building your business acumen - w4a€¦ · building your business acumen a learning collaborative...

Building Your Business Acumen

A Learning Collaborative Experience

Lynn Kimball, Executive Director Yolanda Lovato, Planning and Resource Director

Pearl Bouchard, CLC Manager

1222 N. Post St. | Spokane, WA 99201 | TEL 509-458-2509 | FAX 509-458-2003

SERVING: Northern Ferry, Pend Oreille, Spokane, Stevens & Whitman counties

WWW.ALTCEW.ORG | ADVOCACY. ACTION . ANSWERS.

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Summary of Presentation

• Introduction to the Learning Collaborative

• Focus Areas of Learning

• Tools Designed to Build Your Business Acumen

• Other Key Considerations

• Questions and Discussion


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Support for Learning Collaborative

• Administration for Community Living/Office of Policy Analysis and Development

• The John A. Hartford Foundation

• The SCAN Foundation


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What is the Learning Collaborative?

• Goal: improve integration between hospitals, insurers, health care providers and community-based organizations (CBOs)

• 11 Networks of varying expertise

• Training

• Sharing experiences

• Lessons learned and best practices from first cohort


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Statewide

Evidence-Based Package

Massachusetts

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Regional Brokerage

Los Angles, CA

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Focus Areas of Technical Assistance

• Basics of Health Care and Reform

• Market Analysis

• Quality Improvement Activities


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Basics of Health Care Reform


The Triple Aim: Better Patient Experience of Care Better Population Health Lower per-capita Costs

The Setting: Hospitals Skilled Nursing Facilities Physician Practices

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• Readmission Penalties—FY 2016—2,612 hospitals received 3% penalty (none in WA state)

• Hospital-acquired Condition (HAC)—lowest performing hospitals (bottom 25%) receive a 1% penalty

• Value-based Purchasing—inpatient care based on quality of care; low scoring hospitals can be penalized as much as 1.5%

Health Care Reform - Hospitals


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• All-cause, all-condition hospital readmission performance measurement – FFY 2016

• High performers will receive higher per diem rate for Medicare payments

• Value-based Purchasing – FY 2019 2% reduction or bonus

Health Care Reform – Skilled Nursing Facilities


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• Value-based groups of 100 or more 2015

• Groups of 10 or more 2016

• All physician practices, regardless of size 2017

• Value-based purchasing: High performing 2% increase in payments; low performing 1% reduction in payments

Health Care Reform - Physicians


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WA State Accountable Communities of Health

• Multi-sector collaboratives aimed at improving community health

• Opportunity to promote value proposition of AAA services and interact with health care and payers

• Regardless of 1115 funding success, provides opportunity for relationship development and spin-off initiatives

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Payer Sources

• Medicare Advantage Plans

• Medicaid Managed Care

• Medicare/Medicaid (Duals)

• Accountable Care Organizations (original Medicare)

• Bundled Payment Initiatives (Hospitals & SNFs)

• Medicaid Managed Long-term Services and Supports

• Fee for Service

Market Analysis


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Quality Measures

• HEDIS Measures

• CAHPS Measures

• STAR Ratings

• Health Outcomes Survey (HOS)

• Washington State Common Measure Set

• Health Homes


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Quality Improvement Metrics

• Length of Stay

• Unnecessary ED/Hospital Visits

• Patient Outcomes

• Across Multiple Settings

• Patient Satisfaction


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Quality Improvement Activities

Why are they important to Health Plans?

• Because expenses are allowable costs

• Designed to impact the “triple aim”

• Can be objectively measured and produce verifiable results

• Impacts consumer satisfaction with Plan


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Quality Improvement Activities

Why are they important to AAA’s?

• Our current interventions can affect outcomes for health plans, hospitals, ACOs and provider groups

• Helps define the conversation with Plans

• A new culture must come about—better/faster measures

• We have to measure and improve constantly

• Communicate outcomes with Plans


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Determining Health Plans Quality Rankings

• http://healthplanrankings.ncqa.org


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http://healthplanrankings.ncqa.org/

Tools Designed to Build Your Business Acumen

• Acronyms

• Self-Assessment

• Knowing Your Market

• Developing Service Packages

• Relevant websites


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Other Key Considerations (will be covered tomorrow in “Beyond the

Basics”

Marketing Network Development Branding Service Package IT Platform Why it Matters Selection Process Challenges and Uses Quality Improvement Measurement for Improvement Tools to Support Improvement Examples


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Culture Change

“BUILDING THE BUSINESS CASE: Community Organizations Responding to the Changing Healthcare Environment for Aging Populations”

• 24/7 capacity

• Measurable outcomes/real-time data/data driven decision making

• Rapid cycle quality improvement

• Collective action

• System-wide change in capacity

• Manage resistance to change

• Nurture employees—connect through accountability, goal setting, feedback, engagement

• Engage workforce in strategic thinking

http://www.nasuad.org/hcbs/article/building-business-case-community-organizations-responding-changing-healthcare


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Questions & Discussion


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