succeeding with a moving health system target...succeeding with a moving health system target...

Capital Area Human Services District

Kristin Woodlock RN, MPA

CEO, Woodlock & Associates

[email protected]

917.244.4221

Succeeding with a Moving Health System Target

Woodlock & Associates

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Presentation Notes

Going from the Now to the NEXT to the Future

mailto:[email protected]

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Thank you for saving my life – or at least giving me a role model for what NYC should grow up to be~~

This is NOT your

Grandma’s

Healthcare

Evolution of

Behavioral Health

Providers

We Live in Interesting Times…

We need an

organizing

principle + model

to move forward

Millennial Nonprofit/Behavioral Health Provider

1.0 Refresher


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Cash flow – bankruptcies, I can’t help but identify with the guy hanging on by his fingernails over here! So how many of you were at the Millennial Nonprofit last year? We will speed through it! Evolution – to quote president Trump – “who would have imagined that healthcare could be this complicated!!” I saw an immense need to help people wrap their heads around what should I being moving TO. What is the future state? What can I do now? How do I explain this to staff? So I created the concept of Millennial Nonprofit – a framework to advance our field.

2

3

1

God’s Work

Charitable Organizations

1

Government’s Work

Agents of Government

2

RetailValue-Based Payment3

Evolution of Nonprofits/Behavioral Health Providers


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The field has shifted from complicated to complex – moving from a highly regulated field with structured compensation, to a field that is still highly regulated, but is now competitive. And the shift is creating the need for new leadership skills The difference is subtle but important. Complicated systems may have many parts but when the parts interact they do not change each other. In complex systems, on the other hand, when things interact, they change one another in unexpected and irreversible ways.

Hindsight Government Agent

Model

20/20

Cash Flow

Volume over

Value

Providers Boxed in by Regulation

Policy

Regulation

Incentives

Working Capital

Policy changes before incentives

and structures


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So just how well is the Agent of Government thing working?

01

Organizational Change

02

Financial

Change03

Clinical

Change

Network Provider

IPA,PPS, ACO… 1

“Value over Volume”

Pay-for: reporting, performance, upside risk

3

Increasingly Diverse Payors

Gov’t, Health Plan…2


Contract to Fee-for-Service to Retail

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Why retail? We are FFS. Don’t follow in the same evolutionary path as those who came before you – learn from their work. Leapfrog!!

NOTE: Millennial Nonprofit – is a term of art that is applicable to ANY and ALL BEHAVIORAL HEALTH PROVIDERS. Even… for-profit or government!

• Operating structure in a value-centric world (retail)

• New competencies – New business model

• Competition engine of progress and reform

• Distinctiveness is at the core


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We know what “good” looks like in the agent of government world. Can we see what “good” looks like in a retail world?

…are distinctive and have internalized the concept of value.

…are diagnosticians and solution focused.

…have initiative, skills, products and outcomes needed by the health care system.


Mission

Expertise

LocationStrong

Return onInvestment

Messaging

ResultsSystem Affiliate

Millennial NonprofitsDistinctiveness

Wheel


• Your True North

• Organizing Principle for Your Agency

• Creates Your Identity

• Your mission today vs. yesterday


To promote the behavioral health of children, youth, and families and support a positive transition to adulthood.

The mission of the Institute for Family Health is to improve access to high quality, patient-centered primary health care targeted to the needs of medically underserved communities

Quartet HealthOur mission is to enable every person in our society to thrive by building a collaborative behavioral and physical health ecosystem


Our mission is to strengthen children and families with skills, opportunities, and emotional support to build healthy, successful lives

Pine Street Behavioral Health leads the state of Oklahoma in providing behavioral health care and educational services for individuals with chemical dependency and severe emotional disturbances. Our services are provided in a least restrictive setting, through a continuum of care, with the highest respect for individuals and families served. In addition to direct care services, Pine Street provides consultation and training for mental health, substance use and educational professionals and promotes research in these specialized areas.


Nonprofithub.org

• Delivering on DISTINCTIVENESS • staff credentials• culturally representative and competent• Peer &/or Family-Driven• EBP’s• Awards, accreditation, endorsements

• Credibility

• Scale


• Important

• Driven by customer need: • Access • Safety• Stigma• Signage• Environment (value or not)• Effective space for what you are doing

• Competition & Marketshare


• Health care is becoming a team sport.

• Gone are the days of • solo medical practices • stand-alone clinics • segregated behavioral health

networks


• The future is all about aligning with larger affiliates.

• These could be hospital-based systems, ACOs, IPAs, networks or cultivated close relationships.

• Your reputation in a retail environment is everything.

• You are your reputation - expect Due Diligence


• Are you ready to have your performance stats on the web?

• Are you willing to sign a contract today based on your performance?

