This executive web forum was delivered on May 13, 2021, by Ashley Gibson Director Of Payer Relations, Contracts & Utilization, Hazelden Betty Ford Foundation and Donna Esposito, Director of Payer Relations, THRIVE DETECT, who shared their advice on how to negotiate, design, and implement a successful VBR relationship with a health plan.
In an unfamiliar environment, the leader with the best data has a distinct advantage. That is a frequently heard adage, but I was really struck by the concept at one of our OPEN MINDS Executive Leadership Retreats. The historian talked about how Robert E. Lee’s strategy at Gettysburg was compromised when his cavalry (the advanced surveillance unit of its time) was waylaid.
While leaders know that the right information allows better decisionmaking, in a recent survey, 67% of U.S. corporate executives say they are not comfortable accessing or using data from their tools and resources. And . . .
Sexual harassment in the workplace has been a much-discussed topic in recent years — the #MeToo social media movement and the mass media covering the many celebrities, politicians, and business leaders who have been accused of harassment. In an effort to support clients who have been the victims of sexual harassment, attendees of this presentation will learn the legal definition of sexual harassment, its various forms, and related legal factors. Learn the laws in place that protect victims and how to empower clients who are experiencing harassment to advocate for themselves. Participants will learn treatment implications and approaches for addressing trauma and other symptomatology related to harassment. Join Joyce Marter, MA, LCPC as she discusses working with clients who are experiencing sexual harassment in the workplace.
Behavioral Health Leaders Combine to Provide Best-in-Class Technology and Services
Nashville, TN and Rockville, MD (August 24, 2020) – Warburg Pincus, a leading global private equity firm focused on growth investing, and Martis Capital, a private equity firm focused exclusively on the healthcare sector, have agreed to merge their respective portfolio companies, Qualifacts and Credible Behavioral Health. The combination of these best-in-class technology companies will elevate the experience of behavioral health and human service providers while positioning the combined company for continued innovation and thought leadership in the market.
The company will be led by David Klements, CEO of Qualifacts. Matthew Dorman, CEO of Credible, will continue as a strategic advisor to the company.
“Qualifacts and Credible are highly regarded in the behavioral health software industry. This transformational merger will deliver more value to the behavioral health customers we serve while creating outstanding opportunities for our employees. Both companies share a mission-driven culture and a commitment to operational excellence. I look forward to leveraging best practices as we continue to grow as one firm,” said Mr. Klements.
Combined, the company serves more than 800 behavioral health agencies nationwide, significantly increasing the scale and scope of its products and capabilities.
“We have long admired the strength and capabilities of the Credible platform and are excited by the significant opportunities that will result from this groundbreaking merger,” said Andrew Park, Managing Director, Warburg Pincus. “We look forward to our partnership and to supporting the combined company in its next phase of growth and innovation,” added Amr Kronfol, Managing Director, Warburg Pincus.
“We are excited to bring together two leading providers of software services to the behavioral health market, and are looking forward to partnering with Qualifacts, its management team, and Warburg Pincus to support the development and delivery of mission-critical technology to the industry,” said Shahab Vagefi, Partner, Martis Capital.
Qualifacts is one of the most trusted technology providers of Electronic Health Records (EHR) for behavioral health and human services organizations. As a strategic partner, Qualifacts and its EHR platform, CareLogic®, helps customers focus on what is most important – client care – by optimizing efficiency and productivity while also keeping them ahead of the ever-changing regulatory landscape. For more information, visit www.qualifacts.com.
About Credible Behavioral Health, Inc.
With over 20 years of innovation and experience, Credible is committed to improving the quality of care and lives in behavioral health for clients, families, providers, and management. Since its founding in June 2000, Credible has Partnered with over 475 Partner Agencies in 38 states. Credible is proud to provide secure, proven, easy-to-use, web-based software for clinic, community, residential, and mobile care providers leveraging a true Partnership approach. www.credibleinc.com.
