I was inspired by the dynamic presentations and discussions during the 2020 OPEN MINDS Performance Management Institute earlier this month and continue to reflect on the case studies and examples of innovation and progress across the health and human services landscape. A few of my takeaways: The use of bundled payments is increasing, and claims payment seems to be a problem in every health plan transition–which makes the old rule of 60 days of cash on hand a bit outdated.
Another theme – health information exchange is still not happening – and this is a big concern for the future of specialist provider organizations. Throughout the week, health plan executives expressed concern about the future of smaller provider organizations – and how to provide a sustainable role for them. But, I would argue that fixing the data exchange problem with health plans would go a long way. And finally, there is still no resolution on the issue of standard performance measures for complex consumer services – especially in the area of clinical outcomes. It’s the Tower of Babel out there. And the presentations during the week reflected a number of perspectives.
We announced the results of our 2020 survey on value-based contracting and performance-based compensation –
As health plans and provider organizations move towards alternative payment models and take on more risk, the question remains: Where are provider organization executive teams on the road to value? I presented the results of The 2020 OPEN MINDS Performance Management Executive Survey sponsored by Qualifacts. The survey identifies the latest trends in adoption of value-based reimbursement models and performance measures broken down by specialty provider organization as well as some of the major challenges experienced in managing value.
We had the health plan executive perspective on performance –
Tonya D. Copeland, MBA, Vice President, I/DD Services, UnitedHealthCare Community Plan
At a state-level, individuals with intellectual/developmental disabilities (I/DD) are increasingly served through managed care models. And it’s imperative for organizations to have community resources and infrastructure to support the transition to managed care. During her keynote address, Ms. Copeland discussed efforts to address strategic challenges in Tennessee to build an infrastructure that supports a fully integrated model of care.
Julia Brillhart, RN, MSN, National Vice President, Operations, Magellan Complete Care & John Selig, Vice President, Public Sector, Optum
As payers use specialty plans to coordinate physical, behavioral, and social health care, they are using alternative payment models to make it happen. In this keynote address, the speakers provide an overview of their experiences as payers operating these models and highlight what works well,as well as pain points.
Erin Boyd, Behavioral Network Strategy, Solutions & Program Director, Cigna; Debra Nussbaum, Ph.D., LCSW, Senior Director, Behavioral Product, Optum & Pablo McCabe, LCSW, Director, National & Strategic Accounts Team, Hazelden Betty Ford
Although Centers of Excellence (COEs) have been a long-term strategy in physical health services, it’s still a relatively new approach for behavioral health. We heard from payers on best practices in designing and implementing COEs for behavioral health – including innovative approaches to reimbursement, selection criteria, consumer outcomes, and cost savings.
Cathy Lipton, M.D., CMD, National Medical Director, Institutional Programs, Optum; Melissa Nichols, MHA, SVP, Network Performance & Planning, Beacon Health Options; Lori Fertall, MBA, Director, Value-Based Programs, Community Care Behavioral Health Organization & Susanna Kramer, MA, Director, Performance Evaluation, Community Behavioral Health
Provider organizations must build a value proposition to negotiate effectively and build better partnerships with health plans. This session included a strategic discussion with health plan representatives on their organizational strategies to measure success and demonstrate value with VBR models.
We focused on trends in integrated service delivery –
Monica E. Oss, Chief Executive Officer, OPEN MINDS
While the health and human service market landscape continues to change, one question that remains for executives is, “Will my organization be relevant?” I focused on this during my keynote address and discussed the importance of making critical decisions about alignment and market position as well as emerging integration models that have had influenced the market, and key questions executive teams should consider during strategy development and planning.
Joel Hornberger, MHS, Chief Strategy Officer, National Training and Consulting Director, Cherokee Health Systems; Michael Lawton, Chief Executive Officer, UnitedHealthcare Community Plan of Florida; Donald Parker, LCSW, President, Hackensack Meridian Health Carrier Clinic; Tine Hansen-Turton, President & Chief Executive Officer, Woods Services, Inc.; Lisa Kay, Clinical Program Manager, Cigna & Annette Lusko, D.O., Deputy Chief Medical Officer, Community Bridges, Inc.
The OPEN MINDS Integration Summit focused on the opportunities and challenges of integration, as well as competencies needed for success including leadership, organizational infrastructure, financial management, technology, optimal clinical performance, and consumer engagement.
We covered best practice approaches to strategic planning and growth –
Drew DiGiovanni, Senior Associate, OPEN MINDS
Health and human service provider organization execs are facing uncertainty – but having a successful strategy will serve them well on the road ahead. Mr. DiGiovanni discussed the OPEN MINDS best practice approach to building a strategic plan including a guide to implementation and supports needed to ensure successful execution.
Paul M. Duck, Senior Associate, OPEN MINDS
Is your organization considering a value-based partnership but not quite sure where to start? Mr. Duck provided an overview of best practices in marketing, contracting, and negotiating with health plans in this executive seminar and discussed the best way provider organizations can negotiate with health plans.
