Change Action & Resource Exchange (CARE) Network

Transcription

1 Change Action & Resource Exchange (CARE) Network Webinar for Payer Mix & Operational Efficiencies January 27, 2014 This webinar is being recorded and will be posted on For technical issues, please chat Q&A to Evelyn Kleinbardt For questions about content, please chat Q&A to Justine Lai 1

2 Peter C. Campanelli, Psy.D. Sr. Scholar, Organizational & Community Services McSilver Institute, Silver School of Social Work New York University Chris Copeland, LCSW Chief Operating Officer Institute for Community Living INTRODUCTION 2

3 Introduction Agenda for Today Overview of Payer Mix & Operational Efficiencies Deeper Dive: Payer Mix Deeper Dive: Operational Efficiencies Wrapping Up 3

4 Goals for Today! Set the context for today s payer mix vs. the payer mix of tomorrow The current transitional context vs. the probable future context under Medicaid MCO operations. Discuss strategies for addressing your payer mix Service system diversity Workforce skills 3 rd party billing & contracts Marketing to underserved populations Key Focus on: Expanding the number of people served Providing value based and not volume based services. What Will Not Be Covered Today: In-depth details on strategy implementation Your problem-solving calls are intended to provide a forum where you can brainstorm these details with your fellow clinics 4

5 Who s on the Line? CARE s Payer Mix Cohort: Bikur Cholim (Upstate) Catholic Charities (DVRC; Downstate) Community Concern of Western New York (Upstate) Epic, LI (Downstate) Other CARE clinics who are interested in this topic 5

6 Cohort Composition The payer mix cohort is a small group! Given the mix between upstate and downstate, were not able to meet with other groups during Face to Face Will spend a bit more time on the first call getting to know one another Your calls facilitator will be Jim Monfort, Senior Consultant and Manager of Financial Services, CCSI The emphasis is on YOUR ideas and collective brain-trust Jim will serve as an expert resource to help identify further ways that CTAC can help you 6

7 Recap: Face to Face Meeting Overall focus on help cohorts in getting to know each other Establish brain trust for process implementation going forward Modeling format of the phone calls Clinic presents a problem Brainstorm solutions Problem-solve implementation Process Indicator Reporting Collections by Payer Mix Problem Definition Technique Focused on getting fellow clinic s perspective on key problem hoping to address through CARE Reframing based on new perspective 7

8 Chat Question # 1 As we progress through this 90 minute WebEx we want your feedback via chat and polling questions! Please use the chat box to the right of your screen to answer the following question: Is there anything missing from the above goals that you would like to discuss in this webinar? or Post a different question if you like! 8

9 We want to hear from you! Polling Question #1: Is your entire core team in attendance for this webinar? A. Yes B. No Polling Question #2: How many people are in the room viewing this webinar? A. 1 B. 2-3 C. 4-5 D. 6 or more Thank you! Your feedback and participation in this workshop is important to us. 9

10 Polling Question #3: Who is on the line?* A. Finance B. Clinic Leadership C. Executive Leadership D. Clinician E. Professional Staff *You may select more than one answer. 10

11 Peter C. Campanelli, Psy.D. Sr. Scholar, Organizational & Community Services McSilver Institute, Silver School of Social Work New York University Chris Copeland, LCSW Chief Operating Officer Institute for Community Living OVERVIEW OF PAYER MIX & OPERATIONAL EFFICIENCIES 11

12 What Do We Mean by Payer Mix and Operational Efficiencies? Payer Mix Different payers and their accompanying reimbursement rates Generally are averaged to form a blended rate Two separate states to consider Current State: Interim transition rate structure (APG s, etc.) What s unclear is how long the current state will last Upcoming State: Post 2016 or 2017, expect to transition to Managed Care oversight Operational Efficiencies The type of services offered (service mix) Availability of services through direct provision or partnerships/affiliations Who is providing the services How they are reimbursed How information on services is distributed to the community A successful management of Payer Mix depends on optimizing your Operational Efficiencies 12

13 Our World Post-2016 Transition to managed care organizations Value-based vs. volume-based care Bundled payments per episode of care Payer and service mix as we know it will be completely different Key question to consider: How to optimize the current state while also preparing for the future? 13

14 Digging Deeper Payer Mix Payer Mix represents all of the third party payers you receive money from. These include: Medicaid Medicare Managed Care Commercial Insurance Indigent Care Pool Individual contracts i.e. Foster Care Agencies Self Pay (although not technically a third payer) 14

15 Digging Deeper Operational Efficiencies Centralized Scheduling could be considered an operational efficiency But today we are really focusing on the specific services your clinic delivers to achieve the following goal: To provide exceptional service that efficiently addresses the problems presented by people while providing the highest quality care at the lowest cost per unit of service possible 15

