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Advancing Recovery

Advancing Recovery. Laura Schmidt Dennis McCarty Learning Session 3: December 4, 2012. Advancing Recovery: Change Model. Four Conditions for Change Five Levers of Change Three Supports for Change. Four Conditions for Change. Understand customer needs Use walkthroughs

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Advancing Recovery

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  1. Advancing Recovery Laura Schmidt Dennis McCarty Learning Session 3: December 4, 2012

  2. Advancing Recovery: Change Model • Four Conditions for Change • Five Levers of Change • Three Supports for Change

  3. Four Conditions for Change • Understand customer needs • Use walkthroughs • Commitment from leadership • Clear aim and purpose • Goal – Enhance long-term recovery • Supportive business case • Improve competitiveness

  4. Five Levers of Change • Financial analysis • Utilization and costs; billing codes • Regulatory and policy analysis • Regulatory barriers and facilitators • Inter-organizational analysis • Linkages to internal & external resources • Operations analysis • Enhance efficiency, reduce costs, training • Customer impact analysis • Reduced readmissions, improved recovery

  5. Three Supports for Change • Partnership between payer and providers – joint goals • Use of Plan-Do-Study-Act rapid change cycles – NIATx • Technical assistance, coaching and learning collaborative • Medication Research Partnership

  6. Maine: New buprenorphine pts

  7. Missouri: Screening for Etoh Meds

  8. Colorado: Pts transferred from dtx to outpt

  9. Financial Analysis • Maine allocated $500K for medication • Dallas behavioral health organization did not cover buprenorphine • Missouri added contract flexibility to purchase medications and physician time • Participating centers increased revenues and reduced expenses

  10. Regulatory and Policy Analysis • Missouri and Maine revised licensure requirements to require staff physicians • Maine, Missouri, Rhode Island modified contract language

  11. Inter-organizational analysis • Treatment centers developed links to prescribers • Maine’s SSA worked closely with Medicaid • Treatment centers developed regional collaborations and referral networks • Joint purchasing reduced the cost of medication

  12. Operations Analysis • Treatment centers used walkthroughs to understand the patient experience and improve program efficiency and patient satisfaction • Missouri added billing codes after walkthroughs identified gaps in how to reimburse services • Treatment centers used rapid change cycles to test changes on a small scale before spreading

  13. Customer Impact Analysis • Treatment centers improved patient and referral satisfaction • West Virginia developed support groups for patients taking buprenorphine

  14. In summary … • States and providers tried multiple change strategies to find ones that worked for them • Substantial barrier to adoption and change • Lack of funding for new services • Practitioner resistance • Staff turnover and lack of training • Weak data systems • Medication easier to implement • Continuing care required more extensive change • Successful change required provider and payer collaboration – both systems needed change

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