October 24, 2018 ACLC Member Event Welcome!
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October 24, 2018
ACLC Member Event
Welcome!
Presenter
Presentation Notes
WIFI tents on table Bathrooms down the hall
October 23, 2018
The Health Care Technology Stack
3
CARL VON CLAUSEWITZ
Prussian Cavalry Officer 1792 to 1831
4
THE VALUE ERA:
We are 25 years into a 40-year health care transition
5
MEMORABLE VON CLAUSEWITZ DOCTRINE
“The fog of war”
6
VON CLAUSEWITZ SOLUTION TO “THE FOG OF WAR”
We gain perspective by getting higher
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CORE PRINCIPAL
In a well-functioning market, continual innovation begets a degree of standardization
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EXAMPLE: MODERN COMPUTER
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TECHNOLOGY STACK
Algorithm
Physics
Programming LanguageAssembly Language
Machine CodeInstruction Set Architecture
Micro ArchitectureGates/Registers
Devices (Transistors)
Application
Layers of Abstraction
Basic Technologies
Differentiating Technologies
Presenter
Presentation Notes
What is the “Technology Stack”? Computers rely on layers of technology that range from the abstract but familiar applications at the top (e.g. PowerPoint, Excel) to the elemental physics that serve as the foundation for the hardware functionality. Despite all the complexities, one can reduce a computer’s technology stack to a couple categories based on the evolution of the industry: Standard (or “Basic”) technologies and Differentiating technologies.
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TECHNOLOGY STACK: BOILED DOWN
Algorithm
Physics
Programming LanguageAssembly Language
Machine CodeInstruction Set Architecture
Micro ArchitectureGates/Registers
Devices (Transistors)
Application
Standard Technologies
Differentiating Technologies
Problem?
Presenter
Presentation Notes
The standardization of certain elements allows new entrants to avoid reinventing the wheel and innovate “beyond” So in our computer analogy, if there is a malfunction, the investigation is likely to conclude at the upper levels of technology where the computer company is experimenting.
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A HEALTH CARE STACK
Standard Competencies
Differentiating Competencies
Facilities
Physiology
Scope of practiceModalities
DRGsRVUs
CPT CodesICD-10
Diagnostics
Care management approach
Presenter
Presentation Notes
The crossover (analogy) isn’t perfect but its still helpful The inefficient desktop computer is like the current delivery model and the ever-expanding electrical grid represents the continued rise of health care costs through the obfuscating effects of insurance premiums and tax payer subsidies. And while lawmakers and others recognize the need to reform the financial system, the delivery system changes that are needed are overwhelming – namely due to how deep our system will need to go in order to reconfigure the “technology stack” of American health care delivery.
12
FUNCTIONAL VS DYSFUNCTIONAL
Facilities
Physiology
Scope of practiceModalities
DRGsRVUs
CPT CodesICD-10
Diagnostics
Care management approach
Standard Competencies
Differentiating Competencies
Standard Competencies
Differentiating Competencies
Algorithm
Physics
Programming LanguageAssembly Language
Machine CodeInstruction Set Architecture
Micro ArchitectureGates/Registers
Devices (Transistors)
Application
Health Care StackTechnology Stack
Presenter
Presentation Notes
[This slide is meant to illustrate the varying proportions of “standardized” competencies in a functioning industry versus a dysfunctional one like health care.]
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STANDARDIZATION AND DISRUPTION CYCLES
Standardized Competencies
Differentiating Competencies(Variation in Practice)
Differentiating Competencies
Basic
Ope
ratio
ns
Basic
Ope
ratio
ns
Traditional Standard Competencies
New Standard Competencies
Differentiating Competencies
Basic
Ope
ratio
ns
Traditional Standard Competencies
Stage 1: Status Quo Stage 2: Industry Transition Stage 3: Value Innovation
New Standard Competencies
Stage Description: Care delivery currently benefits little from meaningful standardization (represented by the relatively narrow blue rectangle in the figure just above). Despite a large potential for innovation
due to practice variation (the green rectangle above), a lack of critical mass in care delivery
standards inhibits the adoption of innovation since the “implementation process of an innovation is
misaligned with existing industry structure.”
Stage Description: When an industry has the right financial incentives, organizations are more likely to
be systematic in their review of what they do and what adds the most value for the purchaser.
Systematically identifying and evaluating competencies leads to standardization of even emerging practices that then become the “new
standard competencies.”
