D6/E6: Incentive Systems for High- Performing Care Teams Tom Strong, Program Officer, The Hitachi Foundation Lisel Blash, Senior Research Analyst, UCSF Jay Brooke, Executive Director, High Plains Community Health IHI Summit - March 17, 2015 These presenters have nothing to disclose. Describe and explain a range of strategies for engaging front-line primary care team members in advancing organizational goals Design an incentive system for frontline staff such as medical assistants that Objectives will support patient care needs while also improving job satisfaction Access further tools and resources for improving team cohesion and performance. 1
Who We Are The Hitachi Foundation: An independent philanthropic nonprofit organization established by Hitachi, Ltd. in 1985 What we do: We seek to discover, demonstrate and expand business practices that both measurably improve economic opportunities for low-wealth individuals in the U.S. and enhance long term business value How we do it: Through our two signature programs 3 Today s Agenda Introductions Pioneer Employers Initiative Overview (Lisel Blash) High Plains Community Health Center Incentive Plan (Jay Brooke) Team-Based Variable Pay for Frontline Staff (Tom Strong) Fishbowl! (And open Q&A). 4 2
The Pioneer Employers Initiative (2009-2013) Employers spend far more ($164 billion) on training and development than government or philanthropy. But most of that goes towards middle- or upper- wage employees. Developing a business case for investment in the front lines. Business cases built not only on turnover/retention, but also productivity, revenue, quality, and profitability. 90 case studies illustrating that better business models can result in better jobs for lower-wealth workers in healthcare and manufacturing Case studies are diverse by size, subsector, state, urban/rural, unionization. 5 The Pioneers of Primary Care 15 case studies by UCSF Center for the Health Professions Advanced medical home models Included standalone FQHCs, multispecialty clinics, and larger integrated systems Emphasized new roles and responsibilities for medical assistants within the care team Followed by Care Team Redesign Initiative in 2015 6 3
Incentives Systems for High Performing Care Teams Institute for Healthcare Improvement March 17, 2015 2012-2015 Center for the Health Professions University of California, San Francisco www.futurehealth.ucsf.edu Hitachi Pioneer Employers Initiative 2010: Identifying organizations that are doing well and doing good Investing in frontline workforce Benefitting as a result UCSF Team Field: primary care Occupation: medical assistants 8 4
Medical Assistants (MAs) One of the fastest growing occupations in the the US* Largely female, but racially / ethnically diverse Unlicensed Variable quality education Median wage in 2012: $14.12 per hour* Q: Does Medical Assisting have to be a Dead End Job? *[BLS 2012] 9 Study Selection Criteria Organization with expanded roles for MAs in innovative models of care that: Improved patient outcomes Improved organizational efficiency & financial viability Career enhancement for MAs 10 5
15 Site Visits and Case Studies United States 11 New Roles Relational: Health Coach / CHW / Dual Role Interpreter / Patient Navigator Ambassador to communities HIT / Documentation Panel Manager / Scribe / Super-user Multi-task Rotation Medical records/ greeter / schedule / referrals / phone bank LLRT / Pharm Tech / Lab Tech / CPT / back office Leadership Supervisor, Lead, Trainer, Mentor 6
Improving MA Job Quality 40%+ 15-40% 5-15% 1-5% Up and away! Health Coaching or Leadership Step Advancement or A-la-carte Training Bonuses for quality, productivity, certification 13 It s not just the money MA Interviews--greatest satisfaction from: Being part of a team; Impacting patient care 7
So why provide incentives? Enhance retention Lower recruitment costs Retain training investment Engage MAs in new roles / responsibilities Become employer of choice and draw talent Maintain continuity of care Grow your own workforce Provide jobs and economic development to community members 15 Project Team Susan Chapman, PhD, RN Associate Professor UCSF School of Nursing Research Faculty, Center for the Health Professions susan.chapman@ucsf.edu Lisel Blash, MS, MPA Senior Research Analyst Center for the Health Professions lisel.blash@ucsf.edu http://futurehealth.ucsf.edu Catherine Dower, JD Health Policy & Law Director Center for the Health Professions Funded by the Hitachi Foundation as part of its Pioneer Employers Initiative: www.hitachifoundation.com Publications, Videos, Workbooks and More at: http://futurehealth.ucsf.edu/public/center-research/home.aspx?pid=539 16 8
