selecting effective clinical interventions for …health wealth career services provided by mercer...
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H E A LT H W E A LT H C A R E E R
Services provided by Mercer Health & Benefits LLCMercer Proprietary and Confidential©Mercer 2019
AUGUST 15, 2019
Facilitators:Jake Bowling, MSW - Bowling Business StrategiesLaura Nelson, MD - Mercer
S E L E C T I N G E F F E C T I V E C L I N I C A L I N T E R V E N T I O N S F O R V A L U E - B A S E D P U R C H A S I N G S U C C E S S
V A L U E - B A S E D P U R C H A S I N G : S U P P O R T I N G W H O L E P E R S O N C A R E
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2Copyright © 2019 Mercer (US) Inc. All rights reserved.
O B J E C T I V E S
Understand the importance of transformed care delivery and clinical practice in a value-based era, including how to mitigate risk through stronger clinical care.
1
Identify best practices for creating a cultural and environmental milieu supportive of clinical excellence.2
Learn active/assertive engagement approaches and customer service practices that support clinical engagement.3
Understand best practices when designing care pathways and clinical interventions for clients that buttress Value-Based Purchasing (VBP) success.
4
Share and discuss real world examples and engage in reflective exercises to think about your organization’s strengths, weaknesses, and opportunities to strengthen clinical care.
5
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3Copyright © 2019 Mercer (US) Inc. All rights reserved.
S E T T I N G T H E F R A M EW E ’ R E M O V I N G T O W A R D R I S K
V B P I S G R O U N D E D I N R I S K — PAY E R S A N D P R O V I D E R S A R EI N C R E A S I N G LY B E I N G E X P E C T E D T O H AV E
“ S K I N I N T H E G A M E ”
PROVIDERS MUST DESIGNPROACTIVE MEASURES TO
MINIMIZE RISK, MOVINGFROM FEE-FOR-SERVICE
OR UPSIDE RISK-ONLYSCENARIOS
PROVIDERS MUSTIMPLEMENT THE
INTENSITY, DOSAGE, ANDTYPE OF SERVICES THAT
ARE LIKELY TOEFFECTUATE AND
DEMONSTRATE RELIABLEAND PROVEN RESULTS
PROVIDERS MUST ALSOBALANCE
PERSON-CENTERED CAREWITH WELL-DEFINED
CLINICAL PATHWAYS THATREDUCE VARIABILITY IN
SERVICES AND OUTCOMES
What is your biggest concern regarding your organization’s clinical readiness for risk-based payment models?
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4Copyright © 2019 Mercer (US) Inc. All rights reserved.
C L I N I C A L F O U N D AT I O N S T O VA L U E - B A S E D R E I M B U R S E M E N T
Creating culture of commitment to
clinical excellence and a therapeutic
milieu.
Prioritizing and building skills and
protocols for engagement and customer service.
Implementing evidence-, practice-, and measurement-based clinical care.
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5Copyright © 2019 Mercer (US) Inc. All rights reserved.
C R E AT I N G C O M M I T M E N T T O C L I N I C A L E X C E L L E N C E A N D T H E R A P E U T I C M I L I E U
• Strategies to proactively build provider wellness and help them heal from burnout or vicarious trauma.
• Physical space design to create warm and calming environments.
• Trauma-informed principles and approaches.
• Clear and concrete definition of clinical excellence (aligned with payer definition).
• Agency-wide commitment — led from the top — to culture of clinical excellence.
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6Copyright © 2019 Mercer (US) Inc. All rights reserved.
C R E AT I N G C O M M I T M E N T T O C L I N I C A L E X C E L L E N C E A N D T H E R A P E U T I C M I L I E U
What, in your view, creates a culture of clinical excellence and/or a therapeutic environment?
• Understanding of stages of change to reduce provider frustration.
• Commitment to familial and caregiver support.
• Belief that people can and do recover, should be treated as a whole-person, and should be in the driver’s seat of their care.
• Incorporation of people with lived experiences to build empathic bridges and connection.
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7Copyright © 2019 Mercer (US) Inc. All rights reserved.
P R O F I C I E N T E N G A G E M E N T A N D C U S T O M E R S E R V I C E
Do not count on your staff to be
“naturals” at engagement;
show them how
Understand Engagement
BarriersTake responsibility
for engagement
Understand goals of engagement at different stages in the behavior change process
Develop a written service strategy to ensure consistency
of member experience and cultivate loyalty
Review processes and procedures to ensure workflow is
designed from a member experience
perspective
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P R O F I C I E N T E N G A G E M E N T A N D C U S T O M E R S E R V I C E
What strategies does your organization use to promote engagement?