Stage Description: As the incentive to standardize becomes stronger and the process for
standardizing becomes clearer, the distinction between Differentiating Competencies, New
Standard Competencies, and Traditional Standard Competencies becomes more discernable, creating a virtuous cycle of standardization and disruption with a growing body of Standard Competencies to
serve as a platform for new and competitive market entrants.
Presenter
Presentation Notes
[This slide is meant to illustrate our system could move from unjustified variation in delivery methods to a virtuous cycle of standardization and healthy market disruption. Not a good slide per se with all the text boxes but more for use in a reference deck.]
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ATLAS PROGRESS
Standard Care Delivery & Operations
Foundational Elements
Value-Based Competencies
System Improvement Competencies
Presenter
Presentation Notes
Punchline: which is why attempts to systematically catalogue the standard and emerging competencies required for success under VBP is so crucial – despite how imperfect those attempts can be. We get closer with every iteration. Note: below are the changes that are being recommended to the Atlas Revisions Committee (via the association alliance) Initial Atlas revision recommendations: Revisit the list of competencies through a stricter “Organizational Level Lens” (i.e. individual vs team vs organizational) Separate one-time or periodic events from on-going activities Review with a standard vs novel criteria Consider supporting element relationship for HIT, Finance, and Governance to avoid redundancy Most importantly: use the work groups for feedback and reconvene the Atlas committee
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A NEW COMPUTER
Presenter
Presentation Notes
Imagine a scenario where a computer company releases a new model, that although powerful, consumes a vast amount of electricity – in other words, super inefficient. The highly competitive computer market would force this company to go back and figure out what’s wrong with the machine and at what level the malfunction is occurring. The company would start at the top of what is called the “technology stack” Note: A great story about how Apple got the hardware design wrong on their Apple III: https://www.tekrevue.com/apple-iii-drop/
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A DYSFUNCTIONAL MARKET
Presenter
Presentation Notes
However, imagine a scenario where the computer market does not act as we’ve known it do act historically Rather than dive deep into their technology stack and fix the problem, the VP of government affairs simply lobbies the government to expand the electric grid to accommodate the inefficient device Those inefficient layers of technology and then perpetuated and baked into future products that, although experience some degree of continued innovation, continue to house at their core, flawed technologies. Such is the case with health care
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MOVING FORWARD
• It’s time to
• Fix the financial system that masks an inefficient system (currently underway
with the move to value) and;
• Engage in the hard work of creating the standardized “technology stack” of
health care delivery.
• Many entities will need to contribute to the task of standardization in health care
• Collaboratives are the best vehicle for that kind of work
Presenter
Presentation Notes
The inefficient desktop computer is like the current delivery model and the ever-expanding electrical grid represents the continued rise of health care costs through the obfuscating effects of insurance premiums and tax payer subsidies. And while lawmakers and others recognize the need to reform the financial system, the delivery system changes that are needed are overwhelming – namely due to how deep our system will need to go in order to reconfigure the “technology stack” of American health care delivery.
October 24, 2018
ACLC in 2019
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THE ATLAS
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CASE STUDY BRIEFS
www.accountablecareLC.org/case-study-briefs
Advocate HealthAllina HealthArizona Connected CareAscension Care ManagementAtrius HealthCentura HealthChildren’s Hospital of OCCornerstone Health CareHackensack AllianceHenry Ford Health SystemHill Physicians Medical GroupICAHNIntegra Community Care NetworkIntermountain HealthcareLehigh Valley Health NetworkMaineHealth
Mayo ClinicMemorial HermannMission HealthMoffitt Cancer CenterMontefiore Health SystemMyHealth First NetworkNew West PhysiciansNorthern Arizona HealthcareOneCare VermontOSF HealthcarePark Nicollet Health ServicesParkviewPioneer Valley ACOProHEALTHSharpSignature Medical GroupSt. Vincent’s Health PartnersSummit Medical GroupTotal ACOUT Southwestern
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COMPETENCY GUIDES
• Definitions• Principles • Considerations for provider
types— Hospitals— Integrated Delivery Systems— Medical groups— Markets
• Indicators• Resources
