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Informationyouwillfindinthisissue

• NAHQ-savethedateforthestartoftheAnnualConference–page1

• IntroductiontoanewBoardMember-page3

• Articletitled“LastPlace:AReflectiononRBHA”.ThisarticlegivesinsightintothementalhealthissuesinAZ,nomatterwhatyourroleisinhealthcare.Startsonpage4.

“QualityPaymentProgram:TheClockisTicking”MarkPatton,CPHQ,CSSGB(PresidentAzAHQ)

InthePresident’smessageearlierthisyearwefocusedontwoconcepts,transitionandvalue.Wehavesincethenseen(inApril2016),theDepartmentofHealthandHumanServicesrampuptheconnectionofvalueinhealthcaredeliverytopaymentmethodology.MACRA(MedicareAccessandCHIPReauthorizationActof2015)tookonmoretractionthroughtheproposedchangesinthe“QualityPaymentProgram”.Twopathwayswereoutlinedtobeavailableinordertoimplementthechanges;AdvancedAlternativePaymentModel(APMs)andMerit-basedIncentivePaymentSystem(MIPS).Whatdothesemeanforourrespectiverolesindeliveringhealthcarequality?ConsideringonlytheMIPSpathway,asmostcliniciansareexpectedtobeparticipatinginitiallyinthisoption,weightedelementswillreflectanemphasisonqualityofcaredelivery.Fourperformancecategorieswillinclude;cost,quality,clinicalpracticeimprovementactivities,andadvancingcareinformation.Eachofthesewillrequireefficiencyofprocessleadingtoimprovedpatientoutcomes.Thequalitycategoryalonewillaccountforfiftypercentofatotalperformancescoreinyearone.Thehighqualitymeasureswillrelateto;patientoutcomes,appropriateuse,patientsafety,efficiency,patientexperience,andcarecoordination.Whiletheproposedchangeshavenotbeenconfirmed,theclockisticking.Thatis,paymentmodelsforvalueofcaredeliveryareonthehorizon.Ashealthcarequalityprofessionalswewillneedtobepreparedtotakealeadershiproleinbothunderstandingthemeasuresandnavigatingtheprocesstoachievethemeasures.WithinthescopeofAzAHQwewillaimtogearoureducationalfocustosupportyoureffortsinthecomingmonthstoensureyouareequippedtounderstandtheimpactofthistransitiontovaluebasedcare.

AZAHQ2016SUMMERCONFERENCESAFETY AND REGULATORY UPDATE FRIDAYJuly29,20169:30Registration10:00-3:30PMProgramLocation:FlagstaffMedicalCenterMcGee Auditorium 1200 N. Beaver St. Flagstaff, Arizona 86001 Cost:members$65/non-members$100LunchisprovidedCPHQcredit:4.25hourspendingPleaseuseouronlineregistration. http://azahq.org

AdvancingHealthcareQualityinArizonathroughleadership,educationandcommunication.

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NAHQWebinarsWebinars.Whetheryouarenewtotheworldofhealthcarequalityorifyouhavebeenhereforoveradecade,NAHQhasaneventthatisperfectforyou.LearnhealthcarequalitybasicsinourIntroductiontoHealthcareQualitycourses,takethenextstepandprepareforyourCPHQcredentialwithaCPHQReviewCourse,orsimplygainoverallqualityknowledgewithintheindustrybyattendingtheAnnualEducationalConference.Clickheretoviewalistofeducationalwebinars.

SAVEthedate:NAHQ’sAnnualConferenceSeptember18-20,2017ScheduleforCincinnati,OhioStartingnow,theyarelookingforabstractsforpapersandposters,soifhaveaprojectyouhavebeenworkingonorcompleted,thinkaboutsubmittingit.Topicsuggestionsincludebutnotlimitedto:

• Communication/OrganizationalAlignment

• DataandImprovement• HealthcarePolicy&Reimbursement• Leadership

• PatientEngagement• PopulationHealth• ProjectManagement• Regulatory/Accreditation

UPCOMINGAZAHQEDUCATIONALEVENTSCheckourwebsitefrequentlyforongoinginformationaboutoureducationalevents.

HaveyoujoinedaSIGyet?

Ifnot,you’remissingoutongreatopportunitiestonetworkandshareideas!NAHQMembersareinvitedtojoinanyofNAHQ'sspecialinterestgroup(SIG)discussioncommunitiesontheNAHQNetwork.Visitwww.NAHQ.org/sigsforinstructionsonhowtosignupforaSIG.Youcanchoosetoreceivenoemails(andreadallpostsonline),dailye-mailsoradigestofmessages.Takeadvantageofthispopularmemberbenefitandsignuptoday!

