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Performance Driven Academy

SESSION 4: EFFECTIVE MEASUREMENT PRACTICES

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Brought to you by the Managed Care Technical Assistance Center

Speaking: Briannon O’Connor

Associate Director CCSI’s Center for Collaboration in Community Health

Reminders

• Please make sure everyone in your work group registers for
• ne JUNE in-person session
• If you’re joining us for the first time, complete the baseline

survey and review Webinars 1-3

• Webinars are recorded and you should have received materials

ahead of this webinar

• Use pda@ccsi.org email for any questions, comments, etc.
• Chat in questions/comments to all panelists at any time

What is the PDA?

Elements of a Performance Driven Organization

Developed by CCSI’s Center for Collaboration in Community Health

Goal of the PDA

Actively participating in the PDA will…

• Position you to know your cost, know your quality, and know your

impact within the broader system of care

• Generate a workplan for integrating knowledge gained and transfer

knowledge within you organization

• Provide tools and resources to support effective collaboration,

measurement, financial analytics, and leadership values to support continuous growth and improved efficiencies

• Document your agency’s growth and improvement through the

evaluation

• Demonstrate your agency’s commitment to performance driven

principles through a certificate of completion

Where we’ve been

• Developing a culture that supports performance driven

principles and prioritizes data-driven decision making

• Effective collaboration as a key to success and optimizing

impact

• Best practices to support your human resources and heighten

accountability for performance

• 4. Effective

Measurement

• 5. Continuous

Quality Improvement

• 6. Practice

Development Semester 2: Finance and Leadership

• 7. In-person

sessions

Effective Measurement Practices

The Performance Driven Academy

BRIANNON O’CONNOR, PHD ASSOCIATE DIRECTOR, CENTER FOR COLLABORATION IN COMMUNITY HEALTH COORDINATED CARE SERVICES, INC.

Background of Today’s Speaker

• Doctorate in Clinical Psychology
• Expertise in children’s mental health, research methodology,

statistical analysis, evaluation in real-world behavioral health settings, performance measurement

• CCSI
• Associate Director, Center for Collaboration in Community Health
• Supporting behavioral health providers and networks in meaningful

data analytics and cross-system collaboration for improved

• utcomes

Today’s Learning Objectives

• Provide far too much information for a brief webinar
• Define measurement and its value
• Review tips for measurement best practices
• Provide examples for productive information gathered from

readily available data

• Discuss examples for moving beyond the basics
• Introduce tools to support measurement planning
• Hear a provider describe their approach to measurement

What’s in a name?

What’s in a name?

What’s in a name?

• Measure: Using data to

understand a process, comparison, outcome

• Data: Discrete (numbers)

information collected systematically; ideally stored electronically

• Too simple?

Where can measurement bring value to your organization?

• Streamline processes, become more efficient
• Enhance staff buy-in
• Improve quality of care
• Improve bottom line
• Marketing, position for successful VBP arrangements and network

collaborations Outcomes / clinical progress Financial measures Staff variables Process

Just get started….thoughtfully

Measurement as a new skill

• Perfect is the enemy of good
• Understand data limitations, but

don’t get hung up on them

• Make it part of the routine
• Practice, practice, practice
• Start easy; early success leads

to continued efforts

Where to start or re-energize efforts

• Start with what you’re good at
• What is the impact of your service? What do you do well?
• Why do individuals/families/youth seek out this service?
• What outcomes are you and your staff most proud of?
• What have other service providers told you about what you do well? Why do
• ther providers refer to you? What are you known for?
• What do you consumers say about what you do well?
• What would the alternatives be if this service didn't exist?
• See Brainstorming Impact Tool

Where to start or re-energize efforts

• Focus on immediately actionable information that is meaningful and likely to

show change soon

• Reducing ED visits vs. Mental Health Engagement in Care 30–Days (VBP Quality

Measure)

10 20 30 40 50 60 70 80 90 100 2015 2016 2017 2018

Rate of Potentially Preventable ED visits-Agency

10 20 30 40 50 60 70 80 90 100

January: % new clients engaged in care-30 days February: % new clients engaged in care-30 days March: % new clients engaged in care-30 days

Clinical Team A Clinical Team B Clinical Team C

Where to start or re-energize efforts

• Focus on immediately actionable information that is meaningful
• Reducing ED visits vs. Mental Health Engagement in Care 30–Days (VBP Quality

Measure)

20 40 60 80 100 January: % new clients engaged in care-30 days February: % new clients engaged in care-30 days March: % new clients engaged in care-30 days Clinical Team A Clinical Team B Staff Performance Appraisal Rating

Scale 1) Rarely meets objective 2) Occasionally meets objective 3) Meet objective half of the time 4) Usually meets objective 5) Always meets objective

Area of Responsibility

Score 1- 5

Notes/Additional Detail Client Engagement and Attendance: Based on show rate data as compared to target. Steps to improve: Uses engagement data to measure joining, tracks show rate for caseload, uses client attendance agreements, sends letters, documents follow-up, etc.