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2019 COMMITTEE MODEL
Governance
− Committing to Value-Based Payment− Stake Holder Involvement
Care Delivery− Provider Engagement − VBP Team Building
Finance− VBP Financial Assessment − VBP Financial Collaboration− VBP Financial Alignment− Structure VBP Contracts
Committee Topics (16)
Providers Sponsors Observers
Patient Needs Assessment
− Patient Information Collection − Patient Information Analysis
Patient Care Access − Internal Workforce Optimization − External Partnership OptimizationCare Coordination− Patient Self-Management − Patient Feedback Integration− Informing Care Team− Evidence-Based Care Delivery− Addressing Social Determinants of
Health − Care Transitions
Committee Structure
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FROM WORKGROUPS TO COMMITTEES
Committees
1
2
3 Targeted sponsorships
Scalable opportunity for observers4
More provider representation
Focused topics with a shorter time commitment
Presenter
Presentation Notes
What does the law intend, and how is it supposed to help you? Access Exchanges Premium credit Medicaid expansion Pre-existing conditions Employer mandate Guaranteed Issue: Regulation 26 year olds Medical loss ration 80-20 Rate review is more stringent No caps Age banding: oldest can only pay 3x more than the youngest person (for the same plan) Community rating: rate by geography Eliminates medical underwriting Minimum benefits Creates a robust policy for everyone Essential Health Benefits Prevention Etc./ Unintended Consequences Premium rate increases Employers reducing hours of employees Employers refraining from hiring more employees (above 49) Dependent dumping Payer hesitation to participate in the exchange Lasting political partisanship Unexpected work departure due to availability of individual insurance Union concerns with maintaining existing coverage (Economics claim) Networks are narrowing in exchanges, potential squeeze on access In the notes for the slides called ppaca impact give examples in the notes for each of the 3 major areas of impact. Access - Medicaid, exchanges + ? Mandates Minimum benefits - examples Regulates - 26 yr olds, no caps, no pre existing conditions. The administrations statements regarding affordable care act benefits: Part 1 Rights & Protections Whether you need health coverage or have it already, the health care law offers new rights and protections that make coverage fairer and easier to understand. Some rights and protections apply to plans in the Health Insurance Marketplace or other individual insurance, some apply to job-based plans, and some apply to all health coverage. These rights and protections provide even more choice and control over your health coverage when key parts of the law take effect in 2014. Use this guide to learn about your rights and protections today and in 2014. How the health care law protects you Creates the Health Insurance Marketplace, a new way for individuals, families, and small businesses to get health coverage Requires insurance companies to cover people with pre-existing health conditions Helps you understand the coverage you’re getting Holds insurance companies accountable for rate increases Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick Protects your choice of doctors Covers young adults under 26 Provides free preventive care Ends lifetime and yearly dollar limits on coverage of essential health benefits Guarantees your right to appeal https://www.healthcare.gov/how-does-the-health-care-law-protect-me/
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ATLAS 2.0
Improvements• Review with standard vs.
novel criteria• Separate one-time or
periodic events from ongoing activities
• Organizational vs. team vs. individual
• Language revisions
v 2.0
25
CASE STUDY BRIEFSAdvocate HealthAllina HealthArizona Connected CareAscension Care ManagementAtrius HealthCentura HealthChildren’s Hospital of OCCornerstone Health CareHackensack AllianceHenry Ford Health SystemHill Physicians Medical GroupICAHNIntegra Community Care NetworkIntermountain HealthcareLehigh Valley Health NetworkMaineHealthMayo ClinicMemorial HermannMission HealthMoffitt Cancer CenterMontefiore Health SystemMyHealth First NetworkNew West Physicians
Northern Arizona HealthcareOneCare VermontOSF HealthcarePark Nicollet Health ServicesParkviewPioneer Valley ACOProHEALTHSharpSignature Medical GroupSt. Vincent’s Health PartnersSummit Medical GroupTotal ACOUT Southwestern________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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PROVIDER SOLUTION SNAPSHOT
Concise summaries of provider implementations of specific value-based competencies
• Open submission (not necessary to be a member)
• Submitting organizations get access to entire Solution Library
• Non-providers are eligible to nominate partner (client) providers
• Everyone has something to share!
Description: Parkview was able to reduce unnecessary admissions by partnering with EMTs who assess and treat SNF patients with early signs of sepsis in the SNF rather than transporting them to the emergency department.