AdvancingHealthcareQualityinArizonathroughleadership,educationandcommunication.

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AZAHQ’SLINKEDINGROUP

http://www.linkedin.com/groups/Arizona-Association-Healthcare-Quality-3895572/aboutTheAZAHQLinkedInGroupisnowavailabletoall.PleasetakeamomenttoinviteyourcolleaguesandotherLinkedInconnectionstojointhegroup.

AZAHQBOARDUPDATES

NewBoardMemberWewouldliketowelcomeandintroduceournewestmembertotheboard,StephanieTurner.ShehasvolunteeredtobetheLeadelectforCommunication.StefanieisthePerformanceQualityImprovementCoordinatorforHealthChoiceIntegratedCareinFlagstaff.Sheoverseesqualityofareinvestigations,internalprocessimprovement,andprovidesperformanceimprovementforHCIC’sservicearea.Previously,sheworkedforAetnaMedicaidinPhoenix.WelcomeStefanieTurner!

AZAHQ2016BOARDMEMBERS(CONTACTTHEBOARD)

POSITION NAME Credentials Employer Work Title

President Mark Patton CPHQ, BS Myriad Genetics Strategic Account Manager President Elect (vacant even years)

Past President Jeanne Stueland RN, BSN, MPA, CPHQ HonorHealth Consultant, Quality Outcomes

Secretary Regan City MSHS, PA-C, CPHQ Scottsdale Medical Imaging Quality Manager Secretary Elect (vacant odd years) Denise Betcher MSN, RN, CPHQ Mayo Clinic Arizona Nursing Quality Specialist

Treasurer 2016 Shari Baird MS, RD Phoenix VA Healthcare System Program Manager

Treasurer Elect Regan City MSHA, PA-C, CPHQ Scottsdale Medical Imaging Quality Manager

Communications Team Lead Ellen Kane RN,MSN,CPHQ St. Joseph’s Hospital and Medical Center Senior Quality Analyst

Communications Team Lead Elect Stefanie Turner CPHQ, CHC, LSSGB Health Choice Integrated

Care Performance Quality Improvement Coordinator

Education Team Lead Burton Korer MSN, RN-BC Case Management, CPHQ Korman Healthcare CEO

Education Team Lead Elect Monica Zylstra AD, LPN Iasis Healthcare

Membership Team Lead Thomas Cross MBA AZ Dept of Health Services Quality of Care Specialist

Member at Large Mary Doyle PhD, RN, CPHQ UA College of Nursing Clinical Assistant Professor

AzAHQ Association Manager Holly Grems RN, BSN, MHA, CPHQ HonorHealth Deer Valley Medical Center Patient Safety, QI Consultant

AdvancingHealthcareQualityinArizonathroughleadership,educationandcommunication.

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CONTRIBUTEANARTICLEORIDEAFORTHISNEWSLETTER

Weareseekingarticlesandideasforournextnewsletter!PleaseemailthemtoEllenKane,CommunicationsTeamLead.IwouldliketothankLisaBetancourt,MHA,CPHQforthearticlepresentedinthisnewsletter.

1st Quarter Newsletter 2016 LastPlace:AReflectiononRBHAContributedbyMichaelJ.Mayer,FACHE

Afewdaysago,AlexArthurBuckner(age26),killedhisfamilyandsetfiretohishome.Heheldfirstrespondersatbaywithgunfireandwaseventuallyshotandkilledbypolice.IthasbeenreportedthatBucknerwaschallengedbyschizophrenia.Itwasreportedhehadalonghistoryofmentalhealthissuesanddrugabuse.Familyandfriendsmournandponderhowthiscouldhavehappened.Somewillpointtoguncontrolasanissue,thoughthegunwaslegallyobtainedandthepropertyofthefather.Perhapsmoreshouldhavebeendonetokeepitsecure,giventhebehavioralissueswithAlex,butIcannotspeculateonthatasthereistoolittleinformation.Sadlytheeventisonlythemostrecentofalongstringoftragediesassociatedwiththementallyillandwhathasnotbeendoneforthem.ItisinterestingthatthismatteroccurredwhiletheArizonaStateLegislatureisconsideringatleastonebilltoliberalizeconcealedcarryrights(HB2072).IntheinterestoftransparencyIwillacknowledgethatIamagunowner,andasupporterofSecondAmendmentrights,butIalsobelieveinreasonablerestrictionsdeprivinggunaccessforcriminalsandthosewhohaveahistoryofmentalillness.Idonotthinktheserestrictionswouldhavealteredthesadeventsthatoccurred.