1= <64% Show Rate 2= 65-69% Show Rate 3= 70-74% Show Rate 4= 75-79% Show Rate 5= >80% Show Rate *Calculated monthly and year to date

Celebrate successes!

What question are you trying to answer

AKA Why I cringe at the question “What does the data show?”

Parallel Process: Measures should be SMART

S

• Specific
• The who, what, when, where, why without jargon or ambiguous language

M

• Measurable
• How will you know you’ve met the goal? What data will be used?

A

• Achievable
• Within reach

R

• Relevant
• Meaningful to the organization, staff, bigger picture

T

• Time limited
• When will we review? When do we expect change?

Good idea Better measures Improve access to services Families who initiate contact will be given an appointment within 2 weeks At least 75% of referrals will be proactively contacted within 48 hours ER visits for behavioral health crises will be reduced Crisis services will be available within 30 minutes of all zip codes in the county At least 90% of individuals at risk on Questionnaire at Intake will be provided with targeted crisis management plans and peer support contact information Services provided will reflect cultural/social identity awareness Treatment educational materials will be translated into Spanish and Chinese Providers will document engaging in shared decision making with families and important others for at least 80% of new clients in Q3 2018

Focus and prioritize

Consider…

• How does your impact and question you have for

your data fit within the big picture of state goals, VBP metrics, MCO priorities, etc.?

State Goals VBP Quality Measures What we do well Our Impact What services are provided ? ?

?

?

Start on the right Ask the question how. How would this occur? How would you know? End on the left What do we do that contributes to this?

Fitting into the Big Picture

State Outcomes Reduce avoidable ER/ inpatient use Improve Outcomes

Supports (natural/ community) Connections with social supports Access Benefits

• Social

services

• Healthcare
• Stable

housing Identify barriers Awareness of available community resources Skill building Attend family group sessions Foster supportive relationships Advocacy State Goals Reduce avoidable ER/ inpatient use Improve Outcomes Crises Access Mobile Crisis Services Crisis plan in place Support use

• f de-

escalation strategies Education about relapse prevention, identifying triggers Family self- management wellness tools

Example

Prioritize measurement efforts

• Focus on a few measures only
• Enhance buy-in
• Staff input on where to start
• Consumer feedback

Master the basics

Make the most of readily available data

• Who is served?
• Understanding the basic characteristics of your consumer population
• How are they served?
• Utilization data, quantifying the services you provide
• How well are they served?
• Clinical progress, outcomes, defining the impact of your service
• What is the cost of serving them?
• How effectively are you using your resources in support of your mission
• Stay tuned for Semester 2

See also Dashboard Tool Version 1

Who is served?

• Demographic snapshot of your population
• Identify potential disparities in access to services
• Identify if the population you serve is representative of your community
• Help identify subgroups of interest or niche populations
• Identify targets for new markets or outreach
• Being able to easily summarize the population served is the foundation
• f measurement
• Understanding your denominator

Are there disparities in population served within my community?

Race Distribution-Served in my Agency

African American Caucasian Asian Multi-racial

Race Distribution-Community (Census)

African American Caucasian Asian Multi-racial

Are we using information we collect?

Why are there no PTSD diagnoses? 60% of current clients have a trauma history. Are we trauma informed?

Sample questions to answer with basic demographic data

• What is our gender/racial/diagnostic/primary substance distribution?
• Does it make sense?
• Are there disparities?
• Are staff adequately trained to engage and meet the needs?
• What do we know about unmet needs in social determinants of health?
• Transportation, housing status, childcare, food security, etc.
• Do we effectively link patients with services to meet these needs?

How are they served?

• Identify the services you provide and to whom
• Quantify how many services you provide and how those services are

distributed across your population

• When collected, can identify who is providing the service and how often
• Productivity
• “How am I using my resources?”
• Identify if the service delivery pattern is consistent across services

Are we using evidence-based best practices?

• Evidence-based practice for children with ADHD is parent training. Are

we providing the most effective treatment?

Are we engaging patients quickly? Are we balancing caseload effectively?

Population that needs therapeutic interventions May be more difficult to engage Many assessments at one time tough on staff

What can we learn by comparing results?

Sample questions to answer with basic utilization data

• Do we have the right training for our staff?
• Are we using best practice for modality of treatment?
• Is our staff distribution appropriate?
• How do our productivity targets look?
• Are certain services under- or over-utilized?
• How many clients receive 1 visit, 2-4 visits, 5-10 visits, 11-25 visits, more than

25 visits?

• In a month, quarter, year, episode of care
• Are some service lines showing higher rates of no show/low engagement?

How well are they served?

