Strategies for Success: Strengthening Rural Partnerships JULY 18, 2018 LCDR Fred Butler Jr MBA MPH Senior Advisor for Integration and Quality Quality Improvement and Innovation Group Center for Clinical Standards and Quality Centers for Medicare and Medicaid Services U.S. Department of Health & Human Services
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Strategies for Success:
Strengthening Rural Partnerships
JULY 18, 2018
LCDR Fred Butler Jr MBA MPH
Senior Advisor for Integration and Quality
Quality Improvement and Innovation Group
Center for Clinical Standards and Quality
Centers for Medicare and Medicaid Services
U.S. Department of Health & Human Services
2
For your hard work & commitment
For your leadership and contributions to rural health
For the strategic thinking of everyone in the room
For being part of the continued evolution and
innovation of community-based healthcare
3
Purposes of Session
Share Powerful Leadership and Management Models & Mindsets
Net Forward Energy
Accountability for Bold Goals
Change Management
Resilience
Choice
Real Work, Requests, Offers, Networking, Deal-making & Action
Review potential opportunities for Community-Based Organizations
Generating Results to Address the Opioid Crisis
QIO 11th and 12th Scopes of Work
Gain your perspectives, insights and feedback
4CMS has established large-scale, action-focused networks
to spread quality improvement and generate results on a
1791% of 22,656 Enrolled TCPI Practices are small, rural or operating in medically underserved areas
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DesignationNumber of Practices
Percent of Total Enrollment
Medically Underserved Areas 11,913 52.58%
Rural Areas 3,872 17.09%
Small Practices 17,420 76.88%
Small, Rural, OR Medically
Underserved Practices20,642 91.11%
Small, Rural, AND Medically
Underserved Practices1,997 8.81%
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CCWV Service
Area by zip code
(shaded area)• 15 Health Centers
• 1 Dental Clinic
• 8 Pharmacies
• Behavioral Health
• Pain Management
• 50 School-Based Centers
19Framing the Opioid Problem for
a High Performing Practice in WV
In 2016, the five states with the highest rates of death due to drug overdose were:
• West Virginia (52.0 per 100,000)
• Ohio (39.1 per 100,000)
• New Hampshire (39.0 per 100,000)
• Pennsylvania (37.9 per 100,000)
• Kentucky (33.5 per 100,000)
20Community Care of WV’s Integrated Pain Care model
All patients with pain complaints are welcomed at any practice location
1. Patients are assessed and a determination is made if opioid prescriptions in excess of 30 days is a likely treatment path.
2. CDC guidelines are considered.
3. The patient receives education about the integrated program and a sample controlled substances contract is discussed with the patient.
4. Internal referral to our “specialty” program is made.
5. Patients are contacted by the pain management clinic to begin pre-visit planning including Opioid Risk Assessments, PDMP education, SDoH, SBIRT, psychiatric assessments for comorbidities, etc.
6. The PCP and pain management team develop a shared care plan for treatment after the patient is assessed by the chronic pain team.
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The opioid program data that CCWV does know
Program Result
Patients entering the program since 2013 2692
Active users today 1057
Overdoses from our program users 0
39% of the total hospitals are identified as rural/CAH
23Hospital Improvement Innovation
Network—Minnesota
24Hospital Association of New York State
HIIN: Improvement in Sepsis
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We were taught….
That People Are
Resistant to Change
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In fact…
People Are Not Resistant to Change
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In fact…
People Are Not Resistant to Change
We Change All the Time!
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In fact…
People Are Not Resistant to Change
We Change All the Time!
However…
People Are Resistant to Being Changed.
29Lead Change by Helping People
Invent Their Own Changes
What is working?
What is causing it to work?
What is our objective here?
What could we do…More of?
Better?
Differently?
30Pause for Reflection
and Discussion
1. What is your main insight from this latest
material?
2. What are some of your own experiences
opioids and change management?
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“Real Work” is:
• Making Commitments
• Delivering on Commitments
• Securing Commitments from others
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Work is not…
Talking About Commitments
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Together, Doing Real Work,
We Can Make the World Turn
200 people at the Rural Health Care Improvement Collaboration Meeting
engage repeatedly in making requests and offers….say, 5-10 commitments
each:
That could be 1,000 to 2,000 commitments!
What we ask of you:
Embrace Change!
Seek Out Innovation, New Experiences, New Partners!
Think About Data Differently!
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“The antidote to exhaustion
…is wholeheartedness.”
-- David Whyte
“Crossing the Unknown Sea”
Fostering Resilience in
Ourselves and Others
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What Are the Sources of Resilience?
Wholeheartedness
Purpose
Embracing Change; Leading Change
Partners
Choice
Perspective
A Powerful Model
Stimulus Response
Choice: The Most Powerful Model
Stimulus CHOICE Response
Viktor E. Frankl
Made Extraordinary Choices
Seminal Book:
Man’s Search for
Meaning
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Pause for Reflection and Discussion
As a leader, what might you do more
of, better or differently today, and
going forward?
40Our “Way” of
Operating to Achieve Results
Bold, Clear Aims -- Implemented at Scale
Focus on Results
Do More of What Works
Make Best-In-Class Performance, Common
Performance
Tight About the “What” Outcome; Flexible on
the “How”
Foster and Foment Joy in Work
41Emerging Key Priority Areas to Guide
Our Improvement Work Through 2024
Opioids & Behavioral Health Nursing Home Quality
Burden Reduction Supporting Patients Through Care Transitions