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 are due by 5:00 pm on Friday, November 2.

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 in one template) Please complete the PDF identifying strategies and tactics that your organization can 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:

We are keeping a list of Frequently Asked Questions and posting those that apply to a broad set of providers. Responses are posed for those questions that affect more than one partner.  

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:

  • When the 2018 Call for Partners was released we announced that there would be two Milestone payments. The first payment was a stipend, and the same for all partners. The second is variable, and required completion of key steps, including an individual implementation plan (now called the Change Plan). The Change Plan will form the basis of a Scope of Work, crafted as an addendum to the Master Service Agreement that partners completed in 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 be monitoring that progress through reporting, site visits and meetings with provider teams.
  • Partners are expected to collaborate with others in the region; we don’t feel it is possible for North Sound to 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 some facilitation of collaboration, 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 a chance to review responses to the Change Plan, the ACH will continue to bring partners together where it appears they can mutually support each other’s capacity to complete the goals outlined in the Change Plan, similar to the August 8/9 meeting but on some smaller more targeted scales.

What is the role of the anchor partners that were mentioned in the August Partner Retreat?

  • We got a lot of great feedback on the concept of anchor organizations – some groups of partners have moved forward and formed their own teams – but we left the August retreat with the sense that it was a concept that 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?

  • Adding partners at any time is absolutely fine. What becomes challenging is equating partnership with sharing the earnings or being paid. Partners can work on any initiative. There is no limit to the number of partners who can work on any initiative. Remember, this is not a grant.
  • We understand that need to communicate this clearly before end of the year. As we review the Change Plans, we may identify gaps where we still need partners to implement the initiatives and strategies. We don’t think that is the case, but the Change Plans will answer those questions for us. We will determine whether we add partners, and if so, how and when, by end of the year.

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

  • If your organization works with subcontractors to successfully complete work, the commitment is still yours. Unless that subcontractor is also an ACH partner, 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. The ACH does not hold an expectation of which project any partner will commit to, beyond information you have shared in Part 1 and 2 of the application process. 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 will be reaching out to schedule 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 Service Agreement. Those meetings will be scheduled and conducted between early November and late December of this year.

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 have begun implementing selected strategy(ies) for identified populations by completed the tactics listed below the strategy.
  • The work in 2019 is implementation. In order to earn the first half of our 2019 dollars as a region, we have to report on progress. No one is expecting that everything is complete.  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 consider that your organization may not be ready to commit 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.

Why were some of the more specific tactics shown at the Partner Retreat in August (for example, for opioids) simplified or scaled back?

  • In early drafts of the change plan, we originally had more tactics for strategies. Upon sharing the drafts with some partners and the Program Council, we realized many tactics were very similar across all strategies. For example; “Implement X model.” Or, “Train staff on X strategy.” We moved in the direction of using more universal language that cross cuts ALL the initiatives/ strategies for multiple reasons:
    • It’s simpler and more direct for partners, which was an ask and lesson learned from other ACH’s.
    • It speaks to the scope of work for partners in 2019; implementation and rollout.
    • The cross-cutting tactics (those that apply to everything) mirrors the metrics from the HCA. By rolling up more specific tactics into those standardized by the HCA, we simplify the work for partners who operate across multiple ACH regions.
    • If the strategy is to implement a specific model, we didn’t feel the need to list out each item that goes into the model as a separate tactics. Each practice or tactic list in the model itself, is inherently included in the language of “implement the model.” We expect partners to be familiar with the evidence-based model before committing an organization to a specific initiative and strategy.
    • Also, some strategies have more specific tactics due to their nature. Opioids; there’s a statewide plan already written. HUB; the timeline is different, and work is already underway.

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.  

Can you clarify if you are expecting partners 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.

  • This refers to the quality improvement milestone on page 5, it states “By March 31, 2019, use continuous quality improvement strategies, measures, and targets to support implementation of selected strategy.”
  • 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 not requiring you to submit them 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.
  • The North Sound ACH has not yet selected a practice coaching model to support our partners but will be exploring that during our change plan review and implementation planning process this fall.

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.
  • Any resources that a partner earns can be used to support costs involved in full implementation of evidence-based models and practices.
  • The ACH is not a grantor, so partners will not be technically “applying” for funds.

These processes will require a significant investment, both in staff time and purchase of software, training, etc. We are struggling to know how to commit to these strategies without fully understanding if and how those investments will be paid for.

  • As the ACH has discussed throughout the process, the Medicaid Transformation Project is not providing grants to implement projects. Instead this is to provide incentives to partners who commit to working toward specific outcomes and deliverables.
  • More than 60 partners have made preliminary commitments to work on areas that their organizations were already committed to or were planning to expand in the coming year.
  • The funds are not renewable and cannot sustain an effort, so partners need to be clear on how they will support the work they are undertaking.
  • 2018 partners will know their potential earnings by mid-November, and how much they can anticipate in 2019 if they follow through on commitments and show progress. This has also been discussed at our Board meetings, which are open to the public.
  • Funds received by a partner can be used to:
    • Pay for hiring, training and onboarding needed team members
    • Infrastructure needs
    • Back-fill for lost wages, while team members are at meetings or trainings
    • Attendance at ACH related meetings
    • Additional date or HIE needs
    • Software or other reporting needs
    • Other things identified by partners
  • The ACH is not going to tell partners how they can 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 accommodate that request.

Medicaid Transformation Project Resources:

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