16 The Shifting Dimensions of Both Payer Mix has multiple dimensions Addressing your payer mix may be different depending on the nature of the core issue for each clinic. Does your clinic accept commercial insurance? What is the penetration rate of all payers? Operational Efficiency is likewise dependent on: Knowing what the person seeking help needs and how to best provide it Service mix has been changing depending upon treatment science and regulatory reform 16

17 Lets take a minute to catch our breath Polling Question #4: Have you ever heard of or been exposed to a change effort regarding payer mix or operational efficiency in your current agency? A. Yes B. No C. Unsure Polling Question #5: If yes, in your opinion, did it result in improved revenue or improved client outcome? A. Yes B. No C. Unsure of results D. Not applicable 17

18 Lets Talk About Your Clinic Chat Question # 2: What does operating efficiency look like when one considers various payers in your clinic? Use the chat box to your right to send us your thoughts! 18

19 DEEP DIVE: PAYER MIX 19

20 Payer Arrangements Now The APG rate is currently the Gold Standard Blended Rates Dual Eligibles (Cross Over) Weighted CPTs based on services delivered Differential payments for Medicaid/Medicare vs Commercial Insurance What is the blended rate for your clinic? 20

21 Today s Key Challenges Increasing census especially among those with APG rate structure Increasing service volume Optimizing service mix and providing sufficient diversity of services to meet the need Rate of Medicaid/Medicare clients vs. third party Negotiating third party contracts 21

22 Payer Arrangements in the Future What would you hope replaces the APG rate structure? Individual Capitation Episodes of Care Benchmarking Utilization Review 22

23 Key Challenges Tomorrow Measuring client outcomes Providing dosages of service based on diagnosis, severity and what is required to achieve health/behavioral health improvement Measuring cost of services provided by client 23

24 What Do You Think? Chat Question # 3: What would be of sufficient value to MCOs that they would be willing to pay for it? Take a moment and discuss amongst yourselves then use the chat box to your right to send us your thoughts! 24

25 DEEP DIVE: OPERATIONAL EFFICIENCIES 25

26 Given Current & Future Payer Mix Challenges What are the things we need to really address in our operational efficiencies? Ensuring long-term clinic viability Considering payment rates Serving priority populations What happens if they receive the correct/ incorrect service The ripple effect - what happens if you don t achieve certain outcomes Clinic profiling by managed care companies 26

27 Key Strategies for Viability Increasing diversity of services, aka service mix Competitive marketing strategies Creating Partnerships Community collaborations Prevention & public health Evidence-Based Assessment & Treatment Business Partnerships Addressing Workforce Skills 27

28 Diversity of Services Do you currently offer any of these services? Collaborative Care Medical Monitoring/Assessment Integrated Care Wellness self management 28

29 What Do You Think? Chat/Speaking Question # 4: If no, do you have plans to introduce these services? Take a moment and discuss amongst yourselves then use either click the raise your hand button to speak or use the chat box to your right to send us your thoughts! 29

30 Marketing Community Collaborations MCOs seek clinics with linkages to social support & ancillary treatment What kind of linkages does that entail? Housing providers that provide clinical services and respite care Vocational providers for employment assistance Mobile crisis & outreach Chemical dependency for substance use disorders Building in-house capacity for EBT IDDT services Care management via Health Homes In-house services or linkage to physical health providers 30

31 Marketing Prevention & Public Health Solutions Ensuring Value-Based Marketing & Engagement MCOs seek clinics that are active referral sources within the community What Does This Look Like? Embedding population-based early identification & prevention tools like the SBIRT (Screening, Brief Intervention, & Referral to Treatment) Measure within clinics and other parts of the Agency SBIRT is a substance abuse assessment measure designed to identify potential clients for SUD treatment Outreach to shelters and family assistance centers Online resources to hospitals and primary care providers Warm hand offs and support with preventing ER admissions 31

32 Marketing Providing Evidence-Based Assessment & Treatment Outcome measurement Important within future payment systems that depend on accurate diagnostic assessment Evidence-based interventions to ensure efficient and effective services Provision of IDDT services Identification of Triggers Wellness Self-Management Training Motivational interviewing Stages of change Relapse prevention Achieving diagnostic benchmarks which reflect quality (HEDIS and NCQA Standards) 32

33 Business Partnerships Fundamentally designed to reduce expenses & improve collaboration What does this look like? Combining billing & back-office operations across agencies Contracting to third party vendors for billing, IT or HR functions Joint ventures based on shared functionality Becoming a third party vendor yourself to several other Agencies 33

34 Workforce Skills Required in the Future Medical Literacy Multidisciplinary Decision Making Group and Engagement Skills Understanding outcome metrics Technology 34

