selecting effective clinical interventions for …health wealth career services provided by mercer...

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

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


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?


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.


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.


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.


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


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


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


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


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)?


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?


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


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


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.

selecting effective clinical interventions for …health wealth career services provided by mercer...

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