(Title)

1. Welcome Back Fee-for-Service Kentucky (Title) Name(s) of presenter(s) Organizational Affiliation January 31, 2012 Project Funded by CSAT

2. "Never invest in any idea you can't illustrate with a crayon." – Peter Lynch

3. Process Improvement Model People Change Executive Sponsor Change Leader Change Team Tools aim Walk-through Flowcharting Nominal Group Technique PDSA Cycle Project Rules Use existing resources Sustain the gains Measure change

4. Who’s Who in Process Improvement? (Title) Name(s) of presenter(s) Organizational Affiliation

5. Executive Sponsor Authority to Allocate resources

6. Executive SponsorResponsible for Communicating the Vision Martin Luther King

7. Executive SponsorSees change as a priority Barack Obama, President

8. Executive SponsorEmpowers the change leader

9. Change Leader Someone who is comfortable providing day-to-day leadership, energy and enthusiasm Has the power and prestige to influence people at all levels of the organization Reggie White

10. Change Leader Focuses the team on the change team objective Uses mandates Michelle Obama Oprah Winfrey

11. Change Leader Challenges the status quo Reports directly to the Executive Sponsor Gets results mandated by data Queen Rania of Jordan

12. Change Team Members Staff and supervisors in the work area where changes will be made Customers, family, caregivers People with special knowledge Others who are affected by the change Samaritan Village, Inc. Jamaica Outpatient Program

13. Identify possible changes that could meet the objective Decide how to implement the change Create and conduct rapid-cycle pilot tests until goal is achieved Collect data Study results to see if the change should be adopted, adapted or abandoned Change Team Responsibilities

14. Key Roles:Change Team Focus on AIM LOCATION POPULATION 1

15. What makes this approach to change different? Change is a big experiment No mistakes, no right or wrong Data tells you if the change was an improvement Customer guides change ideas

16. Too often we design processes to meet the organization’s needs and not the needs of the customer.

17. Our Mission The Fee-for-Service project will help addiction treatment providers develop the capacity to bill third party payers • Design a billing system (Level 1) • Improve the billing process to increase collections (Level 2)

18. Use small scale, rapid cycles (PDSA cycles) to break change into manageable pieces For example: Create one bill Eliminate the most common reason that claims get denied Applying the NIATx Way to Improve the Billing Process

19. Learn how to streamline the billing process for one third party payer. Then, do the same for another third party payer. Apply what you learn with MCO’s. Later: Focus on attracting more clients with the desired third party payer. Applying the NIATx Way to Improve the Billing Process

20. Model for Improvement 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement? Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide P A D S

21. The Ball Pass Exercise Experience small scale, rapid cycles: The Ball Pass Exercise Discussion Questions: • What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective?

22. The Ball Pass Exercise • AIM: to pass the ball from person to person as quickly as possible. • RULES: • Only one person may touch the ball at a time; each person must touch the ball with both hands. • The ball must be passed to a person who is not right next to you. • The cycle begins when the Change Leader passes the ball the first time and ends when the Change Leader has the ball at the end. • Prepare a Change Project Form and document information about each PDSA cycle.

23. The Ball Pass Exercise • Select a: • Change Leader • Data Recorder • Cycle #1 (baseline): • Stand in a circle. • The Change Leader passes the ball to another person in the circle. • Each person passes the ball to another person who is not right next to them; when everyone has touched the ball, pass it back to the Change Leader. • The data recorder documents the time from the beginning to the end of the cycle (baseline data)

24. The Ball Pass Exercise • Conduct at least 3 PDSA cycles • PLAN: What can we do to reduce the time required? • DO: Implement the change and measure how long it takes. • STUDY: Did we get the results we expected? Was the change implemented as planned? • ACT: Adopt, adapt or abandon this change idea and decide what the next cycle will be. • Repeat another PDSA cycle.

25. The Ball Pass Exercise • Tell your story: Create a graph to show the data for each PDSA cycle, noting the change that was made for each cycle.

26. The Ball Pass Exercise Discussion Questions: • What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective? Designing Change Projects

27. Model for Improvement 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement? Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide P A D S

28. Designing Change Projects Unfocused improvement efforts are a waste of time and resources AIM

29. Sample Aim Statements • Create a billing process to bill one new third party payer (Anthem) by June, 2012. • Increase the collection rate from 60% to 70% by June, 2012. (Start with Anthem) • Reduce the denial rate for invoices submitted to Anthem from 52% to 35% by June, 2012.

30. Designing Change Projects WritE a good aim statement ON the Change Project Form

31. Flowcharting (Title) Name(s) of presenter(s) Organizational Affiliation

32. Flowcharts force an organizational focus on process. Why Flowchart?

33. Flowcharting is useful for: Providing a starting point to understand the process as it is today. Identifying key problems/bottlenecks Showing where to test ideas for most impact Adding interactivity & fun - gets the team together Creating a simple & succinct visual process overview Why Flowchart?

34. Document authorization limits Client makes first contact Where does the process begin? Where does the process end? Setting up a flowchart Verifying Coverage. START Title the process you are flowcharting. END

35. Key Symbols for Flowcharts Post-It Notes are great for flowcharting. A square identifies a step in the process Action Yes ? A diamond is a decision point in the process and asks a “yes or no” question or offers a choice of direction in the process. No

36. Sample Flowchart Process name: Billing Process Ask about ins. at first contact

37. Change Team Assignment Before You Start 1. Identify a Change Leader to lead the flowchart discussion. 2. Choose one person’s organization and complete the flowchart exercise.

38. Flowchart the billing process. Remember the steps to follow: Define where the process begins and ends Give your flowchart a title: e.g., “FirstContact to Document authorization limits” Define process steps Review/refine flowchart Identify problems and bottlenecks Are there steps on the “Who does what chart” that no one is assigned to? Customer barriers Change Team Assignment

39. 1. Useful? 2. How could you use your flowchart to help engage your organization in the change process? Large Group Discussion

40. The Ball Pass Exercise Discussion Questions: • What did you learn about rapid cycle changes? • How did you decide on a change? • Were you able to implement one change at a time? • Did you decrease the amount of time required? • Why is it important to collect baseline data? • What changes were most effective? How to Measure the Impact of Change

41. The importance of data in a change project. A six-step process for the effective measurement of the impact of change. Learning Objectives

42. Model for Improvement 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement? Reference: Langley, Nolan, Nolan, Norman, & Provost. The Improvement Guide P A D S

43. Data answers three common change project questions…..

44. Data directs the action steps toward a change project improvement goal.

45. Keep data collection and reporting as simple as possible, but be specific. Denial tracking for Anthem

46. A Step Process for Measuring the Impact of Change 6

47. 6 Steps for Measuring the Impact of Change 1 DEFINE YOUR AIM & MEASURES 2 COLLECT BASELINE DATA 3 ESTABLISH A CLEAR GOAL 4 CONSISTENTLY COLLECT DATA 5 CHART YOUR PROGRESS 6 ASK QUESTIONS Always ask why.

48. 1. Define your measures. Clear definitions of your measures should: - Clarify project objectives - Be agreed upon by stakeholders This ensures that the results are interpretable and accepted within the organization.

49. 2. Collect baseline data. Never start a change project without it. QUESTIONS TO ASK: Was the data defined to ensure that we collect exactly the information needed? How accurate is the data? Does accuracy matter? Does the process ensure that the measures will be collected consistently? Do trade-offs exist? Is quality more important than the time required to collect data?

50. 3. Establish a clear goal. • A goal should: • Be realistic yet ambitious • Be linked to project objectives • Avoid confusion This ensures that the results are interpretable and accepted within the organization.