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Session 14 - Incorporating Improvement into Performance Plan

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  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd MID 901 - Establish performance outcomes, MID 910 - Integrate budget and performance Feb 03, MHS adopted Business Plan concept to forecast needs, requirements, and outputs TRICARE Governance Plan, dtd 14 Apr 03, directed MTF, MSM and TRO business plans
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd
  • The Joint Health Operations Council (JHOC) chartered a Performance Planning Integrated Project Team (IPT) Create a revised incentive structure and planning approach aligned with the Quadruple Aim Readiness/Population Health/Experience of Care/Per Capita Cost The approach encompasses the total beneficiary population Direct and Purchased Prime, Standard Piloted at seven sites in 2010. Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Sherry
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Sherry
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010 Todd
  • Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery January 2010
  • Transcript

    • 1. Session 14: IncorporatingImprovement Into ThePerformance Plan Ms. Sherry Stone Military Health System, Performance Planning sherry.stone@us.army.mil 14-1
    • 2. Objectives • Objective 1: Discuss purpose, importance and evolution of business planning • Objective 2: Present overview of Military Health System Performance Planning Process • Objective 3: Demonstrate the steps of deliberate business planning 14-2
    • 3. Performance Planning Performance Planning Framework Task Force Management TRICARE ASD(HA) Quadrennial Future of Initiative Governance 04Mar03 Defense Military Decisions Plan Memo Review Health Care Service Service MHS MHS Strategy Guidance Strategy Guidance 14-3
    • 4. TRICARE Governance Plan• Established overall organizational construct, process, and objectives • Regional Organization • TRICARE Regional Offices (TRO) • Regional Directors • Market Managers - Eleven Multi-Service Markets (MSM) • Business Planning • Service SGs will approve business plans prior to the year of execution • TMA Deputy Director will approve TRO Regional Business Plans prior to the year of execution• MTF Commander is responsible and accountable for the delivery of the TRICARE health benefit to the population enrolled to the MTF• The Services are also responsible for resourcing MTFs in accordance with the approved business plans• The intent; business plan represents a contract between the MTF and the Service and between TMA and the TROs 14-4
    • 5. Remaining Attendant What do Performance Plans Currently Support?• Enrollment and workload projections from MTF Performance Plans are rolled-up and directly feed • Annual Presidents Budget - Exhibit PB-11b • Program Objective Memorandum (POM) - Includes performance objectives • DoD PA&E receives this • Budget Estimate Submission (BES) - Includes performance objectives • DoD Comptroller receives this • PPS annual budget build• Submissions include • Prior year– actual • Current year – Performance Plans • Two future years – Performance Plans• Other uses of MTF Performance Plans include • Where appropriate, substantiate Service & TRO submitted Unfunded Requirements –UFRs • Where appropriate, substantiate Service Unspecified Minor Construction and MILCON• Performance Plans are starting to translate MHS strategy into action 14-5
    • 6. Role of Performance Planning• The intent of performance planning is to translate strategy into action • Which strategy; MHS or Service? - Both!• Translating MHS Strategy • Quadruple AIM • Readiness • Population Health • Experience of Care • Per Capita Cost • Continuous Process Improvement (CPI)• Performance Planning is the new name for business planning • New name same concept 14-6
