June 21, 2019

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It’s a new era for health care providers. Medicare reimbursement based on volume will soon be a thing of the past. In its place are a variety of value-based payment options including the Medicare Shared Savings Program that reward providers for achieving high quality and cost savings. These rewards are not met without their own challenges in change management.
 
The Medicare Shared Savings Program requires providers to take risk on the overall cost of care for their patients. To succeed in a risk-based payment model, providers must focus on implementing new population health services that transform the way they deliver care. Change management can be a daunting process, but when done right, providers and patients reap the benefits.
 
In Caravan’s experience with leading accountable care organizations, the challenge to make the shift to value-based care lies in how to connect often siloed organizations with limited resources into collaborative organizations that can successfully undergo new process improvements.
 
Collaborating for Change
C-suite engagement alone won’t drive organizational change. Neither will introducing new technology or population health solutions without the right support system is in place. Real change requires committed collaboration, from top-to-bottom in a team-based approach.
 
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Caravan’s Chief Operating Officer and Co-Founder Erin Fulton understands first-hand the organizational challenges hospitals can face when transitioning to a value-based care delivery program. Fulton leads Caravan’s transformation initiatives to help our ACOs prepare for new clinical and operational changes.
 
“Change management is our program,” Fulton said. “Depending on the stakeholders that we're engaged with, whether it’s the CEO, practice manager, care coordination program manager, nurse, or a physician, they will be challenged with changing clinical workflows and the day-to-day activities in order to successfully shift from a fee-for-service to a value-based care delivery program.
 
One of the fundamental ways Caravan gets all members of an organization’s team on board is through transparency and accountability. Our ACO clients participate in quarterly steering committee meetings, monthly practice calls, and they stay in regular communication through trainings and office hours.

Caravan’s Chief Program Officer Jack Newsom attributes Caravan’s community scorecard to keeping all levels of stakeholders engaged. The scorecard tracks everything from meeting attendance to reaching targets for clinical initiatives.
 
“We really help them stay accountable for the results,” Newsom said. “A big part of the reason this works for us is that we use a scorecard, one we created, to keep everyone focused on goals. This helps us quickly find and work on any areas of weakness.”
 
Identifying Resource Gaps
Knox Community Hospital in Mount Vernon, Ohio has championed the team-based approach since joining a Caravan Heath ACO in 2016. Their community has achieved impressive results with annual wellness visits (AWVs), and has significantly improved their overall quality scores in the past year. A key to their success was identifying an appropriate professional to serve as the change management champion for the organization.
 
“The organization needs to have driver and point person who is responsible to get things moving,” said Debbie Priest Care Coordinator, Department of Primary and Specialty Care at Knox Community Hospital. “Silos exist in every organization, and it's hard to combat that silo if you aren't in the role of a driver. The individual needs to be someone who has a project management mindset.”

To start the collaboration process, Priest and her team first identified the biggest challenges and asked for input on what was the best approach for working together to achieve common goals. Then they got to work and took it step-by-step.

Have a Plan

“That's really the format we’ve used for each project or program that we've rolled out,” Priest said. “We first pull in all the parties that are involved, and then we ask: ‘How can we piece together the required elements and processes?’ Then we begin identifying which one is the biggest or an edge piece. It's very strategic, but it’s definitely a process that takes time, patience and collaboration. If you're looking for something quick, it certainly isn't a quick process. But we found that an engaged staff helps them feel heard, and that’s integral to the improvement process. Care transformation is definitely a team-based endeavor. One person can’t do it alone.” 
 
Priest and her team created an annual wellness committee that included the front office and nursing staff, coordinators, office managers, and a provider. As their AWVs ramped up, they monitored processes to ensure they were the least burdensome as possible to the staff.
“Everyone has experienced their individual struggles, but because all 22 of our primary care physicians are on board and moving forward together, it has led to the success of the whole,” Priest said. “Some still express that it feels like a lot more work, and although they see the value from the outcome standpoint, they still wrestle with feeling like they are pressured for time. It’s a work in progress, and we’re constantly striving for improvement. If I could offer advice other providers, I’d heartily advocate that they to take Caravan Health’s tools and run with them. You don’t have to reinvent the wheel.”

Population Health Success
Caravan Health Chief Medical Officer Dr. Anna Loengard affirms that providers can utilize nurses to lead AWVs, chronic care management, behavioral health integration and other preventative care services under the supervision of a billing provider, to assess and triage patients’ most urgent needs. 
 
These nurse-led services give patients more time with a medical professional, allowing them to delve more deeply into their health concerns, ask questions, and participate in the development of their long-term care management plan. Physicians are given more time to focus more on diagnosis and treatment – particularly with complex cases.
 

To learn more, watch Dr. Loengard’s webinar on
"How to Combat Physician Burnout and Win at Population Health”.


“I think the quality scores we’ve achieved speak for themselves,” Priest continued. “From the patients’ perspective, they see the value in it, because they start to feel heard. They appreciate that someone is taking the time to look at their overall health. We realize that people can be skeptical and resist if they view it solely as a means to bill for an extra visit. But when they understand we’re helping coordinate an individualized plan for the next 5-10 years, they see the value in it, and it’s reflected in the feedback we receive.”

Making data-driven decisions is also critical in change management efforts. Armed with the facts, providers can uncover sizeable opportunities for improvements in cost and quality.

Get Your Coding in Order

“Don’t treat data collection as a box to check off,” Newsom added. “There is a workflow of how data is input, stored, delivered, collected – and that needs attention and consistency. The same way we have the mantra in health care to ‘reduce variation to improve quality,’ has to be true for data, too.”
 
Diligent attention to HCC coding can make the difference between an ACO collecting shared savings or missing the mark. By integrating coding directly into workflows, providers can get reimbursed appropriately for the care they deliver without creating extra work for clinicians.
 
Conclusion
Caravan Health’s proven change management methodology emphasizes quality, analytics, and a systematic approach to help organizations succeed in value-based payment. Our ACOs vastly outperform national averages and continue to improve over time. Whether you’re currently in an ACO or are looking to get started on the path to success in a risk-based payment environment, Caravan Health can help.

Learn more in our ACO Success Guide or watch ourACO Playbook for Success webinar

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