(title) name(s) of presenter(s) organizational affiliation welcome back fee-for-service kentucky...

(Title)

Name(s) of presenter(s)Organizational Affiliation

Welcome BackFee-for-Service

KentuckyJanuary 31, 2012

Project Funded by CSAT

"Never invest in any idea you can't illustrate with a crayon." –

Peter Lynch

Executive Executive

SponsorSponsor

Change Change

LeaderLeader

Change Change

TeamTeam

People

Walk-throughWalk-through

FlowchartingFlowcharting

Nominal Group Nominal Group

TechniqueTechnique

PDSA CyclePDSA Cycle

ToolsTools

RulesRulesUse existing resourcesUse existing resources

Measure Measure

changechange

ImprovemenImprovemen

tt

ProcessProcess

ModelModel

ChangeChange

ProjectProject

aimaim

Sustain the gainsSustain the gains

(Title)


Who’s Who in Process Improvement?

Executive Sponsor

Authority to Allocate resources

Executive SponsorResponsible for Communicating the Vision

Martin Luther King

Executive SponsorSees change as a priority

Barack Obama, President

Executive Sponsor Empowers the change

leader

Change Leader

Reggie White

Someone who is comfortable providing day-to-day leadership, energy and enthusiasm

Has the power and prestige to influence people at all levels of the organization

Change Leader

Oprah Winfrey

Michelle Obama

Focuses the team on the change team objective

Uses mandates

http://en.wikipedia.org/wiki/File:Michelle_Obama_official_portrait_headshot.jpg

Change Leader

Queen Rania of Jordan

Challenges the status quoReports directly to the Executive SponsorGets results mandated by data

Change Team Members

Samaritan Village, Inc.Jamaica Outpatient Program

Staff and supervisors in the work area where changes will be made

Customers, family, caregivers

People with special knowledge

Others who are affected by the change

Change Team Responsibilities

• Identify possible changes that could meet the objective

• Decide how to implement the change• Create and conduct rapid-cycle pilot tests until

goal is achieved• Collect data• Study results to see if the change should be

adopted, adapted or abandoned

Key Roles:Change Team

Focus on

AIM

LOCATION

POPULATION

What makes this approach to change different?

• Change is a big experiment

• No mistakes, no right or wrong

• Data tells you if the change was an improvement

• Customer guides change ideas

Too often we design processes to meet the organization’s needs and not the needs of the customer.

The Fee-for-Service project will help addiction treatment providers develop the capacity to bill third party payers

• Design a billing system (Level 1)

• Improve the billing process to increase collections (Level 2)

Our Mission

• Use small scale, rapid cycles (PDSA cycles) to break change into manageable pieces

For example:– Create one bill– Eliminate the most common reason that

claims get denied

Applying the NIATx Way to Improve the Billing Process

• Learn how to streamline the billing process for one third party payer.

• Then, do the same for another third party payer. • Apply what you learn with MCO’s.

Later:• Focus on attracting more clients with the desired

third party payer.

Applying the NIATx Way to Improve the Billing Process

Model for ImprovementModel for Improvement

3. What changes can we make that will result in an improvement?

1. What are we trying to accomplish?

2. How will we know that a change is an improvement?

Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide

P

DS

A

The Ball Pass ExerciseDiscussion Questions:• What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a

time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective?

Experience small scale, rapid cycles:The Ball Pass Exercise

The Ball Pass Exercise

• AIM: to pass the ball from person to person as quickly as possible.

• RULES:– Only one person may touch the ball at a time; each

person must touch the ball with both hands. – The ball must be passed to a person who is not right

next to you.– The cycle begins when the Change Leader passes

the ball the first time and ends when the Change Leader has the ball at the end.

• Prepare a Change Project Form and document information about each PDSA cycle.

The Ball Pass Exercise• Select a:

– Change Leader– Data Recorder

• Cycle #1 (baseline):– Stand in a circle.– The Change Leader passes the ball to another

person in the circle. – Each person passes the ball to another person who

is not right next to them; when everyone has touched the ball, pass it back to the Change Leader.

– The data recorder documents the time from the beginning to the end of the cycle (baseline data)

The Ball Pass Exercise

• Conduct at least 3 PDSA cycles– PLAN: What can we do to reduce the time required?– DO: Implement the change and measure how long it

takes. – STUDY: Did we get the results we expected? Was the

change implemented as planned?– ACT: Adopt, adapt or abandon this change idea and

decide what the next cycle will be. – Repeat another PDSA cycle.

The Ball Pass Exercise• Tell your story:

Create a graph to show the data for each PDSA cycle, noting the change that was made for each cycle.



Designing Change Projects






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Unfocused improvement efforts are a waste of time and resources

Sample Aim Statements

• Create a billing process to bill one new third party payer (Anthem) by June, 2012.

• Increase the collection rate from 60% to 70% by June, 2012. (Start with Anthem)

• Reduce the denial rate for invoices submitted to Anthem from 52% to 35% by June, 2012.


ONthe Change Project Form

(Title)


Flowcharting

Why Flowchart?

Flowcharts force an organizational

focus on process.

Why Flowchart?

Flowcharting is useful for:

1. Providing a starting point to understand the process as it is today.

2. Identifying key problems/bottlenecks

3. Showing where to test ideas for most impact

4. Adding interactivity & fun - gets the team together

5. Creating a simple & succinct visual process overview

Setting up a flowchart

Where does the

process begin?