Establish partnership and clearly explain role and goals
Understand and reinforce strengths and
recovery capital
Provide timely, responsive and
structured initial contacts
Promote easy access
Be mindful of care transitions
Promote client choice and
empowerment
Assess and address
immediate needs
Ensure services
maintain their relevance
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9Copyright © 2019 Mercer (US) Inc. All rights reserved.
I D E N T I F Y I N G A N D I M P L E M E N T I N G E F F E C T I V E C L I N I C A L I N T E R V E N T I O N S
• Consider cost, quality, effectiveness, and replicability of EBPs
• Review and analyze the data
• Understand evidence-, practice-, and measurement-based interventions
• EBP staff training, fidelity monitoring and ongoing support/development
• Develop defined care pathways and create processes for appropriate matching
• Use decision support tools and practice guidelines
• Consider effective brief interventions
• Conduct ongoing measuring and monitoring
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10Copyright © 2019 Mercer (US) Inc. All rights reserved.
S A M H S A ’ S E V I D E N C E - B A S E D P R A C T I C E S R E S O U R C E C E N T E R
TOPIC AREA• OPIOID-SPECIFIC• SUD PREVENTION• SUD TREATMENT AND
RECOVERY• SMI AND OTHER
MENTAL HEALTH
POPULATIONS• ADULTS• CHILDREN AND YOUTH• PEOPLE IN THE
CRIMINAL JUSTICESYSTEM
• WOMEN
TARGET AUDIENCE• CARE PROVIDERS• CLINICIANS• COMMUNITY
ORGANIZATIONS• EDUCATORS• FAMILY AND CAREGIVERS• PATIENTS• POLICYMAKERS• PREVENTION
PROFESSIONALS• PROGRAM PLANNERS AND
ADMINISTRATORS• PUBLIC
h t t p s : / / w w w . s a m h s a . g o v / e b p -r e s o u r c e - c e n t e r
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G R O U P D I S C U S S I O N
What data and information do you use to match clients to services or interventions?How might that process change if you have to take on more accountability for outcomes?
What EBPs are currently being utilized by your organization?
Has your organization developed care pathways for specific clinical populations (or sub-cohorts of the same clinical population)?
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B A L A N C I N G S TA N D A R D I Z E D A N D P E R S O N A L I Z E D C A R E
Standardized care incorporates proven practices informed by
guidelines, evidence and expert consensus opinion.
The goal is to strengthen efficiency, reliability, and
effectiveness of care.
Use practice-based evidence; these still must be measurable
and effective.
Implement measurement-based care, which incorporates ongoing client feedback and assessment results:• NCQA HEDIS measures• Screenings/assessment tools
Any examples of practice-based evidence in your organization, program or community?
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S U P P O R T I N G T H E C L I N I C A L W O R K F O R C E
Recruitment
Effective clinical supervision
Clear clinical workflows
EBP training and fidelity support
Tools to support client matching and measurement-based care
Infrastructure to support clinical documentation, data collection/reporting, and use of data
Knowledge of and referral pathways
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14Copyright © 2019 Mercer (US) Inc. All rights reserved.
O T H E R S T R AT E G I E S
What are we missing?
Partner with other organizations to enhance your value proposition and create a continuum of care:• Environmental scan of community
providers and referral sources• Coordinated or integrated behavioral
health and primary care• Providers that can address social
determinants of health • New formal relationships
Incorporate quality improvement mindset across workforce and
departments, including training on how to interpret and act on data
Integrate appropriate innovations and technology:• Telehealth• EHRs• Applications and texting
interventions• Automated member outreach• Web-based tools• Remote monitoring• Decision support tools
Develop and implement protocols to foster member and family involvement
and engagement
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15Copyright © 2019 Mercer (US) Inc. All rights reserved.
C L O S I N G T H O U G H T S
Organizations are under increased pressure to develop reliable and outcomes-focused clinical care.
VBP is a lever to improve clinical care.
VBP provides an opportunity to thoughtfully and creatively design and implement standardized and proven clinical approaches.
There is still ample opportunity (and need) for personalization through measurement-based care and practice-based evidence.
Clinical interventions must be rooted in a culture that is therapeutic and engaging.
The workforce will benefit from clearer practice guidance, stronger professional development and validation of their impact.
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