Using the tools in CEO Checklist (ATTACHED) how would you brief management in your assessment of the organization under those principles? 

You have been chosen as the consultant group to assess the organization’s readiness to perform in a high value care environment (better care, lower cost). Using the tools in CEO Checklist (ATTACHED) how would you brief management in your assessment of the organization under those principles?

Interview key stakeholders in the organization to gain information and categorize in the subsection provided in the checklist (ATTACHED).

Two Pages (one for each element)

Please focus on these two elements as these are my sections to complete!

1)  Governance priority—visible and determined leadership by CEO and Board (one page)

2)  Culture of continuous improvement—commitment to ongoing, real-time learning (one page)

Thanks!

Interview with Steven Bullock, Deputy Director of Operations

Governance:

1. We do not have it, no baseline for level of improvement. By establishing a baseline, we know where we need to improve.

2. The board of directors should have input on the metrics that we used to evaluated staff and improvement.

3. Board priorities and strategies are aligned with our strategic plan. Executive coordinator will take notes. Would address in leadership meetings, then would go down to directors to chime in on solution-based ideas. Overall strategic plan is sent out to all staff.

Culture of CQI

1. Missing the mark there, we talk about training but don’t support it in the way that it needs to be supported. We hire people with a skill set but they also need additional training once they get into our line of work. Create project to work on that allows them to be critical thinkers and make better decisions. It gives them confidence to improve in their work processes. We mentor them and allow them to make mistakes, its an opportunity as a learning experience.

Resource.

3.Appropraite budget, when you understand what everyone needs then you find vendors.

Talking to clinicians that are not IT saving- need to have people that understand those two pieces to design something that we need. When you have compliant issues and it is around funding issues. When you don’t have funding then you would go away

Target Services

1. Targeted individuals by the ECL

2. Admin and Planning- training outcomes. Can complete work within 11 days.

Fully integrated managed care at DESC

Having systems that work well together- having roles and responsibilities, capacity to serve them. All care providers need to be at the same table. The funding sources need to mold together. Housing and clinical dollar are there but every system is in their own worlds. Breaking the barriers of the funding.

Harborview- One hand doesn’t know what the other partners are doing.

How does this combat silos- If we are able to combat the privacy issues, have a care conferencing between partners.

Interview w/Kate Baber 7/25/19

EBP

1. Opioid prescribing have guidelines but no protocol development. A few gaps in the consistency with SMI.

Resource Utilization-

1. Some use of empanelment as it relates to tier levels and long acting injection. Clinical team uses those to guide service intensity.

2. Population heath tools with risk stratification, empanelment, and registries. Collective Medical will allow us to see information on high utilizers. Activate clinical workflows to activate efficient and quick follow up.

Integrate Care

1. Protocols are expectations on when to follow up with people on when to follow up with people who to follow up with after ed, hospitalization, jail. What is the care plan protocol what is the communication expectation to the external care providers. First 6 months of collective to get the nuts and bolts=- having the empanelment of risk stratification and empanelment together to clearly identify clients. Depending on the program and intensity having the follow up be based on the client need. Tighten up expectation of documentation internal and both externally.

2. Our strength is holistic teams- having regular team meetings and care conferencing is important. Seamless communication so the client is not frustrated and getting what they need. Warm hand offs. Externally it is harder to identify who the provider is. Trying to get providers on the same page both externally with internal provider is hard makes medication reconciliation hard.

Shared Decision making

1. Collective Medical, Integrated Care Plans special since housing providers are involved.

The system has a lot to learn from us as we integrate social determinants of health into care. Really redefining whole person. What is the tool to bridge the gap between disparate systems.

2. Can’t speak directly to this it is hard to get clts directly involved in their care. Striving for it in the case manager and CSS level, OTN project has a care navigator role is to engage the client in the care plan. Our use of peer service providers at DESC. PeerPathFinder.

Internal Transparence.

1. Deciding what you are going to measure and figuring out what points in time you are going to modify data. Running reports for a feedback loop. Training staff on data entry so that data is there. Having a base line and periodically measuring. Getting community-based metrics.

