developing a performance-driven organization part 1 · 2017-09-21 · developing a...

Developing a Performance-Driven

OrganizationPart 1

Why is Data Important?JOHN LEE, MBA, DIRECTOR

BRIANNON O’CONNOR, PHD, ASSOCIATE DIRECTOR

REBECCA HAUCK, MPA, CONSULTANT

CENTER FOR COLLABORATION IN COMMUNITY HEALTH

COORDINATED CARE SERVICES, INC.

Portions of these materials were created with support by New York

State Success, in partnership with the Managed Care Technical

Assistance Center and the Center for Collaboration in Community

Health

Welcome & Introductions

PDO- Why is Data Important?

What we will cover during this session:

‣ Consider why data is important

‣ Provide an overview of the elements of a

Performance Driven Organization

‣ Review the foundations of data collection

‣ Review the data collection tool

‣ Cross- systems collaboration and emerging

Performance Driven Organizations

Why is Data Important to you?

Why is Data Important?

‣ Supports the wise use of limited resources

‣ Encourages informed decision making

‣ Heightens accountability to make a

difference/impact

‣ Important in supporting a more certain future

during uncertain times

Why is Data Important?

‣ Encourages an organization to take on meaningful

challenges

‣ Prepares an organization for greater accountability

as new payers (MCOs, ACOs) emerge

‣ Positions an organization for the possibility of

participating in Value Based Payment arrangements

‣ It’s the right thing to do for those receiving services:

adults, children, youth and their families

Why would you want a performance driven culture?

Why would you want a performance driven culture?

‣ Better for your staff

‣ Better for people receiving services

‣ Better for your bottom line

Case Study ApproachINTRODUCING NEXT GENERATION

BEHAVIORAL HEALTH (NGBH)

Continuing Case Study: Next Generation Behavioral Health

Who we serve: Youth 12-21 years old with

Substance Use Disorder and their families in

DuPage and surrounding counties

Next Generation Behavioral Health (NGBH): Services

‣ Community Residence (RRSY):

• 18-bed facility

• Schooling/Tutoring on-site

• Family Support and Education

• Parent Skill Development

• Community Connections and Natural

Supports

• Transportation to AA/NA/support group

meetings

• Individual/Group/Family Therapy

• Medication Management (incl. Suboxone

provider on-site)

‣ Outpatient clinic that provides: • Evaluation/ Screening

• Individual Psychotherapy

• Group Therapy

• Family Therapy

• Medication Management (incl. Suboxone providers on-site)

• Family Support and Education

• Certified Recovery Peer Advocates (CRPA)

• AA/NA & Nar-Anon/Al-Anon meetings on-site

NGBH: Location

DuPage County

‣ Approximately 91,000 residents in a mostly rural county

‣ 11% of families and 14% of the population were below the poverty line with 22% of those under the age of 18

‣ Demographic Characteristics

• 79.6% White

• 8.1% Black or African American

• 1.8 % Asian

• 4.6% Native American

• 2.0% Other Races

• 3.9 % Two or more races

• 4.8% of the population identified as Hispanic

NGBH: Trends in service delivery

‣ Utilization of the community residence beds has increased each year over the last three years, although length of stay decreased

‣ The average age of those youth in residential treatment during the last year was 19, with a range of 14 to 21

‣ NGBH has seen a relatively significant increase in the population of Native Americans being served

‣ The percentage of youth reporting Heroin as their primary or secondary substance at intake has increased from 8% to 20%

NGBH: Context

‣ The state has expressed an interest in involving

Managed Care Agencies more in the Medicaid

service delivery system

‣ Conversations in the county are starting to

mention network development

‣ Performance measurement and data analysis

has become more prevalent in community

taskforce meetings with the LGU

What Are The Components of an

Organization that Effectively Uses Data to

Drive Performance?

A Performance Driven

Organization

Let’s Talk about the Culture of a


What is a Culture?

‣ Culture is the way of thinking, behaving, or

working that exists in a place or organization (such

as a business).

‣ It is a belief system that impacts what is

considered to be of “value” and how decisions are

made.

