Four years ago, many community-based practices focused primarily on commercially insured patients in the Kansas City metro area had little to no awareness of value-based care, no quality improvement infrastructure, no coordination or collaboration across primary care practices in the community, and a lack of trust within community practices.
Leveraging existing staff and infrastructure, Children’s Mercy Kansas City launched the Children’s Health Network (CHN) just three years ago as a clinically integrated network with an intentional shift to focus on the patient and achieve the Triple Aim, be provider led, use data and encourage collaboration.
"[The question was] how do we achieve better outcomes of care for patients across the care continuum?" says Luke Harris, director of operations and population health management at Children's Mercy. "How do you really target the patients that are in need of services?" Harris and his team developed what he dubs the Operational Framework to Improve Care with four areas that drive measurement improvement—foundational, action, communication and enhancing value. At the 2019 Quality and Safety in Children's Health Conference, he discussed how the framework is used across CHN's now established network.
Establish trust in data
Understanding data and measure sets is essential for everything that follows. "You need to build trust in the data," Harris says. "You can not improve or influence behavior without full trust in your data."
This takes time; Harris gives each practice in CHN two months where he and/or his team meets with them weekly to identify questions and issues until they can explain all potential questions or concerns from providers. This exercise helps establish trust in the data; full transparency isn't demonstrated until after the exercise is completed.
"We saw tremendous improvement just by showing providers the data transparently," Harris says. "Providers never want to be at the bottom of the chart." In addition, each practice within CHN is required to become a patient-centered medical home or actively implement the same standards, if they aren't already. "We don't know what's driving improvement unless we know what's actually happening in their practices," Harris says.
For measure sets, it's vital all providers and their teams know the details of the measures. "There's a lot of nuances to the measures that providers need to understand," Harris says. He suggests simplifying their definitions and making a glossary easily accessible by all team members.
It can be beneficial to include specialists in the conversation; they can speak to the clinical value of each measure and offer resources for practices and families to achieve success.
Understand barriers to patient care
The next stage involves deep dives of specific measures. This step, although more of an intensive process, allows Harris, CHN team members and providers to understand barriers to improved patient care and identify best practices.
"There's a lot of due diligence that goes into this," Harris says. "It's making sure we understand the data ourselves, exactly how the measure functions, reviewing the questions we're anticipating to receive to facilitate the discussion with that practice." This process allows for best practices to be identified and communicated to other providers within CHN.
Document quality improvement strategies
Every time the team learns something new about a measure, it gets incorporated into the centralized quality improvement tool kit, facilitating information flow from the top down. The tool kit itself is a two-page document highlighting the key quality improvement strategies for specific measures.
Also included are direct links to resources to support success: billing and coding guides, slide decks with best practices, how-to guides. "It really is a living and breathing document," Harris says.
Additionally, each month Harris has an in-depth meeting with his CHN committee. The formal agenda is too much to be shared with the entire network. To accommodate the need to share important information without overloading frontline staff and providers, a one-page takeaway is written with the key points discussed among the committee and sent to everyone in the network.
"This helps us reach the front line because you don't know how well information is communicated and shared within each practice," Harris says.
Enhance value for primary care practices
There are two parts to addressing what Harris calls "enhancing value." First, value-based performance incentives were established. In 2018, CHN distributed approximately $3 million to all primary care practices within the network. It's estimated in 2019 that $3 to $4 million will be distributed.
The second part is offering Maintenance of Certification (MOC) Part 4 credit, which focuses on quality improvement within a professional practice. At first, Harris says the response was underwhelming; physicians weren't excited by the thought of MOC credit. However, the framework for receiving credit was built and now the response is positive. "It also helps engage frontline providers in what we want them to do," Harris says.