Building Your Business Acumen - Washington … Your Business Acumen Beyond the Basics Yolanda Lovato, Planning & Resource Director John Beck, Business Administration Director Pearl

Building Your Business Acumen Beyond the Basics

Yolanda Lovato, Planning & Resource Director

John Beck, Business Administration Director

Pearl Bouchard, CLC Manager

1222 N. Post St. | Spokane, WA 99201 | TEL 509-458-2509 | FAX 509-458-2003

SERVING: Northern Ferry, Pend Oreille, Spokane, Stevens & Whitman counties

WWW.ALTCEW.ORG | ADVOCACY. ACTION . ANSWERS.

Summary of Presentation

• ALTCEW’s Experience with Business Acumen • Marketing

– Network Development – Branding – Service Package

• IT Platform – Why it Matters – Selection Process – Challenges and Uses

• Quality Improvement – Measurement for Improvement – Tools to Support Improvement – Examples


Support for Learning Collaborative

• Administration for Community Living/Office of Policy Analysis and Development

• The John A. Hartford Foundation

• The SCAN Foundation


ALTCEW and Business Acumen

Goal: Improve integration between hospitals, insurers, health care providers and community-based organizations (CBOs)

• 11 Networks of varying expertise

• Training

• Sharing experiences

• Lessons learned and best practices from first cohort


ALTCEW and Business Acumen

• Expanding opportunities for Area Agencies on Aging

– Managed Care Organizations (Apple Health Plans)

– ACO’s

– BPCI’s

– Care Coordination (Health Homes)

– Transitional Care Management (CCTP)

– Evidenced Based Programming (Varied models)

• Falls Risk Prevention

• Diabetes Prevention and Education


ALTCEW’s Experience

• Network Development – Rural Resources

– Spokane County Meals on Wheels

– Centers for Independent Living (SCIL)

• Branding

• Service Package Development

• Culture Change

• Marketing

• Navigating New Territory – IT

– Quality Assurance/Data


Key Considerations In Marketing

• What problem are we trying to solve?

• What are we going to do to solve the problem?

• What is unique about how we can solve the problem compared to others?

– Network Development

– Branding/Identity

– Service Package


Key Considerations In Marketing (Network)

• Know your network market

• Identify strengths of each of the network partners

• Work on forming network identity separate from each individual partner identity

• Describe the benefits of the enhanced role of the partnership/network

• Develop an MOA (unique)


Key Considerations In Marketing (Branding)

• Importance of branding

• Value Added Strategy/Representation

– Evolution of Conexus™

• Identity distinct from the AAA Social Service Model

– Trademark Registration

– One page overview

(See handouts)


Key Considerations In Marketing (Service Package)

• Lead with a value proposition

• Establishing rates/pricing of services

• Return on Investment (ROI)

• Establish credibility

• “Buying It” is better than “Building It”

• Brokerage – One Contract, multiple services


Marketing to Health Plans

• Look at the population through the health plans perspective

• Acknowledge the work that the plan is currently completing

• Understand the fiscal incentives driving the health plans

• Provide materials before hand

• Plan for a 30 minute pitch….be prepared for 1 hour


Key Considerations in Marketing

• Be patient

• Understand the nature of the competitive market

• Understand what your organization can do as well or Better than anyone else in your area

• Align work with the priorities and fiscal imperatives of the payer source

• Redefine and if necessary, restyle your products and services to meet the payers needs


Key Considerations In Marketing


IT Platform: Why it Matters

*ACL Business Acumen heavily recommends having a medical reporting/billing system to be able to negotiate service contracts with various health network providers.