• Consistent delivery – Diverse Measures & Reports• Volume has 1 definition – Value has infinite• front-line customer • payers


0

500

1,000

1,500

2,000

2,500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Num

ber o

f Clie

nts

Modal Outpatient Visits

Treatment DoseComparing CAHS "All Outpatient" to Goal

# of Clients CAHS 1-10 # Client Goal

Treatment Dose: A clinical and a financial essential element

Access to Care Engagement Models for Short Term Therapy

Treatment ModelsCost of front end clinical

workflow vs. effective treatment dose

Outcomes – Efficiency –Impact

Variation and targets for unique subsets in the “all outpatient”

group. Mobile, school, clinic

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Same day access returns an average of 120,000 Treatment dose produces outcomes and frees up back end capacity. Cost of front end treatment is higher.

Outcomes

Satisfied

Am I on-track?What are my outcomes?

What’s measures matters.Measure what matters!

On Grade Level

School Attendance

Achieving Developmental Milestones

Has Vocational Path

High School Graduation

Chronic Health Condition Well Managed

Part or Full Time Employment

Living in own home or apartment

Has Vocational PathLife Expectancy that of nondisabled Peer

• The Division of Health Care Finance and Policy (DHCFP) Behavioral Health Report Card http://dhcfp.nv.gov/Pgms/CPT/BHSreports/BHreportca rd/BHSReportCard/

• California Dashboard http://www.dhcs.ca.gov/services/Pages/MngdCarePerf ormDashboard.aspx

• Oregon Dashboard http://www.oregon.gov/oha/amh/Pages/bhmetrics.aspx

• Arizona Dashboard https://www.azahcccs.gov/Resources/Reports/dashbo ard.html


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Data is not a thing… it is everything!

http://dhcfp.nv.gov/Pgms/CPT/BHSreports/BHreportca%20rd/BHSReportCard/

http://www.dhcs.ca.gov/services/Pages/MngdCarePerf%20ormDashboard.aspx

http://www.oregon.gov/oha/amh/Pages/bhmetrics.aspx

https://www.azahcccs.gov/Resources/Reports/dashbo%20ard.html

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Live website showing 2 providers

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Non Hospital SUD rehab

ICL LABOutcomes

• Significant improvements in blood pressure lipid profile (total cholesterol, LDL, HDL, triglycerides), breath CO

29

• Findings robust across racial/ethnic groups

100% 100% 100%

44% 45% 41%

0%

50%

100%

SAMHSA Cohort(n=166)*

Black/AA cohort(n=94)*

Hispanic/Latino cohort(n=49)*Initial-At-Risk Reassessment-Below At-Risk Level

ICL-LABOutcomes (cont’d)

• Significant reductions in emergency and inpatient service utilization

• 96% of ICL clients believe they can make changes to improve their physical health30

MANAGINGTHROUGH

DASHBOARDS

IMPACT OF DASHBOARDSON CLINICS

Face-to-face time Increased by

From 18 to 26 hrs/wk

Broken appts Decreased By

From 26% to 17%

Collection rates Increased by

44% 35% 5%From 92% to 97%

IMPACT OF DASHBOARDSON HOME VISITING (SHORT TERM)

Face-to-face time Increased by

From 167 to 212 hrs/mo

Billable units Increased by

27% 11%From 36 to 40 units/mo

IIH sessions Increased by

129%From 35 to 80 sessions/mo

DASHBOARD DEVELOPMENT

Process flow of operations

and data systems

Identify keymetrics andoperationalpain points

Research and implement operational

best practices

Track all program activity

electronically

Develop dashboards to

assist in managing

culture change

As operations become

efficient, focus on outcomes

DASHBOARD DETAILS

Management Summary

A management summary allows senior management to quickly and consistently keep their pulse on the performance of programs at a level that summarizes the key metrics. The CEO can view this document and, in a matter of seconds, identify key success or problems.

DASHBOARD DETAILS

Program Summary

A program summary provides program directors an aggregate level view of their program. This helps to understand populations, geographies, service mix, and other metrics at a clinic-wide level to ensure that expectations are met.

DASHBOARD DETAILS

Staff Productivity

By analyzing staff performance down to the level of each worker, management never has to guess which staff are top performers. Also, making dashboards fully transparent to all staff allows for a sharing of best practices. Viewing each staff’s performance also highlights exactly where problems exist.

DASHBOARD DETAILS

Caseload Analysis

By producing caseload reports that analyze client activity managers are able to quickly spot issues like late treatment plans, lack of visits, service types, etc. By analyzing caseloads in home visiting programs, managers are also able to visually see if catchment areas are being maintained, when visits are being concentrated during the month, and other caseload trends.

PROGRAM DESIGN USING DATA

Time Study

When developing a new program, it is important to understand, down to the hour, how your direct care workers will spend their time. This time study will allow you to develop productivity targets, determine very accurate revenue projections, as well as inform job descriptions.

PROGRAM DESIGN USING DATA

Budget Projections

When designing the structure of a program, having an interactive analytical tool that allows management to experiment with staffing patterns, caseload sizes, salaries, etc. is crucial to ensuring that a new program is fiscally viable and scalable.