About Warburg Pincus
Warburg Pincus LLC is a leading global private equity firm focused on growth investing. The firm has more than $53 billion in private equity assets under management. The firm’s active portfolio of more than 185 companies is highly diversified by stage, sector, and geography. Warburg Pincus is an experienced partner to management teams seeking to build durable companies with sustainable value. Founded in 1966, Warburg Pincus has raised 19 private equity funds, which have invested more than $84 billion in over 900 companies in more than 40 countries. Since inception, the firm has invested more than $10 billion in more than 150 healthcare companies and over $17 billion in more than 320 technology companies. The intersection of these two sectors is a key area of focus for the firm with the current portfolio including WebPT, Modernizing Medicine, Intelligent Medical Objects, Experity, Helix, and SOC Telemedicine. The firm is headquartered in New York with offices in Amsterdam, Beijing, Berlin, Hong Kong, Houston, London, Luxembourg, Mumbai, Mauritius, San Francisco, São Paulo, Shanghai, and Singapore. For more information please visit www.warburgpincus.com.
About Martis Capital
Martis Capital is a private equity firm focused exclusively on the healthcare industry. The Martis team manages more than $1.2 billion of equity capital and is currently investing out of its third fund. With offices in San Francisco, CA, and Washington, DC, Martis seeks to invest in middle market growth companies that provide innovative and cost-effective products and services within targeted segments of the North American healthcare services and information technology sub-sectors. For more information please visit www.martiscapital.com.
So much discussion of canoes these days—and I love water analogies. Until 12 weeks ago, executives of specialty provider organizations had to balance “two canoes”—operating in a fee-for-service (FFS) or cost-based environment, with operating in a wide array of emerging performance-based and value-based reimbursement (VBR) models. But with the pandemic crisis, another layer of complexity has been added—surviving through the crisis while developing a sustainable (and innovative) post-crisis recovery strategy. This is a situation more akin to controlling four canoes.
A common question from executive teams is whether to temporarily shelve the plans for alternative payment models during this crisis period. My answer is two-fold. Certainly, putting a crisis management financial survival plan is a first-order priority. This means grappling with cash flow, maximizing revenue as much as possible, determining a temporary break-even, and reducing expenses to match. These crisis management financial survival plans are the reason we see continuing announcements of layoffs and furloughs in the press (just this week, Allstate To Layoff “Thousands” Of Staff and Hilton Cuts Nearly A Quarter Of Its Corporate Workforce: Will It Regret The Deep Layoffs?).
But I would argue that for most provider organizations, being able to accept more VBR, with more financial risk, will likely be part of any recovery plan. As of our last survey (in March 2020), about 74% of primary care organizations and 61% of behavioral health organizations are participating in some form of VBR, and 16% of those organizations have 20% or more of their revenue in this type of contract. If the prognostications of health plan executives we’ve recently interviewed are any indication (see Finding Opportunity In Adversity: Leadership Lessons From The COVID-19 Crisis), this will likely increase in the post-crisis period.
With that in mind, the discussion during The 2020 OPEN MINDS Strategy & Innovation Institute session, One Foot In Two Canoes: Managing Service Lines For Value-Based Reimbursement & Fee-For-Service At The Same Time!, provided some great insights into navigating the transition to VBR. The session featured Friendship Community Care’s Chief Executive Officer Cindy Mahan, and Executive Vice President of Strategy and Planning, Craig Cloud; as well as Centerstone’s Vice President of Quality, M. Brad Nunn, Ph.D., and Director of Healthcare Innovation, Mandi Ryan, and was moderated by my colleague and OPEN MINDS Senior Associate, Joe Naughton-Travers.
Dr. Nunn and Ms. Ryan presented Centerstone’s work with the Tennessee Health Care Innovation Initiative Strategy (see TennCare’s Delivery System Transformation Shows Savings & Improved Outcomes), which includes patient-centered medical homes (PCMH); health homes for severe and persistent mental illness; reimbursement using episodes of care; and quality and acuity adjusted payments for long-term services and supports (LTSS). The payment structure includes case rate payments for health home services and financial incentives for high-performing provider organizations. It also includes episodes of care payments (two of 48 diagnoses are behavioral health) based on a FFS model with penalties for high costs and gainsharing payments if costs are kept below a threshold.