    • 7. Creating Breakthrough Performancein the MHS - Evolving! Performance Measures Readiness Population Health Ensuring that the total military force is Reducing the generators of ill health medically ready to deploy and that the by encouraging healthy behaviors and medical force is ready to deliver health decreasing the likelihood of illness care anytime, anywhere in support of through focused prevention and the the full range of military operations, development of increased resilience. including humanitarian missions. Experience of Care Per Capita Cost Providing a care experience that is Creating value by focusing on patient and family centered, quality, eliminating waste, and compassionate, convenient, reducing unwarranted variation; equitable, safe and always of the considering the total cost of care highest quality. over time, not just the cost of an individual health care activity. Strategic Plan and Effective Leadership Strategic Plan and Effective Leadership (Quadruple Aim) (Quadruple Aim) Process BudgetImprovement Each Element is essential . Incentives 14-7
    • 8. Expanding Pay for Performanceto Match the Vision• Premise: MHS Value is predicated on three elements – Outputs - the volume of work that we accomplish, measured currently by RVUs/APCs and RWPs/Bed Days • Incomplete – Outcomes – often measured via factors such as HEDIS/JCAHO – Customer Satisfaction• Our focus to date has been centered on productivity (Outputs) as the MHS source of value for the Department.• Goal: Create a financial mechanism for the direct care system that will emphasize value measures for outcomes and customer satisfaction in a balanced fashion with outputs 14-8
    • 9. “Transition” In Both Payment &Delivery Systems Delivery System Fully Integrated Delivery System f of o aymen t Ideal n o lutio n and p C o-ev izatio an t Level 2/3 Org ymen pa and PCMH Medical Homes Transition Primary Care Sub- Volume-driven fragmented care Today Capitation Fee-for-service Fee-for-service Medical Home Full Population Prepayment Payment Payments Fee-for-service System 14-9
    • 10. MHS Performance PlanningFinancial Incentives – Current State and Pilots Rewards for Quadruple Aim Performance Rewards for Volume Integration System In this chart, “incentives” refer to financial rewards 14-10
    • 11. Balancing Act – Effective Efficiency • Health Plan Management & Utilization Management • Clinical point of focus – Access and Quality • Cost point of focus • How do you reconcile the Prospective Payment System (PPS) Fee-For- Service (FFS) construct with effective Utilization Management (UM)? • Under PPS MTF’s are rewarded for sustaining and increasing production • Increasing beneficiary Access to Care • Population Health (Disease & Case Management, Utilization Management) can reduce utilization and consequently production • What can you do? • Understand business processes • Reduce capacity (improved templates and/or enrollment) • Increase “Right of First Refusal (ROFR)” take rate • Realign work from Purchase Care - Recapture • Realign resources from the product line with lowered utilization to a product line that offers recapture potential or extend capacity 14-11
    • 12. Concept of OperationsConcept of Operations Performance Planning $ Pay 4 Performance Reconciliation Readiness Population Health Experience of Care Per Capita Cost 14-12
    • 13. Pay 4 Performance Incentive Measures 14-13
    • 14. MTF Performance Planning Model Population Health Unique Unique Users Users Total Gov’t Paid Enrollment Business Plan Inpatient Outpatient Today 2006 2007 2008 Per Member Tomorrow Per Month ers Us MCSC Enrollment Space Available Price Per RWP Price Per RVU Cost Per RWP Market Share Cost Per RVU Inpatient Outpatient Market Share Inpatient Outpatient Access Satisfaction Performance Quality Improvement 14-14