Where does the

process end?

START

END

Verifying Coverage.

Document

authorization

limits

Client makes first contact

Title the process

you are

flowcharting.

Key Symbols for Flowcharts

?

No

Yes

A square identifies a step in the process

A diamond is a decision point in the process and asks a “yes or no” question or offers a choice of direction in the process.

Action

Post-It Notes are great for flowcharting.

Sample FlowchartProcess name: Billing Process

Ask a

bout ins.

at fi

rst c

ontact

Before You Start

1. Identify a Change Leader to lead the flowchart

discussion.

2. Choose one person’s organization and

complete the flowchart exercise.

Change Team Assignment

Change Team AssignmentFlowchart the billing process.

Remember the steps to follow:

1. Define where the process begins and ends2. Give your flowchart a title: e.g., “First Contact to Document

authorization limits”3. Define process steps 4. Review/refine flowchart5. Identify problems and bottlenecks

• Are there steps on the “Who does what chart” that no one is assigned to?

6. Customer barriers

Large Group Discussion

1. Useful?

2. How could you use your flowchart to

help engage your organization in the

change process?



How to Measure the Impact of Change

Learning Objectives

• The importance of data in a change project.

• A six-step process for the effective measurement of the impact of change.






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Data answers three common change project questions…..

DataData directs the action steps toward directs the action steps toward a change project improvement goal.a change project improvement goal.

Keep data collection and reporting as simple as possible, but be specific.

Keep data collection and reporting as simple as possible, but be specific.

Denial tracking for Anthem

A Step Process

for Measuring the

Impact of Change

66

6 Steps for Measuring the Impact of Change

Always ask why.

1DEFINE YOUR

AIM & MEASURES

1DEFINE YOUR

AIM & MEASURES

2COLLECT

BASELINE DATA

2COLLECT

BASELINE DATA

3ESTABLISH A CLEAR GOAL

3ESTABLISH A CLEAR GOAL

4CONSISTENTLY COLLECT DATA

4CONSISTENTLY COLLECT DATA

5CHART YOUR PROGRESS

5CHART YOUR PROGRESS

6ASK

QUESTIONS

6ASK

QUESTIONS

1. Define your measures.

This ensures that the results are interpretable and accepted within the organization.

Clear definitions of your measures should:- Clarify project objectives- Be agreed upon by stakeholders

2. Collect baseline data.

QUESTIONS TO ASK:A. Was the data defined to ensure that we collect exactly the information needed?B. How accurate is the data? Does accuracy matter?C. Does the process ensure that the measures will be collected consistently?D. Do trade-offs exist? Is quality more important than the time required to collect data?

Never start a change project without it.

3. Establish a clear goal.

This ensures that the results are interpretable and accepted within the organization.This ensures that the results are interpretable and accepted within the organization.

A goal should:- Be realistic yet ambitious- Be linked to project objectives- Avoid confusion

4. Consistently collect data.

Regular data collection is a crucial part of the change process.

Regular data collection is a crucial part of the change process.

As a team, decide:Who will collect the data?How will they collect it?Where will the data be stored?

5. Chart your progress.

Use visual aids forsharing the data.Use visual aids forsharing the data.

Share pre-change (baseline)and post-change data with:

- Change Team- Executive Sponsor- Others in the organization

Line graphLine graph

A simple line graph example

Remember: One graph, one message.

Goal

6. Ask questions.What is the information telling me about change in my organization?

Why was one change successful and another unsuccessful?

Always ask why.

Possible AIM Measures(from the Dashboard)

• Denial Rate

• Collection Rate

Focus on one payer

Possible Cycle Measures

• To focus on reducing the # of denials for a specific reason

– # of clients matched with a clinician with appropriate license (if bills are denied because service was provided by clinician without appropriate license)

– # of days between service and sending bill (if bills are denied because they weren’t submitted in a timely manner)

Begin to fill out

How to Measure the Impact of Change Worksheet

(Title)


CollaborationWhy?

• Capture the wisdom of the Change Team and participants in the Collaborative

• Be willing to share and exchange ideas

• Participate actively and dialogue

• Share and copy best practices

• Divide work tasks and empower others to help

5 Steps to ensure a successful Collaborative:

"If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple.

But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.“

George Bernard Shaw

(Title)


Review and

Next Steps

Review

How-to Steps for the NIATx Process Improvement Model

Review

Use The NIATx Third-Party Billing Guide to identify steps in the process that

need to be implemented.

Review

Are you likely to reach your wildest dreams for the outcome of this

collaborative?

Call to Action

Monthly:• Send Lynn and Elizabeth your updated Change Project Form

• Attend monthly NIATx webinars:Level 1 – 2nd Tues. at 3 pm ESTLevel 2 – 2nd Wed. at 3 pm EST

• Attend monthly KY provider calls

Contact InformationLynn Posze, Convener [email protected]

Elizabeth Strauss, NIATx [email protected]

Jeanne Pulvermacher, [email protected] 608-265-5087

Thank you!

Celebrate

(title) name(s) of presenter(s) organizational affiliation welcome back fee-for-service kentucky...

Documents

change slide

change leader slide

change idea

ball pass exercise slide

organization slide

gains slide

mission slide

abandoned slide