More…
Solution Snapshot NominationOrganization: Parkview HealthState: IndianaProvider Type: Health System
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PUBLICATIONS: COHORT STUDIES
Functional Status / Quality of Life
Clinical / Biological
Status
Cost (Efficiency)
Patient-Centered
Care
LEADERSHIP COHORT POST-ACUTE CARE COHORT
Presenter
Presentation Notes
Leadership - Identify and spread the leadership attributes and skills required to lead successful risk-bearing healthcare delivery organizations PAC - Collaboratively produce and locally test solutions that can enable high value post-acute care under value-based payment models
28
ROUNDTABLE CONTRIBUTORS
PUBLICATION: CALL TO ACTION FOR QUALITY WORKFORCE
— Beebe Healthcare— Christiana Care Health System— Huntington Hospital— Lifespan Health System— Sentara Healthcare— St. Vincent’s Health Partners— The George Washington University Hospital— Universal Health Services— Virginia Hospital Center
AREAS OF FOCUS
• Strategic development and deployment of the healthcare quality workforce
• Alignment and collaboration between C-suite and healthcare quality workforce
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COHORT CONVERSATIONS
DR. KEVIN NELSONPresident, Fairview Physician Associates DR. MARK MCCLELLAN
Director, Duke-Margolis Center for Health PolicyCo-Chairman, Accountable Care Learning Collaborative
@The_ACLC
DR. TIM IHRIGCMO, Crossroads Hospice
and Palliative Care
Presenter
Presentation Notes
John introduce next section of plenary – cohort reports – turn time over to Mark
October 24, 2018
Highest Priority Care Delivery Competencies
Presenter
Presentation Notes
Show competency guide structure – considerations, principles, etc.
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WORK GROUP LEADERSHIP
GOVERNANCE
Dr. Lori Morgan
Huntington Hospital, President and CEO
FINANCE
Edwin Estevez, PhD
RGV ACO Health Providers, CEO
HEALTH IT
Dr. Norm Ward
OneCare Vermont,CMO
CARE DELIVERY
Colleen Swedberg
St. Vincent’s Health Partners, Interim CEO
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GOVERNANCE WORK GROUP
Identify and develop transformational leaders who can implement high-value care strategies across the organization• A leader with a proven track record as a change agent with a reputation for achieving success is essential for
organizational transformation.
Engage internal and external stakeholders through timely and transparent communications that build commitment to the health care organization’s value-based strategy. • Substantive and relevant communication (governance, process, and outcomes) to the organization is critical to
success. Communications should be consistent, adaptable, accurate, and targeted across internal and external stakeholders.
Develop organizational expertise in a specific improvement model using formal interdisciplinary process integration. • A data driven improvement model that utilizes a standardized framework and data management process is critical as
evolving medical knowledge will necessitate adaptive development of best practices in order to reduce unnecessary variability in care.
33
FINANCE WORK GROUP
Understand the financial investment required to support the transition to value-based payment models• An accurate assessment of the necessary financial investment increases with each level of proficiency: basic (understand
costs), intermediate (forecasting), or advanced (intentionally influencing budget).
Negotiate value-based contracts that are informed by quality and cost performance data with payers and employers• Organizations must confirm their logistical and practical ability to meet metrics agreed upon with payer, which includes
having the necessary fields for capturing needed data.
Create financial and other incentives for executive leadership and providers, that reflect your value-driven strategy• Distribution criteria and methods should be an upfront conversation, include the appropriate stakeholders, be reinvented
regularly. • Incentive programs can be implemented apart from shared savings and can include numerous strategies that do not
involve financial payments to recipients.
