Building Your Business Acumen

Transcription

1 Building Your Business Acumen A Learning Collaborative Experience Lynn Kimball, Executive Director Yolanda Lovato, Planning and Resource Director Pearl Bouchard, CLC Manager 1222 N. Post St. Spokane, WA TEL FAX SERVING: Northern Ferry, Pend Oreille, Spokane, Stevens & Whitman counties 1

2 Summary of Presentation Introduction to the Learning Collaborative Focus Areas of Learning Tools Designed to Build Your Business Acumen Other Key Considerations Questions and Discussion 2

3 Support for Learning Collaborative Administration for Community Living/Office of Policy Analysis and Development The John A. Hartford Foundation The SCAN Foundation 3

4 What is the Learning Collaborative? 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 4

5 Massachusetts Statewide Evidence-Based Package 5

6 Los Angles, CA Regional Brokerage 6

7 Focus Areas of Technical Assistance Basics of Health Care and Reform Market Analysis Quality Improvement Activities 7

8 Basics of Health Care Reform The Triple Aim: Better Patient Experience of Care Better Population Health Lower per-capita Costs The Setting: Hospitals Skilled Nursing Facilities Physician Practices 8

9 Health Care Reform - Hospitals Readmission Penalties FY ,612 hospitals received 3% penalty (none in WA state) Hospital-acquired Condition (HAC) lowest performing hospitals (bottom 25%) receive a 1% penalty Value-based Purchasing inpatient care based on quality of care; low scoring hospitals can be penalized as much as 1.5% 9

10 Health Care Reform Skilled Nursing Facilities All-cause, all-condition hospital readmission performance measurement FFY 2016 High performers will receive higher per diem rate for Medicare payments Value-based Purchasing FY % reduction or bonus 10

11 Health Care Reform - Physicians Value-based groups of 100 or more 2015 Groups of 10 or more 2016 All physician practices, regardless of size 2017 Value-based purchasing: High performing 2% increase in payments; low performing 1% reduction in payments 11

12 WA State Accountable Communities of Health Multi-sector collaboratives aimed at improving community health Opportunity to promote value proposition of AAA services and interact with health care and payers Regardless of 1115 funding success, provides opportunity for relationship development and spin-off initiatives 12

13 Market Analysis Payer Sources Medicare Advantage Plans Medicaid Managed Care Medicare/Medicaid (Duals) Accountable Care Organizations (original Medicare) Bundled Payment Initiatives (Hospitals & SNFs) Medicaid Managed Long-term Services and Supports Fee for Service 13

14 Quality Measures HEDIS Measures CAHPS Measures STAR Ratings Health Outcomes Survey (HOS) Washington State Common Measure Set Health Homes 14

15 Quality Improvement Metrics Length of Stay Unnecessary ED/Hospital Visits Patient Outcomes Across Multiple Settings Patient Satisfaction 15

16 Quality Improvement Activities Why are they important to Health Plans? Because expenses are allowable costs Designed to impact the triple aim Can be objectively measured and produce verifiable results Impacts consumer satisfaction with Plan 16

17 Why are they important to AAA s? Quality Improvement Activities 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 measures We have to measure and improve constantly Communicate outcomes with Plans 17

18 Determining Health Plans Quality Rankings 18

19 Tools Designed to Build Your Business Acumen Acronyms Self-Assessment Knowing Your Market Developing Service Packages Relevant websites 19

20 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 Other Key Considerations (will be covered tomorrow in Beyond the Basics 20

21 Culture Change BUILDING THE BUSINESS CASE: Community Organizations Responding to the Changing Healthcare Environment for Aging Populations 24/7 capacity Measurable outcomes/real-time data/data driven decision making Rapid cycle quality improvement Collective action System-wide change in capacity Manage resistance to change Nurture employees connect through accountability, goal setting, feedback, engagement Engage workforce in strategic thinking 21

22 Questions & Discussion 22