Continuous Improvement in Care Management

Transcript

1. Cynthia K. Wallace, MD, MBA, MSPH Continuous Improvement in Care Management
2. 2 But We’ve Always Done it this Way. . . • Why Change? – Market changes – Technology changes – Mission changes – Iterative learning
3. 3 Process Refinement Versus Innovation • Refinement – The act or process of removing unwanted substances ‐ Merriam‐Webster – Inward looking • Innovation – A new idea, method or device – Outward looking
4. 4 Process Refinement • It has to be: Simpler to Do it Right, Than it Is to Do it Wrong. – For us – For health plans – For providers – For members
5. 5 Process Refinements at Health Integrated • Strategic work assignments • Work product standardization • Remote employee management tools • Platform management "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives"
6. 6 Strategic Work Assignments • Intake – Responsible for all initial document procurement activities – Assign cases according to defined assignment matrix • Clinician – Assignments that facilitate relationships • Facilities • Members – Transition of care management • Physician – Plan‐based assignments • Goals • Facilitate excellent member care • Continuity • timeliness • Each team member working to the “top of their license” • Optimize efficiency by creating “experts” • But not at the cost of fragmentation
7. 7 Work Product Standardization • Clinician – Simple clinical documentation templates – Defined length of stay and concurrent review parameters – Clear MD referral guidelines • Physician – Work environment expectations – Simple denial templates – Formal readability expectations
8. 8 Remote Employee Management • Work hours alignment • Daily huddles • Daily 1:1 • Daily productivity tracking – Defined benchmarks • Every other day case audit – Real time feedback • Productivity/quality incentives • Weekly clinician education and team meeting – Video conferences
9. 9 Platform Management • Reducing the number of different ways work gets done – Shift towards web portal mandate – Shift towards platform consistency • Singular platform • Workflow consistency between clients – Shift towards guideline consistency
10. 10 Process Development and Implementation • Identify stakeholders • Map current processes – Include line staff • Define success metrics • Map “ideal” processes – Accept sequential change • Develop implementation timeline • Educate stakeholders • Implement change – “Run‐in” period – Hard stop – Define pilot period before reassessment • Measure outcomes • Refine • Proceed to next intervention
11. 11 Summary • Need to be willing to throw out old practices and embrace new models/technologies – Remote management strategies – Web‐based entry – Video technology • Need to guard against engineering redundancy (waste) rather than solving underlying problem • Anticipate future needs – Changes in federal program funding, changes to ACA • And always, must be – Simpler to do it right, than it is to do it wrong
12. 12 Questions?
13. Managing Care in the Online Environment 13