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)
