social determinants of health - millennium collaborative care · 2019-11-07 · social determinants...
TRANSCRIPT
Social Determinants of Health VBP Collaboration Conference
Finding Your CBO SDOH Partner
Tuesday, November 6, 2019, 9:00 AMBuffalo Grand Hotel
Welcome MessageAl Hammonds, CSSBB, Executive DirectorMillennium Collaborative Care
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Welcome MessageAndy Davis, Chief Operating OfficerErie County Medical Center Corporation
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IntroductionKimberly BackeyMillennium Collaborative Care
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Welcome MessageC. Milano Harden, Ed. M., President and FounderThe Genius Group, Inc.
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Agenda9:00 AM Ballroom Welcome
9:30 AM Ballroom Keynote Presentation
10:15–10:30 AM Break
10:30 AM Ballroom Panel Presentation
12:00 Ballroom Lunch
1:00 Grand Hall CBO Showcase
2:30–3:00 PM Ballroom Closing Remarks
3:15–4:00 PM Ballroom CBO Roundtable
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Learning ObjectivesShare emerging insights, lessons learned and best practices from various system partnersShowcase the innovative, action-learning achievements and insights of the community-based organization (CBO) partnersConvene a fuller complement of the “Eco-System” of key actors into one room, at one time and in one place to appreciate the various system stakeholders’ perspectives, needs, and interestsExplore and deepen system-wide connections with the hope of formal collaborations evolving that improve key health and SDOH outcomes
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Warming Up
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The Balcony-Dance Floor Exercise
Warming Up
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Reflective PracticePerspective-Taking
Seeing Patterns & Diagnosing Problems
Shaping Decisions, Collecting and Analyzing Data
Supporting Organizational Learning
The Two Modes of LeadershipReflective Practice & Strategic Action Taking
Strategic Action TakingTranslating Mission/Vision into Action
Effectively Implementing Programs or Interventions
Making Bold, Thoughtful Decisions
Managing Crisis, Uncertainty, and the Unforeseen
Discussion Guidelines1. SHOSHIN: Have a beginner’s mind.2. New York Times Rule. Speak in headlines, using fine-print only when needed.
Brief time requires that we value expedience over exhaustiveness. 3. The Map Isn’t Always the Territory. Listen for meaning and to understand, to
have a better appreciation for how a person is using their words.4. Trust the Room. Assume good intent and respect the collective intelligence,
wisdom, and life experience in the room.5. Step-Up/Step Back.6. Throw Shine, Not Shade. People over-remember the negative, and rarely have
the emergent good confirmed and reinforced.7. Triggers Are Real. Take self-responsibility for your response/reactions to
others’ words and experiences.8. Vegas Rule. Confidentiality means “I won’t tell” and “I won’t associate a
speaker’s Identity with their story and/or insights, especially outside this room.9. Self-Care. Stand, stretch or Bio-reFRESH as needed, quietly.
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11Technical difficulties? Call 1-866-229-3239
REACT TO
ADAPT TO
CREATE
TRANSFORM
Technical Challenges
Adaptive Challenges
Social Determinants of Health: From The Academy To Community Action
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“…changes in the health care landscape are catapulting social determinants of health from an academic topic to an on-the-ground reality for providers, with public and
private payers holding providers accountable for patients’ health and health care costs and linking
payments to outcomes. These new models are creating economic incentives for providers to incorporate social
interventions into their approach to care.”
- Bachrach, Pfister, Wallis & Lipson, Manatt Health Solutions
Community-Based Organizations: Social Determinants of Health Inventions And
Vibrant Community Networks
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What Are the Social Determinants of Health (SDOH)?
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By Social Determinants of Health,we mean the circumstances in which people are born, live, grow, and work.
SDOH are best described as the following conditions: availability of quality, affordable housing, quality education, poverty/economic stability, nutrition/food security, social and community context, neighborhood and built environment.
Keynote PresentationDenard Cummings, Director of the Bureau of Social Determinants of HealthNew York State Department of Health
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November 2019
New York State Value Based Payment: Social Determinants of Health and Community Based Organizations
Millennium Collaborative CareDenard Cummings, Director Bureau of Social Determinants of Health
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Agenda
I. Overview of Social Determinants of Health• What are Social Determinants of Health?• Why are Social Determinants of Health?
