2007-10-31 cans conference final

The Buddin Praed Foundation & The Massachusetts Department of Social Services

F o u r t h A n n u a l C A N S C o n f e r e n c e

A Needs-Based Approach to Setting Fair Market Rates for Residential Behavioral Healthcare

Treatment for Children and Families

Wednesday October 31, 2007Marriot Copley Plaza, Boston

Presented by:Christopher Marics & Alan Vietze

2The Buddin Praed Foundation & The Massachusetts Department of Social Services Fourth Annual CANS ConferenceA Needs-Based Approach to Setting Fair Market Rates for Residential Behavioral Healthcare Treatment for Children & Families

Purpose of this Presentation1. To define a needs based approach to fair market rate setting

2. To explain how using this approach is different from approaches used in traditional child serving systems

3. To describe how using a needs based approach is consistent with the fundamental principles of System of Care reform

4. To describe the methodology we employed in real-life examples of using a needs based approach to develop and implement fair market rates in a large system of care

5. To discuss lessons learned in the process including: successes, pitfalls and unintended benefits

1. To define a needs based approach to fair market rate setting

2. To explain how using this approach is different from approaches used in traditional child serving systems

3. To describe how using a needs based approach is consistent with the fundamental principles of System of Care reform

4. To describe the methodology we employed in real-life examples of using a needs based approach to develop and implement fair market rates in a large system of care

5. To discuss lessons learned in the process including: successes, pitfalls and unintended benefits


What is a “needs-based approach to setting fair market rates”?

A rational and data-based methodology for calculating a reasonable and fair price for a unit of service that appropriately prioritizes and balances the needs of the three primary stakeholders in the service delivery system:

• The child and family’s need for high quality clinical treatment that is affordable, effective, acceptable and accessible

• The treatment providers’ need to deliver required services while sustaining their organization, its employees and their families

• The funders’ need to maximize the impact of their service purchasing power, contain costs and realize benefits

A rational and data-based methodology for calculating a reasonable and fair price for a unit of service that appropriately prioritizes and balances the needs of the three primary stakeholders in the service delivery system:

• The child and family’s need for high quality clinical treatment that is affordable, effective, acceptable and accessible

• The treatment providers’ need to deliver required services while sustaining their organization, its employees and their families

• The funders’ need to maximize the impact of their service purchasing power, contain costs and realize benefits


• Rational means that the process must “make sense,” i.e. be based on logical assumptions, be transparent, be readily documented and treat all stakeholders fairly


• Data based means that the process must maximize the use of legitimate, widely accepted and preferably empirical data obtained from third-party sources, i.e. sources other than stakeholders in the process

• Reasonable and fair mean that the output of the process, i.e. the rates it yields, must pass the “face validity” test: do they seem to be likely to cover the costs of the services they’re designed to purchase

• Prioritizes and balances the needs we’ll explain these terms on upcoming slides.

• Child and family’s need for high quality clinical treatment means that the process should focus on developing rates for purchasing genuine and authentic professional clinical treatment as well as non-clinical structured supervision and other interventions traditionally delivered by para-professionals

• Affordable, effective acceptable and accessible means that the process should focus on setting rates that will purchase services that minimize direct costs to the family, produce genuine improvements for them, are sensitive to their family dynamics and cultural needs, and are available to them at hours and locations that fit into their schedules and are as close to home as possible.



• The treatment providers’ need to deliver required services while sustaining their organization, its employees and their families means that the process must take into account the legitimate business needs of the providers to keep their organizations solvent and to pay marketable salaries to their employees, many of whom are supporting families of their own.

• The funders’ need to maximize the impact of their service purchasing power, contain costs and realize benefits means the process must take into account the funders’ need to serve as many children and families as possible at the least optimal amount of cost and to achieve real, discernable benefits.


