One of the executive competencies that is increasingly important for health and human service executives is meta-leadership—the ability to create strategic linkages with organizations outside of your own for the benefit of shared outcomes (see Meta-Leadership In Action). This concept goes beyond collaboration (which is part of the equation) to more formal relationships with objectives and results that are critical to organizational success.
Earlier this year, I had the opportunity to learn more about how meta-leadership can be applied to value-based reimbursement. The West Michigan case study, Building An Organization That Can Out-Perform The Competition: Value-Based Reimbursement & Performance Management, was presented at The 2018 OPEN MINDS Children’s Services Executive Summit in the session, by Kristyn Peck, Chief Executive Officer of the West Michigan Partnership for Children (WMPC) and Nancy Rostoni, State Administrative Manager, Performance Based Child Welfare System, Michigan Department of Health and Human Services (MDHHS).
This initiative is about meta-leadership at two levels. First, there is a partnership among a group of provider organizations serving children that has a unique relationship with the MDHHS. WMPC is a non-profit in Kent County formed as the lead agency for a case rate funding model for foster care through a contract. WMPC is a consortium of five private child-placing non-profit provider organizations in Kent County, Michigan: Bethany Christian Services, Catholic Charities West Michigan, D.A. Blodgett-St. John’s, Samaritas, Wellspring Lutheran Services. WMPC has more than 40 additional subcontracted providers of residential, counseling, parent support, domestic violence, and other services (see Status Of Performance-Based Contracting Model).
In October 2017, MDHHS transferred approximately 810 foster care cases to WMPC, with a reimbursement model that included a case rate and specific performance measures. The case rates—including all child welfare services for residential, foster care, and adoption, but not Medicaid-funded services, are front-loaded, semi-annual payments starting at $22,600 for first six months then decreasing from there.
- Payments 1 & 2 (year 1): Above calculated average cost per case
- Payments 3 & 4 (year 2): At calculated average cost per case
- Payments 5+ (year 3+): Below calculated average cost per case
WMPC Performance and Quality improvement team meets with the provider organization managers monthly to discuss key performance indicators, data quality, outcome measures and quality improvement plans. WMPC has seen placements of youth in residential settings—the most expensive line item—decrease by four percentage points from October 1, 2017 to August 20, 2018. Other key performance indicators where there are steady positive trends throughout the year WMPC has been in operation include:
- 94% worker-child monthly contact, up from 90%
- 66% sibling monthly contact, up from 61%
- 88% case plan completion timeliness, up from 86%
- 88% worker-child return home contact, up from 66%
The message on the day—it takes a long time to develop this kind of arrangement, but it’s significant when it happens. Ms. Rostoni explained the background of laying the groundwork in Michigan, noting that child welfare is a state-administrated, state-run system, and health care services are state administered and county run. They brought health out from the human services umbrella, and Kent county 100% privatized in foster care. She explained that while historically they didn’t have data, in 2014, they implemented a statewide tele system that gives them the data they need.
Ms. Peck shared what this work looked like during the forming of WMPC:
WMPC worked collaboratively with our community to develop our mission, vision, and values. We conducted listening sessions and focus groups to ensure we understood the change the community wanted to see. We’ve been able to undertake this initiative with relative ease because our community shares the belief that all children deserve safety, belonging, and the opportunity to flourish. And we believe that we are all responsible for our community’s children.
WMPC and MDHHS validated and refined the data for quality assurance reviews and case record being shared between Michigan Statewide Automated Child Welfare Information System (MiSACWIS) and Mindshare Technology with the goal of developing dashboard reports for performance measures.
As the health and human service system looks to incorporating social services into the value-based arrangements, I think this meta-leadership model is one to keep in mind. This move will require a different set of financial and program design strategies and are tied to a “non-traditional” set of relationships between provider organizations and payers. Increasingly, I think we will see the “vendor” model that dominated both fee-for-service contracting, and managed care network reimbursement replaced by unusual and interdependent operational and financial partnerships like these. For more on meta-leadership in health and human services, check out:
- Meta-Leadership In Action
- Creating Public/Private Partnerships: Making Meta Leadership Work
- The ‘Melting’ Value Chain
- Adaptable Standardization-In Service Of Mission?
- Meta-Leadership In Action: Making Provider Organization Collaborations Work
- Creating Innovative Partnerships With Managed Care Plans
- Best Practice Meta-Leadership: A Framework For Leadership Effectiveness
- Meta-Leadership Framework For Leadership Effectiveness
- Moving Leadership From Complicated To Complex
- Collaboration, Connectivity & Complex Leadership
For more on the issues for children with complex needs, market your calendars for October 28, 2019 in Philadelphia for The 2019 OPEN MINDS Children’s Services Leadership Summit. Our new summit agenda and faculty will be posted soon. For more on last year’s summit, check out The Five Key Drivers Of Change In The Children’s Service Market, Meeting The Challenge Of New Service Lines, and Value/Performance Based Contracting: Meeting The Dual Requirements Of Expected Outcomes & Cost Effectiveness.