34
CARE DELIVERY WORK GROUP
Design care management systems to address both medical and social determinants of health by facilitating access to community partners, and both social support and enabling services
• Initial design of the SDOH integration approach should involve patients, community, and government partners
Support and maintain interdisciplinary care teams with well-defined roles and responsibilities for planning, coordinating, and assuming accountability for continuity of patient care across the continuum
• Whole-person orientation will require involving organizations outside the traditional health system
Incorporate patient’s values, preferences and feedback into care delivery. • A population’s health preferences should influence the actual design of the health system
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HEALTH IT WORK GROUP
Assess the HIT strategy across the organization • HIT strategy should feed into compensation plans that help change physician behavior • Importance of prioritizing patient engagement with HIT tools
Data aggregation strategy • Profound number of data types that must be collected and scrubbed• Data intake must be orchestrated to (1) meet regulatory requirements, and (2) support organization
projects
Obtaining an analytics and insight tool • Benchmarking – Budget, Trend, External• Importance of being a smart purchaser
October 24, 2018
Leadership Imperatives for Driving Value
Dr. Kevin Nelson, Fairview Physician Associates
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PARTICIPANTS AND SPONSORS
Presenter
Presentation Notes
Mark introduce and thank cohort participants and sponsors
38
PROGRAM AIM
Identify and spread the leadership attributes and
skills required to lead successful risk-bearing
healthcare delivery organizations
Presenter
Presentation Notes
Mark – introduce program aim Key benefits: A mental model for leaders seeking to reliably lead successful change under an ACO-type payment model Provide narratives describing the: Decisions ACO leaders are making to guide their organization to success given their context Lessons-leaned from those decisions Leadership behaviors that appear to nurture a culture of collaboration and value-focused care Work to-date: Research-driven interview guide 4 VBRA reports and analytic sites 52 leadership interviews across 8 organizations 3 conference panel presentations highlighting our research and early results
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LEADERSHIP IMPERATIVES
• Set Direction: Mission, Vision, and Strategy
• Establish the Foundation
• Build Will
• Generate Ideas
• Execute (and Embed) Change
• Our future
Presenter
Presentation Notes
Mark – ask Dr. Nelson to speak to the Leadership Cohort guide (interview guide) for leaders. Comments about the guide (optional): Based on extensive research examining change models and leadership theories that have shown repeated success inside and outside of healthcare, we identified a core set of ”leadership imperatives” that are most likely to serve as a critical leadership - change management - guide for ACO leaders. The guide is designed as a tool for leaders, and is a set of questions related to each domain listed above, that walks leaders through the principles of change when progressing an organization or team through a change initiative. The guide includes key quotes from leaders and researchers and the primary list of publications and books that supports the content in the guide. Mark: Today, we’ll focus our discussion on two of the six domains (below), discuss the future of healthcare under and ACO and what it might take for new / young ACOs to accelerate the transition to high-value results (shared savings) Set Direction: Mission, Vision, and Strategy Build Will: Help all staff clarify how all they can adapt and improve current knowledge to achieve our shared aims We choose these two particular questions to cover in our brief time because the focus on two key factors required for behavior change – clarity of purpose (mindset) and a person’s or team’s ability to execute (self-efficacy)
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DOMAIN I
Set Direction: Mission, Vision, and Strategy
• Messaging strategy – the compelling reason why the future as an ACO is attractive to all stakeholders.
Presenter
Presentation Notes
Sample research quotes: Effective leaders challenge the status quo both by insisting that the current system cannon remain and by offering clear ideas about superior alternatives (Berwick) Managers (leaders) can clearly articulate the differences between the new business model and the current business model (Govindarajan, V, Trimble, C) If the implications of the innovation (including its subsequent effects) are fully assessed and anticipated, the innovation is more likely to be assimilated (Gustafson)
41
DOMAIN I – SAMPLE RESPONSES
Positive: “Do it because we believe we can make a difference - both in the life for the workforce and the people and communities we serve.”
Fear/Urgency: “If we do not change ourselves, others will change us based on their perspective.”
Method: “Match the “compelling reason” at a person level, not only at a system, big-picture level - speak appropriately to individual needs and concerns.”
Presenter
Presentation Notes
Leaders indicate they use a range of responses, depending on their specific context – market competitiveness, organizational experience with risk, experience with change (successes and failures), the number of other / competing initiatives, the size of the organization, employed vs. not employed physician practices and others. Mark – Kevin marked “Agree.” A key note in Kevin’s response to the question is: “No more hero work, we need great systems of care; not heroes. This is why exciting personal storytelling is compelling. It keeps us focused on the why, and on why it isn't good enough to reach 75% compliance.” What could Fairview do better to offer a compelling reason why the future as an ACO is attractive to all stakeholders?
42
DOMAIN III
Build Will
Our senior leadership team works with the workforce to clarify
how all staff can adapt and improve current knowledge and
processes based on new performance expectations
Presenter
Presentation Notes
Sample research quotes: Effective executives make sure that both their action plans and their information needs are understood (Drucker) An organization that is systematically able to identify, capture, interpret, share, reframe, and recodify new knowledge; to link it with its own existing knowledge base; and to put it to appropriate use will be better able to assimilate innovations, especially those that include technologies (Barnsley) Demonstrable benefits and valued consequences had a positive impact on implementation success in a study that examined employee opinions regarding reasons for change (Rousseau)
43
DOMAIN III – SAMPLE RESPONSES
“The process is very interactive. We give appropriate direction, goal setting - clarify where we want to be, then work with them to figure out how to get there a "bottom-up" approach is best.”