II. Value Based Payment III.CBO Engagement in VBPIV.ContractingV. Upcoming Initiatives
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Bureau of Social Determinants of Health
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HistoryBSDH established in December 2017 (formerly BSH) to implement the VBP Roadmap requirement regarding Social Determinants of Health and Community Based Organizations
PurposeTransform the New York State Healthcare delivery system by integrating health and human services. Addressing the Social Determinants of Health to improve the quality of care and health outcomes for NYS most vulnerable populations.
Health Systems Integration
SDH Data Standardization
Medicaid Reform
Health Outcomes
Stakeholder Engagement
Bureau of Social Determinants of Health
BSDH
2020
Social Determinants of Health
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Social Determinants of Health Domains
Economic Stability
Poverty
Housing Security and Stability
Employment
Food Security/ Hunger
Transportation
Medical Bills
Education
Early Childhood Education and Development
High School Education
Enrollment in Higher Education
Language and Literacy
Training
Health and Health Care
Access to Health Care
Access to Primary Care/ Trusted Provider
Health Literacy
Quality of Care
Provider linguistics and Cultural Competency
Neighborhood and Built Environment
Affordable/ Quality Housing
Environmental Conditions
Access to Healthy Foods
Crime and Violence
Walkability
Social and Community Context
Social Cohesion
Support Systems
Civic Participation
Discrimination and Equity
Incarceration/ Institutionalization
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Why Are Social Determinants of Health Important?
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Social Determinants of Health
Source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving Complex Problems, 2014 Graphic designed by ProMedica.
20% of a person’s health and well-being is related to access to care and quality of services The physical environment,
social determinants and behavioral factors drive 80% of health outcomes
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Source: Interaction Institute/AndrewWeizman, 2016
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Value Based Payment Roadmap
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Standard: Implementation of SDH Intervention
“To stimulate VBP contractors to venture into this crucial domain, VBP contractors in Level 2 or Level 3 agreements will be required, as a statewide standard, to implement at least one social determinant of health intervention. Provider/provider networks in VBP Level 3 arrangements are expected to solely take on the responsibilities and risk.” (VBP Roadmap, p. 44)
Description:VBP contractors in Level 2 or 3 arrangement must implement at least one social determinant of health intervention. Language fulfilling this standard must be included in the MCO contract submission to count as an “on-menu” VBP arrangement.
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Guideline: SDH Intervention Selection
“The contractors will have the flexibility to decide on the type of intervention (from size to level of investment) that they implement…The guidelines recommend that selection be based on information including (but not limited to): SDH screening of individual members, member health goals, impact of SDH on their health outcomes, as well as an assessment of community needs and resources.” (VBP Roadmap, p. 45)
Description:VBP contractors may decide on their own SDH intervention. Interventions should be measurable and able to be tracked and reported to the State. SDH Interventions must align with the five key areas of SDH outlined in the SDH Intervention Menu Tool, which includes:
1) Education, 2) Social, Family and Community Context, 3) Health and Healthcare 4) Neighborhood & Environment and 5) Economic Stability
The SDH Intervention Menu Tool was developed through the NYS VBP SDH Subcommittee and is available here:https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/
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Through VBP we can address social determinants of health that cause poor health care outcomes by:
• Tackling conditions upstream and midstream
• Using patient centered care models
• Screening for SDH
• Investing dollars into fresh food, transportation, housing
• Leveraging community based organizations to effect change VBP
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CBOs in VBP
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June 2019
Standard: Inclusion of Tier 1 CBOs
“Though addressing SDH needs at a member and community level will have a significant impact on the success of VBP in New York State, it is also critical that community based organizations be supported and included in the transformation. It is therefore a requirement that starting January 2018, all Level 2 and 3 VBP arrangements include a minimum of one Tier 1 CBO.” (VBP Roadmap, p. 45)
Description:Starting January 2018, VBP contractors in a Level 2 or 3 arrangement MUST contract with at least one Tier 1 CBO. Language describing this standard must be included in the contract submission to count as an “on-menu” VBP arrangement.
This requirement does not preclude VBP contractors from including Tier 2 and 3 CBOs in an arrangement to address one or more social determinants of health. In fact, VBP Contractors and Payers are encouraged to include Tier 2 and 3 CBOs in their arrangements.