Friendship Community Care is participating in the Arkansas Medicaid initiative—“Provider-Led Arkansas Shared Savings Entities” (PASSEs). These are “organized care” models that are at risk for all services (physical health care services, behavioral health services, and specialized home- and community-based services) for approximately 40,000 individuals who have intensive levels of treatment or care due to mental illness, addiction, or intellectual/developmental disabilities (see Arkansas Medicaid To Launch Full-Risk Phase Of Medicaid Shared Savings Program In March 2019). In this model, provider organization/health plan collaboratives assume the financial risk.
So, what should executives leading the shift toward VBR—while managing FFS reimbursements at the same time—be doing to keeping both canoes on course? I would suggest focusing on three areas—staff skills and training, system integration and data management, and financial performance. And while things are moving rapidly, and the crisis is shifting timelines for the transition, it is important not to rush, advised our speakers. Stop and do things right, because the transition demands care and dexterity.
Staffing: Whether it’s FFS or VBR, clinical professionals are providing the same type and level of care with the goal of helping consumers get better. But it is managers who need to have two diametrically opposite perspectives. Can one person really manage two antithetical programs—one based on service volume and the other based on the right outcomes with less volume? Can they “switch from a left brain to right brain approach,” as Mr. Naughton-Travers put it? What we may need is two different managers to paddle the two canoes. And staff across the organization who have operated in a traditional FFS model will need to be trained in the new norms of VBR, and will need a clear understanding of expected outcomes.
Systems and data: Provider organizations collect a large volume of data but that usually happens in silos. If all systems are integrated (for example, if the electronic health records are integrated with the enterprise resource planning system) and you invest in staff skilled at business analytics—as both Friendship Community Care and Centerstone have done—executives will have the data they need to continuously monitor the variables for both FFS (productivity) and VBR (impact). Further, policies and procedures to manage each payment stream must be clearly laid out and shared with all staff.
Financial performance: Balancing both canoes requires a laser focus on financial performance. Revenue cycling is critical as Ms. Mahan pointed out. Concurrent clinical documentation is key so billing can happen quickly and accurately. Billing staff must have experience in both types of billing and have access to the data that payers expect.
The pandemic crisis already calls for some exceptional navigation skills to steer through extreme market turbulence. Having one foot in the FFS canoe and the other in VBR makes it more precarious than ever before. But health plans and payers have told us that VBR is gaining traction and we can’t ignore the future even as we manage the present.
For more on leadership in a time of crisis, check out these resources from The OPEN MINDS Circle Library:
A data-driven organization is one that can analyze the trends of the past, successfully navigate the present, and anticipate the future. Determining what data to collect is a critical component of this success, and, just as importantly, how to display and share it. More and more, this kind of data is being organized into electronic dashboards.
A flexible dashboard is critical to an organization’s sustainability, especially during times of uncertainty and disruption. Gathering all of the necessary data and converting it into something useful is a challenging and time consuming task. Which data needs to be collected? What systems will supply the data? Who is responsible for each? Do the systems talk to each other? And finally: Is there a system already in place that can do all or most of what is needed to create a useful dashboard?
The answer to that last question is often an electronic health record (EHR). An EHR that consolidates data from disparate systems and can display the information as a visual and easy-to-understand dashboard is a critical tool that more and more organizations will need in order to succeed.
Why use dashboards?
Every organization’s needs are different, but dashboards have a commonality that aligns with most leadership planning, regardless of the sphere in which a company operates, and are critical to:
Strategy: capturing priorities, their metrics, as well as planning and forecasting
Performance: how is your staff performing? Are your managers and supervisors basing feedback to staff on results-focused data?
Finance: is your money going where you think it does? If not, does your data tell you why?
Organizational strategy is crucial, especially in times of turmoil. Just as crucial is that the strategy has clearly defined what measures should be tracked by an executive team. Key performance measures (KPIs), tied to payer contracts, vendor agreements, and other revenue generating objectives should be outlined so that the data is captured to ensure that requirements are being met (See From Metrics To Action—Making Strategy A Reality).