What Does Culture Mean in a Performance Driven Organization?

Belief system ...from board to management to staff...

that supports the concept of data-driven problem

(opportunity) identification as a path to improved

organizational and individual performance

What are the cultural elements in a

Performance Driven Organization?

An Organization’s Performance Driven Culture is found in its....

‣ Corporate Policy

‣ Leadership Values

‣ Performance Dashboard

‣ Human Resources

‣ Continuous Learning

‣ Communication

‣ Collaboration

Corporate Policy

‣ There is a Corporate Policy (documentation)

in place that reflects the value of

performance driven leadership and the

importance of continuously learning and

improving

•The policy embraced as a shared vision by all

leadership

•Annually reviewed, updated and approved

Leadership Values‣ Leadership Team values data and information in

ways such as:• Routinely talking about agency performance

• Willing to conduct authentic agency program and service assessments using internal and/or external resources

• Always willing to take a “deeper dive” to better understand the meaning of the information

• Performance is an acceptable topic to talk about at the staff and management levels of the organization

• Agency performance is routinely reported out and discussed during board meetings

• Accountability for improvement exists at all levels of the organization

Performance Dashboard

‣ Agency Performance Dashboard is maintained and reviewed on a regular basis

• Covers all areas of performance: financial, quality (fidelity to practice model), service impact, client satisfaction, payer satisfaction feedback

• Opportunities for improvement are identified in the analysis with clear expectations for follow up

• Agreed upon actions tied to opportunities are reported out at a follow up meeting

• Measures are added (or removed) as requirements change

Human Resources

‣ Human resource practices reinforce performance expectations:

• Job descriptions reflect expectation of measurement and continuous improvement to assure best possible performance

• Performance Appraisals incorporate aspects of measurable performance for staff members as well as management

• Professional development driven by identified areas for improvement

• Multiple forms of recognition tied to exceptional performance

◦ Willingness to take action on those that cannot meet expectations after multiple training/retraining efforts

Continuous Learning

‣ Investment in learning/training is made for all

levels of the organization

• Continuous transformation is encouraged during trainings

• Ongoing research to identify evidence based practices

• Investment in innovation

Communication

‣ Exceptional, two-way communication is routinely taking place across all areas of the organization

• Staff members see and hear leadership talk about and act in a manner consistent with agency values

• Staff members are routinely given the opportunity to ask questions and share their thoughts

• Both good news and bad news is shared and discussed

• Each staff member knows and supports the Agency Value Proposition and Values

Collaboration

Definition for internal collaboration:

A work culture where joint communication and

decision making among all members of the

healthcare team becomes the norm, resulting in a

higher level of services than if each was working

alone

Characteristics of Collaboration within an Agency

‣ System thinking and team learning

‣ Recognizing, and acting upon, mutual

interdependency (clinical, financial, quality,

training, etc.)

‣ A just culture that supports fair, equal and

consistent approaches to variances in care

‣ Promotion of a safe/fear-free environment

‣ Celebratory mechanisms to highlight success

Characteristics of Participants that Collaborate

‣ Mutual respect

‣ Effective communication

‣ Support of team based learning

‣ Sense of partnership

‣ Trust

How Might You Know Whether Your

Organization has a Performance

Driven Culture?

Introducing: Performance Driven Culture Assessment Tool

Here is what Next Generation Behavioral Health learned when they completed the Performance Driven Culture Readiness

Assessment

Assessment Findings for NGBH

‣ Need to develop a Performance Dashboard that includes all

areas of focus

‣ Need to take performance information (Dashboard) to the

Board

‣ Need to invest in more training to support ongoing practice

change

‣ Need to improve routine, two-way communication with staff

members, with a focus on sharing of performance information

‣ Need to invest in encouraging authentic collaboration within

and among the various programs and support areas within

NGBH

How Can I Get Started?

