D026 Implementing value based care

IMPLEMENTING VALUE-BASED CARE A S T R AT E G I C AC T I O N P L AN JENNIFER HOGAN RN, BSN What is Value-Based Care (VBC)? A delivery model where providers are paid based on the VALUE of care they provider not the number of patients they see Benefits Include: improved patient outcomes, reduced number of re- hospitalizations and patients living healthier lives in an evidence-based way (NEJM Catalyst, 2017) Value-Based Healthcare Framework UNDERSTANDING SHARED HEALTH NEEDS OF PATIENTS DESIGN SOLUTION TO IMPROVE HEALTH OUTCOMES INTEGRATE LEARNING TEAMS • MEASURE HEALTH OUTCOMES AND COSTS • EXPAND PARTNERSHIPS • REPEAT (Teisburg et al., 2020) BENEFITS OF VBC Patient’s Pay Less for Better Health Care Increased Patient Satisfaction and Provider Efficacy Care is More Proactive Improved Access to Healthcare Information for both Providers and Patients Measurable Outcomes to Foster Success (NEJM Catalyst, 2017) (Institute for Healthcare Improvement, 2016) RATIONALE FOR IMPLEMENTING VBC Patient Advocacy By providing more efficient and improved care for our patients is the greatest avocation for our patients. Patient Safety Patient’s safety is one of the main purposes of VBC by providing routine safe care for our population. Reduction in Healthcare Costs By making care more efficient is is also more affordable for both patients and providers (Teisburg et al., 2017) WGU NURSING PROGRAMS CONCEPTUAL MODEL (Western Governors University, 2016) What is an Advanced Practice Nurse Role in Implementing VBC? “Nurse’s must act as Scientist, Detective and a Manager of The Healing Environment” As provider with the most patient contact, we are best apt to determine what the patient’s most valued care is. APRN’s collaborate to coordinate care and make is efficient. Educate both patients, caregivers and peers on patient’s goals, protocols and policies. Role to manage care and addressing all aspects of care including social and cultural responsibilities. (Western Governors University, 2016) EVIDENCE REVIEW #1 Value-Based Care and Patient-Centered Care: Divergent or Complementary? ● This article discusses the two care models value-based care (VBC) and patient-centered care (PCC) and if they can effectively be used together or if one is more efficient that the other in reference to cancer care settings. ● VBC is defined in this article as value of healthcare that is determined by health outcomes modified by cost. While the quality of PCC is solely determined by patients’ and families decisions and opinions of quality. ● The only way both can co-exist well is if the patients’ preferences and opinions are worked into the VBC metrics. (Tseng & Hicks, 2016) EVIDENCE REVIEW #2 Four Steps Within Your Stride: Surprising Insights from Implementing Value-based Care Delivery ● This article discusses the possibility of organizations to implement VBC protocols and the process for them to achieve it. Organizations with vary in how long implementation takes but it is agreed upon that there is a desperate need to focus on the patient, improve quality and reduce costs. The authors determined there are four steps for organizations to start moving towards VBC. ◆ Step 1: Measure Results ◆ Step 2: Document Care Paths ◆ Step 3: Create Teams ◆ Step 4: Engage in Human Centered Design (Teisburg & Wallace, 2017) EVIDENCE REVIEW #3 Promoting Nursing Leadership in the Transition to Value-Based Care ● This article describes the nurses’ role as agents of change and their responsibilities in all aspects of healthcare to achieve a preferred outcome. The subjects discussed included: ◆ Definitions of Value-Based care ◆ Without Nurses’ involvement VBC can not be successful ◆ Team Based Care is based with collaborations ◆ Changing the culture of stakeholders with education (National Advisory Council on Nurse Education and Practice (NACNEP), 2019) EVIDENCE REVIEW #4 Defining and Implementing Value-Based Healthcare: A Strategic Framework ● This article discusses what VBC is and how it is best implemented. A valid and most often overlooked point made by the authors that patient satisfaction and value are two very different subjects. Techniques and subjects included: ◆ Difference of Patient Satisfaction that ask “How were we” versus Value that asks “How are you”. ◆ Understanding shared health needs of patient ◆ Design a comprehensive solution that improves health outcomes ◆ Integrate learning teams ◆ Measure health outcomes and costs ◆ Expand Partnerships ◆ Including VBC in education of medical providers. (Teisburg et al., 2020) EVIDENCE REVIEW #5 Value-Based Healthcare: Fad or Fabulous? ● This article discusses how the United States can implement the VBC system that has been implemented in many other countries such as Canada and Australia. The guidelines for this is based off of research done by the authors of Value-Based Care, Porter and Teisburg in 2016: 1. Focus of the value to patients, not just lowering costs 2. Competition should be based on results 3. Competition should focus on medical conditions over the full cycle of care 4. High-quality care should be less expensive 5. Value must be driven by provider experience, scale and learning at the medical condition level 6. Competition should be regional and national, not just local 7. Results information related to competition must be widely available 8. Innovations that increase value must be strongly rewarded (Duckett, 2019) TWO STRATEGIES TO IMPLEMENT VBC Staff Participation and Input Encourage staff frequent input and utilize peer committees for improvements Be transparent about changes and have common goals Care Coordination Care Coordination with all patient care departments and providers Provider input on coordinating care with nursing and support staff such as utilizing i-Mobile Technology STRATEGIES & MEASURING EFFECTIVENESS #1 Staff Partic ipatio n and Input Stakeholder & Role Stakeholder & Role Stakeholder & Role Measure Effectiveness Leadership Role: Initiate change, show common goals, mediate negotiations, create trust Providers Role: Provide feedback, advocate for care, implement new systems Nursing Role: Provide feedback, initiate changes, advocate for patients Participation is at or above 80% for peer committees and VBC Counsel meetings. Staff, Leadership and Providers show clear understanding and support for VBC changes. #1 Care Coord inatio n Stakeholder & Role Stakeholder & Role Stakeholder & Role Measure Effectiveness Leadership Role: Initiate change, show common goals, mediate negotiations, create trust Providers Role: Provide feedback, advocate for care, implement new systems Interdisciplinary Departments Role: Provide feedback, initiate changes, advocate for patients Participation is at or above 80% for interdisciplinary meetings. Care is not delayed due to communications between departments and providers and reflected by analyzed data on improved outcomes. TWO ORGANIZATIONAL STRENTHS ◈ A D VA N C E D H E A LT H I N F O R M AT I O N S Y S T E M S ▪ Systems in place to gather and analyze quality data ◈ R E WA R D S T E A M W O R K B E H AV I O R S A N D S U C C E SS E S ▪ Daisy Rewards TWO OPPORTUNITIES FOR IMPROVEMENTS ◈ P O O R S TA FF R E T E N T I O N ▪ Improve conditions, staffing ratios and support to retain staff ◈ I MP R OV E D C A R E C O O R D I N AT I O N ▪ Coordinating care with multiple departments to reduce errors and delays in patient care. ORGANIZATIONAL SUMMARY SUMMARY OF EACH ASSESSMENT READINESS AREA Readiness Assessment Score: 8/15 Indicates my organization may not be ready on several factors. This reduces the likelihood of the success of implementing Value-based Nursing Care at this time ● Defined Need Discussions with our Quality Nurse confirmed that our hospital has established a needs for VBC strategies. (100%) ● Readiness for Change Due to the current pandemic and political environment our organization is not ready for additional changes. The only way they are prepared are with the technology to collect measureable data. (25%) ● Leadership and Management Support Due to the pandemic at this time our organization is only support changes by already having rewards in place for current VBC practices. (33%) ● Time, Resources & Personnel Although most of the resources are present, the organization can not support changes at this time due to resources being put towards the pandemic. (66%) ● Sustainment of the Change While my organization has processes in place to sustain changes with the other factors not in place to have projects succeed it is not the time to implement these changes. (75%) LEVEL OF READINESS TO IMPLEMENT VBC Value Value-Based Nursing Care Readiness Assessment DEFINED NEED Yes No Has your organization established a need to implement value-based nursing care strategies? x 4 READINESS FOR CHANGE Is now the right time for implementing value-based nursing care (e.g., it will not compete with other major changes currently being made within the organization)? 4 x Have employees been informed of the recommendations and been provided an opportunity to comment on the feasibility of the change? 4 x Have implementation plans been developed that include an action plan, training plan, and communication and change management plans? X Does the organization have a Health Information System that has the capacity to collect, analyze and report value metrics and key performance indicators that link nursing care services to patient outcomes? x 4 LEADERSHIP & MANAGEMENT SUPPORT Will the organization’s executive leaders actively support and champion implementation of value-based nursing care. x 4 Does the organization’s leadership reward teamwork behaviors and showcase successes throughout the organization? 4 x Have the strategic recommendations the interprofessional team developed been approved by organizational leaders and managers? 4 x TIME, RESOURCES, PERSONNEL Has an Impact Analysis been completed to determine the influence this change will have on human and financial resources? X Does your organization have sufficient staff with the necessary time and resources to support active project participation? 4 x Will your organization allow time to prepare and continue work on project deliverables? x 4 SUSTAINMENT OF THE CHANGE Has the organization identified value metrics that can be used to measure the effectiveness of value-based nursing care over time? 4 x Will the organization be willing to use continuous improvement processes to measure and assess progress and continuously improve processes? x 4 Will strategies for minimizing potential project failure modes be developed prior to implementation? x 4 Does the organization have a culture that supports and rewards teamwork and innovation in nursing care? x 4 Count the number of “Yes” responses and refer to the next page to determine the organization’s level of readiness for value-based nursing care. READINESS ASSESSMENT SCORE: 8 Organization is NOT ready ● Due to the pandemic with COVID-19, many hospitals have put their quality program initiatives on hold in implementing new policies. While under normal circumstances my hospital would have all of the resources, staff and processes in place to implement any new VBC policies now is not a positive time for change. We have already made many changes to our normal operations and procedures to adapt to the pandemic and our care has had to change with it. Any new crucial polices and protocols that are needed to improve VBC can be created and implemented but the process will be significantly slower than usual and may not be successful. REFERENCES Duckett,S. (2019). Value Based Healthcare: Fad or Fabulous? HealthcarePapers, 18(3), 15-21. Institute for Healthcare Improvement (IHI). (2018). How to Improve. National Advisory Council on Nurse Education and Practice (NACNEP) (2019). Promoting Nursing leadership in the transition to value-based care. Fifteenth report to the secretary of health and human services and the U.S. congress. NEJM Catalyst. (2017). What is Value-Based Healthcare?, NEJM Catalyst Innovations of Care Delivery. Teisberg, E., Wallace, S., O’Hara, S. (2020) Defining and Implementing Value-Based Health Care: A Strategic Framework, Academic Medicine: May 2020 - Volume 95 - Issue 5 - p 682-685 doi: 10.1097/ACM. Teisberg,E. & Wallace, S. (2017). Four Steps within your stride: Surprising insights from implementing vaue- based care delivery. Radiology Management, 39(6), 22-24. Tseng, E.K., & Hicks, L.K. (2016). Value Based Care and Patient Centered Care: Divergent or Complementary? Current hematologic malignancy reports, 11(4), 303-310. Western Governors University (2016). Nursing Programs conceptual model. http// THANK YOU! J E N N I FE R H O G AN R N, BS N E ME R G E N C Y C A R E N U R S E J. H O G A 2 4 @ WG U. E D U