Providers agreement coordination treatment (pact)

Providers agreement coordination treatment (pact)Chris hutsellArizona state universityHci 563

overviewPrimary care:Shortage (access)Inequalities (treatment; misdiagnosis)Nurse practitioner:Scope of practice (wider)Quality (more time per session; specialty)Smi population:Mortality rates (11 years less)Co-morbidity (over 65% pop)Coordination:Integration (communication lacking)Holistic approach (no health w/out mental health)

Innovation processBrainstorming process:Background (developmentally disabled individuals; psychology; family are nurses)5-compententcies (solution-centered mindset = sense of purpose; super-value creation = identify gap, invest what you know)Rapid prototyping:System level integration; county prototypeMaricopa, Az: (Smi considered beyond the scope of typical Medicaid contracts)Course considerations:due to: Inequality; access for populationCurrent model is unsustainableBuilding the case:Social innovation: using existing resources for community problemHigher adaptable model; stigma issues w/providers

Leadership structureCore values:All healthcare is local (point of service should reflect content of work)Simple systems make up complex systems that thrive when they interactSetting a vision:Statement: Increasing the quality of holistic healthcare at the point of service for an underrepresented population that historically has had inequality healthcare services.Emergent leadership:Seeking emotionally competent providers who are willing to let go of old ways in order to practice holistic healthcare.Systems thinking :PACT is a fluid concept with measurable feedback loops that attempts to sustain equilibrium for the population.

Leadership continued..Sustainability plan:Accountability; transparency achieved through:Higher Quality; dissipative leadership; adaptation modelingUser point of service:Input = SMI population; throughput = (BHp); output = clinics providing behavioral healthcareexternal factors:Limited access; Lack of providers; inequality, funding; patients have difficulty communicatingInternal factors: Lack of coordinated care between providers; Scheduling (no shows or showing up late; not enough time slots available); Inefficient discharge (i.e. no follow-up; medication non-compliance); Inefficient registration process (i.e. incompletion)Facilitation mindset:Facilitationis any activity that makes tasks easier for others; Coordination is the harmonious functioning of parts for effective resultsPACT is an acronym for Providers Agreement Coordination Treatment.

Medicaid

evidenceSupporting concepts:improvement models: Require Funding, performance standards; tech assistance; trainingImpact: (mortality; comorbidity; quality; access,; substance abuse; society)Literature search:Qualitative focused; ethnographic mindsetHealthcare Quality for smi population; societal issues; nurse practicioner competencyUser input:Provider: Linkage between (BHP) and (PCP); Coordinating access to specialists; Facilitating access to care; Tracking cost, Accountability; Follow-Up After Hospitalization; Substance abuse Treatment ; Body Mass Index (weight) screening; Cancer screening; Diabetes carePopulation: recent examples (police kill SMI individual w/knife; vet stomped to death; skateboarder kills man in coffee shop)

financeFinancial impact:not-for-profit; aca(reducing federal spending 20 to 3%; provider accountability); (dual-eligible)Grants: samhsa; nimh; nami; Kaiser foundationFunding/ Budget:Pre-pilot (county level)Medicaid expansion ($70 billion potential)Roi:Psychosocial rehabilitation (PSR): $545, 259 per patient annually; greater use of (np)s over $16 billion projected savings for Texas Qualitative: (non-financial gains) leading medical condition costsRegulatory issues:ACA: federal safe harbors; Sarbarnes-oxley act (transparency; accountability, standards)Financial control: (paper trail; monthly report; independent auditing; conflict of interests)

It strategyTech usage:Telemedicine extremely helpful; needs to be utilized more(EHR) tracking smi population extremely important; may need to be subset of larger electronic health record databaseGovernance model:goal (using underutilized resource for underserviced population;) Advantage (higher quality; better access)Characteristics (objective, fair, efficient, timely, adaptable) Stakeholders (engaging; formulation; implementation)Assets:Applications (scheduling; tracking) architecture (big data; stable metabolic panels; higher compliance) data (measures; research) staff (education; opportunity expand practicing scope) value (tangibility; efficiency; relationships; transformation) Influence:Strategies: recognizing routines & patterns, leveraging organizational processes; incrementalism; preparing for uncertainties, and partnerships

PolicyImpeding:Medicaid: experiences frequent cuts; policy procedures vary from state to stateScope of practice (about 26 states allow (NP)s prescription authority)New:(aca): all states must participate in expansion or face cutsHigher standards; more (np) involvement in policy; widening the scope (physicians should not be allowed to monopolize primary care)Change plan:Bundled-payment system (co-morbid conditions)Stakeholder: The need for allies. (ama) is powerful opposition. More funding programs: State health insurance assistance program (SHIP) free counseling

outcomesQuantitative:Mortality; co-morbidity; homelessness; (Pcp) shortage; (NP) increase; homelessness; incarceration, substance abuse; hospitalizations; adherenceQualitative:Healthcare Quality; coordination; stigma; quality of life; societal issues: (productivity loss estimated costs $200 billion annually)Trajectory:Mortality: (reduce 25% in 2yr) quality: (increase panel stability 5% by 12 months) hospitalizations (reduce 20% by 18 months)Homelessness: (5-12% by 6-12 months) incarceration: (25% by 6-12 months) psych (Np): (double workforce by 3-5 yrs)Evolution:1-5 yrs: Establishing & measuring baselines; projected sustainability; national expansion; cultural awareness; patient responsibility 5-beyond: Dual diagnosis programs; more cross-training education; non-traditional environment, school psych-screenings

Objective iiChange theory:Lewins 3 -stage model (unfreezing = policy; change = society; freezing = new patterns)Patterns of thought (communicative interaction - misunderstanding reach critical level)Systems theory:System: (elements = stakeholders; interconnections = relationships; function = treatment)Recognizing signals & triggers of societal environmentsTeamwork:Crisis preparedness (plan); assessmentprocess factors (goals; competence resources = np capable; assessment; work demands = pcp shortage; results)Alignment:Value (Honoring excellence); evolving model goodness of fit; incentives; accountability; transparency; feedbackLeadership skills:relationships (trust; opportunity); vulnerability; emotional competence; revolutionary; change management (reading signpost)Complexity communication (listening; questioning; thinking = critical & brainstorming)