ValueBased Care Management Lecture b Care Delivery Challenges

Value-Based Care Management Lecture b – Care Delivery Challenges and Solutions This material (Comp 23 Unit 4) was developed by Normandale Community College, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90 WT 0003. This work is licensed under the Creative Commons Attribution-Non. Commercial-Share. Alike 4. 0 International License. To view a copy of this license, visit http: //creativecommons. org/licenses/by-nc-sa/4. 0/.

Lecture b Learning Objectives • Discuss systems challenges and opportunities for improving care management related to workflows and communication • Discuss important patient-related challenges and solutions • Discuss how “working to the top of your license” concept contributes to effective, efficient team functions • Describe challenges of care transitions and mitigating interventions, tools, and requirements 2

Care Delivery Challenges and Solutions Overview Image: Care Manager and Patient 3

Opportunities from Evolving Payment Models • Benefits – Incentives for resource utilization – Rewards for better health outcomes – Delivery of better patient experiences • Challenges from change Source: Rundall, T. G. , et. al. , 2016 Image: Cost and Quality of Care 4

Challenges to Care Management • Personal biases and work experiences • Organizational – Technology – Adaptive/culture – Care delivery system design • Patient-Related – Language, cultural issues – Social determinants of health – Patient engagement 5

Challenges to Care Management: Provider and Care Team • • • Personal beliefs Fear of litigation Information hoarding Gaps in Quality Improvement Constant change 6

Challenges to Care Management: Technology • Lack of Health IT • Absent or under used electronic health records • Limited or no interoperability • Underdeveloped data capabilities Source Charles, D. et. al (April, 2015) 7

Challenges to Care Management: Culture • • Lack of team based approach Poor communication Organizational silos Organizational beliefs, values, attitudes 8

Challenges to Care Management: Health Care System Design • Workflow design – Complexity – Programming and cultural routines – Payment models – Inconsistent forms and requirements Source Wald, J. S. et. al June, 2015 9

Challenges to Care Management: Patient-Related Issues • Language • Cultural traditions • Dietary or religious practices 10

Challenges to Care Management: Patient-Related Issues 2 • Fear, uncertainty, feeling intimidated – health-related – health care system-related • Social determinants of health – Income and educational level – Health insurance status – Physical environment/housing – Access to transportation and health care Source Healthy. People. gov 11

Patient Engagement in Care Management • Patient as center of care team – Engage as a partner – Create understanding of what to do and why to do it • Tools and resources needed to enable participation Source Washington, L. , 2014 12

Contributing Factor: Complexity of Condition • Chronic conditions – Competing needs of the patient – Difficulty in getting support • Multiple sources of information – Difficult for patients to integrate information Source Hong, A. L. , August, 2014 13

Contributing Factor: Complexity of Health Care System • • Lack of integration Legislative/regulatory restrictions Understanding of HIPAA Resistance to change 14

Solutions to Technology Barriers: Leverage Health IT • Interoperability and information exchange – Between Health IT systems within an organization – With other facilities – With patients 15

Solutions to Technology Barriers: Employ Best Practices • • Admission discharge and transfer (ADT) Registries Patient Panels Report production Decision support Evidence-based guidelines Care plan availability 16

Solutions to Cultural Barriers in an Organization • Organizational culture change initiatives • Shared decision making and motivational interviewing • Social media • Patient Advisory Councils Source: Hong, A. L. , August, 2014 17

Solutions to Cultural Barriers in an Organization 2 • Expand the “culture of safety” • Provide team training • Work to the top of your license Source: Colwell, J. , 2006; MN Dept. of Health, 2007 18

Solutions to Health Care System Design Challenges • Implement system redesign • Build infrastructure – Manage change – Identify change champions – Support quality improvement • Formalize team roles Source: HRSA, 2011 19

Solutions to Health Care System Design Challenges 2 • Map process flows to support care management • Use consistent, key documents to manage transitions • Transition to alternative payment models to support appropriate resource use Source: HRSA, 2011 20

Solutions to Challenges Faced by Patients • Patient Engagement – Increase health literacy – Ask questions – Identify a personal support system – Provide electronic access to information Source Washington, L. , 2014; AHRQ, October, 2014 21

Solutions to Challenges Faced by Patients 2 Social Determinants of Health • Social Workers • Community Organizations • Legislation Source: ODPHP, Social Determinants of Health Image: Social Determinants of Health, ODPHP 22