‣ Consider using the Performance Driven Culture

Assessment Tool to better understand your

readiness for a world of heightened accountability

for outcomes

‣ Complete the tool during a Leadership Team

Meeting so that all may offer their perspectives. It

is the conversation that will be very important

‣ Develop a work plan for addressing gaps in

cultural readiness

What data should I collect and how?

Master the basics

Emphasis on outcomes, outcomes, outcomes but…

A lot that can be done with key data elements valuable across systems (agencies, providers, counties, etc.)

1. Who is served? Demographics, understanding your population and demographics

2. How are they served? Utilization, quantifying the services you provide

3. How well are they served? Outcomes, understanding the value of your service

4. What is the cost of serving them? Fiscal data, how effectively are you using your resources in support of your mission

Demographics: Why it’s important

‣ Provide a snapshot overview of your population

‣ Identify potential disparities in access to services

‣ Identify if the population you serve is representative of

your community

‣ Help identify subgroups of interest or niche

populations

‣ Identify targets for new markets or outreach

‣ Being able to easily summarize the population served is the

foundation of measurement (Understanding your denominator)

Utilization – Why it’s important

‣ Identify the services you provide and to whom

‣ Quantify how many services you provide and how

those services are distributed across your population

‣ When collected, can identify who is providing the

service and how often

• Productivity

• “How am I using my resources?”

‣ Identify if the service delivery pattern is consistent

across services

Outcome – Why it’s important

‣ Determine if consumers are satisfied with the

services

‣ Assess if consumers are engaged in the process

‣ Determine if consumers are accessing your

services in a timely manner

‣ Identify if consumers are reaching their goals

and/or making progress toward those goals

Finance – Why it’s important

‣ Compare your budget to actuals for:

• Revenue

• Costs

• Revenue per Unit

• Costs per Unit

‣ Look at your payer mix to determine variances

in reimbursement

Introducing the Data Summary and Visualization Tool

In the tool, enter:‣ Roster/list of clients• Basic demographic, utilization and outcome data for each client

‣ Basic financial information • Revenue, costs, units of service (budget and actuals)

Tool auto-populates a real-time analysis of performance‣ Demographics

‣ Utilization

‣ Outcomes

‣ Finance

Let’s see what it can do!

Data Collection

Demographics – understanding the

basic characteristics of who you

serve

What is the average

age served?

What is our gender

distribution?

Does this make

sense?

What is our race and ethnicity

distribution?

What percentage of our

population identifies as

homeless?

Do we have a need to translate our

documentation into multiple

languages? If so, which languages?

What percentage of our population

has a trauma history?

Customizing the Tool

to Your Needs

Demographics

Example Findings and Follow Up

Questions

Low compared to county

demographics

65% of current clients are

under the age of 16 – are

we involving family

members in treatment?

Utilization – quantifying the

services you provide

Do I have the right

training for my staff?

Is my staff distribution

appropriate?

Are we using best practices?

Utilization


Questions

46% of our

adolescent

population has

alcohol or heroin

as their primary

substance – are

we engaging

families? Are we

providing med

management?

Our youngest clients are receiving an avg. of 20 group

sessions – is this the best practice for the youngest clients?

Only 2 family sessions – is this enough for this young age?

13-18 y/o – less than 1 family session on average? Too low

16-18 y/o – no group sessions. Are we missing an opportunity

to better engage these clients?

Outcome – understanding the value

of your service

What are the priority outcomes in

your agency?

What percentage of my current clients have

made progress on reduced frequency of use

of their primary substance since admission?

Are there differences between

outcomes by primary substance?

Are there differences

between outcomes by # of

family sessions?

Outcome


Questions

More than 40% of current clients

show no improvement or

increased frequency of use of

primary substance

Of those clients

showing no

improvement or

increased use:

• 57% had

received 0

family sessions

• 43% had only

received 1

family session

Finance – how effectively are you

using your resources in support of

your mission

Data Entry Requirements

What is my payor mix?

How are each of my programs

doing fiscally, comparing actual

YTD to budget?

How is my agency as a whole

doing fiscally, YTD compared to

budget?