AdvancingHealthcareQualityinArizonathroughleadership,educationandcommunication.

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WhatIdofindinterestingisthatwhiletheStateofArizonaisseekingtoliberalizetheabilityofitscitizenstocarryguns,ithasahistoryofcuttingresourcesandnotaddressingtheneedsofvulnerablepopulationsdealingwithmentalhealthissues.Thestatehasbeeninadequateinprovidingfortheneedsofthispopulation.Arizonacutmentalhealthfunding$108.4million(23%)between2009and2011,reducingservicestoabout14,000Arizonacitizenslivingwithmentalillnessandresultingintheeliminationofcasemanagement,brandnamemedications,accesstosupportgroupsandhousingandtransportationsubsidiesforpeoplelivingwithseriousmentalillness(Source:NationalAllianceonMentalIllness(NAMI),“StateMentalHealthCuts:ANationalCrisis”,2011).NAMIreportedincreasesinthefiscalyearbudgetsending2014and2015,andalthoughincreased,NAMIstillreportedArizonaas51st(includingDistrictofColumbia)onmentalhealthissuesamongallthestates(Source:ThePewCharitableTrusts,“SomeStatesRetreatonMentalHealthFunding”,2014).MentalHealthAmerica(MHA)similarlyplacedArizona51standmayhavebeenthesourceoftheNAMIranking,(ParityorDisparity:TheStateofMentalHealthinAmerica2015).MHAalsoreportedthebottom10statesintheOverallRankingalsorankamongthebottom10statesinthefollowingpooroutcomes.Ihavenotseenmorerecentstatisticsreported.FromtheUSCensusBureau(2014),Arizonaranks41stinpercapitaspendinginpublicwelfare,35thforhealthandhospitals,14thforpoliceandfireprotection,16thforcorrections,48thforhighways,51stinexpendituresperstudent.FromthesestatisticsIobservethatArizonaappearsfarmoreconcernedwithpoliceandcorrections,thanithasbeenformentalhealth(andhealthingeneral)orineducation,andseemscontenttositatthebottomquartileonthesemeasures.IsubmitthatifArizonadidabetterjobattendingtotheeducationofitscitizensandtothewelfareofthoseinneed,includingthementallyill,itwouldnotneedtospendsomuchonpoliceandprisons.Thisisnotanewproblem,withthetragicshootingofCongresswomanGabrielleGiffordsandthekillingofsixinnocentcitizensinArizonafocusingnationalattentiononthestateofthepublicmentalhealthsysteminArizonaandotherstates,andastringofsimilareventssincethen,leadingtoMr.Buckner.TherehavebeenrecentchangestomentalhealthfundinginArizona,with$427millionaddedinfiscalyears2015and2016(2016estimated).ThefiguresarefromaletterfromAHCCCStoNAMI(January2016).The2016increaseislargelyafunctionofadditionalmoneybeingmadeavailablebythefederalgovernment,ratherthanstateresources.Theimpactofthesechangeshasnotfounditswayintopublishedreports,anditisunclearifpatientswhodidnotreceiveservicesduringtheperiodsofcutbackswillbeabletorecoverunderthecurrentarrangements,oriftheimpactofthosereductionswillbepersistent.Howtheadditionalfinancialresourcesaretobeappliedisyettobeseen.

AdvancingHealthcareQualityinArizonathroughleadership,educationandcommunication.

