Developing a Performance-Driven
OrganizationPart 1
Why is Data Important?JOHN LEE, MBA, DIRECTOR
BRIANNON O’CONNOR, PHD, ASSOCIATE DIRECTOR
REBECCA HAUCK, MPA, CONSULTANT
CENTER FOR COLLABORATION IN COMMUNITY HEALTH
COORDINATED CARE SERVICES, INC.
Portions of these materials were created with support by New York
State Success, in partnership with the Managed Care Technical
Assistance Center and the Center for Collaboration in Community
Health
Welcome & Introductions
PDO- Why is Data Important?
What we will cover during this session:
‣ Consider why data is important
‣ Provide an overview of the elements of a
Performance Driven Organization
‣ Review the foundations of data collection
‣ Review the data collection tool
‣ Cross- systems collaboration and emerging
Performance Driven Organizations
PDO- Why is Data Important?
What we will cover during this session:
‣ Consider why data is important
‣ Provide an overview of the elements of a
Performance Driven Organization
‣ Review the foundations of data collection
‣ Review the data collection tool
‣ Cross- systems collaboration and emerging
Performance Driven Organizations
Why is Data Important to you?
Why is Data Important?
‣ Supports the wise use of limited resources
‣ Encourages informed decision making
‣ Heightens accountability to make a
difference/impact
‣ Important in supporting a more certain future
during uncertain times
Why is Data Important?
‣ Encourages an organization to take on meaningful
challenges
‣ Prepares an organization for greater accountability
as new payers (MCOs, ACOs) emerge
‣ Positions an organization for the possibility of
participating in Value Based Payment arrangements
‣ It’s the right thing to do for those receiving services:
adults, children, youth and their families
Why would you want a performance driven culture?
Why would you want a performance driven culture?
‣ Better for your staff
‣ Better for people receiving services
‣ Better for your bottom line
Case Study ApproachINTRODUCING NEXT GENERATION
BEHAVIORAL HEALTH (NGBH)
Continuing Case Study: Next Generation Behavioral Health
Who we serve: Youth 12-21 years old with
Substance Use Disorder and their families in
DuPage and surrounding counties
Next Generation Behavioral Health (NGBH): Services
‣ Community Residence (RRSY):
• 18-bed facility
• Schooling/Tutoring on-site
• Family Support and Education
• Parent Skill Development
• Community Connections and Natural
Supports
• Transportation to AA/NA/support group
meetings
• Individual/Group/Family Therapy
• Medication Management (incl. Suboxone
provider on-site)
‣ Outpatient clinic that provides: • Evaluation/ Screening
• Individual Psychotherapy
• Group Therapy
• Family Therapy
• Medication Management (incl. Suboxone providers on-site)
• Family Support and Education
• Certified Recovery Peer Advocates (CRPA)
• AA/NA & Nar-Anon/Al-Anon meetings on-site
NGBH: Location
DuPage County
‣ Approximately 91,000 residents in a mostly rural county
‣ 11% of families and 14% of the population were below the poverty line with 22% of those under the age of 18
‣ Demographic Characteristics
• 79.6% White
• 8.1% Black or African American
• 1.8 % Asian
• 4.6% Native American
• 2.0% Other Races
• 3.9 % Two or more races
• 4.8% of the population identified as Hispanic
NGBH: Trends in service delivery
‣ Utilization of the community residence beds has increased each year over the last three years, although length of stay decreased
‣ The average age of those youth in residential treatment during the last year was 19, with a range of 14 to 21
‣ NGBH has seen a relatively significant increase in the population of Native Americans being served
‣ The percentage of youth reporting Heroin as their primary or secondary substance at intake has increased from 8% to 20%
NGBH: Context
‣ The state has expressed an interest in involving
Managed Care Agencies more in the Medicaid
service delivery system
‣ Conversations in the county are starting to
mention network development
‣ Performance measurement and data analysis
has become more prevalent in community
taskforce meetings with the LGU
What Are The Components of an
Organization that Effectively Uses Data to
Drive Performance?
A Performance Driven
Organization
PDO- Why is Data Important?
