FAQs About Partner Change Plans

Change Plans:

North Sound ACH’s Call for Partners was structured into a three-part application process, and successful partners have already completed Part 1 (brief application and broad partner commitments) and Part 2 (Partner Self Assessment survey).  Partner Application Part 3: the Change Plan has now been released, and completed Change Plans were due on November 2 2018.

NOTE: Instructions and details were sent only to the main contacts specified on partners’ original application (the CEO/ED and the person submitting).  

  • The Change Plan: a fillable PDF (all initiatives are contained in the one template) The PDF identified strategies and tactics that your organization could commit to for the target population identified.
  • Change Plan How-to Guide: provides background and context for the Change Plan; instructions on how to complete the form; and information on how staff are available to support you through this process

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FAQs:

Why are partners asked to complete a Change Plan at the individual organizational level, when partnerships or collaboration are described as important or required in the Change Plan?

The Change Plan serves multiple purposes:

  • The Change Plan forms the basis of a Scope of Work, crafted as an addendum to the Master Services Agreement that partners completed when signing up in the Financial Executor portal.
  • The Change Plan demonstrates an organization’s commitment to the strategies that will be reported in the coming year. The ACH will monitor that progress through partner reports, site visits and other partner meetings.
  • Partners are expected to collaborate with others in the region. We don’t feel the North Sound region will be successful without collaboration among and between clinical and non-clinical partners, who will report on their efforts throughout the coming years.

How will the ACH facilitate collaboration across providers to support successful implementation activities?

  • The ACH will do convene various meetings, but partners are not dependent on the ACH to do so. Several partners are already pulling organizations together to define how they will work collaboratively.
  • Once we have reviewed all responses to the Change Plan, the ACH will  invite partners where it appears they can mutually support each other’s capacity to complete the goals outlined in the Change Plan.

What is the role of anchor organizations (mentioned during the August 2018 Partner Retreat)?

  • We got a lot of great feedback on the concept of anchor organizations. Some partners have moved forward and formed their own teams. We left the August 2018 retreat with the sense anchor organizations couldn’t be forced or required. Instead, groups of partners can come together based on the Change Plans and either self-facilitate conversations or ask for ACH help in bringing groups together.

Will the ACH add partners in 2019?

  • We will consider adding partners after review of the 2018 Change Plans. Some will be contracted partners and others will be collaborating by sharing in technical assistance and capacity building learnings.
  • As we review the Change Plans, we may identify gaps where we still need partners to implement the initiatives and strategies. The Change Plans will answer those questions for us.

What if I need to work with subcontractors to achieve my commitments?

  • If your organization subcontracts with others to successfully complete work, the commitment is still yours. You will be held accountable for completing reporting requirements, attending trainings, and partner or ACH meetings. You have the responsibility to ensure the strategy is successfully implemented.
  • The ACH does not dictate HOW you will complete the work. You are making commitments to use the evidence-based models and practices to achieve better outcomes.

Has North Sound ACH already determined which of the projects each participating provider will participate in, or will the Change Plan impact that decision?

  • North Sound ACH is not making any commitments on behalf of providers, nor assigning them to any body of work. The Change Plan will identify which projects your organization is committing to participating in. We expect that Change Plan commitments will represent your organization’s practical, realistic capacity to implement strategies based on your knowledge of your organization’s direction and commitment to work looking forward.

When should we expect to hear feedback from the ACH and will there be an opportunity to make any revisions to our Change Plan based on those discussions?

  • The ACH is scheduling one-on-one meetings with partners to review completed change plans in order to ensure we understand your commitments, as they will form the basis of addendums to your Master Services Agreement. Those meetings will be scheduled and conducted through the end of February 2019.

The milestones require that tactics are implemented by March 31, 2019. Can you provide clarity as to whether you intend to have us fully implement the strategies we select by the end of the next quarter?

  • Think of it in this way – by March 31, 2019 you must have begun implementing selected strategy(ies) for identified populations by completed the tactics listed below the strategy.
  • The work in 2019 is implementation. We are not expecting that tactics or strategies are complete by March 31 2019.  We want all partners to be successful and are committed to helping you launch your implementation activities.
  • Everything in the change plan describes what we and partners are working toward. We will be tracking progress toward the changes. Hardly any of the tactics are a ‘toggle’, most are a process.

I don’t think I can achieve (or implement) the required tactic, can you clarify the expectations?

  • The Change Plan, like the Medicaid Transformation Toolkit, is based on a set of evidence-based models and practices. If you do not see your organization committing to a tactic that is identified as required, you should not commit your organization to that specific strategy for the ACH. Remember, the ACH is not requiring any organization to commit when it is not prepared to do so.

Will the ACH help with quality-improvement trainings? Will you specify which staff have to be trained (only clinical staff, all frontline staff, all staff)?

  • We are committed to providing QI technical assistance and linking partners to existing QI coaches and/or trainings.
  • The type of QI assistance is still in the works, but we are actively advocating for regional QI trainings with Health Care Authority support and we believe that more information is soon to be provided.
  • ACH provided QI trainings will be based upon need and depend on what is already available from the state. As partners move through the first milestone “Assess and report the state of organization’s quality improvement capacity, including: workforce trained, quality improvement (QI) tools and methodologies in use, quality improvement (QI) specific policies and procedures.”, we should have a better sense of regional needs and will plan accordingly.
  • Who receives or takes part in trainings will be determined by the organization, not the ACH staff.