Health IT Solutions for Reducing System Complexity • Expand access to information and to care – Locations and hours – Systems integrations – Telehealth services – Patient navigators – Patient contact centers Sources: Washington, L. , 2014; Gingrass, J. , 2014 23

Solutions for Complex Conditions – Indiana ICDMP Process Components 1. Identification of Eligible Participants 2. Risk Stratification 3. Nurse Care Management 4. Telephone Care Management 5. Information System 6. Primary Care Collaboratives 7. Program Evaluation Image: Process Flow for Indiana ICDMP Source: Milbank Quarterly, March, 2006 24

Care Management Lecture b Summary • Challenges experienced when adapting care management practices • Framework to adopt to assist with change • Decisions for how to spend time and resources • Provision of training and support 25

Care Management Lecture b – References 1 References Charles, D. , Gabriel M. , Searcy, T. (April, 2015). Adoption of Electronic Health Record Systems among U. S. Non-Federal Acute Care Hospitals: 2008 -2014. ONC Data Brief No 23. Retrieved from https: //www. healthit. gov/ Colwell, J. (April, 2006). Teamwork is the new mantra for quality improvement. ACP Observer. Retrieved from http: //www. acpinternist. org/ Gingrass, J. (September 15, 2014). Breaking Down Barriers to Care: Strategies for Expanding Patient Access. ECG Management Consultants (ECGM). Retrieved from http: //www. ecgmc. com/ Hong, A. L. Siegel, A. L. , and Ferris, T. G. (August, 2014). Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? The Commonwealth Fund. Retrieved from http: //www. commonwealthfund. org/ Hong, C. S. , Abrams, M. K. , Ferris, T. G. (August 7, 2014). Toward Increased Adoption of Complex Care Management, N Engl J Med 2014; 371: 491 -493 DOI: 10. 1056/NEJMp 1401755 Maurer, M. , Dardess, P. , Carman, K. L. , et al. (May 2012). Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA 290 -200 -600019). AHRQ Publication No. 12 -0042 -EF. 26

Care Management Lecture b – References 2 References Milbank Quarterly (March 2006). The Indiana Chronic Disease Management Program. NCBI 84(1): 135– 163. doi: 10. 1111/j. 1468 -0009. 2006. 00441. x Office of Rural Health Primary Care, Minnesota Department of Health (December, 2007). Expanding Scope of Practice to Allow Work at the Top of a License. Retrieved from http: //www. health. state. mn. us/ Rundall, T. G. , Wu, F. M. , Lewis, V. A. , Schoenherr, K. E. , & Shortell, S. M. (2016). Contributions of relational coordination to Care Management in accountable care organizations: Views of managerial and clinical leaders. Health Care Management Review, 41(2), 88. Selecting Care Management Interventions. (October 2014). Agency for Healthcare Research and Quality (AHRQ). Retrieved from http: //www. ahrq. gov/ Social Determinants of Health (n. d. ). Healthy. People. gov U. S. Department of Health and Human Services Health Resources and Services Administration (HRSA). (April, 2011). Quality Improvement. Retrieved from http: //www. hrsa. gov/ 27

Care Management Lecture b – References 3 References Wald J. S. , Novak L. L. , Simpson C. L. , et al. (June, 2015). Health IT-Enabled Care Coordination and Redesign in Tennessee. (Prepared by RTI International, under Contract No. 290 -2010 -00024 I). AHRQ Publication No. 15 -0048 -EF. Washington, L. (February 2014). "Enabling Consumer and Patient Engagement with Health Information" Journal of AHIMA 85, no. 2 56 -59. Images Slide 3: Care Manager and Patient, CC BY-NC-SA 4. 0 Slide 4: Cost and Quality of Care, CC BY-NC-SA 4. 0 Slide 22: Social Determinants of Health (n. d. ). Office of Disease Prevention and Health Promotion (ODPHP). Healthy People 2020 Retrieved from: https: //www. healthypeople. gov Slide 24: Milbank Quarterly (March 2006). The Indiana Chronic Disease Management Program. NCBI 84(1): 135– 163. doi: 10. 1111/j. 1468 -0009. 2006. 00441. x Process Flow for Indiana ICDMP [Online Image]. 28

Care Management Lecture b This material was developed by Normandale Community College, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90 WT 0003. 29