Performance measures should be tied to an organization’s strategic plan and goals, with clearly defined KPIs. To better manage staff performance, your EHR will need to capture productivity data and have the ability to create a dashboard for managers to easily and regularly review. This ensures that good performance is rewarded quickly or subpar performance corrected in a timely manner, with solid reasoning behind the decisions and feedback.
Managers should be trained on how to use metrics-based measurements to better gauge both staff and departmental performance. Many organizations already do this to some degree, but creating a consistent training methodology can take what is often a haphazard approach to the next level. “What gets measured gets done,” as the saying goes. Providing supervisors with metrics by which to manage their teams – and holding them accountable for results – is the next step in the process of making your organization data driven. Focus will need to shift from completion of tasks to the achievement of outcomes and goals.
Strategic performance should also tie into an organization’s financial picture in order to gauge how well various business lines are doing and how they affect overall financial health. Dashboards that track strategy and performance goals are best suited to determine how both are affecting the financial picture, including:
• Payer contracts and their requirements
Organization budgets by business line
How well an organization is – or is not – meeting regulatory requirements
Forecasts and trends in the industry and organizationally
Leadership teams must agree on which KPIs will be developed and monitored to insure that of these are all being met.
How do you build and utilize a dashboard?
If having a dashboard is this important, how should an organization build one? Organizations with a fully integrated EHR already have an advantage over those that don’t, as most EHRs are able to acquire and display data from multiple external systems. These EHRs, at a minimum, need the capacity to:
Additionally, the process of developing dashboards should be clearly defined. Dashboards with immediate value and more accessible data should be implemented first. Prioritizing the most useful data is the key to obtaining a positive return on investment (ROI). Keep the adage “nice to know versus need to know” handy when performing prioritization exercises.
The simpler dashboards, once in place and in use, can be followed by more complex dashboards that require more implementation time to get up and running. KPIs should be prioritized that are tied to strategic plans, contracts, clinical outcomes, and finances.
Executive teams and managers will need dashboards to track KPIs for:
• Financial perspectives to help identify high-level measures for executive teams to monitor
Customer performance to ensure ongoing client satisfaction
Organizational innovation to call out areas that are possible growth and expansion opportunities
Will the pandemic change your use of dashboards in the future?
With COVID-19, the need for an EHR and a powerful dashboard has only increased in importance. Researchers have developed COVID-19 dashboards to integrate into EHRs in order to capture data about potential hotspots and aid in rapid decision-making (See 3 Ways Providers Use EHRs to Treat COVID-19 Patients). And as telehealth becomes a critical way for providers to deliver services, dashboards that can capture new outcome and reporting data for virtual care delivery will only grow in importance.
EHRs will need to integrate new or customized workflows to ease the transition to virtual care for providers and patients. They will need to show outcomes to those payer organizations that are implementing new measures and looking to see how telehealth impacts patients. These measurements are vital to ensuring maximum reimbursements.
The ability to manage value-based payments is also important, as the pandemic has caused many organizations to change processes and workflows, which means new data needs to be emphasized or tracked. It is important that organizations can prove value to payers through metrics on processes and outcomes, and a well-built dashboard gives you the ability to verify that you are collecting that data and that it is readily available (See Using Data To Follow The Money & Stay True To The Mission).
As the pandemic changes the way that services are delivered, organizations will continue to adapt. But how to adapt, how to judge what is working, what needs to be cast aside, how to prepare for an uncertain future, and how to prove value and streamline new processes, calls for a vast amount of decision-making – decision-making that should be guided by data. Dashboards that are flexible enough to gather a wide range of data from multiple legacy systems and display the aggregate of that data in ways that are meaningful and impactful is a critical tool that your EHR should provide. Organizations without this capability should be looking to acquire it.
Dashboards are critical for health and human services organizations to effectively use data to manage organizational performance, track metrics to ensure success with value-based contracts, identify wasteful spending patterns, and quickly address performance issues.