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Tier 1 CBO• Non-profit, non-Medicaid billing, community based social and human service organizations
e.g. housing, social services, religious organizations, food banks• All or nothing: All business units of a CBO must be non-Medicaid billing; an organization cannot have one component that
bills Medicaid and one component that does not and still meet the Tier 1 definition
Tier 2 CBO• Non-profit, Medicaid billing, non-clinical service providers
e.g. transportation provider, care coordination provider
Tier 3 CBO• Non-profit, Medicaid billing, clinical and clinical support service providers • Licensed by the NYS Department of Health, NYS Office of Mental Health, NYS Office for Persons with Developmental
Disabilities, or NYS Office of Alcoholism and Substance Abuse Services.
Tier 1, Tier 2, and Tier 3 CBO Definitions
DOH’s VBP website has a directory of CBOs.
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Advancing Care with CBOs in VBP Experience providing non-medical services that
address barriers to improved patient health outcomes
Follow up with patients
Find and engage disengaged patients
Overcome cultural competencies, geographical and language barriers
Report back outcomes and ensure patient centered care
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Value-Based Payment Arrangements
DOH has approved 95 SDH interventions and CBO contracts
o Mainstream Managed Care – 65 contracts
o Managed Long Term Care –19 contracts
o Programs of All-Inclusive Care for the Elderly – 11 contracts
A list of approved interventions are posted on the SDH CBO website: www.health.ny.gov/mrt/sdh
*MMC/PACE Roadmap requirement started 1/1/18 and MLTC started 4/1/19
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Approved Interventions Medically tailored mealsAsthma trigger remediation with SDH screening
Chronic condition self-management classes with peers
SDH screening and services based on needs identified
Vouchers to purchase locally grown fruits and vegetables with coaching on health meal preparation; transportation to wellness (and fitness) class; benefit coordination to enroll in SNAP
Primary care engagement of no-shows and disengaged patients
Neighborhood park build with educational classes and farmers market initiative
Housing location services, application, interview assistance, tenancy sustaining services
Screening and services for at-risk children that are three years old
Money management, benefits/entitlements for seniors, home equity, and scams and security.
Diabetic telehealth and transportation to wellness services.
Senior companion program with social transportation.
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• Screening for Social Determinants of Health utilizing SDH Assessment Tool
• Comprehensive Interventions that address multiple social risks and needs
• Legally establish CBO consortiums with one lead contracting entity (All CBO Tiers included)
• Community Based Organization lead intervention design
• Possess a common understanding of issue and utilize common language to discuss the issue
Best Practices/ Lessons Learned
Photo licensed under CC BY-SA-NC
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Contracting
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CBO Contracting Options• CBO contracts are not required to include risk
• CBO contacts must include upfront funds for startup costs
• CBO contracts could be structured as:
Payment for services rendered
Contracts without a risk-based component
Upside only
No downside risk
If savings are achieved, CBO receives a portion of shared
savings
If losses are incurred, CBO would not take on any losses
Upside and Downside risk
Risk sharing contract
If savings are achieved, CBO receives a portion of shared
savingsIf losses are incurred, CBO
would take on some degree of loss
Most contracts are structured as “payment for services rendered”.
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Key Items for Contracting
• What is the “Effective Date” of the contract and when does it end?• Does the contract automatically renew after the initial period?
Contract Term
• Who are you contracting with, the MCO or VBP Contractor (Hospital, IPA,ACO)?• Use the legal names for each entity in your contract
Contracting Parties
• Describe your project implementation• What services will be provided by the CBO?• How many people will the intervention target? All members in thearrangement?
Members that meet specific requirement?• Will the MCO or VBP Contractor identify targeted members and refer membersas
needed?• How will you evaluate/measure success?
Scope of Project
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Key Items for Contracting
• What area(s) will the intervention cover
Geographical Area
• CBO contracts must include an agreement to share member data to allow: targeting SDH intervention to yield the most impact. evaluating intervention outcomes.
Data Sharing Agreement
• How will your organization get paid? Lump sum? Monthly or quarterly reimbursement.• Are payments or bonus payments tied to specific measures and outcomes? i.e.
number of referralsmade, number of visits or contact hours, number of patient who are successfully reconnected to healthcare provider.
Payment Method
• How often are reports due?• What data points are collected?• How will you track the people that are served in the intervention?