• Determine if consumers are satisfied with the services
• Assess if consumers are able to access services in a timely manner and

engage effectively

• How long does someone wait from first contact to first assessment? First

therapeutic visit?

• What is the average/median wait time?
• Does it differ by season, program, clinician, client demographics, referral source etc.
• Identify if consumers are reaching their goals and/or making progress

toward those goals

• Tip: Avoid “yes/no” goals

What can we learn from regular progress monitoring that we can’t wait until discharge to know?

More than 40% of current clients show no improvement or increased frequency of use of primary substance within the first 3 months of treatment

Sample questions to answer with basic clinical progress data

• What percent of our current clients are improving in

symptoms/functioning/substance use from assessment to first 90 day review?

• Are there differences in rate of improvement by demographics? Clinician?

Type of service received?

• Are staff adequately trained in writing clear, measurable objectives?
• Is the information we need documented?

Moving beyond the basics

Use a lot of the same data to answer more complicated questions

• Predictive analytics without the complex data modeling
• Complex questions don’t usually need a high-level analyst
• How do I know who is going to use a lot of inpatient and ED

services before they are a high utilizer?

• In many cases, you already do

✓Look at the empirical literature, state reports, clinical experience ✓Stratify outcomes by patterns of interest ✚Pivot tables in excel to describe differences in outcome for multiple characteristics

• How does this outcome differ for women of different ages across several racial

backgrounds?

Use a lot of the same data to answer more complicated questions

• What can you learn from outliers?
• How many do you have?
• What’s different about them than most others?
• Can you define episodes of care?
• Can you attribute cost per episode of care within

subgroups of patients?

• Set up meaningful comparisons
• Comparisons are critical
• Within agency, across programs
• Across network, county, region, state benchmarks

Variable of interest

Break some bad habits

Data that isn’t actionable (or required) is a waste of time and resources

• Annual meeting show and tell
• File drawer
• “Someday” this might be useful

Tools to Support Measurement

Brainstorming Impact

• Series of questions to guide discussion within your workgroup
• What is the impact of your services? How do you know? What do you do

with that information?

Data Availability and Use Checklist

• Examples of typically available data
• Consider what you already collect, what’s done with it

Dashboard Templates: Version 1

• Two tools (OMH/OASAS focused) available from previous Performance

Driven Organization overview

• Excel workbooks that auto-populate pivot tables and visualizations
• Updated/upgraded version coming soon in Semester 1
• http://ctacny.org/training/tools-support-development-performance-driven-

culture-long-island-and-nyc

Agency Experience

We are pleased to welcome:

Frankie Tangredi & Liz Schreiber

Rochester Regional Health

Rochester Regional Health 2018 Data Strategy Frankie Tangredi

4/11/2018

55

RRH BEHAVIORAL HEALTH SERVICES

56

370,000

Annual Outpatient Clinic Visits

2,000+ Individuals

Enrolled in Home Health Care Management

75 Active

Psychiatric Inpatient Beds

86 Addiction

Beds Emergency Department Access Points (includes CPEP)

1000+ Staff Members

$75M+

Annual Revenue Chemical Dependency Residential Programs 24 Woman’s Beds & 18 Young Men’s Beds School Based Health Centers 14 Behavioral Health Locations; 4 Counties

2 4

5

DSRIP - Mental Health Embedded in 13 Primary Care Practices

4,300

Inpatient Discharges

1

Impact

• Strategic Goals

achieved

• Change

Processes created

Phase 5

Value Creation

• Insights
• Decision Making

based on data

• Investments

between people and business

• utcomes realized
• Predictive

Analysis

• Cultural

Transformation

Phase 4

Effectiveness

• Key Performance

Indicators Tracked

• Process

Improvements Defined

• Expanded

Organizational Accountability

• Sophisticated

Analytical Tools Developed

Phase 3

Measurement

• Standardization
• Metrics defined
• Formulate HR

Dashboards

• Improvements

Acknowledged

Phase 2

Justification

• Data Collection
• Reporting
• Rudimentary

data analysis

• Distributed

Efforts

Phase 1

Data Roadmap

RRH Strategic Areas: Quality and Data

58

What do I do next?

Take-aways: How Can I Get Started?

• Meet with your workgroup
• Set aside some time to think about the Brainstorming Impact Tool

questions

• Gather (or have someone gather) information listed on the Data

Availability Tool

• Have some informal discussion with staff about what they think

would be helpful to measure using readily available data

• Select 1-2 areas to target for one quarter
• Just get started

Mark your calendars and register

Webinars (Wednesdays, 12-1pm): Continuous Quality Improvement, 5/2/18 Practice Development and Management, 5/23/18 In-person events in late June (10am-2pm) Register individually (not by agency) Albany, Date TBD Rochester, Date TBD NYC, Date TBD

Send us any questions or feedback

Use the chat box

• r

email us at: pda@ccsi.org