What we will cover during this session:
‣ Consider why data is important
‣ Provide an overview of the elements of a
Performance Driven Organization
‣ Review the foundations of data collection
‣ Review the data collection tool
‣ Cross- systems collaboration and emerging
Performance Driven Organizations
Let’s Talk about the Culture of a
Performance Driven Organization
What is a Culture?
‣ Culture is the way of thinking, behaving, or
working that exists in a place or organization (such
as a business).
‣ It is a belief system that impacts what is
considered to be of “value” and how decisions are
made.
What Does Culture Mean in a Performance Driven Organization?
Belief system ...from board to management to staff...
that supports the concept of data-driven problem
(opportunity) identification as a path to improved
organizational and individual performance
What are the cultural elements in a
Performance Driven Organization?
An Organization’s Performance Driven Culture is found in its....
‣ Corporate Policy
‣ Leadership Values
‣ Performance Dashboard
‣ Human Resources
‣ Continuous Learning
‣ Communication
‣ Collaboration
Corporate Policy
‣ There is a Corporate Policy (documentation)
in place that reflects the value of
performance driven leadership and the
importance of continuously learning and
improving
•The policy embraced as a shared vision by all
leadership
•Annually reviewed, updated and approved
Leadership Values‣ Leadership Team values data and information in
ways such as:• Routinely talking about agency performance
• Willing to conduct authentic agency program and service assessments using internal and/or external resources
• Always willing to take a “deeper dive” to better understand the meaning of the information
• Performance is an acceptable topic to talk about at the staff and management levels of the organization
• Agency performance is routinely reported out and discussed during board meetings
• Accountability for improvement exists at all levels of the organization
Performance Dashboard
‣ Agency Performance Dashboard is maintained and reviewed on a regular basis
• Covers all areas of performance: financial, quality (fidelity to practice model), service impact, client satisfaction, payer satisfaction feedback
• Opportunities for improvement are identified in the analysis with clear expectations for follow up
• Agreed upon actions tied to opportunities are reported out at a follow up meeting
• Measures are added (or removed) as requirements change
Human Resources
‣ Human resource practices reinforce performance expectations:
• Job descriptions reflect expectation of measurement and continuous improvement to assure best possible performance
• Performance Appraisals incorporate aspects of measurable performance for staff members as well as management
• Professional development driven by identified areas for improvement
• Multiple forms of recognition tied to exceptional performance
◦ Willingness to take action on those that cannot meet expectations after multiple training/retraining efforts
Continuous Learning
‣ Investment in learning/training is made for all
levels of the organization
• Continuous transformation is encouraged during trainings
• Ongoing research to identify evidence based practices
• Investment in innovation
Communication
‣ Exceptional, two-way communication is routinely taking place across all areas of the organization
• Staff members see and hear leadership talk about and act in a manner consistent with agency values
• Staff members are routinely given the opportunity to ask questions and share their thoughts
• Both good news and bad news is shared and discussed
• Each staff member knows and supports the Agency Value Proposition and Values
Collaboration
Definition for internal collaboration:
A work culture where joint communication and
decision making among all members of the
healthcare team becomes the norm, resulting in a
higher level of services than if each was working
alone
Characteristics of Collaboration within an Agency
‣ System thinking and team learning
‣ Recognizing, and acting upon, mutual
interdependency (clinical, financial, quality,
training, etc.)
‣ A just culture that supports fair, equal and
consistent approaches to variances in care
‣ Promotion of a safe/fear-free environment
‣ Celebratory mechanisms to highlight success
Characteristics of Participants that Collaborate
‣ Mutual respect
‣ Effective communication
‣ Support of team based learning
‣ Sense of partnership
‣ Trust
How Might You Know Whether Your
Organization has a Performance
Driven Culture?
Introducing: Performance Driven Culture Assessment Tool
Here is what Next Generation Behavioral Health learned when they completed the Performance Driven Culture Readiness
Assessment
Assessment Findings for NGBH
‣ Need to develop a Performance Dashboard that includes all
areas of focus
‣ Need to take performance information (Dashboard) to the
Board
‣ Need to invest in more training to support ongoing practice
change
‣ Need to improve routine, two-way communication with staff
members, with a focus on sharing of performance information
‣ Need to invest in encouraging authentic collaboration within
and among the various programs and support areas within
NGBH
How Can I Get Started?
