a boston pioneer aco’s “shared expectations: building ... · a boston pioneer aco’s “shared...
TRANSCRIPT
A Boston Pioneer ACO’s “Shared Expectations: Building
from the Ground Up”
Laurie Herndon, MSN, GNP-BC Director of Clinical Quality
Mass Senior Care Foundation [email protected]
May 12, 2015
Leadership Summit Lifespan Network
Maryland Hospital Association
Goals for This Afternoon
Share Focus Inspire
The
Ground in
2009-2010
Fertile Soil: State Leadership and Vision
http://www.patientcarelink.org/uploadDocs/1/Strategic-Plan-for-Care-Transitions_2-11-2010-(2).pdf
The Foundation:
State Vision/Local Execution
The cornerstone (or foundation stone) concept is derived from the first stone set in the construction of a masonry foundation, important since all other stones will be set in reference to this stone, thus determining the position of the entire structure.
Why This Mattered
• Scale matters
• Language changed
• Key stakeholders involved
“It is not about the forms, it is
about the relationship”
MA INTERACT Champion
What About The Forms Though?
Provided platform for: • Organizing our
work as a group • New language of
collaboration
Why the SNF focus?
• Priority relationship driven by data and number of readmissions from SNFs
• Not the only focus • SNF
• SNF provider teams
• Hospitals
• ACOs
• ……
Building Progress Update
Key Stakeholders
• Pioneer ACO representatives
• Mass Senior Care • 1-3 Members
• Leading Age • 1-2 Members
• Monthly meeting
• Convener role
• Meeting space
• Agenda
• Document version control
Key Stakeholders: Clinical Leaders
March 2013
• Mass Senior Care Spring Meeting
• Leading Age to occur in April
2013 Mass Senior Care Spring Meeting
Standards
• Staffing
• System Continuity
• QI Efforts
• Screening/Admission
• Medical Coverage
• Care Transition
• Facility Environment
• Care System
• Care planning and Coordination
• Medication Reconciliation and Education
• Advance Directive Documentation
• Communication of Discharge Paperwork to the Group
• Standard Discharge Checklist and Planning
• Selection of Transfer Facility
Good News/Bad News
Reporting
Contractual Obligations
Readmissions Consumer Satisfaction
Getting To Standard Readmissions Measure
David Gifford, MD, MPH SVP for Quality & Regulatory Affairs
American Health Care Association [email protected]
Getting To Standard Consumer Satisfaction Measure
Nicholas G. Castle, Ph.D.
Department of Health Policy and Management,
Graduate School of Public Health, University of
Pittsburgh [email protected]
Remember this?
• Why the SNF focus?
• Priority relationship driven by data and number of readmissions from SNFs
• Not the only focus (right?) • ✔SNF
• ✔SNF provider teams
• Hospitals
• ACOs
• ……
Early Stages
Lessons Learned
• Large scale/key stakeholder collaboration sets the foundation
• Local/grassroots collaboration and innovation is required to actually get the job done
• Language matters • Trust, respect at highest levels
• “Standards” at grassroots and frontline
The Challenge
• Maintaining momentum and “bandwidth”
• Staying out of the silo • What else is going on?
• CMS 5 star change
• QIO data/SOW
Think About
• What is status of your “ground” right now?
• What should the foundation be?
• Where are the conditions right to begin building right away?
• Who are your key stakeholders?
• Who is your “coalition of the willing”?
Most Important
“It is not about the forms, it is about the relationship”
Thank You!