We explored different perspectives on the importance of a data-driven approach to demonstrating value –
James Stewart, President & Chief Executive Officer, Grafton Integrated Health Network/Advisory Board Member, OPEN MINDS; Dianne Shaffer, LMSW, Director of Systems Development, Integrated Services of Kalamazoo; Cathy Lipton, M.D., CMD, National Medical Director of Institutional Programs, Optum & Sarah Green, RN, BSN, MBA, HCS-D, COS-D, Senior Integrated Healthcare Specialist, Southwest Michigan Behavioral Health
Are you effectively leveraging your data? It’s the key to coordinating care, but many organizations struggle with what data is needed and how to leverage it. In this session, speakers discussed their experiences bringing together disparate types of data to use it for care coordination.
Katie Morrow, LBSW, MPA, Vice President, Compliance, Streamline Healthcare Solutions
In a market that is increasingly value-based, payers expect provider organizations to capture and report outcomes data to prove value. Ms. Morrow discussed innovative ways to leverage outcome measure requirements for reimbursement and reducing the administrative burden on staff.
Julie Hiett, MSW, Senior Director, Population Health Management, Netsmart & John W. Newcomer, M.D., President & Chief Executive Officer, Thriving Minds
A data-driven, client-centric approach is critical to effective collaboration between payers and provider organizations. During this session, speakers explored how technology and data sharing drives better consumer outcomes and facilitates collaboration between payers and provider organizations.
Ashley Sandoval, Associate Chief Executive Officer, Emergence Health Network & Stan Monroe, J.D., President & General Counsel, MindPath Care Centers
Demonstrating your value is critical to health plans – especially in the context of developing partnerships. In this presentation, Ms. Sandoval and Mr. Monroe discussed their experiences developing performance metrics to partner with health plans.
We learned more about the best practice models for performance management –
Arvin Singh, MBA, MPH, MHL, LSSGB, PhD.c, Chief Operating Officer, Odyssey House Louisiana
Providing efficient, effective care is often easier said than done. Mr. Singh explained how he’s used Lean Six Sigma – an improvement methodology process – to eliminate problems, remove waste and inefficiency, and improve conditions to better serve consumers.
Carol Clayton, Ph.D., Chief, Translational Neuroscience, Relias
The performance management process is never final. It’s a dynamic process that requires constant adaptation to a changing landscape. Dr. Clayton provided an overview of the state of performance measures and management and some new initiatives that will ensure clinical excellence and optimal service delivery.
Erik Marsh, President & Chief Executive Officer, DATIS HR Cloud
Finding the right balance between focusing on employees and fulfilling financial requirements to keep an organization afloat isn’t easy. Mr. Marsh discussed the keys to a successful workforce management strategy that ensures financial sustainability while meeting industry standards of employee best practices.
Finally, we took a deep dive into tech – including discussions on the importance of leveraging technology for competitive advantage –
Marianne Birmingham, MS, CMUP, Regional Director of Compliance and Quality, Sequel Youth & Family Services; Jason Willetts, Chief Technology Officer, Sequel Youth & Family Services; John Stupak, Chairman, Sequel Youth & Family Services & Theresa Jenkinson, Vice President, Strategic Initiatives, Inglis
Technology gives provider organizations the opportunity to improve the quality and efficiency of care – as long as it’s leveraged correctly. In this session, the speakers focused on opportunities for technology in residential treatment and new innovative solutions for programs.
Joseph P. Naughton-Travers, EdM, Senior Associate, OPEN MINDS
Despite the importance of technology, a number of questions remain when it comes to the investment, adoption, and implementation of tech operations. Mr. Naughton-Travers facilitated a discussion on managing technology that included organizational framework and plans for optimizing tech investments and operations.
Ray Wolfe, J.D., Senior Associate, OPEN MINDS
A number of resources in a VBR world and technology remains a significant barrier to success. Mr. Wolfe explored some of the major questions provider organizations have when making technology-related decisions and explained how to help executives make optimal tech decisions.
Vanessa R. Lane, MBA, Vice President, Revenue Cycle Management/ Data Analytics, Grafton Integrated Health Network
In a value-based world, one competency that separates organizations from the competition is the ability to manage costs while transitioning away from fee-for-service models. Ms. Lane explained what it means to have an effective revenue cycle management model, and to optimize the current cycle to ensure success.
For even more, join us in New Orleans the week of June 1 for The 2020 OPEN MINDS Strategy & Innovation Institute. The week will start with The 2020 I/DD Executive Summit: Strategies For The Future led by OPEN MINDS Senior Associate Ray Wolfe, J.D. Don’t miss keynote speaker Carl Clark, M.D., president and chief executive officer, Mental Health Center of Denver for his keynote address on June 2, Innovation By Design: Capturing Value In Healthcare; followed by Allison Rizer, MHP, MBA, vice president of strategy and health policy at UnitedHealthcare, for her keynote address on June 3, Emerging Models & New Benefits For Individuals Dually Eligible For Medicare & Medicaid; and my keynote address, Transforming Organizational Performance: Using Data To Find Advantage & Sustainability.