MassHealth

36% of opioid deaths involve a prescription opioid. (CMS Roadmap: Fighting the Opioid Crisis; November 2019). The Six Building Blocks Program was developed by a physician-led team from the University of Washington and the Kaiser Permanente of Washington Research Institute to improve management of chronic pain and chronic opioid therapy in primary care settings. A clinician-led Stroudwater team assists up to six practices to integrate team-based care principles and the Six Building Blocks Program into daily operations. Stroudwater works with physicians and staff to customize and implement the program, including:

• Program education: Program overview, implementation stages, operational factors, resource materials
• Review and Gap Analysis: Current staffing and infrastructure, policies and procedures, workflows, and tools to manage chronic pain and opioid therapy
• Gap Analysis findings and group action planning
• Virtual Implementation coaching and support – up to 6 hours per practice over 3 months

We would be happy to customize this project to meet client needs.

Domain:

• 2: Care Coordination/Integration
• 8: Population Health

Price Range: $25k – $75k

Improving ED throughput and inefficient practices and improving the use of appropriate care settings are key to reducing MassHealth ACOs’ total cost of care. Efficient practices are essential to ensure time-sensitive treatment, transfer, discharge or admission. Stroudwater ED operational improvement engagements evaluate current practices and processes and identify gaps in workflows overburdening providers and staff while potentially impacting outcomes. Specific attention will be directed to ED utilization and national benchmarks related to ED throughput and outcomes.

Areas reviewed and evaluated include:

• ED Value Stream from registration to patient disposition
• Avoidable ED visits Multiple Visit Patients (MVPs)
• Current and potential programs to identify and direct patients to the appropriate alternative levels of care. Clinician-led engagement will include a written summary and leadership meeting to present analysis, findings, prioritized recommendations, and improvement actions. Professional cost is per hospital and based on ED volume.

We would be happy to customize this project to meet client needs.

Domain:

• 7: Performance Improvement
• 8: Population Health

Price Range: $75k – $100k

It is widely recognized that Post-Acute Care (PAC) is a significant component of total cost of care and is a key component of the care continuum. The challenge is identifying the best partners, then monitoring quality, utilization, and cost patterns of the various PAC providers and the resulting impact on the ACO’s overall performance. Poorly performing PAC providers may contribute to high avoidable ED utilization, inpatient admission/readmission rates and poor clinical outcomes. Stroudwater will assist ACOs to evaluate their current PAC networks and to develop strategic and tactical action plans to identify top performers and address underperformance. Evaluate ACOs’ existing PAC network, perform ACO population-based market analysis, recommend potential new PAC resources and models, and recommend strategic and tactical action steps and approaches to build and strengthen the ACO’s overall PAC strategy and performance. Cost is based on ACO size and organizational complexity.

Domain:

• 2: Care Coordination/Integration
• 7: Performance Improvement
• 8: Population Health

Price Range: $75k – $100k

CMS Conditions of Participation require hospitals to implement, maintain and evaluate a formal, documented Quality Assurance Performance Improvement (QAPI) program to monitor and continuously improve patient care. Hospitals participating in MassHealth ACOs must establish and maintain a quality program that aligns with and supports achievement of MassHealth ACO quality metrics. Stroudwater’s clinician-led quality improvement offering provides a comprehensive evaluation of the organization’s quality program, including recommendations for strategic improvements based on MassHealth ACO and national metrics. The engagement focuses on identifying opportunities for operational and clinical quality performance improvement through data analysis and interviews. Stroudwater assists with development of action plans with specific, measurable outcomes to drive overall quality improvement, minimize adverse events, and reduce readmissions.

The engagement includes a written summary and leadership meeting to present analysis, findings, prioritized recommendations, and improvement actions. Professional cost is per hospital and based on licensed bed size.

Domain:

• 7: Performance Improvement

Price Range: $25k – $75k

To improve ACO member clinical quality outcomes and access to primary care, Stroudwater works with physician practices to implement the Team-Based Care model. The model involves restructuring of clinical workflows to redistribute responsibilities across the entire team, enhancing practice efficiency, increasing provider productivity and capacity, while improving patient/clinical team engagement. This model varies from, but is highly complementary to, the PCMH model.

There are four major components, as adapted by each organization:

• Co-location of providers and core clinical staff
• “Co-visit” model – MA/Nurse performs real-time documentation in patient’s EHR while provider examines patient
• Pre-visit planning
• Daily morning team huddle

A clinician-led team will assist up to three physician teams to implement this model. Consultant activities include education and training; high-level assessment of current operations; onsite coaching and implementation support; and three hours per physician team ongoing virtual support for up to three months.

Domain:

• 2: Care Coordination/Integration
• 7: Performance Improvement
• 8: Population Health

Price Range: $25k – $75k

Stroudwater will work with an ACO and their participating hospitals to provide high-level financial insight into the impact on revenue and overall financial performance based on the chosen ACO model and cost savings target assumptions and scenarios. Through the engagement, Stroudwater will work with leaders to establish and modify assumptions, including volume and expense variation; educate on the strategic importance of financial decisions made; and develop a five-year pro forma that projects the net financial performance of the organization. The goal of the engagement is to provide leaders with the financial framework to make decisions regarding changes to the delivery of care that better align with the imperatives of the MassHealth contractual value-based reimbursement and incentives. The listed price range will cover the financial modeling of a one- to four-hospital system.

Domain:

• 1: Actuarial and Financial

Price Range: $25k -$75k