Reporting and Data Collection
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CBO Contracting ExamplesA. Contracting directly with an MCO to support a VBP arrangement
B. Subcontract with a VBP Contractor (Hospital, IPA, ACO, etc.)
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CBO Contracting Examples- ContinuedC. Contracting directly with an MCO to support multipleVBP arrangements
VBP arrangement
MCO
VBP Contractor
(Hospital, IPA, ACO, etc.)
Tier 2 or 3 CBO
Contract
Tier 1 CBO
D. Multi-tier CBO partners contracting directly with an MCO to support a VBP arrangement
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Questions to Consider Before ContractingConsiderations
1) Know what you can do going in:• Are you looking for a smaller project with option to grow? Or can you handle a bigger scale?• Do you have the ability to invest in new staff, technology, data collection, etc.?• Do you have the ability to deliver on ALL aspects of contract? (reporting, health screening, incomplete
services and so much more)
2) Do you need to hire appropriate legal counsel or leverage pro-bono legal services
3) Start the conversation – formal or informal and follow-up
4) Are you willing to use other funding streams to supplement the contracting arrangement or do you expect direct payment through a contract for services?
5) Even with direct contracting, do you have the resources to cover your cost your cost if there is a lag in payment?
6) Know how much of your cost you are willing to absorb should payment be predicated on outcomes.
7) What determines walking away?
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Upcoming Initiatives
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Proposed Roadmap Updates 1. Allow for and encourage multiple means for investments
into social determinants of health interventions.2. Emphasize MCO engagement with CBOs through data
sharing.
3. Specify the template to be use regarding the evaluation and reporting of interventions by MCOs.
4. DOH allows for plans to expense activities related to SDH interventions by including expenses in the medical portion of the plans rate. This allows for flexibility in the type, number, and size of SDH interventions and Increases the total dollars available for SDH Interventions.
Admin
SDHMedical
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Upcoming • Roadmap changes • CBO Directory and Engagement Survey
o Survey is designed to allow for the creation of partnerships between Plans, VBP Contractors and CBOs.
o Updated bi-weekly. o Engagement survey is used to track the integration of CBOs into VBP.
• Released SDH Status Report Template for VBP arrangements o Template is filled out once a year by the Plan, VBP Contractor and CBO.o Checks in on the progress of the intervention including the evaluation of the intervention.
• Z-code data guidanceo Connects core ICD-10 z codes to SDH assessment questions.
• Webinar learning series with best practices
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DSRIP 2.0- Social Determinant of Health Networks• Lead entities will be selected through a competitive
procurement.• The lead entity of the SDHN will create a network of CBOs
that will collectively use evidence–based interventions to coordinate and address housing, nutrition, transportation, interpersonal safety and toxic stress.
• The SDHNs will target Medicaid members with complex health and social needs, and children/families with children experiencing, or at risk of, significant and multiple adverse childhood experiences.
• Contracts and funds would flow through the plans to the SDH network to align SDH interventions with value–based services contracts.
1. Formally organize CBOs to perform SDH interventions
2. Coordinate a regional referral network with multiple CBOs and health systems
3. Create a single point of contracting for VBP SDH arrangements
4. Assess Medicaid Members for the key State–selected SDH issues and make appropriate referrals based on need.
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Resources
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SDH CBO Website
• VBP University• Data resources• Approved interventions• Upcoming events and webinars• Guidance documents • Contracting terms• CBO directory • Forms and templates• Important links (VBP University, MCO directory, PPS directory, etc.)• Listserv for email updates
www.health.ny.gov/mrt/sdh
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Questions?
[email protected]@NewYorkMRTwww.health.ny.gov/mrt/sdh
Break
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Panel PresentationFacilitator: Milano Harden
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PanelistsAnthony Sanfilippo, Project Manager, CBO Consortium of Upstate New YorkAlexander J. Wright, JD, Founder & General Manager, African Heritage Food Co-OpRaul Vazquez, MD FAAFP, Chief Executive Officer, Greater Buffalo United Accountable Care Organization/G-Health EnterprisesDenard Cummings
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What is the Consortium doing around NYS VBP SDOH Roadmap?
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CBO Consortium of Upstate NYConnecting for Health Equity
• CBO Consortium of Upstate New York was founded in 2018 by Healthy Community Alliance Inc. (HCA)
• In 2018 HCA was awarded the Rest of State CBO Planning Grant (one of 3 consortia funded) to support community-based organizations (CBOs) in the rapidly transforming health care and wellness delivery system.