    • 15. MTF Performance Planning Process SECTION 1 SECTION 2 SECTION 3 SECTION 4 Evaluation of Evaluation of Analysis – The why Determination Current Future phase Phase Environment Environment Enrollment -Future Product Lines DMISID = 89 -Satisfaction -HA Strategy/Guidance Enrollees 0 Plan Enrollees Plan 0 to 4 6,4 84 6,3 30 6,347 6,348 Enro l ees Plan Bencat GenderAge GroupHisto ry FY03 FY04 FY05 Bencat Gender Age GroupHisto ry FY03 FY04 FY05 Bencat Gender Age GroupHistory FY03 FY04 FY05 0 to 4 129 122 113 109 -Enrollment -Population alignment 0 5 to 14 8,7 99 9,0 22 8,969 8,996 5 to 14 737 756 728 701 -Access -HA/TMA Policy M 15 to 17 17 17 17 18 18 to 24 13,377 16,416 16,506 16,496 25 to 34 13,589 15,196 15,170 15,115 M 15 to 17 1,3 48 1,3 46 1,337 1,317 18 to 24 958 983 983 979 25 to 34 407 410 408 401 M 15 to 17 417 450 448 443 18 to 24 520 630 634 633 25 to 34 84 84 85 89 -Satisfaction 35 to 44 6,816 8,017 7,929 7,815 35 to 44 273 242 244 245 35 to 44 787 752 694 648 -Quality & Prevention -Service Strategy - 45 to 64 772 1,001 926 874 45 to 64 107 107 104 99 45 to 64 2,870 3,290 3,402 3,512 65+ 0 0 0 0 65+ 0 0 0 0 AD ADFM 0 to 4 6,1 99 6,0 19 6,023 6,058 Ret/Others 0 to 4 104 108 104 101 -Access 5 to 14 8,6 30 8,7 59 8,763 8,804 5 to 14 711 708 678 656 -Performance R/Y/G Service Guidance - 15 to 17 5 1 2 4 15 to 17 1,4 10 1,4 28 1,420 1,406 15 to 17 414 457 446 429 18 to 24 2,002 2,393 2,384 2,377 18 to 24 5,7 67 5,5 07 5,531 5,540 18 to 24 586 659 663 663 F F F 25 to 34 1,869 2,216 2,167 2,111 25 to 34 9,6 75 9,1 23 9,172 9,135 25 to 34 203 208 202 198 -Quality & Prevention 35 to 44 682 892 843 799 35 to 44 4,8 43 4,8 59 4,833 4,815 35 to 44 1,070 1,057 1,000 944 -Target Population Population changes - 45 to 64 87 121 113 107 45 to 64 935 928 930 918 45 to 64 3,015 3,469 3,551 3,624 0 65+ 0 65+ 0 0 0 0 Total 39,215 46,270 46,057 45,716 Total 55,8 35 55,0 63 55,063 55,063 Total 11,649 12,750 12,750 12,750 -Currency DMISID = 123 -Enrollment Strategic Partnerships - Empanelle d TRICARE Plu s 4,188 4,188 4,188 4,188 Enrollees History Normative Enrollee Care for Other Space-A Space-A Plus Care TFL Care Total Plan Demand Demand In-house Other DC Purchase Enrollees AD Non-AD <65 (65+) In-house Primary Care 156,859 197,765 175,617 17,270 4,878 18,245 7,289 20,943 109 40,031 262,234 HistoryFY03 ChangeFY04 ChangeY05 Change F -OR utilization Emergency 27,048 28,722 16,565 3,064 9,093 7,047 1,244 5,345 9 3,827 34,038 -Currency requirements Civilian Market All Bencats Mental Health/Social Work 60,390 121,569 88,550 19,794 13,226 18,859 2,803 11,017 7 3,405 124,641 106,700 114,083 7,3 83 113,8 70 (212) 113,530 (341) Ortho/Phys Ther 47,251 83,559 50,166 28,448 4,945 15,108 3,484 7,728 17 6,099 82,602 Internal Med Sub 1,580 70,929 13,497 54,131 3,301 2,731 466 1,571 14 3,556 21,834 Surgery 9,852 21,934 5,783 15,355 796 2,091 193 793 7 2,412 11,279 -Measures Surgery Sub 8,574 14,066 2,501 11,208 356 991 112 345 6 1,667 5,622 -OR Utilization -TRO/MCSC changes Ophthalmology/Optometry 29,549 51,051 31,734 11,961 7,356 3,197 2,589 2,180 19 5,273 44,991 OB/GYN 28,224 41,881 21,131 20,031 718 6,008 520 2,418 16 1,734 31,827 RVUs ENT 8,383 11,971 3,375 8,059 538 1,042 73 269 - 438 5,198 Dermatology 6,847 12,199 2,019 6,717 3,463 470 58 136 - 505 3,189 -Production Facility 25,338 10,791 - - 10,791 - - - - - - -Measures -Benefit changes Radiology 5,924 1,529 - - 1,529 - - - - - - Anesthesiology 1,445 159 - - 159 - - - - - - Pathology 554 296 - - 296 - - - - - - Home Health Care 765 205 - - 205 - - - - - - Other 16,115 22,163 3,925 15,869 2,369 1,084 398 1,136 1 1,459 8,003 -Production Total 434,699 690,790 414,863 211,907 64,020 76,875 19,230 53,879 204 70,406 635,457 SECTION 5 SECTION 6 SECTION 7 SECTION 8 Coordination Phase Develop Action Plans Write the Business Submit Template & Production Plan Plan Plan -Area MTFs Develop Business Plan -TRO/MCSC -Measures & Initiatives Complete Organizational Summary Governance Structure -Services’ -VA -CPI Projects Organizational Chart -HA/TMA Scope of Services -Civilian Hospitals -Assessment Planning Partnerships and Alliances MCSC/Network Providers *Competitive Edge Contracted Arrangements Veterans Administration Agreements *Keys to Success Other DOD Facilities and Scope of Services Conduct Market Analysis *Important Assumptions Market demographics by risk adjusters (Age, Sex, Ben Cat) and Zip Code *Assess Financial Impact Enrollment status by risk adjusters and Zip Code Care Patterns (MTF work by product line, PSC by Spec and Pt zip) PSC government cost by enrollment status, risk adjuster, zip code, and specialty sorted high to low SECTION 9 Monitor Plan Performance 14-15