“We have “mocks” (simulations) to practice change with our practices. We do whatever we can to help them learn what they need to learn –we hold the hand of staff and physicians as much as possible.”
“We outline the goals and then let them figure out the how – helping as best we can if asked.”
Presenter
Presentation Notes
Mark – Kevin marked “Agree.” A key note in Kevin’s response to the question is: “We are just getting there. This is definitely where we want to go - we just aren't quite there yet. Based on our previous work, I imagine we will get to "strongly agree" before too long. What will it take for you to get there? What has worked and why as you’ve worked to help you teams adapt – to develop the capabilities they need to succeed? Some of your colleagues expressed concern about the organization’s emphasis on Lean, when so much of the change work is about transformation. A few concerns include, “With Lean you can lose sight of goals”, “we need to make sure Lean is part of the getting to our aims, not the end point for our culture and mindset of value.” If you would, please comment on how Fairview is trying to balance implementing Lean with the need for providing teams the space to test change ideas, to allow for the “space for failure” required to leapfrog over key barriers.
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ACCELERATING CHANGE
*Direct all correspondence to Daniel
We’ve seen it take 3 or more years for the majority of Medicare ACOs to consistently achieve shared savings.
What “essential” leadership characteristic(s) covered in the guide would you focus on to accelerate the transition to consistent success as an ACO? Are there characteristics not covered in the guide you think are essential?
Presenter
Presentation Notes
Mark…
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DOMAIN VI
*Direct all correspondence to Daniel
The future of our organization under an ACO is a place where......
…we can give dollars back to people – through employment and reduce healthcare cost
...more patients will have the care they need at a price they can afford
…we provide the right care, at the right place, at the right time.
…I can make a difference.
…we’ll learn how to adapt to a transformative healthcare system.
…we successfully navigate a path between misaligned system goals.
Presenter
Presentation Notes
To finish, let’s touch on what we believe is possible for healthcare and the communities / people we serve through an ACO model. Kevin’s response – “…we are changing the world.” Does this vision resonate with the front-line care staff at Fairview? Would the front-line care staff say this is the future at Fairview under an ACO? What key leadership attributes are you employing everyday (regularly) to help them believe they can change “the world” by working under the Fairview ACO?
October 24, 2018
Building Successful Partnerships Across the
Care ContinuumDr. Tim Ihrig, Crossroads Palliative Care
47
PARTICIPANTS & SPONSORS
48
PROGRAM AIM
Invent the go-to "resource guide" value-focused health
and social care systems need to establish a
comprehensive care model for patients requiring an
acute-to-post-acute care "episode" and supportive,
compassionate care when experiencing a severely life-
limiting or terminal illness.
Presenter
Presentation Notes
Issue: Creating a health and social care system that reliably delivers high-value outcomes in a financially sustainable manner for seriously-ill populations is a key challenge of our time. It is clear, healthcare leaders cannot use the same navigation techniques employed under fee-for-service payment models to define and implement the change pathway to optimizing care and outcomes for these populations. Given the increasing accountability for downside risk of attributed lives, to confidently chart the path forward it is critical every system and their partners become mutually proficient in capturing and using new data to institute whole-person, relationship-based care and create measurement systems that provide timely insights describing what is working and why. To make an efficient transition, the Network must collectively employ systems-thinking change models that simultaneously mitigate immediate challenges, create new technology and care capabilities, and align the workforce and care network partners with new performance expectations. Key industry benefit: As a result of using the program deliverables, we anticipate the organizations collaborating to define and execute a PAC strategic plan will markedly advance their care system capability to a reliable level of high-value outcomes most meaningful to patients and communities.
49
KEY DELIVERABLES
1. PAC Guidebook: Outlines the core internal and relational capabilities PAC organizations need to succeed under risk-based payments.
2. PAC Value-Based Readiness Assessment (PAC VBRA): assess "readiness" for PAC delivery success according to the PAC Guidebook.
3. Post-acute care Accountable Care Atlas: PAC specific competencies added into the ACLC Accountable Care Atlas
4. PAC-focused Case Study Briefs (CSBs): 2-3 case study reports highlighting US-based examples of high-value, coordinated systems of care for the acute-post-acute care continuum.