Children & FamiliesObtain convenient and high quality clinical treatment that addresses

their needs

Potentially Conflicting Stakeholder Needs

ProvidersMeet the families needs while paying marketable

salaries and keeping their organization solvent

FundersServe as many children and families as possible

for as little cost as possible


Reformed Systems of Care

Traditional Child Serving System vs. Systems of Care

Historical Child Serving Systems

Funders’ Needs

Providers’ Needs

Child & Family

Needs

• Variable rates for seemingly comparable services• Vaguely defined services

• Little or no family input into services

• Limited group of historical providers• Legacy annually renewed cost-based contracts

• Access and quality problems

Top Priority

Unbalanced Weight

Child & Family Needs

Providers’ Needs

Funders’ Needs

Top Priority

Typical Characteristics

Equal Weight

• Fair, market-based rates for a “menu” of standard, family requested & clearly defined clinical treatment services

• Continuous family input into services

• An expanded group of legacy and new providers• Flexible fee for service or performance based contracts

• High quality, culturally competent, accessible services

Expected Characteristics

System of Care Reform Process


Reformed Systems of Care


Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight






Is this Consistent with System of Care?


Is this Consistent with System of Care?Reformed Systems of Care


Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight






Stroul & Friedman’s 1986Core Values of System of Care

Child Centered & Family Driven

Community Based

Culturally Competent




Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight








Community Based


Definition:Child Centered and Family Driven means that the needs of the child & family dictate the types & mix of services provided.




Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight








Community Based


Definition:Community Based means that the locus of services as well as management & decision making responsibility rests at the community level.




Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight








Community Based


Definition:Culturally Competent means that agencies, programs, & services are responsive to the cultural, racial & ethnic differences of the populations they serve.




Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight








Community Based


Yes Yes YesYes Yes YesYes Yes YesYes Yes YesYes Yes Yes




Providers’ Needs

Funders’ Needs

Top Priority

Equal Weight








Community Based


Yes Yes YesYes Yes YesYes Yes YesYes Yes YesYes Yes Yes

A needs based approach to rate setting permits maximum flexibility in the funding mechanism allowing community providers

to customize service packages to the specific needs of the child and family.


Needs Based Rate Setting Methodology

Determine appropriate clinical interventions and settings for identified needs using available “best practices” information.2

Analyze all available data to determine the current and anticipated needs of children served by the system of care.1

Determine the appropriate provider credentials for each inter-vention and the amount of time needed to deliver it.3Use market-based compensation data to quantify the cost of each of the interventions 4Use market-based data to add in overhead and room and board costs (for residential treatment)5

Use a standard formula to calculate rates for services6

• Twenty-six workgroup meetings over the course of one year

• Participants included representatives from all stakeholder groups

• Six-step process as follows:

Mos

t Tim

e S

pent

●

●

Chi

ld &

Fam

ily N

eeds

Prio

ritiz

ed

Pro

vide

r Nee

ds R

epre

sent

ed

Fund

er N

eeds

Rep

rese

nted

Em

piric

al

Dat

a U

sed


Data Sources

Data Sources Used

Determine appropriate clinical interventions and settings for identified needs using available “best practices” information.2

Analyze all available data to determine the current and anticipated needs of children served by the system of care.1

Determine the appropriate provider credentials for each inter-vention and the amount of time needed to deliver it.3Use market-based compensation data to quantify the cost of each of the interventions4Use market-based data to add in overhead and room and board costs (for residential treatment)5

• CANS data• Children and family input 1

1 Obtained through local family and youth support organizations

• CALOCUS2*• Consults with families & providers

• CALOCUS• Consults with families & providers

• Salary.com*• US Bureau of Labor Statistics*

• Better Business Bureau3*• US Department of Agriculture4*

2 Child and Adolescent Level of Care Utilization System (CALOCUS) v. 1.5 published by AACAP and AACP

3 Standards for Charity Accountability published by the Better Business Bureau’s Wise Giving Alliance

4 Expenditures on Children by Families, published annually by the USDA Center for Nutrition Policy and Promotion

*Accessible on line


Six factors were indicated in the CALOCUS and had to do with the treatment environment rather than the child

Twelve of these factors were revealed in the CANS data and were child specific. We referred to these as “Constellations of Need”

Child Specific Factors“Constellations of Need”

A. Needs1. Developmental

2. Emotional

3. Behavioral

4. Substance Use

C. Age

8. 6 to 9

9. 10 to 12

10. 13 and 14

11. 15 and 16

12. 17 to 21

B. Risk

5. High Risk Behaviors

6. No High Risk Behaviors

7. No Risk Behaviors

Treatment Environment Factorsas derived from CALOCUS

D. Treatment Intensity

13. High

14. Moderate

15. Low

E. Restrictiveness

16. High

17. Moderate

18. Low

Our analysis of the CANS and CALOCUS data indicated that eighteen factors had to be considered in developing treatment interventions appropriately calibrated to the needs of the children and families to be served.

