Download AE is an example of a collective impact initiative

THE
COMMONWEALTH
FUND
The Long-Term Quality Alliance and its
Innovative Communities Initiative
Mary Jane Koren, M.D., M.P.H.
VP LTC Quality Improvement, The Commonwealth Fund
[email protected]
Grantmakers in Health Annual Meeting
March 8, 2012
With thanks to Pat Sprigg
from Carol Woods in NC for
some of these slides
What is the Long-Term Quality Alliance?
•
Inaugurated in 2010
– A coming together of diverse stakeholders striving for balance
between provider, consumer and other groups
– First chair Mary Naylor, current chair Carol Raphael
•
Purpose: To improve the effectiveness and efficiency of care and the
quality of life of people receiving long-term services and supports by
fostering person- and family-centered quality measurement and
advancing innovative best practices.
•
Initial focus: care transitions – from the LTSS side of the equation
– Measurement
• Develop and test new measures or adapt existing measures
• Harmonize with other measures proposed or in use (AHRQ;
NQF; NCQA)
– Quality improvement
• Conduct pilots and demos to test or adapt proven practices
• Collaborate with existing QI organizations to support
interventions and track data (QIOs, IHI, trade associations,
others)
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COMMONWEALTH
FUND
Why transitions?
Area
Agency
on Aging
Home
County
Social
Services
Assisted
Living
?
Cooperative
Extension
Nursing
Home
Mental
Health
Provider
Rehabilitation
Continuing Care
Retirement
Community
Faith
Community
County
Council/
Department
on Aging
Home Health
Care
Community Resource
Connection
Adult Day
Services
Senior
Center
THE
COMMONWEALTH
FUND
“If (re)hospitalizations are frequent, costly, and
able to be reduced, why haven’t they been?”
Challenges exist on multiple levels:
• Hospital-level barriers
– Financial disincentives, no financial incentives, not high on priority
list, limited knowledge / sharing of disease-specific efforts & care
transition interventions among hospitals
• Community-level barriers
– Not common to engage organizations across continuum of
services to collaborate on improving care, lack of IT connectivity,
no reimbursement for coordination & systems and organizations
working in silos
– We stay within the health care box and don’t look at the contextual
issues, e.g. transportation, full-service grocery stores, housing,
public safety, legal services and guardianship
• State-level barriers
– Lack of population-based data, lack of understanding
costs of poor quality on systems, effect of fragmented
payer market and lack of CMS participation
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COMMONWEALTH
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The Innovative Communities Initiative
• Time is ripe: hospitals now have an incentive (as per the ACA)
to collaborate with LTSS providers to improve transitions from
one level of care to the next
– Medicare to recover payments made to hospitals for
unnecessary readmissions within 30 days of discharge
beginning in October 2012
• Delivery system change happens at the local level
• Community delegations of 3-5 individuals invited to attend the
first LTQA Summit* (12/10)
– Shared challenges and solutions
– Explored participating in the ICI
• Collective action is required for lasting impact – it takes a
community
THE
COMMONWEALTH
FUND
*Supported by the SCAN Foundation
Collective action to achieve collective impact*
Collective impact initiatives represent ongoing commitments
by key stakeholders from different sectors to a common
agenda for solving a specific social problem
• Step 1: Assembling the components
– Identify and develop a supporting infrastructure
– Forge new partnerships across interest groups
– Build strong working relationships among important players
through continuous, ongoing communication
– Concentrate on identifying and then addressing the common
problem
– Jointly agree on what success will look like and have a shared
measurement system to track progress towards the goal
– Use mutually reinforcing activities to maximize existing
resources
• Step 2: Sustaining gains
*Kania and Kramer, Collective Impact; Stanford Social Innovation Review, Winter 2011
THE
COMMONWEALTH
FUND
Key Partners
Communities across the US are
beginning to consider transitions
of care as a community –based
challenge that requires shared
ownership and close collaboration
across settings. (Institute for
Healthcare Improvement)
THE
COMMONWEALTH
FUND
Community Engagement is a journey,
and, like any journey, it takes time
From Communication
To Cooperation
To Coordination
To Collaboration
THE
COMMONWEALTH
FUND
Lessons from the field: Listening to the
LTQA’s Innovative Communities
• Identify a Change Agent
• Stakeholders: Consumers: Make the Case
• Encourage Collaboration: Public & Private
Partnerships
• Build Synergy: But Keep Alignment
• Demonstrate Impact (Now vs. Future)
• Choose Intervention –Find the Fit-Don’t
Duplicate
• Capture the Data – who/what/how/why
• Sustainability is Critical!
THE
COMMONWEALTH
FUND
The role of LTQA
• Serve as a repository of information
• Propose and promote common definitions and
terminology
• Be a coach and a convener for the communities
• Identify state and federal funds to assist the
collaboratives
• Launch a consumer education campaign
• Educate public officials and lawmakers
• Advocate at the national level for flexibility to innovate
• Identify regulatory barriers to innovation
THE
COMMONWEALTH
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11
What can you do?
• Examine your foundations priorities – could they be furthered by
the creation of an LTQA type Innovative Community?
• Discover what your community/region/state is already doing – lots
of good things may be underway already but struggling and you
can give them wings
• Convene
• Provide technical assistance; build infrastructure
• Give seed money
• Reward achievements
• But just DO something – don’t walk away because the long-term
services and supports issues are big and complex
Remember –
The way to eat an elephant is one bite at a time!
THE
COMMONWEALTH
FUND