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Ihavesomepersonalexperienceinthismatter,withafamilymemberinthe“system.”Afewportionsofthedefinitionof“System”fromMerriamWebsterarepresentedincontrasttowhatIhaveobserved:“aregularlyinteractingorinterdependentgroupofitemsformingaunifiedwhole”and“harmoniousarrangementorpattern.”Thefinalattributecouldbemorepertinent:“anorganizedsocietyorsocialsituationregardedasstultifyingoroppressive.”Iincludetheseanecdotestopersonalizethecoldstatisticsofthereportsavailable.OurfamilymemberisexperiencingthesamechallengesasMr.Buckner,andwehaveexperiencedacontinuousstringofproblems,withcaregivers,theRegionalBehavioralHealthAuthority,andvariousstateagencies.Ourfamilymember’snutritionalassistance(SNAP)wasrecentlycuttozero,wepresumeduetotheGovernor’sinitiativethatrequiresparticipantstowork.HeisclassifiedasSMIandthesoleincomeisSSI/MAO,amountingto51.4%offederalpovertylevel.Thedeterminationwasthatincomewastoohightoreceiveassistance.Thematteriscurrentlyunderappeal.Itisn’tmuchbutheshouldgetwhatheisentitledto.Thisisthesecondtimehisbenefitwascutinerror.WesupplementhisneedsofcoursebutnoteveryfamilyinArizonahastheresourcestodothis.Arecentstoryonlocalbroadcastnewsindicatesthestateisconsideringreducing/eliminatingSNAPforanother100,000.HowmanyoftheseareSMIisnotknown.Howcanapersonparticipateinaddressingtheirmentalhealthissuesiftheirbasicneedsarenotbeingmet?TheintegratedRBHAsystem,thoughinitiallypromising,hasalsobeenadisappointmenttodate,boththetreatmentofthosedealingwithmentalillness,andalsoinprovidinganadequatesupportsystemforthepopulationtheyserve.TheproblemiscompoundedbyotherstateprogramsthatseektodeprivethesepersonswitheventheminimalsupportthatArizonacurrentlypurportstoprovide.Housinghasbeenachallenge,withfartoofewunitsavailable,andforthosethatare,theconditionsarewhatonemightcalldeplorable.HouseBill2488regardingahousingsubsidywasapprovedbyGovernorDuceyonApril10,2015.Itmaybegintoaddressthelackofhousingavailabletothementallyill,butitwilldependonfunding,andhoweffectivelytheprocessismanaged.IalsoperceivecertainareasofPhoenixredlinethecommunitiestomaketheavailabilityofhousingmoredifficult.OnewondersifMr.Bucknerlivedinhisparents’housebecauseotherhousingwasnotavailable.Thankfullyourfamilymemberwasplacedsincelivinginourhomewasnotanoptiongivenideationthatwaspresent,buthehashadmanyproblemswiththehousingorganization.IhavehaddiscussionswithadministrationatAHCCCSaboutthehousingissueandwasinformeditwasnotfundedinthebudget.Iaskedwhy,sinceadequatehousinghasbeendocumentedasaresourceforhelpingmaintenance,ifnotrecovery,ofthosementallyill.Icontrastedthecostofhousingcomparedtoaninpatientstay.Thelogicofaddressinghousingseemsinescapable,butsinceitisnot“treatment”wecannotseemtogetpastthathurdle.Withthesubjectofinpatientadmissionsinmind,Icanappreciatetheintenttocontrolcostsasmuchaspossiblebyavoidingadmissions,butIhaveobservedtheoutpatientsettingasbeingwoefullyinadequateinimprovingthementalstateofourfamilymember,muchlessmaintaininghisfunctioning.Ihaveobserveda

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steadydeclineover4years,withlackoffollow-upandcoordinationamongthecaregivers.Withapologiestothoseintheprofessionwhostillcareandareenergized,Iobserveapassivedefeatistattitudeaboutcaringforthesepatientsamongothersprovidingservices.Ihaveobservedactiveresistancetoengagedfamilymemberswhoprovidemuchmoreinformationthanthecaregiverscouldeverobserveinthebriefandinfrequentvisitstheyhavewithpatient,aswellasresistancetothefamilymemberswhoadvocatefortheneedsofthesepatients.ThisobservationwasechoedinconversationswithNAMIasaproblemaroundthecountry.Ourfamilymemberhasrecentlymovedtoadifferentclinicandwehopethiswillchange,butitspeaksvolumesaboutothersIobserveatNAMImeetingswhohaveexperiencedtheseissuesformuchlongerthanI.Theyaresimplywornouttryingtogetthesystemtoact.Dealingwiththeemotionalandothertollsofhavingafamilymemberwithmentalhealthissueswouldsimplybeenough,withouthavingtofightotherentitiesconcerningthepatient’swelfare.Astoadmissions,somepatientssimplydonotthriveinanoutpatientsetting,butitseemstheonlywaytogetanadmissionisifthepatientpresentsadangertoselforothers.Bythetimeapatientdevolvestothatstate,itisoftentoolate.Topunctuatethematter,Ihaveobservedthecaregiversattributingtothepatientinsightandthecognitiveabilitytomakerationalinformeddecisionswhennosuchabilityexists.Whileitmaybelaudableandrespectfultoassumeahighleveloffunctioning,tocontinuedownthatroadwhentheseattributesarenotpresentexposesthepatienttohazard.Patientcompliancewhenthereislackofinsightorunpleasantsideeffectsofmedicationisaproblem.Ourfamilymemberisoncourtorderedtreatment,butotherthanpresentingforhisinjectionheissociallyisolatedanddoesnotparticipateincounselingorotheractivitiesthatcouldhelphimtoorienthimselfandengagewithothers.Iinquiredwiththeattorneyrepresentingthecountyaboutexpandingthescopeofthecourtordertoincludeoutpatientcounselingandweretoldthecourtwasdisinclinedtoact.Iobservethesystemappearscontenttochemicallyrestrainthepatientwithanti-psychotics,butofferslittlemore.ThatisthereasonIthinkthestructureofaninpatientorresidentialprogramwoulddomoreforthesepeople,butthiswouldcostmorethanlettingthepatientlanguishaloneinanapartment.Complianceisalsochallengedbydisruptionsinthecareteam.Inthelastyear,ourfamilymemberhashad3locumtenenspsychiatristsattendingtohim.Theproblemisnotconfinedtopublicsectorprograms.AlthoughthePaulWellstoneandPeteDomeniciMentalHealthParityandAddictionEquityActof2008(MHPAEA),asamendedandaugmentedbyPatientProtectionandAffordableCareAct(ACA),significantlyreducedinsurancebiasagainstbehavioralhealthservices,includingaddingmentalhealthandsubstanceusedisorderservicesasEssentialHealthBenefits,sometypesofplansstillhavetheoptiontoexcludebehavioralhealthcompletely.Inaddition,notwithstandingthetermsofthelaw,manyinsuranceplansstillimposerestrictionsonbehavioralhealththattheywouldneverconsiderapplyingtomedicalservices.Ihaveobservedplansdenybenefitsonthebasisofthelowexpectationofachievingimprovementinashortperiodoftime.Serviceshavealsobeendeniedbecausethepatientisonlybeingmaintainedatthecurrentstate.Anumberofbehavioralchallengesarechronic,perhapslifelong.Aninsurancecompanywouldnotdenyservicesforsomeonewithcongestiveheartfailure,COPD,