‣ Consider using the Performance Driven Culture
Assessment Tool to better understand your
readiness for a world of heightened accountability
for outcomes
‣ Complete the tool during a Leadership Team
Meeting so that all may offer their perspectives. It
is the conversation that will be very important
‣ Develop a work plan for addressing gaps in
cultural readiness
What data should I collect and how?
PDO- Why is Data Important?
What we will cover during this session:
‣ Consider why data is important
‣ Provide an overview of the elements of a
Performance Driven Organization
‣ Review the foundations of data collection
‣ Review the data collection tool
‣ Cross- systems collaboration and emerging
Performance Driven Organizations
Master the basics
Emphasis on outcomes, outcomes, outcomes but…
A lot that can be done with key data elements valuable across systems (agencies, providers, counties, etc.)
1. Who is served? Demographics, understanding your population and demographics
2. How are they served? Utilization, quantifying the services you provide
3. How well are they served? Outcomes, understanding the value of your service
4. What is the cost of serving them? Fiscal data, how effectively are you using your resources in support of your mission
Demographics: Why it’s important
‣ Provide a snapshot overview 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 of measurement (Understanding your denominator)
Utilization – Why it’s important
‣ 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
Outcome – Why it’s important
‣ Determine if consumers are satisfied with the
services
‣ Assess if consumers are engaged in the process
‣ Determine if consumers are accessing your
services in a timely manner
‣ Identify if consumers are reaching their goals
and/or making progress toward those goals
Finance – Why it’s important
‣ Compare your budget to actuals for:
• Revenue
• Costs
• Revenue per Unit
• Costs per Unit
‣ Look at your payer mix to determine variances
in reimbursement
Introducing the Data Summary and Visualization Tool
In the tool, enter:‣ Roster/list of clients• Basic demographic, utilization and outcome data for each client
‣ Basic financial information • Revenue, costs, units of service (budget and actuals)
Tool auto-populates a real-time analysis of performance‣ Demographics
‣ Utilization
‣ Outcomes
‣ Finance
Let’s see what it can do!
Data Collection
Demographics – understanding the
basic characteristics of who you
serve
What is the average
age served?
What is our gender
distribution?
Does this make
sense?
What is our race and ethnicity
distribution?
What percentage of our
population identifies as
homeless?
Do we have a need to translate our
documentation into multiple
languages? If so, which languages?
What percentage of our population
has a trauma history?
Customizing the Tool
to Your Needs
Demographics
Example Findings and Follow Up
Questions
Low compared to county
demographics
65% of current clients are
under the age of 16 – are
we involving family
members in treatment?
Utilization – quantifying the
services you provide
Do I have the right
training for my staff?
Is my staff distribution
appropriate?
Are we using best practices?
Utilization
Example Findings and Follow Up
Questions
46% of our
adolescent
population has
alcohol or heroin
as their primary
substance – are
we engaging
families? Are we
providing med
management?
Our youngest clients are receiving an avg. of 20 group
sessions – is this the best practice for the youngest clients?
Only 2 family sessions – is this enough for this young age?
13-18 y/o – less than 1 family session on average? Too low
16-18 y/o – no group sessions. Are we missing an opportunity
to better engage these clients?
Outcome – understanding the value
of your service
What are the priority outcomes in
your agency?
What percentage of my current clients have
made progress on reduced frequency of use
of their primary substance since admission?
Are there differences between
outcomes by primary substance?
Are there differences
between outcomes by # of
family sessions?
Outcome
Example Findings and Follow Up
Questions
More than 40% of current clients
show no improvement or
increased frequency of use of
primary substance
Of those clients
showing no
improvement or
increased use:
• 57% had
received 0
family sessions
• 43% had only
received 1
family session
Finance – how effectively are you
using your resources in support of
your mission
Data Entry Requirements
What is my payor mix?
How are each of my programs
doing fiscally, comparing actual
YTD to budget?
How is my agency as a whole
doing fiscally, YTD compared to
budget?