35 Workforce Skills Medical Literacy Staff will develop a fundamental understanding of how to live a healthy life while living with comorbid chronic physical conditions Understand pre-disposing factors of things like Metabolic Syndrome Heart Disease Asthma Diabetes Understand Fundamental Wellness selfmanagement Issues 35

36 Workforce Skills Multi-disciplinary Decision Process Using the EHR to engage in virtual case conference The concept of treatment to target and provision of specialty stepped care Developing the clinic treatment plan based on a comprehensive service plan approach 36

37 Workforce Skills Group & Engagement Skills Organizing skill based common content groups such as wellness self management,diabetes management, effective parenting etc. Engagement through empathy and understanding of life roles and goals. Providing linkage to needed support services that improve the life of the individual 37

38 Workforce Skills Understanding Outcome Metrics Outcome is defined as improvement in functioning (e.g., psychological, emotional, behavioral) Outcome is a measure (e.g., a score, an indicator) that may be collected over time, and assesses change in behavior or psychosocial well being Outcome is best measured using standardized assessment instruments Outcome is assumed to result from an intervention, treatment or service 38

39 Workforce Skills Technological Flexibility Does your staff know how to use the EHR as a management tool? Technology helps clinics flexibly manage upcoming changes E.g. International Classification of Disease ICD 10 is released in October 2014 Replaces ICD 9 which limited clinician classification Significant opportunity to optimize organizational performance both clinically and financially Permits expansion of diagnostic and treatment specificity Expansion of outcome measurement -> dove-tails into new payment methodology Depends heavily on capacity of pre-existing EHR. 39

40 How Do I Get This Done? Frame in the context of organizational change Organizational change is inevitable and necessary for survival Do not attempt more than one change at a time prioritize! Once you arrive at consensus on the overall goals, form a change team to lead the charge The change team ( within CARE, your CARE Team) maps out a logical implementation progression Plan is shared with others to get buy-in Plan is implemented Research methods, pilot, and iterate! Don t forget to collect metrics that track progress and outcomes! 40

41 Additional Considerations Specific Implementation Research Pilot Concrete Next Steps 41

42 QUESTIONS?? We will take a few minutes to answer any questions thus far. Please use the chat to the right of your screen to ask any questions you might have thus far. Feel free to continue chatting in questions as we continue on in the webinar! 42

43 Questions?? Do you have any questions? Either click the hand button and we will unmute you to talk, or chat us! Both can be found in the control panel to your right. 43

44 NEXT STEPS Chris Copeland COO at ICL 44

45 First Call What To Expect Each clinic will be asked to re-introduce themselves again Explain briefly why everyone has chosen to address payer mix and operational efficiencies Clarify group ground rules and call schedule going forward Discuss this webinar and the strategies that you plan to implement Be prepared with data What is your current collections rate by payer mix? What do you want to change about these numbers? 45

46 Remaining Calls What To Expect Each clinic will be given an opportunity to present the key problem/implementation process they are going through Take advantage of other clinics expertise to brainstorm solutions The presentation schedule will be set before the first call Will be given a format to structure presentation Since it s a small group, its really important everyone attends & contributes! Impact on wealth of ideas and available resources 46

47 Cohort Communication Will be invited to a list-serve that all members of the cohort can use to communicate with the group Will be automatically invited Will use to coordinate available times for calls and send out the call schedule in advance Primary resource for all content/implementation questions For content questions the list-serve can t answer, Lauren Jensen at [email protected] is your contact! Will help identify further resources 47

48 CARE Next Steps Meet with your CARE team to brainstorm what strategies you want to address What gets at your core problem? What resource support do you want from your cohort? Test out the list-serve Give your call availability! 48

49 Data Collection The Payer Mix cohort will collect: Collections rate by payer class (% of cash received vs. revenue billed) Will be collected at midpoint & end of CARE Collected via a Qualtrics link

50 Other Upcoming CARE Webinars Topic Date Presenter Payer Mix 1/27/14, 11:30 1 PM Peter Campanelli & Chris Copeland Billing & Collections Developing Best Practices 1/30/14, 11:30 1 PM Dewey Howard No Show Management & Engagement 2/5/14, 12:00 1:30 Kara Dean-Assael & Yvette Kelly Effective Strategies for Staff Communication & Accountability 2/7/14, 12:00 1:30 David Wawryznek & Julie Gutowski Open Access 2/11/14, 2:14 3:45 Joy Fruth, MTM Services Centralized Scheduling 2/12/14, 3:15 4:45 Scott Lloyd, MTM Services 50

51 Contact Us Justine Lai CTAC Business Practices Project Manager Phone: x * Preferred 51

52 Thank you!! Your feedback is appreciated Please fill out the survey afterwards 52