The story of one provider’s path to value-based care

SUS used accreditation standards as part of a wholesale commitment to performance management. Now the organization is well positioned to market itself within value-based and other outcomes-based payment models.

Portion of the color-coded chart illustrating survey answers at Services for the UnderServed (SUS)

By CARF International

In late 2017, two dozen program leaders from Services for the UnderServed (SUS) arrived at a conference room in the agency’s 17th floor New York headquarters. They had with them data from SUS’s annual consumer satisfaction survey, charted and illustrated so that nothing would be missed.

It was the first year following a major revamp of the company’s satisfaction survey, which had successfully increased the response rate 113% from prior years. On the heels of this success, leaders were eager to review the new feedback and parlay it into strategies to improve services.

The charts quickly revealed the first area for improvement. One program showed statistically significant lower scores than others on the question, “Does staff listen carefully to you.” It was exactly the kind of feedback the leaders at SUS had been looking for. Within minutes, they began building a plan to implement new trainings for both staff and consumers on effective listening and mindfulness.

As they constructed their strategy, one thing became clear: The exercise was not a burden. They were not just working on a feel-good document to hide away in a filing cabinet. Instead, it was seen as an opportunity for growth.

The resulting plan would be visible and actionable. It would be shared with all stakeholders, including executive leadership and board of directors, direct service staff, and most importantly, persons served. It was a demonstration of the transparent quality-improvement philosophy that SUS had committed to more than ten years prior.

Rewind to 2007

SUS is a 2,400-employee nonprofit provider of services for behavioral health, intellectual/developmental disabilities, veterans, and persons who are homeless. In 2007, it was several years into a companywide project to strengthen the connection between its stated organizational values and actual practices.

SUS was focused on being able to measure quality of services and define what impact services have on clients’ wellness. It wanted to weave the elements of continuous quality improvement and transparency completely into its company DNA.

SUS knew the foundation for these goals is a person-centered culture.

That’s where accreditation standards came in, according to Wanda Cruz-Lopez, Senior Vice President for Behavioral Health at SUS. “’Person centered’ is a philosophy. It has to be something that is engrained in the organization,” said Cruz-Lopez. “CARF gave us a way of doing it. It’s like you have a philosophy, but then you have something tangible to say that this is what you need to do.”

SUS committed to accreditation over the course of several months. With a philosophy and framework in place, it began to implement several initiatives over the next several years. These efforts fell into the following larger categories:

• Calibrating hiring and training practices
  It’s “Getting the right people on the bus,” as SUS CEO Donna Colonna often says. Hiring and training helps build an organization with people who have a similar belief system.

• Breaking down barriers to admission and services
  This included updating intake processes, establishing connections with other providers and community resources, and streamlining referral routes. It also meant bringing some primary care services on site, such as screening and monitoring for conditions like diabetes or hypertension.
  
  The idea was to remove the perceived walls between physical health services and social services, and address the whole, individual person.

• Tackling the challenge of engaging staff and consumers
  The revamp of the annual consumer satisfaction survey is an example of this initiative. The aim was to open actionable dialogue with stakeholders.

• Founding a Program Planning and Evaluations department
  Social services agencies have always been great at telling stories—human-interest stories or stories about a noteworthy client. But they have not always been great at quantifying the effectiveness of services or linking those stories to healthcare outcomes. SUS created the new department to establish baselines and goals for programming and to analyze agency trends.
  
  This performance management has been vital, said Cruz Lopez. “Look, if we are going to talk about effectiveness, we really need to do some baselines. In the past, we were telling stories about individual clients. That can be effective, but it’s really about measuring data and keeping track of what it is that we do in a way that speaks to numbers, not just telling great stories. Was the intervention successful, how did we make a difference in this person’s life, can we replicate, etc.?”

SUS’s efforts have had a positive effect on service quality and client relationships. But the recent rise of outcomes-based payment models means SUS is also in a great position to market itself for new funding opportunities.

Success participating in outcomes-focused payment models

Wanda Cruz-Lopez (center), Senior Vice President for Behavioral Health at SUS, participates in a roundtable discussion with Michael Johnson (podium), CARF’s Managing Director of Behavioral Health. The discussion, titled “Accreditation as a Partner on the Road to Value-Based Care,” was held at the ASAP Conference in September 2018

Outcomes-based care models have emerged in recent years in response to rising healthcare costs. They encourage providers to better collaborate on care, provide treatments and services customized to each person receiving them, and focus more on driving positive health outcomes.

Unhitching reimbursement from process (fee-for-service) and moving it toward outcomes can benefit providers, persons receiving services, and payers by:

• Freeing up providers to deliver services more efficiently and cooperatively.
• Raising the quality of services as they are tuned more toward individual needs.
• Lowering hospitalization rates—and therefore the overall cost of services—by focusing on prevention.

The challenge for providers is that many are unprepared to join in these new models, especially those in social services. To participate, a program’s outcomes must be defined, measured, and sharable. This requires a strong performance management process that many providers do not yet have.

SUS, however, is in a good position. For example, in 2016 when it applied for the SAMHSA-led demonstration program for Certified Community Behavioral Health Clinics (CCBHCs), it had to complete a readiness checklist to determine its ability to provide the CCBHC criteria. The organization found that it was already well aligned.

SUS’s first clinic moved quickly through the application process, and a second clinic recently received approval for the CCBHC project expansion.

“The fact that we had gone through the accreditation process now for quite a number of years really prepared us,” said Cruz-Lopez. “There were so many things on our checklist that we were like, this is so great that we’ve already done this. Our policies and procedures were in order and we had the things we were measuring already in place.”

SUS has also seen an improvement in applications and RFPs for grants, which the Program, Planning, and Evaluations department manages. “We’ve had a 67 percent success rate, which is phenomenal,” said Cruz-Lopez. “With grants, they say, ‘give me a story where you have been effective in what you say you are doing.’ Now we can tell that story and support it with data. We can say we implemented motivational interviewing or wellness self-management and people were able to go through the curriculum and we have X number of people who used to have 3 or 4 hospitalizations annually and now they are down to 1, or whatever it is. We can articulate that a lot better.”

“Again, CARF has helped us to capture that kind of information because we have established the program goals that are defined and measurable. So it has helped us get more funding opportunities than we had in the past. It’s all data driven.”

The next generation of healthcare payments will be performance based

The 2017 consumer satisfaction meeting resulted in several new initiatives for improvement. In addition to new trainings for listening and mindfulness, SUS leaders also decided to host a community meeting on the topic of safety and create more opportunities for program participants to discuss what safety means to them.

In summary, SUS was able to increase participation in the survey and gather more actionable data.

These efforts are just some examples of the performance management and improvement practices that SUS committed to several years ago. As a result, SUS has been able to take advantage of the front wave of new outcomes-based payment opportunities. But the trend will continue. Service providers looking to participate in future reimbursement models will need to embrace strong performance management practices today.

To learn more about CARF’s standards for performance management and improvement, please contact us.

12/4/2018
(Behavioral Health,Employment and Community Services,Performance Management and Improvement)