What are my cost per unit and
revenue per unit? Both budgeted
and actual YTD
Finance
Example Findings and Follow Up
Questions
One of NGBH’s programs is
operating at a current deficit
NGBH – Recap FindingsDemographics‣ 65% of current clients are under the age of 16 – are we engaging families?
Utilization‣ 12 y/o receive an avg. of 20 group sessions; 16-18 y/0 have no group sessions
‣ 13-18 y/o have < 1 family session on average - are we using best practices?
Outcomes‣ >40% of current clients show no improvement/increased freq. of use of prim.
sub.
‣ Of those, 57% had received 0 fam. sessions and 43% had received 1 fam. Session
‣ Correlation between family sessions and decreased sub. use
Finance‣ One of NGBH’s programs is operating at a current deficit – requires review
Data Collection - Tips
‣ Know your definitions
‣ Pay attention to Spelling
‣ Check for completeness and accuracy of your data
• Check ID numbers
• Check data categories
‣ Determine if the data you collect is meaningful
• Does collecting Housing Status make sense for my agency/service?
• What information is critical to know?
‣ Pay attention to the Time Period
How Can I Get Started?
‣ Attend future events
• MCTAC events
‣ Establish a work group
‣ Access tools on the MCTAC website
‣ Play around with the data tool
Now What?
Individual
MH Agency/Services
Your Agency/NGBH
(CD services)
Juvenile Justice Agency
Now What?
Individual
MH Agency/Services
Your Agency/NGBH
(CD services)
Juvenile Justice Agency
Cross-System Collaboration and Data Sharing
PDO- Why is Data Important?
What we will cover during this session:
‣ Consider why data is important
‣ Provide an overview of the elements of a
Performance Driven Organization
‣ Review the foundations of data collection
‣ Review the data collection tool
‣ Cross- systems collaboration and emerging
Performance Driven Organizations
Question
Have you ever attempted to work more closely
with other providers or other systems, but met
with limited success… and a fair amount of
frustration?
During this session, we will talk more about
such opportunities
Cross System Collaboration and Data Sharing
Goal: Understand why external collaboration is important and become aware of models/approaches being used to support collaboration among service providers and other support systems.
‣ Why is collaboration with other providers and other systems important?
‣ Build awareness of a Systems /Network Dashboard (Demonstration)
‣ What are the challenges of collaboration?
‣ Techniques and models that are being used to support effective provider and cross-system collaboration
‣ So… What about Next Generation Behavioral Health?
Why Do We Need to Work Together?
The Importance of Working with Other Providers
‣ To achieve an impact that we cannot achieve alone (cross system impact)
‣ It is the right thing to do for the client
‣ The service payment environment is shifting:
• Pay for Performance
• Value Based Payments
• Pay for Reporting
‣ Behavioral Health Care Collaboratives (networks of BH providers) are being developed in New York State
The State’s Managed Care for Children Vision
Systems Dashboard‣ Example of measures that may drive payment in the
future
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
EngagementFamily-Driven
Values
Continuity of
Care
Access
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
Access
Average days from
first contact with SUD
Outpatient Clinic until
first visit with
treatment provider
Average days from
first visit until second
visit for those
Programs with Open
Access
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
AccessInpatient SUD
Readmission Rate
(within 30 days)
Average Length of
Stay for those in a
Detoxification or
Inpatient Rehabilitation
Service
Percentage of those
using services with
reduced Juvenile
Justice Involvement
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
Access
Percentage of
programs
demonstrating
competency in Trauma
Informed Care
Percentage of families
engaged in
adolescent’s
treatment, by level of
care
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
Access
Percentage of those
using services enrolled
in a Health Home
Percentage of those
using services referred
to a SPA service
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
Access
Percentage of SUD
Rehabilitation
Discharges followed
by a lower level SUD
service within 14 days
DuPage County System Dashboard
System
Collaboration
Linkages to
Services
Engagement
Family-
Driven
Values
Continuity of
Care
AccessPercentage of SUD
Detoxification or
Rehabilitation
Discharges followed
by 2 or more lower
level SUD services
within 14 days of
discharge
So.....How do we work together?
What are the fears and challenges of collaboration?
