Crea%ng  a  Value  Orienta%on  &  Ar%cula%ng  the  Impact  

The  Movement  from  Volume  to  Value  

Ra2onale  for  Change  to  the  Health  Care  System  

Be:er  Care,  Be:er  Health,  Lower  Costs    

“Ever  rising  health  care  costs  are  a  na2onal  challenge.  The  United  States  currently  spends  16  percent  of  its  GDP  on  health  care  which  is  nearly  twice  as  much  as  any  other  na2on.  At  the  same  2me,  key  health  indicators  suggest  that  we  are  not  geMng  

our  money’s  worth”      

NYS  DOH,  Plan  to  Transform  the  Empire  State’s  Medicaid  Program  

 

Current  environment  Transi2ons  we  are  seeing  in  the  behavioral  

healthcare  field    

•  Greater  reliance  on  Evidence  Based  Best  Prac2ces    •  Movement  to  Managed  Care    •  A  road  map  to  value  based  reimbursement  models  •  Outcomes,  Outcomes,  Outcomes  

–  Outcomes  provides  staff  and  clients  with  measures  to  determine  ways  to  improve  upon  exis2ng  work  

–  Outcomes  answers  ques2ons  about  the  work  we’re  doing  and  offers  deeper  insights  about  what  is  or  isn't  going  on    

All  agencies  will  have  to  collect  and  focus  their  efforts  on  data  collec2on  to  be  able  to  document  the  value  they  return  to  their  community  and  the  children,  youth  and  families  they  serve  

 

Measuring  Quality  –  the  Na2onal  Prospec2ve  

The  Affordable  Care  Act  charged  the  U.S.  Department  of  Health  and  Human  Services  with  developing  a  Na2onal  Quality  Strategy.  As  a  result  (SAMHSA)  has  developed  the  Na2onal  Behavioral  Health  Quality  Framework  (NBHQF).  The  goals  of  the  Na2onal  Quality  Strategy  addresses  the  following  goals:  •  evidence-­‐based  prac2ces    •  Family-­‐driven  and  youth  guided  care    •  coordinated  care  •  healthy  living  for  communi2es  •  reduc2on  of  adverse  events,  and    •  cost  reduc2ons  

NYS  Quality  Vision    The  quality  strategy  for  behavioral  health  is    being  developed  by  OMH  and  OASAS  and  will    embrace  NY  State  vision  of  a  system  that  is:  §  Family-­‐driven  §  Recovery  and  resiliency  oriented  §  Integrated  and,    §  Value  Based/Outcome  driven  

 

NYS  Quality  Vision  con2nued  

Quality  outcome  measures  will  support  the  following  goals:  

§  Improve  access  to  and  engagement  in  community-­‐based  behavioral  health  services,  including    

§  Services  designed  to  improve  and  maintain  independent  func2oning  and  quality  of  life  

§  Increase  provider  implementa2on  of  evidence  based  prac2ces  that  integrate  behavioral  and  physical  health  services  

NYS  Quality  Vision  con2nued  

§  Improved  health  care  coordina2on  and  addresses  con2nuity  of  care  

§  Reduced  avoidable  behavioral  health  and  medical  inpa2ent  admissions  and  readmissions.  

§  Con2nuous  quality  improvement  at  the  clinical,  program,  plan,  and  popula2on  levels.  

§  Reduce  dispari2es  in  health  outcomes  for  people  with  behavioral  health  condi2ons  as  compared  to  the  popula2on  at  large.  

 

What  does  this  mean  for  you?  

•  Your  organiza2on  will  be  evaluated  based  on  the  value  equa2on:        

•  Financial  incen2ves  and  reimbursement  models  will  closely  align  with  value  not  volume  

Value   =   Quality  Cost  

What  does  this  mean  for  you?  con2nued  

•  Crea2ng  a  value  oriented  organiza2onal  environment  and  incen2ve  systems  that  rewards  value  will  be  cri2cal  to  con2nued  success.    

•  Access  to  good  quality  metrics  that  are  then  used  to  inform  prac2ce  and  improve  systems  will  be  vital.  

•  Communica2ng  your  value  to  all  stakeholders  will  be  key.  