    • 16. Performance Plans – MTF UniqueBased upon enrollment DMISService POCs:Stephen Larsen – Air ForceStephen.larsen@us.af.milSherie Kim – NavyLinda Niemeyer - NavyEva.kim@med.navy.milLinda.niemeyer@med.navy.milSherry Stone – ArmySherry.stone @amedd.army.milTMA POC:Todd.Gibson@tma.osd.milAccess:triservicebps.amedd.army.mil 14-16
    • 17. MTFs forecast healthcaredelivery plan along withcritical initiatives forquality and/or readinessimprovements based uponService guidance. 14-17
    • 18. MTFs forecast criticalinitiatives quantatively andqualitatively based uponService guidance 14-18
    • 19. 14-19
    • 20. 14-20
    • 21. Critical InitiativesService Specific andAlign with MHS Strategy 14-21
    • 22. Critical Initiatives ImpactReflects projectedimprovements and POC 14-22
    • 23. Capacity is determined based uponavailable skill type provider 1 FTEs toMEPRS B and/or RVUs per encounter 14-23
    • 24. Capacity is determined based uponavailable skill type provider 1 FTEs toMEPRS B and/or RVUs per encounterDemand is determined based uponbeneficiary utilization of health careby MHS product line 14-24
    • 25. Realities of Today• Resources (money and people) are tight.• US healthcare costs are four times that spent on National Defense .• Line Commanders note rising health care costs claim significant portions of their budgets.• Resource allocation in the future will receive considerable scrutiny.• The stakes for MTF Commanders are high. 14-25
    • 26. Case Study• What are the strategic objectives (Health Affairs/Service guidance) and MTF initiatives?• Where are you today vs. where you need to be?• What can you fix now vs. what takes additional preparation?• How can you quantitatively and qualitatively articulate performance improvement initiatives to move your organization closer to the strategic direction of the organization? 14-26
    • 27. A Closer Look• What resources do you actually have?• Utilization rates and demand of population?• Should you be doing more or less?• What do you need to get there?• Strategic reinvestment of resources: • Promote the Medical Home concepts • Improve access to care and patient satisfaction • Should reduce costs over time 14-27
    • 28. Initiatives to Improve Efficiency • Access • Right size empanelment to PCM availability. • Incorporate the primary care team concept. • Scrutinize and manage clinic templates. • Aggressively seek continuity for routine care. • Promote continuity with PCM. • Avoid unnecessary appointments (labs, consults). • Leverage RN’s and CPG’s when appropriate. • Are your beneficiaries satisfied with access? 14-28
    • 29. MTF Performance Plan • Executive Summary • What business are you in? • Where am I achieving objectives • Strengths, weaknesses, opportunities, and threats in alignment with organizational objectives and strategies • Targeted areas for performance improvement • Assumptions and timetables • Objectives • Targets and how will you achieve them • Market • Demographics of total market, demand, MTF target market, and MTF market • What can you provide and what will you send to the network or other MTFs? • Cost • What is the projected cost of your initiatives? • What the projected PPS earnings for direct care services? • What is your projected loss to the network? • Resources • Human capital impacts/required to achieve plan • Facility opportunities and constraints • How do you know when you’ve achieved your objectives? 14-29
    • 30. Final Thoughts• The purpose of planning is to translate strategy into action to maximize quality clinical outcomes• Performance Planning involves strategies that focus on healthy outcomes and patient satisfaction.• Reimbursement strategies emphasize both. • Pay for performance will measure performance in outcomes and satisfaction• Hitting this target will requires a strategy that ensures a primary care infrastructure founded in a well resourced Medical Home with appropriate subspecialty care support.• MTF Commanders must continuously re-assess performance and reinvest resources as necessary to meet the needs of the population. 14-30

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