Name(s) of presenter(s)

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Welcome Back Fee-for-Service Kentucky
(Title)
Name(s) of presenter(s) Organizational Affiliation
January 31, 2012 Project Funded by CSAT
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"Never invest in any idea you can't illustrate
with a crayon." Peter Lynch
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Process
Improvement
Model
People
Change
Executive Sponsor Change Leader Change Team
Tools
aim
Walk-through Flowcharting Nominal Group
Technique PDSA Cycle
Project
Rules
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Whos Who in Process Improvement?
(Title)
Name(s) of presenter(s) Organizational Affiliation
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Executive Sponsor
Authority to Allocate resources
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Executive SponsorResponsible for Communicating
the Vision

Martin Luther King
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Executive SponsorSees change as a priority

Barack Obama, President
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Executive Sponsor Empowers the change leader

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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
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Change Leader
Focuses the team on the change team
objective Uses mandates
Michelle Obama
Oprah Winfrey
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Change Leader
Challenges the status quo Reports directly to the
Executive Sponsor Gets results mandated by data
Queen Rania of Jordan
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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
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Change Team Responsibilities

• 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

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Key RolesChange Team
Focus on AIM LOCATION
POPULATION
1
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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

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• Too often we design processes to meet the
  organizations needs and not the needs of the
  customer.

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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)

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Applying the NIATx Way to Improve the Billing
Process

• 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

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Applying the NIATx Way to Improve the Billing
Process

• 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 MCOs.
• Later
• Focus on attracting more clients with the desired
  third party payer.

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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
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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?

Experience small scale, rapid cycles The Ball
Pass Exercise
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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.

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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)

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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.

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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.

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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
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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
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Designing Change Projects

Unfocused improvement efforts are a waste of time
and resources
AIM
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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.

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Designing Change Projects

WritE a good aim statement
ON the Change Project Form
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Flowcharting
(Title)
Name(s) of presenter(s) Organizational Affiliation
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Why Flowchart?

• Flowcharts force an organizational
• focus on process.

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Why Flowchart?

• 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

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Setting up a flowchart
Verifying Coverage.

• Where does the
• process begin?
• Where does the
• process end?

START
Title the process you are flowcharting.
END
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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
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Sample Flowchart
Process name Billing Process
Ask about ins. at first contact
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Change Team Assignment
Before You Start
1. Identify a Change Leader to lead the
flowchart discussion. 2. Choose one persons
organization and complete the flowchart
exercise.
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Change Team Assignment

• Flowchart the billing process.
• Remember the steps to follow
• Define where the process begins and ends
• Give your flowchart a title e.g., First
  Contact 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

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Large Group Discussion

• 1. Useful?
• 2. How could you use your flowchart to
• help engage your organization in the
• change process?

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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
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Learning Objectives

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

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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
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Data answers three common change project
questions..
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Data directs the action steps toward a change
project improvement goal.
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Keep data collection and reporting as simple as
possible, but be specific.
Denial tracking for Anthem
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A Step Process for Measuring the Impact of
Change
6
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6 Steps for Measuring the Impact of Change
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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.
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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?

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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.
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4. Consistently collect data.
As a team, decide Who will collect the data? How
will they collect it? Where will the data be
stored?
Regular data collection is a crucial part of the
change process.
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5. Chart your progress.

• Share pre-change (baseline)
• and post-change data with
• Change Team
• Executive Sponsor
• Others in the organization

Use visual aids for sharing the data.
Line graph
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A simple line graph example
Goal
Remember One graph, one message.
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6. Ask questions.
What is the information telling me about change
in my organization?
Why was one change successful and another
unsuccessful?
Always ask why.
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Possible AIM Measures(from the Dashboard)

• Denial Rate
• Collection Rate
• Focus on one payer

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Possible Cycle Measures

• To focus on reducing the of denials for a
  specific reason
• of clients matched with a clinician with
  appropriate license (if bills are denied because
  service was provided by clinician without
  appropriate license)
• of days between service and sending bill (if
  bills are denied because they werent submitted
  in a timely manner)

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• Begin to fill out
• How to Measure the Impact of Change Worksheet

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Collaboration Why?
(Title)
Name(s) of presenter(s) Organizational Affiliation
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5 Steps to ensure a successful Collaborative

• Capture the wisdom of the Change Team and
  participants in the Collaborative
• Be willing to share and exchange ideas
• Participate actively and dialogue
• Share and copy best practices
• Divide work tasks and empower others to help

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"If you have an apple and I have an apple and we
exchange these apples then you and I will still
each have one apple. But if you have an idea and
I have an idea and we exchange these ideas,
then each of us will have two ideas.
  George Bernard Shaw 
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Review and Next Steps
(Title)
Name(s) of presenter(s) Organizational Affiliation
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Review
How-to Steps for the NIATx Process Improvement
Model
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Review

• Use The NIATx Third-Party Billing Guide to
  identify steps in the process that need to be
  implemented.

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Review
Are you likely to reach your wildest dreams for
the outcome of this collaborative?
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Call to Action

• Monthly
• Send Lynn and Elizabeth your updated
• Change Project Form
• Attend monthly NIATx webinars
• Level 1 2nd Tues. at 3 pm EST
• Level 2 2nd Wed. at 3 pm EST
• Attend monthly KY provider calls

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Contact Information
Lynn Posze, Convener Lynn.Posze_at_ky.gov 502-564-4
456 Elizabeth Strauss, NIATx Coach elizcstrauss_at_g
mail.com 425.556.0198 Jeanne Pulvermacher,
NIATx jeanne.pulvermacher_at_chess.wisc.edu
608-265-5087
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Celebrate
Thank you!