What are my cost per unit and

revenue per unit? Both budgeted

and actual YTD

Finance


Questions

One of NGBH’s programs is

operating at a current deficit

NGBH – Recap FindingsDemographics‣ 65% of current clients are under the age of 16 – are we engaging families?

Utilization‣ 12 y/o receive an avg. of 20 group sessions; 16-18 y/0 have no group sessions

‣ 13-18 y/o have < 1 family session on average - are we using best practices?

Outcomes‣ >40% of current clients show no improvement/increased freq. of use of prim.

sub.

‣ Of those, 57% had received 0 fam. sessions and 43% had received 1 fam. Session

‣ Correlation between family sessions and decreased sub. use

Finance‣ One of NGBH’s programs is operating at a current deficit – requires review

Data Collection - Tips

‣ Know your definitions

‣ Pay attention to Spelling

‣ Check for completeness and accuracy of your data

• Check ID numbers

• Check data categories

‣ Determine if the data you collect is meaningful

• Does collecting Housing Status make sense for my agency/service?

• What information is critical to know?

‣ Pay attention to the Time Period

How Can I Get Started?

‣ Attend future events

• MCTAC events

‣ Establish a work group

‣ Access tools on the MCTAC website

‣ Play around with the data tool

Now What?

Individual

MH Agency/Services

Your Agency/NGBH

(CD services)

Juvenile Justice Agency

Cross-System Collaboration and Data Sharing

Question

Have you ever attempted to work more closely

with other providers or other systems, but met

with limited success… and a fair amount of

frustration?

During this session, we will talk more about

such opportunities

Cross System Collaboration and Data Sharing

Goal: Understand why external collaboration is important and become aware of models/approaches being used to support collaboration among service providers and other support systems.

‣ Why is collaboration with other providers and other systems important?

‣ Build awareness of a Systems /Network Dashboard (Demonstration)

‣ What are the challenges of collaboration?

‣ Techniques and models that are being used to support effective provider and cross-system collaboration

‣ So… What about Next Generation Behavioral Health?

Why Do We Need to Work Together?

The Importance of Working with Other Providers

‣ To achieve an impact that we cannot achieve alone (cross system impact)

‣ It is the right thing to do for the client

‣ The service payment environment is shifting:

• Pay for Performance

• Value Based Payments

• Pay for Reporting

‣ Behavioral Health Care Collaboratives (networks of BH providers) are being developed in New York State

The State’s Managed Care for Children Vision

Systems Dashboard‣ Example of measures that may drive payment in the

future

DuPage County System Dashboard

System

Collaboration

Linkages to

Services

EngagementFamily-Driven

Values

Continuity of

Care

Access


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

Access

Average days from

first contact with SUD

Outpatient Clinic until

first visit with

treatment provider

Average days from

first visit until second

visit for those

Programs with Open

Access


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

AccessInpatient SUD

Readmission Rate

(within 30 days)

Average Length of

Stay for those in a

Detoxification or

Inpatient Rehabilitation

Service

Percentage of those

using services with

reduced Juvenile

Justice Involvement


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

Access

Percentage of

programs

demonstrating

competency in Trauma

Informed Care

Percentage of families

engaged in

adolescent’s

treatment, by level of

care


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

Access

Percentage of those

using services enrolled

in a Health Home

Percentage of those

using services referred

to a SPA service


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

Access

Percentage of SUD

Rehabilitation

Discharges followed

by a lower level SUD

service within 14 days


System

Collaboration

Linkages to

Services

Engagement

Family-

Driven

Values

Continuity of

Care

AccessPercentage of SUD

Detoxification or

Rehabilitation

Discharges followed

by 2 or more lower

level SUD services

within 14 days of

discharge

So.....How do we work together?

What are the fears and challenges of collaboration?

