Opportunities To Better Understand System Of Care Dynamics: Engaging Community Behavioral Health Providers in Using Dynamic

System of Care Data and seeking Collaborative Solutions to Community Health Challenges

Integrating Data Analytics into Practice & Motivating Value-based Decisions:

by Chris Potter, M.Ed.December, 2014

My Commitment to Integrating Analytics into Clinical Practice :

For over 30 years, I have served within many roles delivering behavioral health services, ensuring compliance with quality of care standards, and implementing quality improvement projects on behalf of Community Mental Health Programs. I have worked in a variety of community health settings within Oregon and Minnesota, providing managerial and clinical services as: Quality Improvement Coordinator, Program Quality Analyst, Lead Clinician, Licensed Psychologist (Minnesota), Program Manager, and Supervisor.

Throughout my career, I’ve promoted value-driven quality improvement processes, developed specialized mental health programs, conducted multiple data-informed practice management projects, and delivered a broad range of clinical services for children and adults. Over the past 20 years, I’ve committed myself to providing leadership in developing and implementing protocols that empower performance improvement within healthcare organizations.

A Commitment To Data-Driven Community Health System Transformation

I started collecting and analyzing data in the late 1990’s. Over the years, I formulated three major projects toward the goal of gaining an understanding of dynamic partnerships within systems of Care, and toward developing tools that can assist ‘System of Care Partners’ in learning from the data about how their health outcomes are affected by the dynamics of partnerships within their community system of care.

Three Projects: Three Data Analysis Dimensions• Each project represented a different phase of studying, understanding,

and developing materials and processes to facilitate more standardized procedures to maintain consistency throughout the project.

• Project #1 focused on the clinical relationship: – the Practitioner=Recipient of Care relationship.

The product of this project culminated in development of Symptom and functioning evaluation tools, self-monitoring forms, and self-guided coping skill development courses. Given the focus on managing stress and conflict more effectively, I called this approach ‘Assertive Self-Care (ASC).’

• Project #2 focused on the systemic organizational relationships between:– the Recipient of Services=The Practitioner=and Organizational Management.

While integrating use of balanced scorecard benchmarks, clinical and cost outcome data by program type, and desire to identify organizational feedback from each participant’s relationship, I assembled materials and a standardized quality improvement process I called “Outcome Driven System Development (ODSD).”

• Finally, while working for a state government organization, I sought out models that took into consideration more complex relationships between population specific health improvement-state governmental organizations and community health organizations:

– Recipient of care=Practitioner=Organizational management=Community Stakeholders

• This approach resulted in a variety of quality assessment tools and modelling processes aimed at building more effective collaboration between state and local healthcare organizations, focusing on ‘System-of-care Partnership Analysis (SPA).’

In conclusion, there appears to be great benefit in collecting and integrating basic symptom, functioning, and performance data into clinical practices. This can prove to be useful within three ‘dimensional partnerships’:

1. in clinical practice: between practitioner and care recipient, 2. In behavioral health organization: between practitioners, care recipients, and

organizational performance managers, and3. In state health authority: between practitioners, care recipients, organizational

performance managers, and state and local stakeholdersThe following slides show how data is analyzed in each partnership dimension:

Example of client outcome evaluation after episode of Treatment: Assertive Self-Care: Risk Factors: diabetes, sib past Resource Needs: 2 out of 11

Strengths, motivators: "I want better life"

Outcome Goal better direct my anger

Stresses/changes teenage son - abusive

Psych. Medications: Prozac

Supports: husband

CC: rb

Prescriber: 0

Appointment # 1: 9/15/05

Appointment type: i

Initial GAF: 50

Therapy Protocol: sf-sm

Level of Care (0-4): 1

age: 37

Gender F

Dx 1: dep

Dx2: anx

Substance Abuse Hx.: n

Medical complication: y

Weight complication: y

Unemployed: y

PD features: y

Filing for Social Security: 0

Last Psych Hosp.: 01/00/00

Termination code: 0

No of no shows 1 Last NS date: 11/22/05 Review Date: 1/0/00

Latest Appointment: 11/3/05

Appointment number 3

Recent GAF: 60

What's helped: When hous is clean I feel better, stopped smoking

Client current plan: get things done

Treatment Progress:

2 2 2 2

1

2 2 2

1

0

1

0 0

44

3 3 3

1 11.5

1

2 2

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4

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Developed by Chris Potter, M. Ed.