*The Electronic Health Records (EHR) system should provide the following:

MEANINGFUL USE is using certified electronic health records technology (EHR) to:

– Improve quality, safety, efficiency, and reduce health disparities

– Engage patients and families

– Improve care coordination and population and public health

– Maintain privacy and security of patient health information



Ultimately, it is hoped that the meaningful use compliance will result in:

• Better clinical outcomes

• Improved population health outcomes

• Increased transparency and efficiency

• Empowered individuals

• More robust research data on health systems


Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs

http://www.cms.gov/EHRIncentivePrograms/01_Overview.asp


IT Platform: Key Considerations

National Committee for Quality Assurance (NCQA) has a Patient-Centered Medical Home Recognition (PCMH) NCQA Vendor Contact List

• List has “Pre-validated Product Names” of EHR Vendors

• Interactive with health technology

WWW.ALTCEW.ORG Beyond the Basics

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IT Platform: Selection

• Contacted all vendors on NCQA list

• Had a task force of staff and Planning and Management Council members which: – Screened initial RFQ submittals

– Selected 3 finalists for full RFP

– Rated the responses

– Contacted current user references

– Negotiated initial rates

– Recommended to PMC and Governing Board for approval to contract

• Full RFQ is available upon request

• Panel selected NextGen Healthcare Ambulatory EHR

WWW.ALTCEW.ORG Beyond the Basics

| ADVOCACY. ACTION . ANSWERS.

IT Platform: Challenges

• Getting DSHS IT to allow us to use state system to access NextGen

• Staff time commitment to implement

• Modifying a medical practice system to our model

• Need a Medicare provider number to get ultimate billing capabilities

• System is expensive and will need consulting support


IT Platform: Initial Uses

• Consolidated data for 5 Health Homes contracted services

• Tracking of Matter of Balance class participants

• Development of Care Transition pilot program with CHPW


IT Platform: Ultimate Uses

• Person centered database to track all non-OAA

& ALTSA services • Full communications with paying sources • Platform for private pay services • Always current to Meaningful Use, HIPAA, and

medical billing


IT Platform


Quality Improvement: Why?

• Our current interventions can affect outcomes for health plans, hospitals, ACOs and provider groups

• Helps define the conversation with Plans

• A new culture must come about—better/faster/accelerate change

• We have to measure and improve constantly

• Communicate outcomes with Plans


Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs



Quality Improvement: Performance Measurement

Three faces of measurement:

Accountability

Research

Improvement


Quality Improvement: Setting Up a Successful

Project

• Involve senior leadership

• Move through rapidly

• Transparency*

• Resources

• Motivate others

*Importance of Documentation:

Reflection, capture knowledge, create organizational memory, transfer learning


Quality Improvement: Tools to Support Improvement

– Project Charter Form (in packet)

– Run Charts (or line graphs)

• 12 points to add median

• 20 points to add mean

• 5 or more data points/consecutive up or down = trend

• 6 points consecutive = shift


Quality Improvement Tools: PDSA

Quality Improvement Tools: Driver Diagrams

Quality Improvement: Making Measurement Useful

Do one improvement at a time

Make it important to staff

Collection of data easy and frequent enough

Not a measure of accountability or research

Gather baseline data

Important to contracting with MCOs, ACOs, BPCIs, etc.


Quality Improvement: Sources

• PH55X: “Practical Improvement Science in Health Care”; Harvard X, Harvard University. https://courses.ed.org

• Taylor, MJ, et al. BMJ Qual Saf 2013; 0: 1-9

• Bennett, B and Provost, L. “What’s Your Theory?” www.qualityprogress.com

• “Defining and Using Aims and Drivers for Improvement: A How to Guide”, CMS https://innovation.cms.gov/files/x/hciatwoaimsdrvrs.pdf


https://courses.ed.org/

http://www.qualityprogress.com/

https://innovation.cms.gov/files/x/hciatwoaimsdrvrs.pdf

Quality Improvement


Lessons Learned

• I thought I knew more than I could ever know about ACA having done work with the Exchange.

• There is an entirely new vocabulary and list of acronyms.

• Working in the medical field is complex and decisions take much more time than imagined.

• Change is challenging, particularly when talking culture change within an organization

• Social service agencies have to begin framing from a business perspective


Lessons Learned

• The need to consistently reinforce what relationship this work has to our overall mission

• It is NEVER too soon to talk about sustainability

• Time is of the essence


Next Steps

• Change our approach from reporting to performance based

• Secure multiple contracts

• Continue environmental scan for partners and payers

• Strengthen relationships with medical partners

• Broaden work by developing business plan

– Private pay market


Any Further Questions?


Documents

Building Your Business Acumen - Washington … Your Business Acumen Beyond the Basics Yolanda Lovato, Planning & Resource Director John Beck, Business Administration Director Pearl