Presenter
Presentation Notes
To produce the deliverables described we are walking through a series of activities. Our first activities focused on defining: The breadth of services considered within the scope of our ”care system” –-- the acute-to-post-acute care continuum. Creating patient personas – our program is grounded by the patient personas (described in our discussion with Tim) Conducting a publication review phase – an environmental scan - to capture the key competencies identified as essential for ACO success. Thus far, we’ve identified 238 competencies across all of the reviewed publications – some of which are duplicates. Our next phase will translate the activities described above into a PAC-specific VBRA, with each cohort member testing the VBRA locally. Once testing is complete – in early 2019 – we’ll finalize the VBRA and release it publicly.
50
OUR FOCUS – SAMPLE PERSONA
Mr. Goldberg• 72 year old male with Idiopathic Pulmonary Fibrosis Persona,
experiencing fatigue, cough, and shortness of breath• Previously healthy, other than HTN and High BP, both under
reasonable control. He was overweight, with BMI 30.4.• Presented to the ED, found to have pulse oximetry of 86 and
fibrotic appearance of his lungs; admitted to the hospital. High resolution chest CT confirmed diagnosis of IPF. Deemed not a candidate due to cardiac disease, age, and obesity.
• Married for 48 years and his wife is in reasonable health. They have 3 children who are married and live out of state
Presenter
Presentation Notes
For Dr. Tim – Tim can describe how we’ve kicked off our design by developing patient personas. The point isn’t to describe the persona in detail – simply to visualize our human-centered design approach, and our focus on the “why” We created several personas, then each cohort member interviewed actual patients to ensure we accurately captured their perspectives – goals and preferences. From there, we created a patient value compass - next slide.
51
OUR FOCUS – SAMPLE VALUE COMPASS
Functional Status / Quality of Life
Clinical / Biological
Status
Cost (Efficiency)
Patient-Centered Care
Functional Status & Quality of Life• Socially active with wife• Minimal fatigue• Going on walks with wife• Minimal coughing• Able to cook with wife, family and
friends• Live high quality life until the end• Able to travel out of state to visit my
children
Cost (Efficiency)• Avoid inpatient visits• Minimal co-pays• Minimal Rx costs• No return ED visits• Minimal imaging• Avoid maxing deductible• Avoid leaving my wife with medical debt
Clinical/Biological Status• Controlled HTN• Controlled BP• Stabilized CAD w/out surgery• Reduced fibrotic appearance• Minimal polypharmacy• Prevent future MI
Patient Centered Care• I am informed about each decision
made for my care• I prefer decision aids when deciding on
a care plan with my provider• My treatment plans are informed by
my decisions and I’m aware of upside and downside possibilities
• My wife is included in decision-making and is trained to help me (us) care for my needs
• We have a minimal number of trips to care providers
• We have a minimal number of bills and contact with insurance companies
• We receive help with home care
Presenter
Presentation Notes
For Dr. Tim – Same as the previous slide. The point isn’t to describe the persona in detail – simply to visualize our human-centered design approach, and our focus on the “why”
52
16 Competencies < 9 Capabilities < 4 Domains
CURRENT VBRA
Presenter
Presentation Notes
For Dr. Tim (or Mark?) - A key aim of our work is to develop a VBRA ACOs and their partners can use to collaboratively define and execute a PAC strategic plan that will markedly advance their care system to a reliable level of high-value outcomes most meaningful to patients and communities. The map displays the domains, capabilities and competencies in the current (ACO readiness) VBRA. We imagine the VBRA map will be similar, but the results of our work over the several months will determine the final VBRA content.
53
INSIGHTS FROM “DR. TIM”
1. If you could wave a magic wand, what would you do to create an acute-to-post-acute
care system that optimizes care and health outcomes for all?
2. If you could wave a magic wand, what payment policy attributes would you institute
for the acute-to-post-acute care system to optimize care and health outcomes?
3. What insights from the reviewed publications are most important for us to consider
when building the PAC VBRA?
Presenter
Presentation Notes
Dr. Tim – Question 1: Improve clinical acumen Question 2: Based on our experience and results as a Pioneer, establishing aligned incentives across all providers is essential; with appropriate distribution of up-front investments and savings. Question 3: Again, supported by our experience, the timely electronic exchange of data across partners is essential. The supports key secondary competencies: minimizing care gaps, the ability to evaluate and remediate variation, ensure transitions are smooth, etc. The other key point emphasized in our research is the need for a clear network evaluation methodology. The current ratings need improvement – and can’t reliably identify high-performing systems. It is important to have clear partner selection criteria that is based on in-person interviews and site visits.
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