For the purpose of designing needs-specific treatment interventions, we cross-tabulated these factors to produce the following table.

Data Analysis and Implications


Age

CALOCUS* Level Four“refers to services provided to children and adolescents capable of living in the community with support, either in their family, or in placements such as group homes, foster care, homeless or domestic violence shelters, or transitional housing.”*

CALOCUS* Level Five“refers to treatment in which the essential element is the maintenance of a milieu in which the therapeutic needs of the child or adolescent and family can be addressed intensively. This level of care traditionallyhas been provided in non-hospital settings such as residential treatment facilities or therapeutic foster homes. Equivalent services have been provided in juvenile justice facilities and specialized residential schools, and could be provided in homeless and/or domestic violence shelters or other community settings.”*

“Constellations of Need” derived from CANS data

CALOCUS* Level Six“services are the most restrictive and often, but not necessarily, the most intensive in the level of care continuum. Traditionally Level Six services have been provided in a secure facility such as a hospital or locked residential program. This level of care also may be provided through intensive application of mental health and medical services in juvenile detention services and/or educational facility provided that these facilities are able to adhere to medical and psychiatric care standards needed at Level Six. ”*

1. Developmental Needs2. Developmental Needs & Substance Use

7. Complex Behavioral Needs8. Complex Behavioral Needs & Substance Use9. Complex Behavioral Needs & Developmental Needs10. Complex Behavioral Needs & Developmental Needs & Substance Use

3. Severe Emotional Needs4. Severe Emotional Needs & Substance Use5. Severe Emotional Needs & Developmental Needs6. Severe Emotional Needs & Developmental Needs & Substance Use

6 to 9

10 to 12

13 to 1415 to 16

17 to 21

6 to 9

10 to 12

13 to 14

15 to 16

17 to 21

6 to 9

10 to 12

13 to 14

15 to 16

17 to 21

50

Children with High Risk Behaviors

Children with No High Risk Behaviors

Children with No Risk Behaviors

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

50

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

50

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

* Child and Adolescent Level of Care Utilization System (CALOCUS) v. 1.5 published by AACAP and AACP

Cross Tabulation of Data Factors


Implications of Cross Tabulation1. Three levels of residential treatment varying by restrictiveness and intensity of

treatment

2. Further stratification by age and “Constellations of Need” results in 150 theoretical templates of care calibrated to age, needs and level of care3 levels of care X 5 age categories X 10 “Constellations Need = 150 unique treatment protocols.

6. We theorized we could then use this “base rate” as a starting point for a rational method for calibrating the treatment protocols to the other levels and age and needs groups.

3. A rate system with 150 unique specialized rates would be impractical and unwieldy

4. It would be unlikely to achieve fine tuning of clinical interventions to the specificity required by this level of stratification

5. Focused our efforts on developing one “base rate” for the Level 5 - 15 to 16 age group, representing the largest number of children in our data sample and system

Another look at the cross tabulation will illustrate what we mean by this.


Age

CALOCUS* Level Four“refers to services provided to children and adolescents capable of living in the community with support, either in their family, or in placements such as group homes, foster care, homeless or domestic violence shelters, or transitional housing.”*

CALOCUS* Level Five“refers to treatment in which the essential element is the maintenance of a milieu in which the therapeutic needs of the child or adolescent and family can be addressed intensively. This level of care traditionallyhas been provided in non-hospital settings such as residential treatment facilities or therapeutic foster homes. Equivalent services have been provided in juvenile justice facilities and specialized residential schools, and could be provided in homeless and/or domestic violence shelters or other community settings.”*

