At The 2019 I/DD Executive Summit hosted by OPEN MINDS and CapGrow, I had the chance to learn about the move to managed care care for individuals with intellectual and developmental disabilities (I/DD). My colleague, Sarah Threnhauser discussed some of the early lessons learned in I/DD & Managed Care – What Are The Early Lessons For Providers?. What some organizations don’t realize is that managed care goes beyond the implementation of health plans and begins to fundamentally change the way care is delivered. A parallel issue that often receives heightened scrutiny with the move to managed care is how to assure quality care for consumers financed under the model.
We ended our day at the 2019 I/DD Executive Summit learning about how two organizations are attempting to measure quality, in the session, New Skills For A New Market: Quality Systems & Performance Management featuring Bruce Block, M.D., Chief Learning and Medical Informatics Officer, Pittsburgh Regional Health Initiative; Carli Friedman, Ph.D., Director of Research, The Council on Quality and Leadership; and Patrick Maynard, Ph.D., Chief Executive Officer, I Am Boundless, Inc.
Pittsburgh Regional Health Initiative (PRHI) and I Am Boundless took two complimentary approaches to quality improvement and management. PRHI created a quality improvement system that identifies issues in specific areas of its organizations and then works with team members in those areas to design a solution. The focus is on individual teams improving a specific problem in their service line or area. I Am Boundless on the other hand decided to implement an organization-wide, externally developed quality assurance system. Essentially, the organization overhauled their business and clinical practices to meet the guidelines set by the new quality assurance system.
Dr. Block talked about his experience with the Pittsburgh Regional Health Initiative (PRHI), a regional collaborative which addresses health care safety and quality improvement. What their survey of local agencies found was that performance measurements were used by the central office staff and not shared with direct care staff, electronic health records (EHRs) were not used for collecting quality improvement data, and that most organizations were not providing value that could be demonstrated through data. As a result, PHRI worked with organizations to embed quality improvement in the organizations. They also created – a real concern collection system, which identified the most pressing quality concerns. Then the organizations addressed these problems using the “plan, act, do, study” wheel. Additionally, the organizations appointed a quality manager and quality improvement dashboard that is automatically filled and shows exactly where a project is in the process and where a quality coach needs to come in and offer assistance.
Dr. Friedman explained that The Council on Quality and Leadership (CQL) utilizes The Basic Assurances® tool, which looks at quality and safety at the organizational level. The Basic Assurances® tool includes 92 indicators in 10 factors such as safe environments, natural supports, and dignity and respect. In order to receive accreditation, organizations must demonstrate that they not only have the systems in place to meet the indicators, but also implement them in practice. Based on research at 28 Mosaic agencies, supporting approximately 3,000 people, CQL has been able to demonstrate meaningful results. For example, when individuals have meaningful work and activity choice, the per person behavioral health issues rate was 1.22 over three years compared to 4.61 when individuals did not have meaningful work and activity choice.
Dr. Maynard explained that in the past five years, I Am Boundless has grown exponentially from a $27 million budget serving 800 individuals to an $80 million budget serving 3,000 individuals. As a result, the organization has become a lot more complex and the old “smoke signal” system of management was no longer a viable option. To course correct and prepare for value-based reimbursement, I Am Boundless choose to adopt the CQL Accreditation as the foundation for shifting to a culture of performance measurement and management. To help implement the transition to CQL, I Am Boundless hired a Director of Quality Assurance and a Director of Service Experience. The Director of Quality Assurance manages accreditation, audits, and compliance like CQL. On the other side of the equation, the Director of Service Experience is responsible for consumer engagement and experience. Together these positions help manage the quality side of the value equation.
Both Dr. Block, Dr. Maynard, and Dr. Friedman talked about two keys to implementing successful quality systems. The first is to move from a culture of “doing my job” to a culture where quality is everyone’s job. This means coaching staff to point out quality issues, sharing and explaining performance measures (and the reason for them), and providing the necessary training to improve care. Second, organizations need to have the technological systems in place to improve quality. Dr. Friedman noted that there is really no way for organizations to follow the value path without the right technology. Dr. Maynard added that as organizations become more complex, technology to manage that complexity becomes crucial.
For even more, join us at The 2019 OPEN MINDS Management Best Practices Institute on August 12 in Long Beach for the executive seminar, “How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating, & Contracting With Health Plans” featuring Deb Adler, Senior Associate, OPEN MINDS.