Do partners have to submit HCA’s pay for performance metrics? Some of this data is not available internally, for example it comes from claims or from the PMP.

  • Pay for performance metrics are based on data that is currently collected by the state and will not require partners reporting to the ACH.
  • We want to know if your organization is currently collecting any of the HCA’s performance or similar metrics, but we don’t anticipate asking or requiring you to submit that data to us. This helps us understand if partners currently collect information that aligns with strategies they have selected. As we work with the HCA to produce more meaningful data for our partners, we plan to work in collaboration with our partners on how best to utilize internal data and the HCA provided data to monitor progress. This is another tactic we will explore with you. Link to the HCA measures: http://www.northsoundach.org/wp-content/uploads/2018/10/Toolkit-Metrics-Crosswalk.pdf

What is practice coaching or transformation coaching? Can you send me a link where I can learn more about this?

  • Practice coaching is a technical assistance model that connects clinical practices with coaches or facilitators that can assist them in planning and implementing new models of care and embedding evidence-based guidelines into their practice–as well as with other barriers or challenges their practice may face, such as billing or HIT issues.
  • The practice facilitation curriculum from AHRQ describes the key competencies of a practice coach: https://pcmh.ahrq.gov/page/primary-care-practice-facilitation-curriculum
  • Practice Coaching initiatives in our region include the Practice Transformation Support Hub and the Pediatrics TCPi coaching, as well as other system-specific TCPi initiatives.

What age is considered pediatric?

  • Typically, the upper age limit is 21, unless otherwise specified by a particular model, guideline, or set of recommendations.

Can you clarify the expectations around using SBIRT in dental settings?

  • SBIRT is an intake/screening tool to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.
  • Having SBIRT (Screening, Brief Intervention, Referral to Treatment) across Care Transformation strategies was a recommendation from the workgroup leads during the 2017 planning process.

In section A, the Capacity Building refers to “milestones” as well as Tactics, but I didn’t see any milestone dates. What are the expected dates for these milestones.

  • They are ongoing — the reason we didn’t put in details is because this is what we expect throughout 2019 for our partners.

Throughout Section C there are specific approaches/models called out. Can partners utilize different approaches already in place rather than adopt new ones?

  • This can be discussed in one-on-one meetings–the toolkit has some flexibility with which models can be selected and how they are implemented, but we will have to understand how individual or different approaches align with the toolkit models.
  • Evidence based models and practices are demonstrated to reach certain outcomes; if a partner is using a different approach there would need to be documentation of its effectiveness in reaching the same or similar outcomes to the evidence-based model or practice.

Referring to the Section A, page 4: Are the “increased use of…” bullets going to be part of the metrics coming out in November?

  • Generally, when we included “increase use of “ it was to acknowledge that some partners may already have this tactic in place.
  • These bullets on “increase use of” are:
    • Increase use of Prescription Drug Monitoring Program (PMP).
    • Increase use of Washington Syndromic Surveillance Program/Rapid Health Information Network (RHINO).
    • Increase use of Washington State Immunization Information Systems (WA IIS).
    • Increase use of Washington State EMS system (WEMSIS).
  • These are HIE systems that we seek to promote or expand use of with our partners. We recognize that many of our partners may have them in place or have begun implementation. However, what we see from the HCA is that there is limited reporting in these systems currently–we are seeking to increase their utilization throughout all appropriate partners.

Can you expand on the reporting requirements? For example: Pg. 5 “report on existing quality improvement metrics

  • Partners will be given an HCA Metric crosswalk document that shows which HCA accountable metrics crosscut different strategies. We are asking partners to let us know which of these metrics they’re already collecting data on.

Is there a link or document that we can reference the Evidence Based Models?

Can we request funding to purchase Evidence Based programs listed in objectives?

  • The ACH will be supporting partners as they commit to implementation in terms of capacity building and development. This may include training, technical assistance, on-site coaching, and some limited HIE/HIT support.
  • In addition, any resources that a partner earns can be used to support costs involved in full implementation of evidence-based models and practices.

How will investments such as software and training be paid for?

  • The Medicaid Transformation Project incentives are not renewable and cannot sustain an effort, so partners need to be clear on how they will support the work they are undertaking.
  • Funds received by a partner can be used for:
    • Hiring and training needed team members
    • Infrastructure needs
    • Back-fill for lost wages, while team members are at meetings or trainings or other ACH related meetings
    • Additional data or HIE needs
    • Software or other reporting needs
    • Other things identified by partners
  • The ACH will not tell partners how to use their funds with minimal exceptions, such as you cannot use the funds to draw down federal matching funds, or to supplant existing Medicaid support.

When it is time for our one-on-one meeting can multiple partners attend together?

  • If multiple partners agree that they would like to meet jointly we will do our best to accommodate that request.

Medicaid Transformation Project Resources:

https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-resources