To learn more about best practices in utilizing dashboards we interviewed Bob Shueey, Operations Director and Corporate Compliance Officer for South Central Behavioral Services (SCBS). SCBS is a nonprofit community behavioral health agency located in Nebraska, which provides a continuum of services for persons with serious and persistent mental illness (SPMI). SCBS is often the provider of last resort for many of these individuals, utilizing a sliding fee scale in order to accommodate as many income levels as possible. They also provide outpatient mental health and substance use services for non-SPMI adults, children, and families. SCBS services ten counties in rural Nebraska and much of what they provide is community-based.
SCBS brought a number of strengths to the development of dashboards. The organization’s leadership has a data-driven culture, starting with Susan Henrie, the CEO, whose approach to decision making is, “Bring me data, not anecdotes.”
Mr. Shueey’s educational background includes two years in computer programming, which has been a good complement to his other education in human services and experience at SCBS. His background allowed him to develop his own reports when he realized a need for more data. He is now very involved in SCBS business intelligence (BI) report development.
Mr. Shueey began working with SCBS in a direct care role in 2005, operating in a variety of roles before becoming the Director of Rehabilitation Services. For the past six years he has been the SCBS Operations Director and Corporate Compliance Officer. In this position he works with clinical and administrative managers and directors to most effectively operationalize day-to-day business processes, including helping to integrate services into the IT system. He meets with the clinical and administrative Directors on a weekly basis, with ad hoc meetings scheduled as needed. He also serves as Treasurer and a member of the Executive Board for the Nebraska Association of Behavioral Health Organizations.
Mr. Shueey stated that “dashboards are a critical component of operations at SCBS.” The process of developing them began approximately five years ago. SCBS requires an on-going update of its client assessment (Treatment Outcome Package – TOP) for all clients, so ensuring this task was being completed within established timeframes was very important. This was very challenging at that time, with approximately only 30% of all needed updates completed within the required due dates. So the decision was made to develop an audit tool that would track compliance.
When looking at how to build this tool, it became clear to Mr. Shueey and other leaders that, “it was most important that the tool would remind staff when an update was due, rather than just track staff compliance with meeting due dates.” The first dashboard was designed to let the Front Desk staff know if any clients being seen that day needed to have a TOP update completed that day as well. This began their journey of developing and implementing dashboards.
In Mr. Shueey’s role as Corporate Compliance Officer, he would audit charts to ensure documentation was complete and met requirements. Now he has a complete compliance dashboard that lets him know if any documentation requirements have not been met.
For example, one compliance requirement is the completion of client signatures. SCBS had processes in place to ensure that this requirement was being met, but there were challenges, such as mailing documentation that required signatures for clients with guardians and then following up to ensure that the documentation was returned. A dashboard was developed, and whenever a service was completed the dashboard was immediately updated, including the status of required signatures. Mr. Shueey now receives daily alerts about documentation that is not meeting compliance needs and can immediately email the therapist to address identified issues. The reports also lets him know about staff who are having on-going compliance issues.
This dashboard has saved significant time for Mr. Shueey. Previously he had to check a number of different data sources and then send follow up with emails to staff – a process that often took several hours, as compared to the current process which takes about three minutes a day. The dashboard draws from 14 reports, which allows a much more thorough review of compliance adherence. According to Mr. Shueey, “SCBS used to routinely have about 700 records that were out of compliance for a variety of reasons at any one time. Now there are rarely more than 30 records concurrently out of compliance.”
After the success of the compliance dashboard, SCBS then began to develop others for Clinical Directors. Another compliance requirement is the completion of client signatures to the treatment plan. Each Director now has their own dashboard that provides alerts when treatment plan are updated, along with a link to that client’s chart, so that the Director can review and sign off on documentation after ensuring all signatures are in place.
There a number of other SCBS dashboards currently in use:
The Front Staff dashboards now provide the TOP report information described above, along with the status of client fee collection balances. This has greatly improved collections for SCBS.
If a therapist wants to send client records to any provider, the therapist can note this in the client record and an alert is sent to support staff’s dashboard.