• The Consortium collaboratively works with CBOs to advance health equity and assist organizations in achieving better population health outcomes in their communities.
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CBO Consortium of Upstate New York Goals and Objectives
One Year Planning Grant – NYSDOH• Develop a diverse Consortium across Rest of State - 48 Upstate Counties
within Five Regions
• Deliver targeted training and technical assistance to help position CBOs for engagement with healthcare system reform
• Support the development of organizational infrastructure and functions of community programming, data analytics and policy to attain the highest opportunity of health for all individuals.
• Strategically plan for longer term engagement of CBOs and the Consortium in system transformation
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What challenges/wants have you seen across the state?
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Thought Leader Forum Results:Possible Short and Long Term Goals/Wants• Clarity – understanding the big picture
• Technical Assistance - data collection and reporting, technology, a central portal of information for consortium, training on multiple topics, technical assistance on contracting, grant writing, and more.
• Staffing - staff development, board development, and ability for shared contracting and hiring
• Inclusivity – connecting and building relationships with additional CBOs, strategizing together, and networking
• Funding - mechanisms that are innovative, sustainable, and help CBOs get and stay at the table.
• Improved Collaboration - partnerships with regional, county, and state services.
• Resources – Shared benefits such as data platforms, strategic plans, infrastructure support, and advocacy.
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How are you working with PPSs around the state to further CBO engagement?
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Grant Activities• County Co-leads are working with Regional Leads on
recruitment strategies.
• 215 CBOs and 32 Affiliates recruited across the 48 counties.
• Ongoing communication with PPSs on CBO engagement and event planning.
• 125 CBOs gauged on technical assistance needs.
• 5 Thought Leader Forums held across the state to gain input on CBO needs, strengths and Consortium opportunities.
• 10 In-Person technical assistance sessions. 2 in each region: Measuring What Matters and Contracting Basics and Support.
• 15 Webinars and 5 All-Call meetings held via Zoom.
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How can an organization participate?
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Why did HCA apply for an extension and what will we do with more time?
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Why an extension?
• Recruitment of eligible CBOs took longer than originally anticipated
• More time required to deliver the technical assistance requested in the needs-assessment
• More time requested to focus on affinity groups and pilot projects that focus on promising practices and data sharing
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Extension Activities • Recruitment of eligible CBOs will continue as well
as continuation of technical assistance• Building a web-based resource library for CBOs to
access after the grant• Regional scans of data connectivity efforts will be
conducted and shared• Pilot project linking CBOs with closed-loop
referral systems within regional Behavioral Health Care Collaboratives (BHCCs)
• Pilot project to develop data collection and sharing within a regional network of CBOs
• Supporting the formation of SDoH networks or integrated care hubs to advance participation in VBP arrangements
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CBO Consortium Membership
• 2 Types of Membership• Honorarium Eligible
Membership• 501(c)3 Non Profit• Non Medicaid billing• Budget less than 5M• Addressing a SDOH for 2 years
• Affiliate Membership• Those who don’t meet the 4
criteria for honorariums
• Membership Forms can be found on the CBO Website
www.CBOconsortium.org
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Live and Recorded Technical Assistance
• Must pre-register (CBO name is required)• CBOs can invite as many staff as they wish to participate• $100/hr honorariums for eligible CBOs
• CBO Academy is on Easy LMS• CBO staff can access recorded TA• Honorariums can be earned on the CBO Academy as well
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Webinar Topics Available to Eligible Members•1st Consortium All-Call (5/30/19)
•Motivational Interviewing (MI) Primer Part I (6/4/19)
•Understanding BHCCs (6/6/19)
•Changing Healthcare Environment Primer (6/11/19)
•Motivational Interviewing – Part II (6/25/2019)
•Partnering and Contracting (6/26/19)
•2nd Consortium All-Call (6/27/2019)
•Strategic Planning (7/9/19)
•Understanding Health Homes (7/11/19)
•Introduction to Compliance (7/11/19)
•Plan, Do, Study, Act (PDSA) (7/19/19)
•Cultural Competency (7/23/19)
•3rd Consortium All-Call (7/25/19)
•Introduction to IT Security (8/2/19)
•Managed Care Primer (8/13/19)
•4th Consortium All-Call (8/22/19)
•Social Determinants of Health Primer (8/30/19)
•Fundamentals of Effective Financial Operations (9/9/19)
•Value Propositions (9/11/19)
•5th Consortium All-Call (9/23/19)
•6th Consortium All-Call (10/21/19)
•DSRIP 2.0 What You Need To Know (10/25/19)
•Measuring What Matters: Defining and Measuring Impact for Community Based Organizations
(More to come)
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Little Engine That DidFounded in 2016 with 30 patrons, the African Heritage Food Co-Op now has two stores in both Buffalo and Niagara Falls. It has over 150 members and has served approximately 30,000 folks in the past three years.