“Constellations of Need” derived from CANS data

CALOCUS* Level Six“services are the most restrictive and often, but not necessarily, the most intensive in the level of care continuum. Traditionally Level Six services have been provided in a secure facility such as a hospital or locked residential program. This level of care also may be provided through intensive application of mental health and medical services in juvenile detention services and/or educational facility provided that these facilities are able to adhere to medical and psychiatric care standards needed at Level Six. ”*

1. Developmental Needs2. Developmental Needs & Substance Use

7. Complex Behavioral Needs8. Complex Behavioral Needs & Substance Use9. Complex Behavioral Needs & Developmental Needs10. Complex Behavioral Needs & Developmental Needs & Substance Use

3. Severe Emotional Needs4. Severe Emotional Needs & Substance Use5. Severe Emotional Needs & Developmental Needs6. Severe Emotional Needs & Developmental Needs & Substance Use

6 to 9

10 to 12

13 to 1415 to 16

17 to 21

6 to 9

10 to 12

13 to 14

15 to 16

17 to 21

6 to 9

10 to 12

13 to 14

15 to 16

17 to 21

50

Children with High Risk Behaviors

Children with No High Risk Behaviors

Children with No Risk Behaviors

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

50

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

50

49

4847

46

45

44

4342

41

40

39

3837

36

35

34

3332

31

30

29

2827

26

25

24

2322

21

20

19

1817

16

15

14

1312

11

10

9

87

6

5

4

32

1

* Child and Adolescent Level of Care Utilization System (CALOCUS) v. 1.5 published by AACAP and AACP

Cross Tabulation of Data Factors


Standard Discharge Month

Total Interventions

20

Total Interventions

19

Standard Intake Week

Standard Treatment Month

Intake to Discharge

Treatment Planning and Coordination

15 clinical services

2 Clinical interventions for the child & family together

1 Clinical intervention for family

1 Therapeutic activities for the family

2 Therapeutic activities for the child & family

7 Treatment planning & coordination activities

7 non-clinical services

Total Interventions

22

*a therapeutic service delivered by a staff person who is not clinically licensed*a clinical service delivered by a staff person who is clinically licensed

6 Therapeutic* services for the child

6 Clinical** services for the child

4 Nursing interventions for the child

A total of 51 unique services to be “costed out”

Determining the “Basic” Treatment Protocol


Intake Service (Delivered During First Week of Residency) Provider Hours1. Intake Psychiatric Assessment & Report Psychiatrist 2.00

2. Nursing Assessment & Report RN 1.00

3. Pediatric Assessment & Report Nurse Practitioner 0.50

4. Family Orientation BA/BSW + 4 0.50

5. Child Orientation HS Diploma/BA 0.50

6. Review & signing admission paperwork & consent forms with child & family BA/BSW 1.00

7. Psychosocial assessment & Substance Abuse Screen & Report LCSW 2.50

8. Child and Adolescent Needs & Strengths Assessment (CANS) LCSW 1.00

9. Milieu Assessment & Report BA/BSW 0.50

10. Recreation/Leisure Assessment & Report Recreational Therapist 0.50

11. Nutritional Screen & Report Licensed Dietician 0.50

12. Specialty Assessments & Reports LCSW 0.00

13. Psychological Screen & Report Psychologist 2.00

14. Arrange for update of child study team IEP information BA/BSW + 4 1.00

15, Initial Treatment & Crisis Plan Development, Documentation & Consultation LCSW 1.50