FINANCIAL DASHBOARDS

Contract Billing Summary

As dashboards highlight the accomplishments and assist programs in fixing program issues, it is important to ensure that the efforts of the programs are mirrored by equal efforts by central support staff. Contract billing, in particular, needs to be carefully monitored to ensure fiscal viability and program success.

• What is your cost?• Fixed vs. Variable• Stability of costs• Relationship to what someone will pay

• Lean Processes – Waste the enemy• The enemy is often us• Identifying transitional barriers and solutions• Regulation, rates, etc.


• In RETAIL, you get what you pay for

• Quality is a variable, but is inextricably linked with what the buyer is willing to pay.

• Come back to your mission statement (true north)• Early and innovative (Apple)• Strong value proposition (eye of the buyer)• Capacity to report, bill timely and with accuracy


• Does anyone know you exist?

• Look at messaging from the eye, ears and perspective of your customer. Not yourself.

• Rarely do people know or care about BH until it effects them

• Keep it simple, real and DISTINCTIVE


• What’s hot – CBOs, SDH, etc

• Many have had bad experiences with BH or your Agency.

• How to prevent• How to counter


Lose your Agent of

Government Thinking !

Become a Flourishing

Business For Good

Work To Close the Gap Between

Current/Future State

Adopt Millennial Nonprofit Thinking

Start Working the

DistinctivenessWheel

Millennial Leader-Steps


Risk Awareness & Protective Factors


• There were problems in the “Agent of Government” phase.

• Government and we are blind to some of the problems

• Nonprofits have thick reputational veneers

• Government, Foundations, Accreditation Organizations or Associations have not ‘cracked the code’ to identify agencies at profound risk


External Factors

• Environment• Health and Human

Services Markets• Government• Philanthropy• Access to Capital

Agency Operations

– Leadership

• Executive

• Governance

– Capacity

• People

• Systems


Presenter

Presentation Notes

Contracting systems, clinician to biller to management are different from FFS systems which are different from retail. Build smart Real-time data Rapid Process Improvement

• Transition will NOT be swift nor linear• Providers will operate with multiple incentives and

payment models• Increased exposure to risk

• FUNDAMENTAL CHANGE IN OUR THINKING AND PRACTICE• Solutions needed beyond volume growth or cost

reduction• Delivery of outcomes to keep market share • Being highly efficient at delivering excellent care to

strengthen contract position• Know your organization –internal due diligence

Government Agent Retail


IndependentOrganizational

Assessment

Nonprofit Vector Scan®


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Presentation Notes

The Nonprofit Vector Scan™ is an independently administered tool to assist nonprofit health and human services agencies in a robust and candid conversation about strengths, risks and priorities. The elements covered within the Nonprofit Vector Scan ™ are intentionally selected to cover common, high-challenge areas for nonprofits, items that can impact referrals, ability to achieve or communicate outcomes or actions that impact an agency’s “runway” to make changes Clarity on your “business” is critical to making good retail decisions. Reality is – Many nonprofits do not know where they stand at all. Most do not know where they stand in a value based world. Volume – yes. Value –no. Value of fresh set of eyes… hard to see things clearly that you so invested in. Hard for organizations to have direct communitication - The Abilene Paradox, first described by Professor Jerry Harvey, from the George Washington University. He described a leisure trip which he and his wife and parents made in Texas in July, in his parents’ un-airconditioned old Buick to a town called Abilene. It was a trip they had all agreed to – or at least not disagreed with – but, as it later turned out, none of them had wanted to go on. “Here we were, four reasonably sensible people who, of our own volition, had just taken a 106-mile trip across a godforsaken desert in a furnace-like temperature through a cloud-like dust storm to eat unpalatable food at a hole-in-the-wall cafeteria in Abilene, when none of us had really wanted to go” The Abilene Paradox describes the situation where everyone goes along with something, mistakenly assuming that others’ people’s silence implies that they agree. And the (erroneous) feeling to be the only one who disagrees makes a person shut up as well, all the way to Abilene

Audit

Organizational Culture

Information Technology


Driven by Data

Media

Supply Chain


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Presentation Notes

Supply Chain – Open Access issue

Finance

Administration

QI- Corporate Compliance


Everyone has a WhyWhy do you get up in the morning? Why does your organization exist? Your Why is the purpose, cause or belief that inspires you to do what you do. When you think, act and communicate starting with Why,

you can inspire others.Find your Why

https://startwithwhy.com/find-your-why?ref=home



Other Reflections…

Real Time DataEHR Maximization

Disaster Planning Service Delivery

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Presentation Notes

Jobs?

Too many of these problems are diseases of despair that spring from

deficits of hope.Dr. Vivek Murthy

US Surgeon General2013-2017

Thank you!

Kristin [email protected]

mailto:[email protected]

succeeding with a moving health system target...succeeding with a moving health system target...

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