications and planning documents




Community Assets


Community Implemen-

tation


Minimize Obesity & Eliminate Disparities

Improve planning & advocacy for school

and community nutrition

Identify and target communities at highest risk for food insecurity

Incentivize schools to comply with established nutrition & wellness policies

Overcome cultural & informational barriers to

better nutrition

Create a data mining capability to inform the public and target initiatives

Motivate grassroots demand for better school

nutrition policies

Increase breast feeding support through education

Leverage funding opportunities for improving nutrition

Maximize nutrition value for kids in school, family, & other settings

Increase Healthy Eating

Facilitate the availability of fresh and locally grown

fruits and vegetables

Get Up and Go!Nutrition Theme

A creative collaboration between public health, community leaders, community organizations and institutions, business, and government eliminates cultural and economic health disparities by focusing on prevention through behavior and lifestyle changes.

Vision:

Teach gardening skills & encourage

community gardensCoordinate community and family nutrition education

Promote replacement of sugary and unhealthy snacks

with healthy alternatives

Ranking Possible Initiatives for this Objective


* Top ideas that have the highest strategic value and with the highest ability to do


Health Summit – February 18, 2010

Leaders focused on top 5 Strategy Map objectives

1. Sustain best practice programs

2. Improve delivery and quality of care using evidence-based best practices

3. Increase access to specialty care

4. Ensure access to comprehensive care

5. Increased enrollment in a primary medical home

This work becomes the...

Community Balanced Scorecard33

Vision: Osceola County will be a community where all uninsured and underinsured residents have full access to the health care services that they need.


Community Assets


Community Implemen-

tation



Target our initiatives

for greatest need

Measure our success




health care


programs


Ensure the public health workforce is skilled to address health issues

Increase enrollment in a primary care

medical home

Pool and match resources with needs

Use resources at maximum value

Increase & optimize external resources



health care



Community Assets


Community Implemen-

tation



Increase enrollment in a primary care medical homes

Expand Primary Care Capacity for Under-

& Uninsured

Better Leverage Partners to Connect People to Primary

Care Medical Homes

Clearly Define PCMH Role

Co-locate FQHC Clinics & Free Clinics w/ ER

Recruit & Reward PC Professionals

Recruit & Reward Volunteers for Free Clinics

Extend Free Clinics to Operate in Faith Orgs.

Team with Healthcare Schools

Expand County’s FQHC Sites

Enhance Profitability of Serving Underinsured

Enhance ER Diversion Formalize Targeted Referral Processes for HC Orgs

Segment Interventions for Populations & Conditions

Better Coordinate Who Should Do What

School-based programsDevelop

Partner-Specific Programs




Adopt evidenced-based best practices for increasing medical

home enrollment & use.

Medical Home Enrollment

Setting Implementation Priorities


Low Medium High

Low

Medium

High

Stra

tegi

c Im

port

ance

Difficulty of Implementing


Encourage Others to “Jump In”

Low Medium High

Low

Medium

High

Stra

tegi

c Im

port

ance

Difficulty of Implementing

Programmed Priorities



Community Results Compacts



Next Steps

• In Saint Clair County

• In Osceola County



Next Steps

“The Sequel: Did we get it right?”1. Reconvene Health Summit

2. Give feedback from their initial work

3. Identify what they think is most important

Health Leadership Council1. Present recommendations from “The Sequel”

2. Use Implementation Priority Grid (next slide) to make decisions on 3-5 top objectives

3. Develop timelines for implementation

40

Population & Participant Outcomes



Outcomes & Performance Drivers

Performance Driver

Population Outcomes

Participant Outcomes Performance

Drivers





Community Assets


Community Implemen-

tation



Target our initiatives

for greatest need

Measure our success




health care


programs


Ensure the public health workforce is skilled to address health issues


medical home



Increase & optimize external resources



health care



Community Assets


Community Implemen-

tation




health care


programs



medical home




health care

No. successful programs sustained beyond initial funding period

No. people diverted from emergency room to a medical homeNo. non-urgent ER visits

•Sample Draft Measures



Community Assets


Community Implemen-

tation


Improve outcomes of people with, or at risk of, diabetes mellitus and cardiovascular disease


programs



medical home




health care


No. people diverted from ER to a medical homeNo. non-urgent ER visits

No. physicians in specialty care network (by specialty)

Percent of people who have a usual source of care


No. people enrolled in free clinics with access to comprehensive care



Community Assets


Community Implemen-

tation


Improve outcomes of people with, or at risk of, diabetes mellitus and cardiovascular disease


programs



medical home




health care

No. diabetes patients who improve in Hgb A1c levels No. hospitalizations for people with congestive heart failure


No. people diverted from ER to a medical homeNo. non-urgent ER visits

No. physicians in specialty care network (by specialty)

Percent of people who have a usual source of care


No. people enrolled in free clinics with access to comprehensive care

Additional Sources

• Documentation posted at www.RTMteam. net

• Recorded Webinars at www.RTMteam.net and www.Insightformation.com

• Chapters 7, 17, & 18 in The Public Health Quality Improvement Handbook of PHF & ASQ (ASQ Quality Press, Milwaukee, 2009)

• Upcoming presentation at NPHPSP training in Dallas (April 14: Day before MAPP training)

• Request a PDF of these slides on evaluation survey




http://www.insightformation.com/�


Opportunities for More Communities

• If you have partners, you can get started

• Projects can with one community at a time or groups of communities– Indicate interest on evaluation survey

• Potential for communities at different stages of MAPP or not using MAPP

• Contact Paul Epstein ([email protected]) or 212-349-1719

• Contact Heidi Deutsch ([email protected]) or 202-507-4214


mailto:[email protected]�

mailto:[email protected]�


Community Balanced Scorecards to Make MAPP Partnerships ...

Documents

Transcript of Community Balanced Scorecards to Make MAPP Partnerships ...