What  now:    Step  1:  Determine  where  you  fit  in  

Create  your  VALUE  PROPOSITION  §  Define  the  problems  and  goals  that  your  organiza2on  is  best  suited  to  address  in  the  new  behavioral  health  care  environment  

§  Evaluate  the  processes,  resources,  and  talents  that  will  be  necessary  to  be  a  successful  and  valued  partner  

§  Measure  your  current  effec2veness  and  efficiencies  §  Clearly  ar2culate  how  your  agency  will  play  a  part  in  the  triple  aim  of  health  care  reform:  

»    Improving  the  Experience  of  Care  »    Improving  Health  »    Reducing  Costs  

 

Step  2:  Determine  what  you  are  going  to  need  

Undertake  a  gap  analysis  to  determine  skill  sets,  processes,  organiza2onal  structures  and  technologies  that  will  be  necessary  to  achieve  your  value  proposi2on.  Focus  on:  

§  Staffing  and  training  §  Does  your  staff  have  the  skills  to  interact  effec2vely  with  the  integrated  physical  and  behavioral  health  treatment  communi2es  

§  Do  you  have  the  data  analy2c  and  financial  modeling  skills  and  tools  necessary  to  move  from  Volume/Cost  to  Outcome/Cost  monitoring  

§  Organiza%onal  Structure  §  Do  you  have  organiza2onal  silos  the  are  barriers  to  effec2ve  and  efficient  care  

§  Are  your  organiza2onal  incen2ves  suppor2ng  volume  over  quality  

Step  2:  Determine  what  you  are  going  to  need  (con2nued)  

§  Technologies  §  Can  you  quan2fy  and  collect  the  outcome  data  you  will  need  to  evaluate  your  performance  

§  Can  you  electronically  share  clinical  data  with  other  service  providers  in  a  secure  fashion  

§  Do  you  have  tools  and  data  sets  necessary  to  shih  to  popula2on  management  and  evaluate  Outcome/Cost  across  agency  episodes  of  care  

§  Processes  §  Quality  Assurance  Program  

§  How  do  you  use  the  informa2on  gleaned  from  this  process?  §  Quality  Improvement  Process  §  U2liza2on  Management  Process    

Step  3:  Develop  a  plan  for  managing  outcomes  and  s2ck  to  it  

Design  and  implement  a  plan  that  will  get  you  from  where  you  are  today  to  where  you  need  to  be  tomorrow.  

§ Priori2ze  and  address  low  hanging  fruit  immediately  §  Set  benchmarks  and  2melines  and  hold  yourself  accountable  

§  Look  to  secure  resources  where  ever  possible  §  Solicit  input  from  all  levels  of  your  organiza2on    §  Embrace  change  for  the  value  it  will  bring  to  the  quality  of  your  services  and  the  value  it  will  return  to  the  clients,  families,  and  communi2es  you  serve.  

 

Develop  your  plan  

Quality  Improvement  Planning  Process    Plan   •  Iden2fy  where  to  focus  first  

o  Most  Cri2cal  Area?  o  “Low  Hanging  Fruit”  o  Biggest  Barrier?  

•  What  will  be  implemented  to  address  the  iden2fied  area?    

Do   •  Implement  •  Measure  –  Ar2culate  change  through  data  

Study   •  What  were  the  results?    •  Benchmarking  •  Monitor  

o  Crea2ng  a  Scorecard  •  What  do  you  do  with  the  informa2on?  Making  it  Ac2onable.    

Act   •  Based  on  the  findings,  what  next?        

Tools  to  use   Logic  Modeling  Strategic  Planning    

Communicate  your  value  

•  Educate  the  board  as  your  representa2ves  in  the  community  

•  Evaluate  your  Mission  and  Vision  statements  to  see  if  they  align  with  the  new  emphasis  on  value  

•  Review  your  print  and  online  branding  to  incorporate  your  value  statement  

•  Devote  a  sec2on  in  your  annual  report,  990,  and  in-­‐house  newsle:er  to  value  and  quality  

Communicate  your  value  con2nued  

•  Provide  value  updates  to  your  stakeholders  including  clients,  families,  funders  and  payers  

•  Do  not  forget  to  measure  client  and  family  sa2sfac2on  and  incorporate  that  into  your  value  statement  

Resources  you  may  find  helpful  

•  OMH:  Online  access  to  Sta2s2cal  Data  h:ps://www.omh.ny.gov/omhweb/sta2s2cs/    

 

Resources  (con2nue)  Guidance  and  Direc2on  •  Quality  Strategy  for  the  New  York  State  Medicaid  Managed  Care  Program  

h:ps://www.health.ny.gov/health_care/managed_care/docs/quality_strategy.pdf    •  2015  Quality  Assurance  Repor2ng  Requirements  

h:ps://www.health.ny.gov/health_care/managed_care/qarrfull/qarr_2015/docs/qarr_specifica2ons_manual.pdf    

•  SAMHSA  –  Data,  Outcomes,  and  Quality  h:p://www.samhsa.gov/samhsa-­‐data-­‐outcomes-­‐quality/samhsas-­‐efforts    

•  Na2onal  Commi:ee  for  Quality  Assurance  (NCQA)  h:p://www.ncqa.org/  

•  Atlas  of  Integrated  Behavioral  Health  Care  Quality  Measures  h:p://integra2onacademy.ahrq.gov/atlas    

Thank  you  for  a:ending!