16. Initial Treatment & Crisis Plan Consultation with Psychiatrist Psychiatrist 0.25

17. Initial Treatment & Crisis Plan Consultation with Nurse RN 0.25

18. Initial Treatment & Crisis Plan Family & Child Debriefing LCSW 0.25

19. Comprehensive Treatment & Discharge Plan Development, Documentation & Consultation LCSW 3.00

20. Comprehensive Treatment & Discharge Plan Consultation with Psychiatrist Psychiatrist 0.25

21. Comprehensive Treatment & Discharge Plan Consultation with Nurse RN 0.25

22. Comprehensive Treatment & Discharge Plan Family & Child Debriefing (telephonic) LCSW 1.00

Basic Intake Week - Detail


Treatment Month Services Provider Hours Frequency

23. Allied Therapies Licensed Therapist 6.00 Weekly

24. Milieu Activities HS Diploma + 3 /BA 1.28 Daily

24. Community integration focused leisure/recreational activities HS Diploma +5 /BA 7.00 Weekly

26. Activities of Daily Living Skills Training HS Diploma + 3/BA 0.25 Daily

27. Direct Child Supervision HS Diploma + 3/BA 6.00 Daily

28. Individual Therapy LCSW 1.50 Weekly

29. Group Therapy LCSW 3.00 Weekly

30. Medication Management Psychiatrist 1.08 Monthly

31. Clinician clinical visit with child LCSW 0.00 Daily

32. Psychiatrist clinical visit with child Psychiatrist 0.50 Monthly

33. Psychiatrist clinical visit with family Psychiatrist 0.50 Monthly

34. On Site Family Therapy (Child present) LCSW 1.00 Weekly

35. In-Home Family Therapy (Child present) LCSW 2.00 Weekly

36. Medication Dispensing RN 0.08 Daily

37. Health/Hygiene/Sex Education RN 0.25 Weekly

38. Nursing PRN RN 0.25 Weekly

39. Medication Education RN 0.54 Monthly

40. Pre-Vocational Skills Training BA/BSW 3.00 Weekly

41. Individualized Strengths Development Vetted & Trained Adult Volunteer 1.00 Weekly

Basic Treatment Month - Detail

These Services Replaced with In Home Discharge Preparation during Discharge Month


Each for two visits2.00BA/BSW +444. Discharge Family Preparation

Once2.00BA/BSW +443. Level of Care Change Family Preparation on site

Monthly1.00BA/BSW +442. PRN In Home Family Psycho educational Activities tied to Comprehensive Treatment and Discharge Plan (Child not present)

FrequencyTimeProviderDischarge Month Services

Treatment Planning & Coordination Services Provider Time Frequency

45. In-House Individual Service Coordination BA/BSW +4 1.50 Weekly

46. Monthly CANS Review and Update LCSW 1.00 Monthly

47. Attend Treatment Team Meeting: BA Service Coordinator BA/BSW +4 0.50 Monthly

48. Attend Treatment Team Meeting: Child Supervision HS Diploma + 3/BA 0.50 Monthly

49. Attend Treatment Team Meeting: Clinician LCSW 0.50 Monthly

50. Attend Treatment Team Meeting: Psychiatrist Psychiatrist 0.50 Monthly

51. Attend Treatment Team Meeting: RN RN 0.50 Monthly

Basic Discharge Month - Detail

Basic Treatment Planning & Coordination - Detail


Inter-Level Service Calibration based on Needs

Daily0.250.000.00Psychiatrist* Psychiatrist's time attending Clinician's Daily Debriefing on Child Status

Daily0.500.000.00RN* RN's time attending Clinician's Daily Debriefing on Child Status

Daily0.500.000.00HS Diploma + 3/BA* BA staff time attending Clinician's Daily Debriefing on Child Status

Daily0.500.000.00HS Diploma + 3/BA* Time attending Clinician's Daily Debriefing on Child Status

Daily0.750.000.00LCSW* Clinician's time conducting Daily Debriefing on Child Status

Monthly0.002.002.00BSW + 442. PRN In Home Family Psycho educational (Child not present)

Weekly1.001.002.00Vetted & Trained Adult Volunteer41. Individualized Strengths Development

Monthly1.080.540.54RN39. Medication Education

Monthly1.080.500.50Psychiatrist32. Psychiatrist clinical visit with child

Daily0.250.000.00LCSW31. Clinician clinical visit with child (level 6 only)

Monthly1.081.080.54Psychiatrist30. Medication Management

Weekly5.003.003.00LCSW29. Group Therapy

Weekly2.251.500.99LCSW28. Individual Therapy

Daily12.006.006.00HS Diploma + 3/BA27. Direct Child Supervision

Weekly4.007.0010.00HS Diploma + 3/BA25. Community integration focused leisure/recreational activities

Daily1.571.281.00HS Diploma + 3/BA24. Milieu Activities

Weekly9.006.003.00Licensed Therapist23. Allied Therapies

Frequency 65 4ProviderService Delivered

Hours at Level


Treatment Regimens

Environment of Care


Rate Calculation Formula (in simplistic terms)