Any time an adverse incident occurs, an alert is sent to the Health and Safety Coordinator’s dashboard for follow up as needed.
IT uses a dashboard to track task requests by type.
According to Mr. Shueey, “The previous SCBS EHR was very rigid” – there was a list of available reports, but few options to create customized reports. The current EHR business intelligence module allows dashboards to be customized to best suit the needs of end users. All dashboards are also providing “real time” information – rather than generating reports based on data from a month ago. As he stated, “The goal is to get timely information to a person who needs it, when they need it.”
For example, if a dashboard identifies a client chart that needs to be updated, the clinician can click a hyperlink in the dashboard compliance report to connect to the client’s chart and make the needed update immediately.
But challenges remain. As Mr. Shueey stated, “There can be gaps between what users want, and what the system can actually do.” There have also been problems in developing reports that stem from unclear user requests, not identifying the needed data or its source, and not properly defining the collection process for that data.
As an example, SCBS developed an initiative to track A1C data for clients receiving psychotropic medications. SCBS learned that a timestamp had to be included along with the test results for the data to be meaningful – so therapists know exactly when the test was administered.
Mr. Shueey discussed future data needs for SCBS. He stated that Nebraska is exploring the utilization of more value-based reimbursement models for Medicaid. SCBS has experience working with a value-based reimbursement payment model for ACT services. Specifically, they tracked inpatient utilization. They are hopeful this experience can be built upon if and when more value-based reimbursement models are utilized for other Medicaid behavioral health services.
Like many providers, SCBS, moved rapidly to providing services remotely during the pandemic. Existing dashboards may need on-going modification with the increased usage of digital service delivery.
Mr. Shueey had some advice for other providers who are looking to create and/or improve their current dashboards. He stated that many providers are constrained by their current EHR, which often are restricted to a small set of standardized reports with limited capabilities for customization.
Ask yourself this question: does your current EHR support the development of useful, customizable, and readily accessible real time dashboards that end users can directly access? If the answer is no, you may want to consider options sooner rather than later.
He also stated that, “Dashboards are not only for the C-Suite. They should provide data to make it easier for all staff to do their jobs. If everyone has access to data, then it is possible to create a culture of accountability in the organization.” Actionable Business Intelligence will be a requirement for any organization that wants to succeed in the future.
One key tool for executive teams planning for recovery after this crisis period is having the metrics to make the right decisions. I tend to think of this data in three domains. There is financial data for short-term cash management strategy. There is strategic market information for planning long-term post-recovery strategy (this includes both external and internal data). And there is service performance data to optimize value.
We got a great example of the last—service performance data—in the presentation, Measurable Client Outcomes – A Provider’s Journey Continues, by Scott Zeiter, executive vice president and chief operating officer, and Jeremy Ulderich, director of educational consulting at Grafton Integrated Health Network last week at The 2020 OPEN MINDS Strategy & Innovation Institute. Grafton has implemented a sophisticated approach to providing measurement-based care (MBC) in their programming for consumers with complex behavioral challenges. The program started over a year ago (for more on their program launch, see Implementing Measurement-Based Care—From Idea To Action). Their presentation focused on what they have learned after fully implementing the MBC service model.
The model is based on a five-step process—identify the consumer behaviors that are problematic and need to change; develop a goal for behavior change; select an “intervention” (from an empirically-based list of practice options); develop a plan for integrating the intervention into a consumer care plan; and measure the effectiveness of the intervention. This sounds simple but is a complicated undertaking to determine what interventions are most effective in specific consumer groups. Mr. Zeiter explained, “We needed to come up with a response to value-based contracting. Defining value is difficult. We needed to take a step ahead of the external stakeholders. That has had a positive impact, and the payers have taken an interest in it, as a way to define true value. We wanted to root this into evidence-based practices.”