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diabetes,HIVoranynumberofotherchroniclongtermillnesses,yettheyopenlydoitinbehavioralhealth.Thisisagapthatshouldbeclosedatthefederallevel,andcanbeclosedatthestatelevel,foratleastthoseplansthestatehasjurisdictionover,buttheproblempersists.Thewebsitewallethub.comhasArizonaas15thbestinstateandlocaltaxburdenamongthestatesfor2015.TheTaxFoundationrankedArizona34thfor2012,inthiscasethehighernumbersbeingbetter.Arizonaclosedoutits2015fiscalyearwitha$266millionsurplus—anearly$400millionturnaround(Source:ArizonaRepublicJuly20,2015).GovernorDuceyhassaidthathewillworkwiththeLegislatureontaxcutsdistinctfromthebudget.(SourceArizonaPublicMediaJanuary15,2016.)Arizonansarenotexcessivelyburdenedbytaxes,andthesurplusesrecentlyrealizedneednotbetheimpetusfortaxcuts.AHCCCSstatesfundinghasincreasedandthatisastepintherightdirection,providedtheexecutionisthere.TheDepartmentofBehavioralHealthServicesisbeingmergedintoAHCCCSthisyear.Thestateneedstobecertainprogressisnotdelayedintheadministrativeintegration.AHCCCSiscreatinganewDivisionofHealthCareAdvocacyandAdvancementthatincludestheOfficeofIndividualandFamilyAffairs.ThatteamisleadingeffortstoincorporatepeerandfamilyinvolvementwithintheAHCCCSPolicyCommittee.Thisisalsoagoodstep,butthestateneedstobeproactiveinadvocatingfortheneedsofpatientswithoutotherstorepresentthem.AHCCCSisalsodevelopingaDeliverySystemReformIncentivePayment(DSRTP)programforArizona.Aproviderincentivesystemcouldbeaneffectivestepinassuringaccessandqualitytocare,provideditismeasurableandactionable,andthateachcomponentofthepatient’scareteamcanbedistinctlyevaluated.Thecompassisagainturnedintherightdirection,butthereismuchtobedone.Withimprovedfunding,publicandprivate,perhapstheshortfallinavailableresourcesandthestabilityofthenetworkprovidingservicescanbeaddressed.Integratingthecareteamsandlivingsupportisstillanissue.Arizonashouldnotbecontentwithbeinglast.“Anation’sgreatnessismeasuredbyhowittreatsitsweakestmembers.”GandhiMichaelJ.Mayer,FACHESubmittedbyLisaBetancourt,MHA,CPHQwithpermissionoftheauthor,MichaelJ.Mayer,FACHEhttp://newsmanager.commpartners.com/acheaz/issues/2016-04-017 Editor: Allison Bright, MHA Co-editor AJ Thomas 1st Quarter Newsletter 2016 Newsletter Editor: Allison Bright, MHA Co-editor AJ Thomas