1. Three Faceted ApproachWe can serve your patients/members:
➔ Mobile MarketsWe can bring fresh produce or a full grocery experience to any location
➔ Physical Store locationOutside of a market we can continue to service you constituents
➔ DeliveryTransportation is not an obstacle
Mobile Market: Tailored to your needsAffordableCulturally Competent
GBUAHN Market: Big Picture:Incentivizes Patients
Fosters Trust
Combats food Insecurity
Anything Less Than Ownership is Unacceptable.
Tip
Don’t wait till the end of the presentation to give the bottom line.
Reveal your product or idea (in this case a translation app) up front.
Working with AHFC makes a statement. It says that your organization is community forward. It says that your organization understands that success through self sufficiency is of paramount importance. No one questions if you support community owned business, because we have a reputation of being the community.
“By coming here you will comeout the most beautiful, betterperson you could ever be andthat’s what I am now, todaybecause of GBUAHN”
- Member testimonial
Benefits: Medical Appointment Assistance Care Management Telehealth
24/7 Nurse Advice Line Home/Video Visits
Courtesy Transportation Specialty Care Services Wellness and Fitness Center Nutritional Education Referral to Community Services
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GBUAHN members have the lowest total cost of care among these five(5) health cost guideline settings:1. Facility Inpatient (e.g. inpatient stays, surgery)2. Facility Outpatient (e.g. Skilled Nursing Facilities, Emergency Room Services, Physical Therapy)3. Professional Costs (e.g. Primary Care Office Visits, Preventative Screenings)4. Pharmaceutical Costs5. Ancillary Costs (e.g. Durable Medical Equipment, Private at-home Care)
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80% IP reduction after the first year of implementation. This downward trend has continued for 6 consecutive years.
67% ER reduction after the first year of implementation.This downward trend has continued for 6 consecutive years.
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GBUAHN is one of two out of 29 Health Homes with a 5 star rating5 star ratings in HARP conversions (at 45.74%), Retention (at 95.48%), and Overall scoring 79
VBP AGREEMENTS
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GBUACO outperformed both State and National Averages
The ACO performed better than the National Average on 9out of 12 of the measurable metrics
The ACO performed better than the State Average on 7 outof 15 of the measurable metrics
GBUACO’s premier practice Urban Family Practice alsooutperformed in both State and National Averages…
UFP outperformed the National average on 11 out of 12 ofthe measureable metrics
UFP outperformed the State average on 12 out of 15 of themeasureable metrics 81
From 2017 to 2018, Urban Family Practice improved on
11 out of 13 of the measurable metrics
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Controlling Costand
Improving Quality
Case Reviews
Utilization Committee
MedaCubeED Diversion Line
TytoCare and Telehealth
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IN 2018, SAVED…$748,850
on ER Visits$323,061
on Inpatient Stays for Alcohol and Drug Abuse
$1,942,796on Pharmaceutical Costs
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Question and Answer Session
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InvocationRev. Kinzer M. PointerChair, Millennium Collaborative Care Board of ManagersPastor, Agape Fellowship Baptist Church
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Lunch
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CBO Showcase
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Closing RemarksRev. Kinzer M. PointerChair, Millennium Collaborative Care Board of ManagersPastor, Agape Fellowship Baptist Church
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www.millenniumcc.orgFind Millennium on social media:
Thank you!
Table Role Assignment
• Facilitator: ensures everyone’s opinion has been heard
• Scribe: takes note of everyone's responses
• Time Keeper: makes sure we are sticking to the allotted time
What have we learned?1. What are the most important takeaways from today?
2. What do you want to learn more about?
3. What will you implement when you get back to your organization as a result of today?
4. What could have we done differently to prepare for this event?
5. If this event were to be duplicated…• what would you want to see be done differently?• What would you want to see be done again?
