Population Health ManagementInnovation Community

Final Webinar!

August 31, 2015

Today’s Agenda

• What worked and didn’t work with the Innovation Community

• Participant Population Health Management Project Focus

• Breakthroughs/ Breakdowns• Surprises• Advice to Providers Doing Population Health

Management

Summary Learnings

Gathered from:• Work Plans• Small group calls• Webinars• Submitted Evaluation

Forms

Overview of Participation in Evaluation• 21 of 35 Members Participated

• 60% Participation

What worked with the Innovation Community

• Webinars

• One-on-one Consultations & Reading Materials

• Step-by-step process for conducting PHM

• PHM Readiness Checklist

• Data Fluency Book

What didn’t work with the Innovation Community

• Need calendar of webinars and touch-base/coaching times in the beginning

• Need more interaction between members

• Accept fewer members and focus on grouping organizations based on their level of PHM readiness or stage of implementation

Member Service Focus

2% System level Provider (e.g., state entity, hospital system, regional network, or managed care)

76% Behavioral Health Provider Adult Focus

20% Behavioral Heath Provider Pediatric Focus

.5 % Residential Services Provider

.5% Primary Substance Abuse Services Provider

.5% Homeless Residential Provider

Member PHM Project Focus

• Pediatric Integration (e.g., autism services, anxiety)• Adult Integration (e.g., high blood pressure, diabetes,

obesity, tobacco use)• Dashboard Implementation• Using Data to Inform Clinical and Administrative Work

Breakthroughs! • Realized need to step back, take time to focus on what

is possible • Learned need to take smaller steps/goals • Everyone in organization has different perspective on

what PHM is…get it confused with other projects we’re engaged in…

• We tried to do too many projects…leadership finally figured this out!

• Realized we need to hire someone to specifically focus on PHM

• Can’t wait for our EMR to work must jump in without it

Surprises!

• We were further ahead with PHM/IH that we gave our selves credit for…

• Our board really embraced PHM• How hard it is to get staff to change a little bit• How hard it is to get our EMR to support PHM• The importance of leadership driving the change• Limited resources on PHM…esp. concerning pediatrics

Breakdowns…

• Hard to link all projects together• Overshot our targets…should have made project goals

more realistic• Not enough staff time to dedicate to this project due to

all other projects• No funding to support PHM (e.g., EMR improvements

or hiring staff specifically for PHM)• Getting multiple departments or organizations to buy-in

to process of change • EMR is not supportive of PHM needed to use Excel

Advice to Others Wanting to PHM• Leadership must drive change…C-suite must be in work

group…also good to have variety of disciplines on team • Start with what feels like small project charter but will soon

see it is bigger than you think!• Start with data that is available, clean, and meaningful to

staff• Start with “Why” then move to “What”• Make sure there is clear alignment on the targets/goals of

your PHM project• Use Plan-Do-Check/Study-Act cycles to monitor rollout• Find organizations that have done this already and talk to

them

Advice to Others Wanting to PHM

• Make sure terms like PHM are defined and understood

• Easy to get distracted by many needs/avenues for improvement…stay focused until project is complete then take on next project

• Start with one set of data that you can work with then scale up from there

• Engage staff early and often regarding the definition of PHM and provide training

• Don’t talk about it just do it

Theory U Otto Sharmer, PhD, MIT, 2007

Problem Solution

Focus

DeepeningCreativity, new thinking

Creativity, New processes

Creativity, New structures

Broadening

Overall Themes• Take time to find out what is a realistic

project target• Clearly define terms• Leadership Must Drive Change• Talk with others doing this work• EMR’s may not support effort must be creative• Organizations should take inventory of all time

staff have available to engage in PHM. May require other projects are put on back burner…

Closing Comments?

Thank YOU

for participating!

Different perspectives are a gift to innovation