‣ Lack of success with intra-agency (within)
collaboration for one or more of the partners
‣ Financial incentives exist to remain the same,
including the fee for service payment model
‣ Maintaining the motivation and investment from
the stakeholders
‣ Ability to keep focused on those values that are
mutually shared
Techniques/models that have been used to support effective provider or cross-system collaboration
‣ Collaboration and Teamwork to Better Serve
Young People (Pathways Transition Training
Collaborative)
‣ STAAR Initiative: Team-to-team collaboration
across organizational boundaries resulting in
reduced readmissions
‣ Collective Impact (John Kania & Mark Kramer,
Stanford Social Innovation Review)
Collaboration and Teamwork to Better Serve Young People (Pathways Transition Training Collaborative)
Intended use: A cross-system collaborative
approach for reaching across fragmented services
and systems to build constructive working
relationships that will assist young people to
achieve their goals.
STAAR Initiative: Team-to-team collaboration across organizational boundaries resulting in reduced readmissions
‣ A model that encourages providers to work together to
improve the transition to the next setting (example:
inpatient to community) by creating partnerships
between “senders” and “receivers.”
‣ Created by Amy E. Boutwell, MD, MPP Co-founder,
STARR (State Action on Avoidable Rehospitalizations),
Initiative Collaborative Healthcare Strategies, Lexington,
MA (part of the Institute for Healthcare Improvement).
What is Collective Impact?
‣ A framework to tackle deeply entrenched and complex social
problems
‣ An innovative and structured approach to making collaboration
work across government business, philanthropy, non-profit
organizations and citizens to achieve significant and lasting social
change
‣ The approach is premised on the belief that no single policy,
government dept., or organization can tackle or solve the
increasingly complex social problems we face as a society.
‣ Calls for multiple organizations or entities from different sectors to
abandon their own agenda in favor of a common agenda, shared
measurement and alignment of effort.
Cross Cutting Themes in Developing a Collaborative Model
What aspects do these approaches share?
‣ Need for Trust among participants
‣ Common purpose. Clear shared understanding of the
desired impact/outcome of the work that is measurable
‣ Respect: assuming best intentions
‣ Communication that is meaningful, regular and creates
motivation to continue on
Cross Cutting Themes in Developing a Collaborative Model
What aspects do these three approaches share?
‣ Shared values
‣ Clarity concerning how decisions are to be made
‣ Shared training so that each participant understands and
appreciates the work done by others
‣ Ability to identify and address issues among participants
(differences of opinions, actions taken without support) in a
very timely and open manner
How cross-systems data sharing is important to effective collaboration and what data sharing can accomplish
‣ Helps to define the clarity of purpose of the
collaboration
‣ Provides ability to measure impact of work over time
‣ By taking a deeper dive, data will assist in better
understanding a problem are.
• Example- Are there differences by age, gender or race/ethnicity
How do you start the conversation?
How do you start the conversation?
Ask the following questions:
◦ What can we accomplish by working together that we
cannot accomplish alone?
◦ What are the priority outcomes as described by the
payers (State, MCOs, county, foundations)?
◦ What should my agency be measuring that
contributes to the priority outcomes?
So… What about Next Generation Behavioral Health
‣ NGBH have been invited to be part of an
emerging Behavioral Health network… a
Behavioral Health Care Collaborative.
So… What about Next Generation Behavioral Health
‣ Recognizing that the success of the network will require effective cross-provider collaboration, they are taking the following steps:
• Practice internal, cross-department collaboration. Successful intra-agency collaboration improves the chances for successful interagency collaboration
• Development of a NGBH values statement so that they may clearly articulate what is important to them as they begin to work with others
• Begin to review internally generated data, as well as data provided to them by their LGU to better understand the system opportunities for improvement.
Feedback? Questions?
Next Steps
‣ Please see the MCTAC website for access to the tools shared today• Performance Driven Culture Readiness Assessment
• Data Collection and Visualization Tool
• http://ctacny.org/training/tools-support-development-performance-driven-culture-long-island-and-nyc
‣ If you have additional questions, contact CCSI’s Center for Collaboration in Community Health
John Lee, MBA Director
585-613-7627
www.ccsi.org/The-Center
Thank you for your participation!