2. Go back to collective to perform and gain HH incentive payments. GPRA data is going into effect this fall measuring rates of follow up. OTN.

3. Billable hour improvement with the SAGE program. The issue of folks not meeting service intensity per week. How do we help and encourage people. Implementing case managers get feedback, supervisors have support in that feedback process-coaching-barriers or training. Loop back after time goes by to determine progress reports. Monthly service intensity.

Culture of CQI

4. Goal is to reduce hospital admission and unnecessary hospitalization. Improve response time and workflows to determine what we need to be assessing them for. Are they going to the ED for PCP needs or do they need a mini crisis plan. Collective medical having access to be able to see that information which is available through limited information. Would measure by program initially. Larger programs in a stratified way by tiers of intensity. Is there difference between teams or case managers. Monthly lookbacks.

IT Best Practices.

Evidence Base Protocols

2 Collective Medical – in implementation phase with small programs. Right now the platform and notification is not plugged into our EHR. Providers are charting in our EHR when we are exploring. We are the only behavioral health organization to implement this. Collective is a Start up company.

Trends in Healthcare

The future of who our payors will be is uncertain past 2021. May need to change our contracting, billing, documentation. How our payors incentivize us to complete services.

Practice level – do we grow our licenses to provide physical health services?

22nd ave- That is the model .6 FTE ARNP 1,600 visits annually. Clinic is designed in a way that it is both a full physical and behavioral health clinic. There will be enough provide capacity to get comprehensive set of services they need at one time. In person warm handoffs is really critical. Should develop a study to compare reduction of ed and inpatient hospitalization.

Resource Utilization-

2 Multiservice provider that allow us to do multidisciplinary meetings once a week. Integrated service plans. Are able to have cross department consultations to support someone’s needs, If some starts to decompensate or health condition, the client does not need to decomp to a crisis level to receive services.

Integrated Care

2 Vulnerability assessment tool to assess individuals needs. Do a lot of work to triage clients to make sure they receive a VAT assessment in coordination with the county. JAMA article in 2009 housing. End of life issues in our housing and shelter settings, people being able to live at home as long as they can.

Interview w/Graydon Andrus

Resource Utilization

1. Different programs have different methods for this. Crisis Solution Center- Contract requirements and RTF requirements. Clear tracking systems how many people come in and by what source. Outpatient treatment program- usually seeking out the individual and those who need it most are becoming enrolled. Track them in a formal manner-Outreach and engagement client. By EHR reports that are sent to the various supervisors and program managers. How has not been seen in 30/60/90 days. Reengagement specialist position. Authorized staff positions, managed each program and project manager.

2. SUD program manager- clients without funding on their caseloads. Case managers who are not paying attention to their whole caseload-clients who are being left in the dust and not being paid attention to. CSC does not have a solid procedure in place.

3. Done team by team-rare that one program would be able to borrow from another program. There are oncall staff. Need a stronger system for when we redistribute load

Targeted Services

1. Are most high intensity clients are served- if they get word through hospital monitoring they will get up to see them. Collective medical tracking. Vulnerability assessment tool- stratifies people we serve into levels of vulnerability. Shows if progress is being made each year. ECL-brings immediate attention to all services staff connected to that person.

2. HOST outreach and engagement program- we have a mobile crisis team.

More co-located primary care clinics in our buildings. Looks like more work to staff in the end it’s not more work it is about thinking about work differently. Harborview is operating a full-blown clinic and urgent care unit.

Culture of CQI

2.A lot of the reports that we share with program managers- who has funding and who does not. Monthly QA/QI committee always exploring extraordinary occurrences. Going to be doing better in the future as we are integrating primary care.

3. Attempting identify individuals who. CQI procedures of the month protocols and reminders

IT Best Practices

1. The system is done well-fluid and reporting back on what is going on with clients. Flexibility in using CHASERS. A process that should be done once a year.

Internal transparency

3 Action Item report to make sure that case managers knew what needed to be done in the upcoming month. Previously lacked the tools necessary to give the feedback loop to individuals.

Shared Decision Making

1 Right now the only information they can get information from other organizations.