Organizational Change and Value-Based Payments: Is the New York State IDD Service World Ready?

It was Eric Hoffer who said it best, “In times of change learners inherit the earth; while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

The health and health related services landscape continues to change from payment arrangements based on volume in fee-for-service to alternative payment models based on value. IDD service providers are no longer in a world apart– and must implement ways to address performance by measuring the OUTCOMES of the services that they provide. The key focus for IDD organizations  currently is to continue to master the latest roll-outs of regulations, which is doing more of the same.  They must, however, begin to make this change from volume to value and measuring outcomes or find themselves “perfectly prepared for a world that no longer exists.”

Understand this:  despite the lack of guidance on what a value-based payment system will look like for NYS IDD services, providers must create their own metrics to measure outcomes and to assess risk areas.  From the top execs to the front-line workforce–tools are required.  What is your agency’s five-year plan?  what conversations are you having with the Board? Is your agency ready to possibly receive a grade?

Organizational change must occur at the executive level. The executive level must provide clear directives to management, and management must be charged with being resourceful and effective at implementing executive level directives.  The front-line workforce must buy-in and follow management’s lead.  IDD service providers are no longer in a world apart– providers must implement ways to address performance by measuring the OUTCOMES of the services that they provide.

Providers that pride themselves on high-success rates on OPWDD and OMIG audits based on agency compliance with documentation and fiscal requirements must now dig deeper and ask: is the workforce at my agency providing services to people that yield valuable outcomes?  It is no longer enough to maintain documentation compliance.  Providers must reevaluate their agency’s mission and develop strategic plans to implement the organizational change that is required today.

Though resources are limited, it is critical that executives reevaluate and regroup and ask:   What is our current structure, where do we currently place the bulk of our resources? Where do we now need to place resources?

Inform the Board.  Medicaid funding may not be enough to maintain anymore.  Fundraising is a function of the Board, and  now more than ever is the time to fund-raise.  Does the board have knowledgeable consultants to advise them in their oversight role?

Stay informed.  Research and consider joining a provider association that is right for your agency.

Develop your team. Does the agency have a Risk Analyst on staff? Is there someone on staff that understand healthcare management?  Are the Compliance Officer and Privacy Officer up to date on their duties and knowledge base?  Is billing prepared for changes to NYS billing systems and on how to bill for reimbursements other than “straight medicaid”? Is the administrative team prepared to enter and ensure compliance with contracts from insurance companies?  It may be time to invest in clinicians and experienced nurse consultants.  Is there an effective training program for the workforce? Is the quality management/improvement team attending training/webinars and conferences and reporting back to contribute to the agency’s strategic plan?

Collaboration makes it happen.  To increase success, departments must work together, and executives must set this tone for the agency.  For example, the billing department must work regularly with program management, enrollment management and quality management to  facilitate communication when individuals make changes to their services, to their living arrangements or if they enter managed care.  Departments should share regular reports. Executive management should provide oversight and support in this process.

Train and retain your workforce.  No plan will be successful without a prepared and valued workforce.  Executives must ensure that recruitment, retention, performance evaluation and staff development is invested in, trends are analyzed and that goals are set.

Be transparent with staff and stakeholders.  Without transparency, trust and confidence in the agency will waiver, leading to adverse consequences.  Keep everyone abreast of organizational transformation plans.  Provide the latest information available to increase stakeholder engagement at the agency and state policy-making level.  Executives should not hoard information when change affects everyone.  Encourage everyone to learn and share independently and collaboratively.

Now is the time for agency executives to consider themselves as leaders in the healthcare industry.  Now is the time for board governance to receive notice that they need knowledgeable members/consultants. Now is the time to learn about the objectives of the Department of Health and the Centers for Medicare and Medicaid Services. Now is the time to engage in stakeholder engagement at the agency level.  Now is the time to consider the value of knowledgeable consultants on staff.

Agencies cannot wait for directives from OPWDD.  Form committees, join committees and understand that the ship is now sailing in a new direction.

What are some innovative ways that providers can plan and execute organizational change with limited resources?


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