What were the key effects of this process at Grafton? Mr. Ulderich shared a few stats, showing that in their Assessment of Basic Language and Learning Skills, the overall consumer score increased from an average of 318.05 to an average of 545.62—up to 80% growth from prior assessment. And in the Assessment of Functional Living Skills Criterion, there was a 32% increase in overall consumer scores. Mr. Zeiter noted the success, saying, “Once we gave the staff that tool, it was incredibly effective, and the staff felt tremendously empowered. The message we wanted to give the staff at Grafton was, we are going to give you control of the data. It is going to emanate from you. We are going to give you that and give you the roadmap we are following in hopes that you will help us follow it.”
There were three big takeaways from the session—the importance of the tech infrastructure; the challenges of a shift in clinical culture to embrace MBC; and the possible strategic advantages of MBC in a market moving to value. The tech infrastructure discussion was interesting. The keys to success are the combination of access to “big data,” the ability to automate the compilation and reporting of that data, and the ability to customize dashboard views for Grafton teams.
Mr. Zeiter and Mr. Ulderich explained that this reveals the true promise in their work, to allow specialists to correlate variables like demographics, diagnoses, frequencies of concerning behavior, and evidence-based practices, to determine what factors were more effective in determining outcomes. The key is to begin “gathering the data pile.” Mr. Zeiter explained, “Historically we were concerned about precision when we talked about testing things. When you look at Silicon Valley, they are now less interested in precision and more interested in gathering as much as possible and then weeding through it to determine the correlations.”
And after you get the “data pile,” the key is automating the data collection and the production of customized dashboards for end users. Grafton is currently running 65 different reports to support its programs and has the potential to run as many reports as needed. Mr. Zeiter explained, “With the information, we can dashboard anything, but we are just scratching the surface of all the data we are collecting. At this point we have immediate access to data and can use it for a variety of reasons.”
But beyond getting the technology right, there is the challenge of creating a metrics-based culture, particularly among direct care staff and clinical professionals. It takes time to change the culture. As Mr. Zeiter noted, “There are many clinicians clearly still focused on relationships and process but that doesn’t exclude their interest in the data. They want to see the concrete impact of their interventions.” But it takes a lot of administrative time to ensure staff are using the tools correctly and staying on point with the treatment goals. Mr. Zeiter added, “Constantly having to follow behind to ensure the treatment goals are updated has been very work intensive. They need constant supervision.”
Most exciting was the Grafton view of the role of this information in their future strategy. Mr. Zeiter noted that by the end of this month, they will develop a data set with integration of all of their operating databases. The purpose is to use the assessment data, the behavior data, and the goal mastery to start to identify the factors that can predict the cost of care.
In 2021, health and human service budgets are going to be stressed—and all payers will be looking to get more “value” for their expenditures. The ability to tie services to outcomes and to cost will be a key competitive advantage.
Hello from day two of The 2020 OPEN MINDS Strategy & Innovation Institute. This year, what has been top of mind for many executives attending the Institute is how to adapt your strategy in the current crisis—and how to use innovation to succeed in an altered health and human service landscape.
But one question keeps coming up—where do “value” and “value-based” reimbursement fit in all of this? I think the looming budget deficits will make all payers focus more on the value of what they get for the money spent on beneficiaries. These deficits would also likely propel more use of managed care by Medicaid and Medicare—and more value-based reimbursement that includes more financial risk to provider organizations. My initial thinking about what likely lies ahead was confirmed by Charles Ingoglia, the chief executive officer for the National Council for Behavioral Health, in our panel discussion, Navigating The New Normal With COVID-19 Part 2: An Update On Sustainable Strategies For The Disrupted Market, with David Klements, president and chief executive officer of Qualifacts System and Jon Wolf, president and chief executive officer of Pyramid Healthcare.
How do executives demonstrate the value of their service lines and use their performance data to establish a competitive advantage? How do they leverage that data to get more and better contracts with health plans and other payers? That was the focus of yesterday’s session, Demonstrating Organizational Value To Gain A Competitive Advantage, which featured Joe F. Rutherford, chief executive officer of Gracepoint; and Nicole Lawson, Ph.D., deputy executive director and chief operating officer at Oakland Community Health Network (OCHN).
