Louisiana CPC+ Learning Session 2

Transcription

1 Louisiana CPC+ Learning 2 Cajundome Convention Center 444 Cajundome Blvd, Lafayette, LA August 29, 2018, 9 a.m. 4:15 p.m. CT Time (CT) 8:30 9:00 a.m. Registration Welcome and Introduction 9:00 9:15 a.m. Facilitator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Full Group 1 Using Data to Drive Improvement (Livestream) Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality 9:15 10:15 a.m. Identify continuous improvement opportunities using Louisiana Regional Care Delivery and Medicare Feedback data Demonstrate how to use Louisiana Medicare Feedback Report data to guide continuous improvement Audience: All participants 10:15 10:30 a.m. Break 10:30 11:30 a.m. Morning Breakout s Page 1 of 9

2 Time (CT) 10:30 11:30 a.m. 10:30 11:30 a.m. Breakout A Implementing Continuous Improvement Techniques Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Format: Practice Presenter and Workshop Discuss the components of building a robust QI team and the importance of having a QI team at the practice level Identify the components of the Plan-Do-Study-Act (PDSA) quality improvement tool and recognize in an example Develop a PDSA for implementing a QI team (If a practice already has a robust QI team, the practice lead will develop a PDSA around a current QI project) Audience: CPC+ practice champion/learning leads, CPC+ clinical leads, CPC+ Practice Lead RING participants Breakout B Self-Management Support (SMS) for Patients Format: Discussion and Workshop Identify how practices are using effective goal setting, action planning, and shared decision-making Strategize actionable steps to determine which patients will receive SMS and whom, within the practice, will deliver these services Identify tools to evaluate a patient s needs Audience: CPC+ care managers, CPC+ practice champion/learning lead, CPC+ clinical lead Page 2 of 9

3 Time (CT) Breakout C Integrating Social Determinants of Health Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality 10:30 11:30 a.m. Identify social determinants of health and their impact on patients Determine a strategy for assessing and addressing patients social needs Audience: CPC+ Track 2 practices, CPC+ care managers, CPC+ practice champion/learning lead, CPC+ clinical lead, CPC+ practice leads 11:30 1:00 p.m. Lunch Full Group 2 Applying Risk Stratified Care Management (Livestream) Presenting Practice: Cenla Practice Format: Practice Presentation and Roundtable Discussion 1:00 1:45 p.m. Identify how other CPC+ practices are implementing risk stratification within their practices Explain how other practices are using their EHR to help risk stratify patients Identify ways to incorporate clinical intuition (Step 2) into the risk stratification process Audience: All participants 1:45 2:00 p.m. Break 2:00 3:00 p.m. Afternoon Breakout s Page 3 of 9

4 Time (CT) 2:00 3:00 p.m. 2:00 3:00 p.m. Breakout A Episodic Care Management Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Format: Small Group Discussion Define episodic care management and its value in providing high quality care Determine a panel size and workflow for episodic care management in your practice Audience: CPC+ practice champion/learning leads, CPC+ clinical leads, CPC+ care manager participants, CPC+ Care Manager RING participants Breakout B Behavioral Health Integration Strategies for Implementation Presenting Practices: TBD Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Format: Presentation/Q&A Roundtable Discussion Identify tactics used to support the implementation of your behavioral health (BH) model Strategize on actionable steps to address common challenges in behavioral health integration (BHI) implementation Audience: Track 2 practices in the planning and implementation stages of behavioral health integration and Track 1 practices interested in BHI Breakout C Payer-Practice Networking Format: Full Group Discussion 2:00 3:00 p.m. Strategize about ways to enhance communication and partnerships between payer partners and practice leadership Identify opportunities for improved multi-payer collaboration within the Louisiana region through which practices could better achieve the CPC+ aims Audience: CPC+ practice leads, CPC+ clinical leads 3:00 3:15 p.m. Break Page 4 of 9

5 Time (CT) 3:15 4:00 p.m. 4:00 4:15 p.m. Full Group 3 Building Your Patient & Family Advisory Council (PFAC) (Livestream) Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Identify ways to engage PFAC members Identify one way to communicate the work of your PFAC to your patients Strategize about how to create a practice culture that supports the implementation and integration of a PFAC Audience: This emergent session is for practices who are planning or have completed their first PFAC meeting. This is a full group session and will be aimed towards the entire practice staff. Leaving in Action; Reflection and Next Steps Facilitator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Page 5 of 9

6 Descriptions Goals for the Day Assess your practice s progress in CPC+ Find a continuous improvement method or activity to take back to your practice Take one idea back to your practice that you can implement next week Questions to Run On How can my practice use data to drive continuous improvement for CPC+? How can my practice use risk stratification to drive care management? How can my practice engage patients in their own care? Full Group 1 Title: Using Data to Drive Improvement Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Presenting Practice: N/A Description: The ability to utilize data to drive continuous improvement is a critical component of CPC+ and a key element in practice transformation. During this session, practices will review current Louisiana regional data. Practices will then be provided with sample practice data for analysis and discussion around using the data to drive decision-making for improvement. Audience: CPC+ all Identify continuous improvement opportunities using Louisiana Regional Care Delivery and Medicare Feedback data Demonstrate how to use Louisiana Medicare Feedback Report data to guide continuous improvement Morning Breakout s AM Breakout A Title: Implementing Continuous Improvement Techniques Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Format: Practice Presenter and Workshop Description: Engage participants to understand the importance and components of developing a robust quality improvement (QI) team. There will be a high-level overview of Plan-Do-Study- Act (PDSA), and practices will have the opportunity to begin a PDSA for their respective practices. Audience: CPC+ practice champion/learning leads, CPC+ clinical leads, CPC+ Practice Lead RING participants Discuss the components of building a robust QI team and the importance of having a QI team at the practice level Page 6 of 9