‣ Lack of success with intra-agency (within)

collaboration for one or more of the partners

‣ Financial incentives exist to remain the same,

including the fee for service payment model

‣ Maintaining the motivation and investment from

the stakeholders

‣ Ability to keep focused on those values that are

mutually shared

Techniques/models that have been used to support effective provider or cross-system collaboration

‣ Collaboration and Teamwork to Better Serve

Young People (Pathways Transition Training

Collaborative)

‣ STAAR Initiative: Team-to-team collaboration

across organizational boundaries resulting in

reduced readmissions

‣ Collective Impact (John Kania & Mark Kramer,

Stanford Social Innovation Review)

Collaboration and Teamwork to Better Serve Young People (Pathways Transition Training Collaborative)

Intended use: A cross-system collaborative

approach for reaching across fragmented services

and systems to build constructive working

relationships that will assist young people to

achieve their goals.

STAAR Initiative: Team-to-team collaboration across organizational boundaries resulting in reduced readmissions

‣ A model that encourages providers to work together to

improve the transition to the next setting (example:

inpatient to community) by creating partnerships

between “senders” and “receivers.”

‣ Created by Amy E. Boutwell, MD, MPP Co-founder,

STARR (State Action on Avoidable Rehospitalizations),

Initiative Collaborative Healthcare Strategies, Lexington,

MA (part of the Institute for Healthcare Improvement).

What is Collective Impact?

‣ A framework to tackle deeply entrenched and complex social

problems

‣ An innovative and structured approach to making collaboration

work across government business, philanthropy, non-profit

organizations and citizens to achieve significant and lasting social

change

‣ The approach is premised on the belief that no single policy,

government dept., or organization can tackle or solve the

increasingly complex social problems we face as a society.

‣ Calls for multiple organizations or entities from different sectors to

abandon their own agenda in favor of a common agenda, shared

measurement and alignment of effort.

Cross Cutting Themes in Developing a Collaborative Model

What aspects do these approaches share?

‣ Need for Trust among participants

‣ Common purpose. Clear shared understanding of the

desired impact/outcome of the work that is measurable

‣ Respect: assuming best intentions

‣ Communication that is meaningful, regular and creates

motivation to continue on

Cross Cutting Themes in Developing a Collaborative Model

What aspects do these three approaches share?

‣ Shared values

‣ Clarity concerning how decisions are to be made

‣ Shared training so that each participant understands and

appreciates the work done by others

‣ Ability to identify and address issues among participants

(differences of opinions, actions taken without support) in a

very timely and open manner

How cross-systems data sharing is important to effective collaboration and what data sharing can accomplish

‣ Helps to define the clarity of purpose of the

collaboration

‣ Provides ability to measure impact of work over time

‣ By taking a deeper dive, data will assist in better

understanding a problem are.

• Example- Are there differences by age, gender or race/ethnicity

How do you start the conversation?

How do you start the conversation?

Ask the following questions:

◦ What can we accomplish by working together that we

cannot accomplish alone?

◦ What are the priority outcomes as described by the

payers (State, MCOs, county, foundations)?

◦ What should my agency be measuring that

contributes to the priority outcomes?

So… What about Next Generation Behavioral Health

‣ NGBH have been invited to be part of an

emerging Behavioral Health network… a

Behavioral Health Care Collaborative.

So… What about Next Generation Behavioral Health

‣ Recognizing that the success of the network will require effective cross-provider collaboration, they are taking the following steps:

• Practice internal, cross-department collaboration. Successful intra-agency collaboration improves the chances for successful interagency collaboration

• Development of a NGBH values statement so that they may clearly articulate what is important to them as they begin to work with others

• Begin to review internally generated data, as well as data provided to them by their LGU to better understand the system opportunities for improvement.

Feedback? Questions?

Next Steps

‣ Please see the MCTAC website for access to the tools shared today• Performance Driven Culture Readiness Assessment

• Data Collection and Visualization Tool

• http://ctacny.org/training/tools-support-development-performance-driven-culture-long-island-and-nyc

‣ If you have additional questions, contact CCSI’s Center for Collaboration in Community Health

John Lee, MBA Director

585-613-7627

[email protected]

www.ccsi.org/The-Center

http://ctacny.org/training/tools-support-development-performance-driven-culture-long-island-and-nyc

mailto:[email protected]

http://www.ccsi.org/The-Center

Thank you for your participation!

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