Constellations of Needs

+ X

Human Resource CostsMarket-Based Salary Data

Market-Based Benefits Data

Salary.com regional

data

US Bureau of Labor

Statistics regional data

Salary.com regional benefits data

Administrative Costs

National BBB 501(c)3

Guidelines

X

Room and Board Costs

USDA’s Expenditures on Children by Families+

A Needs-Based Fair Market Rate forResidential Behavioral Healthcare Treatment

for Children and Families

Child and Adolescent Needs and Strengths (CANS) Data

The Child and Adolescent Level of Care Utilization System (CALOCUS) version 1.5. published by AACAP and

American Academy of Community Psychiatrists

Types of Care derived from the intersection of the CALOCUS and the Constellations of Need

Treatment regimens developed by

residential workgroup


Implications of this Rate Setting ApproachDepending on implementation, the Out-of-Home Treatment Rates may be “naturally incentivized” toward intakes and discharges.

40

45

50

55

60

65

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Weeks of Treatment

Hou

rs o

f Tre

atm

ent

Inta

ke

Standard Treatment D

isch

arg

e

Treatment Team Meetings

Hours of Treatment to Children and Families


Actual Pre-existing Residential Treatment Rate Structure Compared to Actual Proposed Needs Based Rate Fair Market Rates

Implications of this Rate Setting Approach

Contracts Arranged by Per Diem Rate

Rat

es

Lowest

Highest

Highest

Three Types of Preexisting Residential Treatment

Type 1: Non JCAHO-Approved Residential Treatment Centers (RTCs)Type 2: Community Based Psychiatric Treatment Residences

Type 3: JCAHO-Approved RTCs





Rat

es

Lowest

Highest

Highest




Wide Variance from highest to lowest inter- and intra- types of residential treatment





Rat

es

Lowest

Highest

Highest




Confusion regarding which type serves which children in the area of rate overlap





Rat

es

Lowest

Highest

Highest

Preexisting Rate Structure Replaced by New Proposed Rates


Type 3: JCAHO-Approved RTCsRate range for Level 6 programs serving children with high needs

Rate range for Level 5 programs serving children with moderate needs

Rate range for Level 4 programs serving children with low needs



Implications of this Rate Setting ApproachR

ates

Highest


Rate range for Level 6 programs serving children with high needs



Three distinct levels of care reflective of child and family needs

Lowest



Implications of this Rate Setting ApproachR

ates

Highest


Rate range for Level 6 programs serving children with high needs



Lowest

An increase in child and family needs…

… is addressed by an increase in service intensity and…

…an increase in reimbursement rates.


Lessons Learned: Successes

1. Succeeded in bringing together a diverse group of stakeholders, held their interest and achieved results.

2. The work process itself was highly educational to all participants and the audience for whom we worked and to whom we reported.

3. Participants and audience learned how irrational the existing rate structure was and how possible it was to replace it with one that actually makes sense and meets all stakeholders needs.

4. The process initiated a system-wide dialogue about how to accurately calibrate rates according to clinical treatment protocols to ensure the purchase of desired services.

5. That dialogue continues to this day…


Lessons Learned: Pitfalls

1. Participation in the process should be targeted to high level financial and clinical folks. Unfortunately, this targeted audience is usually too busy to make the type of time commitment needed to bring the process to completion.

2. The process for setting the rates was the easy part. For a variety of reasons, to date the system hasn’t been able to develop and initiate a plan for implementing the developed rates.

3. Workgroup participants must be very carefully and strategically selected to avoid perceived exclusion that can result in criticism and sabotage by those feeling excluded.

4. Documentation of all discussions and decision making is key: people frequently forget what they’ve said


Lessons Learned: Unintended Benefits

1. The workgroup experience and its products, although not implemented as intended, have increased the level of awareness and understanding of the interplay of clinical treatment and reimbursement rates amongst the system of care community.

2. The clinical protocols developed by the workgroup have become a resource for clinical treatment in the system and have been used for a variety of additional purposes.


Additional Information

Christopher [email protected]

Alan [email protected]

2007-10-31 cans conference final

Documents