7 Identify the components of the Plan-Do-Study-Act (PDSA) quality improvement tool and recognize how to use PDSAs using an example Develop a PDSA for implementing a QI team (If a practice already has a robust QI team, the practice lead will develop a PDSA around a current QI project) AM Breakout B Title: Self-Management Support (SMS) for Patients Format: Discussion and Workshop Description: This session will allow participants an opportunity to hear how practices in their region have started to implement self-management support. In addition to practice presentations, there will be small groups working together to develop a practice needs assessment for self-management support (SMS), define roles for delivering SMS and effective tools to be used with patients. Audience: CPC+ care managers, CPC+ practice champion/learning lead, CPC+ clinical lead Identify how practices are using effective goal setting, action planning s, and shared decision-making Strategize actionable steps to determine which patients will receive SMS and whom, within the practice, will deliver these services Identify tools to evaluate a patient s needs AM Breakout C Title: Integrating Social Determinants of Health Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Presenting Practice: N/A Format: Roundtable discussion Description: This session will include a high-level overview of care associated with patients for whom social needs may impact their health status and risk. The session will also explain why integrating social needs assessments are important to succeed in CPC+. Practices will have time to discuss strategies for assessing social needs and identify ways to address the social needs of their patients. Audience: CPC+ Track 2 practices, CPC+ care managers, CPC+ practice champion/learning lead, CPC+ clinical lead and CPC+ practice leads Identify social determinants of health and their impact on patients Determine a strategy for assessing and addressing patients social needs Full Group Title: Applying Risk Stratified Care Management Page 7 of 9

8 Presenting Practice: Cenla Family Medicine Associates Format: Practice presentation and roundtable discussion Description: After a brief presentation from a practice who has risk stratified its patients, practices will work in table groups to answer guided questions to learn from their peers and develop an action plan for implementing risk-stratified care management in their practice. Audience: CPC+ All Identify how other CPC+ practices are implementing risk stratification within their practices Explain how other practices are using their EHR to help risk stratify patients Identify ways to incorporate clinical intuition (Step 2) into the risk stratification process Afternoon Breakout s PM Breakout A Title: Episodic Care Management Facilitator/Moderator: Amasa Baldwin, MHA, CPHQ (TMF Health Quality Format: Small group discussion Description: We will engage participants to understand the difference between episodic care management and longitudinal care management. We will discuss practice workflows as well as right sizing panels for episodic care management. Audience: CPC+ practice champion/learning leads, CPC+ clinical leads, CPC+ Care Manager RING participants Define episodic care management and its value in providing high quality care Determine a panel size and workflow for episodic care management in your practice PM Breakout B Title: Behavioral Health Integration Strategies for Implementation Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Presenting Practice: Potentially Scott Family Physicians using primary care behaviorist model Format: Presentation/Q&A Roundtable discussion Description: During this session, we will focus on practice networking and roundtable discussion. The facilitator will cover an introduction to CPC+ behavioral health integration to include a high-level overview of each model and the differences between the two from a Care Delivery and logistical standpoint. Participants will select a table representing the BH option (Option 1 or Option 2) that they have chosen or are considering. Panelists will share why they chose their model, implementation steps, and how they overcame barriers. Practices will have the opportunity to learn from each other s challenges and successes. Audience: Practices in the planning and implementation stages of behavioral health integration. Identify tactics used to support the implementation of your behavioral health (BH) model Strategize on actionable steps to address common challenges in behavioral health integration (BHI) implementation Page 8 of 9

9 PM Breakout C Title: Payer Partner Collaboration Format: Full group discussion Description: Payers will discuss questions generated by practices prior to the Learning event. Audience: CPC+ practice leads, CPC+ clinical leads Strategize about ways to enhance communication and partnerships between payer partners and practice leadership Identify opportunities for improved multi-payer collaboration within the Louisiana region through which practices could better achieve the CPC+ aims Full Group 3 Title: Building Your Patient & Family Advisory Council (PFAC) Facilitator/Moderator: Christina Brown, MA, NLC, EMT (TMF Health Quality Presenting Practice: Potentially Family Clinic, Inc. Description: During this session, we will focus on practice networking and roundtable conversation. Panelists will share steps they followed in the implementation of their model, how they engaged practice staff in creating a culture of patient and caregiver engagement, and how they overcame barriers to implementing and maintaining their PFACs. Audience: This emergent session is for practices that are planning to or have completed their first PFAC meeting already. This is a full group session, and it will be intended for the entire practice staff. Identify ways to engage PFAC members Identify one way to communicate the work of your PFAC to your patients Strategize about how to create a practice culture that supports the implementation and integration of a PFAC Page 9 of 9