15 Profiled Organizations Asian Health Services, CA Cabin Creek Health Systems, WV Central Massachusetts Community Health Center DFD Russell Medical Centers, ME Franklin Square Medical Center, MD High Plains Community Health Center, CO Kaiser Permanente Baldwin Park Medical Center, CA Northwestern Medical Group, Chicago, IL PeaceHealth s Team Fillingame, OR Southcentral Foundation, AK The Special Care Center, NJ University of Utah Community Clinics University of California, Davis Family Practice Center Union Health Center, NY WellMed, TX 17 High Plains Incentive Plan One Community Health Center s Way of Sharing the Wealth 9
Incentive Principles Provide all staff with opportunity to earn additional income It takes a village to care for a patient (Team Based Care) Needs to combine productivity and quality elements Reward needs to be shortly after effort 10
Medical Incentive Fifteen work days per month to qualify 80% based on patient visits per day 20% based on Meaningful Use Standards Provider earns $400 for 18 visits per day & $100 for hitting 15/15 MU Standards Each other team member earns $80 for productivity and $20 for MU Medical Incentive (cont.) All other medical and support staff earn $10 for each team that hits incentive levels Administrative staff earn $40 for each team earning a productivity goal and $10 for each team hitting MU goals Part-time staff earn incentive based on percent of full time worked 11
Dental Incentive Decided everybody should earn the same compensation Same 15 worked days threshold Production starts @ 315 visits per month to earn $75 Percent of Medicaid patients starts @ 25% and pays $15 w/ bumps of $5 for each 5% Quality Measure is 60% of patients completing treatment plan within six months Dental Incentive (cont.) Administrative staff earn $30 for each dental team meeting the production goal and $10 for each one meeting the treatment complete goal 12
What Does It Cost? 85 Employees $7,000,000 budget 2014 -$238,471 + benefits Approximately $250,000 Team-based Variable Pay for Frontline Staff March 17, 2015 Presented by: Tom Strong, Senior Program Officer The Hitachi Foundation 13
Traditional Concepts of Variable Pay Commissions Annual Bonuses Executive Compensation Meant to drive sales Individualized Highly competitive Meant to reward good performance Individualized Usually based on annual review Meant to align management with ownership Stock-based (usually with options) Limited to highest tiers of company 27 Two Portraits of Broad-Based Performance Pay 28 14
Features of Effective Team Bonus Programs Overarching goal is to align incentives Serves business needs - pays for itself Transparency/Line of sight Team payouts Open-ended vs. project-based payouts Law of Unintended Consequences In other words ownership thinking! 29 Serving business needs Any effective bonus/gainsharing program ultimately needs to pay for itself. This means basing it on metrics that serve a clear business need a critical number Bonuses should be tied to surpassing a target benchmark (gainsharing) rather than baseline improvement (profitsharing) 30 15
Transparency/Line of Sight Path to bonuses need to be transparent: Targets must be understandable from a lay employee s perspective Targets must tie out clearly to employee and/or teams daily activities Targets need to be achievable! Payouts should be frequent enough that positive results are reinforced and negative results can be corrected quickly. 31 Team vs. Individual Payouts Individual payouts are historically far more widespread (i.e. commissions, year-end bonuses). But if your goal is to foster team-based care, then targets and payouts need to support teamwork. Free riders are best addressed as part of team management. 32 16
Project-Based Bonuses (Minigames) There is no rule that bonus programs have to be open-ended! Minigamesare short-term activities designed to correct a weakness or pursue an opportunity in the company. Can be combined with a pilot and/or PDSA. Like any game, should have a goal, a timeframe for play, a scoreboard, and a reward for winning For far more information, see The Great Game of Business. 33 Mind The Law of Unintended Consequences When you subsidize something, you will get more of it! Choosing key targets always needs to be a balanced affair Use counterbalancing metrics (either at same time or in rotation) to manage risk Integrated Packaging Corporation: SWEAR (Safety, Waste, Efficiency, Absenteeism, Returns) 34 17
Further Reading The Citizen s Share Kruse, D; Freeman, R; and Blasi, J. The Great Game of Business Stack, J. A Lapsed Anarchists Guide to Leadership Weinzweig, A. Team Based Rewards: Current Empirical Evidence & Directions for Future Research DeMatteo, J; Eby, L; and Sundstrom, E. Ownership Thinking Hams, B. 35 And a Few Case Studies Marlin Steel Optimax Systems Integrated Packaging Corporation NewAge Industries Roll Forming Corporation High Plains Community Health Center Kaiser Baldwin Park All available at: http://www.hitachifoundation.org/ourwork/good-companies-at-work/pioneer-employers 36 18
Thank you. The Hitachi Foundation tstrong@hitachifoundation.org 37 19