1. [Team Name] Expedition Storyboard Bundled Payments:
Transitioning to Value-Based Care
[Team Name]
Organization Name
Participants Name(s)
Your Contact information

2. Core Team NAME and TITLE ROLE YOUR PASSION IN THREE WORDS
Project Lead /
day-to-day leader
Front-line staff*
Data analyst
Finance team member
Additional team member
(insert role here)
It takes a team to make good work happen. Add the names and roles of those that will make up your core improvement team for this work. Keep it to 3-5 people for now.
*nurses, doctors, physical therapists, care coordinators and managers, etc.

3. Organization & Background
QUESTIONS
ANSWERS
What is the name of your organization?
Where are you located?
How would you best describe your organization (e.g. hospital, clinically integrated network, skilled nursing facility, payer, etc.)?
How big is the population you will serve with this bundle? (#)
How would you describe the population this bundle will serve?

4. Purpose Statement By November 17, 2016, we hope to…
As your faculty team, we hope that by November 2016, i) you have learned new content to assist in making a positive change in care delivery for the population segment of your choice, and ii) you have a concrete, documented plan for enacting that change.
You are making a commitment of time and resources for the next three months, what do you hope to accomplish as a result of your participation?
By November 17, 2016, we hope to…

5. Understanding the Current and Future State
Call 1
Volume to Value:
Understanding the Current and Future State
Action Period Assignment:
Identify the patient population for your bundled payment design
List the payers in your market engaging in bundled payments, and identify the payer you will develop your bundle for.
Due: Thursday, September 29, 2016

6. Choose Your Target Population
Start where you are:
What groups are you already providing targeted or condition-based care to?
Consider your care delivery approaches
Are care approaches consistent across various groups? Or are care approaches distinct?
Who is not thriving?
Are there groups who are underserved or left out?
Examples of Target Populations:
Total joint replacement patients
TJR patients aged 65+
Maternity/Delivery
CHF patients
Sepsis patients
CABG patients
Acute myocardial infarction patients
Call 1 – Action Period Assignment

7. Target Population
For the purpose of this Expedition, please identify a target population you will develop a bundle for.
Total Population (full population served)
Size
Subpopulation
(Your total population segmented)
Target Population
(Focus of your initial projects)
Insert here who you consider to be part of your total service population (e.g. all patients who receive a total joint replacement of the lower extremity, all CHF patients).
What is the size of your total service population?
If you had to divide up your total population into segments, how would you do so (e.g. seniors 65+ years old, travel patients, employer patients, etc. seen in our hospital)?
What is the size of each of these subpopulations?
Among your subpopulations, which population do you anticipate will be the focus of your initial bundled payment work? Add any population modifiers or descriptions necessary to define the target population accurately (e.g. seniors 65+ with no current history of joint replacement, BMI <25)
What is the size of this target population?

8. Payment Environment
List the payers in your market involved with value based payment and value-based care initiatives. Star the payer that you will develop your target population bundle for during this Expedition.
Name of Payment Initiative
Population Impacted
Call 1 – Action Period Assignment

9. Call 2: Getting Started: Key Components of a Bundle
Action Period Assignment Options:
Outline the assets and needs in care delivery for your target population
Define the key elements of your bundle using Baystate Health’s 8 steps framework
Due: Thursday, October 13, 2016

10. Understanding Assets and Needs
Review available data on your target population
Interview at least two care team members that serve the target population
Who in this population is doing well? Why are they doing well?
What needs does this population have that our organization is not set up to manage?
What variation or inefficiencies could be improved upon?
Compile key themes in the needs and asset grid
Call 2 – Action Period Assignment Instructions

11. Your Population’s Assets and Needs
Target Population: [Insert population here]
Assets
Needs
Call 2 – Action Period Assignment

12. Define Key Bundle Elements
Define the key elements of your bundle using Baystate Medical Center’s Bundled Payment Approach to creating a replicable model
Use the following slides to navigate through the eight steps as they apply to your setting
Fill in any details you already have confirmed and available, and make note of where you may need to follow up to seek more information, input or guidance
Note that these steps are not necessarily sequential, so you may want to update responses regularly over the course of bundle development

13. 1) Convene the right team: List all parties who will need to be involved including: legal/policy, clinical, quality analysts, finance, communications, etc. 2) Define the episode: Ensure necessary data is available (inpatient/outpatient data) Complete analysis and risk adjustment assessments 3) Develop measures (including considerations of the Triple Aim): Select quality metrics to monitor for bundled episode 4) Develop care model: Identify expert(s) to develop care models development for bundled episode (inpatient and post-acute care)

14. 5) Identify cost reduction opportunities:
Review of resources/utilization patterns
Review product standardization opportunities or product substitution
6) Price the bundle:
Determine the key cost metric indicators
7) Plan the gain-sharing:
Consider Stark, anti-kickback and antitrust guidelines
Develop potential gain sharing strategies/methodologies
Define eligibility criteria for provider participation
8) Develop a continuous process improvement plan:
Develop a quality and cost tracking scorecard
Employ Lean tools and PDSA cycles as necessary

15. Call 3: Developing and Driving Outcomes for Patients in Bundled Payments
Action Period Assignment
Using the provided workbook (or your organization’s preferred template), develop a process map to collect data on the care process selected in Session 1
all the way through the cycle of care.
Resource: IHI Blog from Kevin Little and Mike Birbati about process mapping
Due: Thursday, November 3, 2016

16. Data Discussion Before you map your process, consider:
What do you want to know about your target population?
What is challenging about getting the information you need to know?
What data can you start with right now?
Consider health equity: what can you learn from the data about populations who might not be served equitably?
Call 3 – Action Period Assignment

17. Process Map
Use the provided workbook or your organization’s preferred tool to map your complete care process, and insert your completed grid or process map below.

18. Call 4: Performing in a Bundle: Engaging and Informing Stakeholders
Action Period Assignment
Build a list of key stakeholders for a stakeholder engagement plan, starting with the patient
Optional: consider using a driver diagram to identify the drivers for different stakeholders, including what motivates their involvement in the care process?
Due: Thursday, November 17, 2016

19. Stakeholder Engagement Plan
Role or Department
Names of key representatives
What is their stake in this process?
Engagement Points or Approaches
Example: Patient
Name of patient advisor or panel
Center of procedure – receiver of care
Pre-op education
Opt-in/Informed consent
Post-op care coordinator f/u
Engage family for support
Frontline Staff
Finance Team
Post-acute providers
Surgeons
Payer
Call 4 – Action Period Assignment

20. Driver Diagram Call 4 – Optional Action Period Assignment
Primary Drivers
Secondary Drivers
Aim:
You might consider using a driver diagram to identify the drivers for different stakeholders – what motivates, engages, drives their involvement?
Call 4 – Optional Action Period Assignment

21. Call 5: Care Team Redesign and Partnerships in the Post-Acute
Wrap-Up Assignment
Present this storyboard to your team, including any new ideas in care redesign and post- acute partnerships, and gather input to refine plans for your bundle

22. Partnerships with Post-Acute Care
Criteria to consider when cultivating a post-acute care network:
Clinical Expertise
Clinical Outcomes
Oversight of the Care Provided
Patient/Family Satisfaction
Care Management Feedback
Certifications
Star Ratings
Call 5 – Wrap-Up Assignment