My big picture takeaway from their comments? Provider organization executive teams need to become experts at “demonstrating” their value as a method for landing new business. They need to understand what data the health plans are looking for; to gather that data and manage their operations to improve that performance; to know the performance of their competitors; and to communicate those performance differences to health plan executives.
Mr. Rutherford spoke from his experience at Gracepoint, which developed a medically integrated collaboration with a local Tampa-area hospital to target psychiatric consumers who were using emergency departments (ED) frequently, at an average cost of $2,032 per visit. With this program, Gracepoint was able to reduce avoidable ED readmissions by 51% and the time it took to cycle through the ED by 57%.
Dr. Lawson presented the payer perspective. OCHN is a managed Medicaid behavioral health organization responsible for Oakland County, Michigan. They have a broad provider network and have developed 15 different value-based models for provider contracting, including bundled rates, monthly case rates, capitated approaches, and fee-based payments with incentives. One example is a value-based arrangement for employment services with the desired outcome of increasing the number of working age adults in integrated employment at competitive wage rates. OCHN pays incentives for achieving specific performance targets.
How do executive teams use performance data to get new and better contracts? Our speakers suggested six steps.
Be strategic—Provider organization executives need to look a couple of years ahead and choose a strategy to demonstrate value that will (eventually) position them for revenue growth either through affiliations or additional contracted services. What organizations do you plan to communicate your “better value” to? What performance measures are important to those organizations and their managers? Those are the important questions.
Be consumer-focused—Being consumer-focused is essential for success not only for increasing consumer referrals, but also for gaining traction with preferred health contracts. Some of the common measures of consumer performance include Net Promoter Score and measures of consumer engagement. Good performance on these measures demonstrates a commitment to a person-centered planning process, evidence-based practices, and consumer engagement. Dr. Lawson explained, “Quite simply, a ‘provider-of-choice’ is person focused. When these critical elements of a collaborative service network exist, product, promotion, and price naturally fall in place.”
Be prepared to go “at risk”—Most payers are skeptical of performance data. To demonstrate your confidence in your data, be prepared to assume some financial risk based on your data. Mr. Rutherford noted that when he started this new service, “I rolled the dice on this, in all honesty. We wanted to have it documented that this would work, and we did offer it free of charge. Now they pay our expenses plus some administrative savings.”
Start small—It takes data to succeed, but not too much all at once. Select a limited number of performance measures to start and expand over time. This will allow your program experience and your relationship with your payers to drive the process. (For more on a best practice model for becoming a data-driven organization, see my presentation with Relias’ Carol Clayton, Ph.D., Making Tough Decisions In Turbulent Times: 12 Steps To Creating Your Data-Driven Organization.)
Communicate—Communicate early and communicate often about your performance with the target customers, both payers and consumers. One mistake that executive teams commonly make is to assume that your stakeholders know about, and understand, your great performance difference. Think about communicating this information using white papers, industry presentations, social media, consumer group meetings, local market press releases, and your web site. These are just a few channels to consider.
Be persistent and prepared to pivot—Demonstrating value is a moving target. As new competitors enter the market, management teams need to be prepared to constantly improve their processes and practices to be “best in class.” This requires persistence and the ability to continually modify both your service solutions and your relationships with partners (either other provider organizations or payers). Dr. Lawson explained, “Failing forward is still progress. Be willing to start and know you will have to make changes as you learn and progress.”
In the post-crisis era, market advantage will go to the provider organizations that can demonstrate the “value” (the performance metrics versus the cost) of their services. This needs to be an integral part of strategy and will require innovative thinking to meet complex multi-stakeholder needs in a market with increasing competition for consumer services. I am reminded of the words of Philip Kotler, the marketing consultant—“There is only one winning strategy. It is to carefully define the target market and direct a superior offering to that target market.”
For more on health plan relationships, check out these resources from The OPEN MINDS Industry Library:
For more on the innovations, as well as the strategies, that are leading provider organizations through one of the most trying times in recent memory, stay tuned all week as we discuss strategy for specialty provider organization management. You can follow us on twitter @openmindscircle#OMstrategy.
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