Integrating Performance and Outcome Data into System DevelopmentIntegrating Performance and Outcome Data into System Development ProcessProcess

SystemsIntegration

Staff Productivity

Clinical Effectiven ess

Outcome Outcome Driven System Driven System

DevelopmentDevelopment

Total Services delivere d Client Serv ice Hours/month

Clinicia n Direct Serv ice hours/monthNumber of ne w cases/ month

Number of uni que i ndiv iduals seenCost of Serv ice per Lev el of Care

Efficiencies to reduce cos ts

Quali ty of care*Client S tatus Assess ment:

•Symptom/ Functi oni ng status c hange•Risk fac tors a nd res ponse•Functi oni ng Sta tus: Voca tional/Educati onal/•Coor dina tion of care be twe en prov iders

Outcomes per i nterv enti on & Populati on Group: Ev idence Based Prac tices v s. Outcomes of Sta ndar d Care

Anal ysis of Hi gh Serv ice Utilizers & Treatment v ariance be twee n clini cians:

Customer sa tisfa ctionServ ice Access time: from call to 1st appointmentSatisfac tion wi th care

Ma nage ment Str uctureStaff W orkloa d Mana ge ment:

•Documentation Timeliness•Staff Satisfaction

•Incentives for Performan ce•Recognition of Innovation

Multi-S yste m interface:

Cross-system service integrationPartner relation ships

*Assessme nt drawn from ‘Na tional Outcome Measures’, DS M IV criteria, ‘Prime -MD S urv ey’, ‘Common Fac tors i n Ps ychotherapy’

* System-of-care Partnership Analysis The Golden ‘Value’ Process Cycle

Using Meaningful Metrics to Evaluate Systemic Partnership Dynamics Working Toward Balancing Whole System Dynamics with Whole Person Needs

System-of-Care Partnership Dynamics:

Partnership: ‘Intervention/Performance Process Cycle’ Assess needs & Previous Intervention Reponses

Engage Individual on Intervention Plan Implement Intervention: planned strategies

Collaborate on Care with community care partners Monitor Progress & revise strategies as required

Transition Care to Community Support Network

Utilization/Covered Population Group

Outcomes/Covered Population Group

Cost Quality

VV == VVaalluuee ooff CCaarree ‘‘BBaallaannccee’’

3-Provider Organization (Management) Partnerships

2 – Practitioner Partnerships

A

I

V T E

C M

A

I V

T E

C M

4 – Community

Stakeholder Partnerships

1 – Recipient(s) of care

Partnerships

A

I

V T E

C M

A

I

V T E

C M

A

I

V T E

C M

System-Of-Care Dynamic Transactions

Balancing Costs and Quality between Community Partnerships

Assess Health, Stress, Conflict, Abilities, Experiences,

Environment, & Resources

Implement Intervention/ Performance Improvement

Plan

Transition level of care/oversight to Community Support Network

Engage Individual in a process to

identify outcome, performance goals

Collaborate with community

health promotion/ professional

partners

Monitor Progress on plan,

& on factors contributing to

success toward goals

Golden Value

Triangle

System of Care Partnership Performance Analysis Groupings

Monthly-Quarterly data reports: focused on Access and Outcomes for

Specific Populations, Service Coordination, Provider Performance

Benchmark Progress, and Community Wellness Initiative Goals and Impact

Governance Body- Provider Network Community Health Improvement Benchmarks

Target Metrics

Monthly data reports: focused on Practitioner Performance, Caseload Management, and Provider

Performance Improvement Processes to meet Benchmark Goals

Time Time

Time Time

Individual-Practitioner Intervention Plan

Management-Practitioner Performance Improvement Plan

Stakeholder-Organization Quality Improvement Initiative Plan

Quarterly data reports: focused on Provider Performance in meeting Benchmark Goals,

Population-specific health access and outcomes,

Community Wellness Initiative Impact

Target Metrics

Target Metrics

Target Metrics

Real-time Service data reports: focused on Practitioner Interventions,

Recipient follow-through, Outcomes/Satisfaction, Service

Coordination, and

Recipient’s ‘whole health’ status

Four Partner Dynamic System of Care Contracting

System Transformation

Consultation modelsSolution Focused ConsultationCollaborative Governance Dynamic Value Improvement Process

Governance System

SpecialistRole

ManagerRole

StakeholderRole

CustomerRole

Productivity

Quality

Metric

Metric

Resource acquisition

Benchmark goals

Monthly outcomes

ClinicianRole

ManagerRole

StakeholderRole

ClientRole

Productivity

Quality

Metric

MetricClinical goals

Service utilization

Clinical outcomes

Provider System

Dynamic Contracting• Value monitoring process• Required QA standards• Risk management protocols• QI Benchmarking process: • Quarterly goals• Performance indicators

• Access• Outcomes• Utilization• Service coordination

• Continual progress monitoring• (Rapid) Performance improvement

process

Promoting Healthy Communities

Using Performance Metrics Effectively to Understand How Community Healthcare Systems Work and

To Influence How Health Care Decisions are Made

Engaging Community Residents and Service Providers to• Encourage Healthy Behaviors and • Foster Collaborative Solutions to Health Challenges

For more information, contact Chris Potter, M.Ed.: Pdxchrisp@MSN.com