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Building the Capacity of Indigent Care Networks by Standardizing and Collecting Data More Efficiently Kellan Chapin, MPH Executive Director, Care Share Shelisa Howard-Martinez, MPA Collaborative Network Specialist, Care Share Linda Kinney, MHA Dial: Passcode: Deputy Director, Care Share Health Alliance

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Webinar Overview Introduction and Webinar Purpose – Kellan Chapin (10 minutes) Background of Standard Outcomes and Measures Work- Shelisa Howard-Martinez (20 minutes) Work by Care Share Evaluation Committee Standard Outcomes and Measures Pilot Project Key Learnings from Pilot Nine Standard Measures Available Technical Assistance and Tools – Linda Kinney (10 minutes) Questions & Answers – moderated by Adrian Russell (30 minutes)

Care Share Health Alliance Care Share is a statewide nonprofit that helps communities coordinate care for low-income uninsured and underserved individuals. We help communities by: Bringing people together to create a shared plan for serving those in need; Sharing knowledge and resources within communities; Sharing best practices and guidance among communities and across the state.

Care Share Health Alliance Care Share is funded by: the Blue Cross and Blue Shield of North Carolina Foundation; The Duke Endowment; Kate B. Reynolds Charitable Trust; the North Carolina Health and Wellness Trust Fund; and the North Carolina Office of Rural Health and Community Care. Thanks to their support, Care Share’s technical assistance is available to communities throughout the state at no charge. Visit or call for more information.

Care Share TA Service Map Western NC – Julie Lawhorn Central NC - Linda Kinney Eastern NC – Shelisa Howard-Martinez

Collaborative Networks Bring together all of the local (most commonly defined as county) stakeholders who provide health services and other resources that promote and improve the health of low-income, uninsured North Carolinians Are developed when its members decide they want to form one and then create a formalized structure Have a shared vision, their priorities are determined by one strategic plan, they provide integrated systems of care to local communities and work to achieve common outcomes/system that improves access, quality, health and reduces unnecessary or escalating costs

Webinar Outcomes 1.Learn about nine standard measures and common definitions that have been tested by local indigent care networks. 2.Learn how Care Share’s technical assistance can help build your networks’ capacity to collect and report standard data. 3.Learn how your network can implement standard measures and common definitions.

Vision for Standard Outcomes and Measures for Networks From its inception, Care Share's vision included developing standard outcomes, measures, and common definitions for networks and providers participating in networks No other organization in the state has this role Standard measures are needed so Networks can: Improve performance and quality of work Report to funders and document outcomes for grant writing Demonstrate and communicate their value Compare and share best practices with other Networks who serve low-income, uninsured people Important for this work to be community-driven so that measures are useful and meaningful to Networks.

Standard Outcomes and Measures – Evaluation Committee Work June 2009 – Care Share Evaluation Committee membership formalized and charged with developing standard outcomes, measures, and definitions for Collaborative Networks and providers participating in local Networks Evaluation Committee membership composed of professional evaluators from state-level healthcare policy and research centers and representatives from local indigent care networks and statewide funders

Standard Outcomes and Measures – Evaluation Committee Evaluation Committee developed: 7 domains: Access to Care, Utilization/ Appropriate Use of Care, Efficiencies and Cost Savings, Improved Health, Quality of Care, Patient Experience, and Provider Experience 46 standard measures covering all 7 domains A glossary of standard definitions to help networks apply measures to data collection Work was developed with feedback of Collaborative Network Committee and Care Share Board of Directors

January 2010 Standard Outcomes and Measures Survey to Safety Net Purpose of Survey – 1.To gather recommendations for core measures that would be used in a Pilot Project 2.To assess the current data collection capacity of indigent care networks and providers 3.Identify potential participants for Pilot Project 84 surveys completed Survey noted wide variability in: Types of data being collected by networks and providers who serve low-income, uninsured people, Capacity to collect and report data between types of organizations Capacity of respondents to collect and report data for specific domains and measures

Standard Outcomes and Measures – Pilot Project Evaluation Committee recommended developing Pilot Project to test and refine 14 measures within 5 domains: 1.Access to Care 2.Cost Savings/Efficiencies 3.Utilization/ Appropriate Use of Care 4.Quality of Care 5.Improved Health Status

Standard Outcomes and Measures Pilot Project Purpose Work with a group of 6-10 Pilot Sites to: Finalize a list of “core” Standard Outcomes & Measures Test and refine online data collection tool - Standard Measures Web Portal Identify needed TA services Identify challenges and best practices in data collection and reporting Facilitate shared learning

Standard Outcomes and Measures (SOM) Pilot Project Sites Name of NetworkCounties Served CapitalCare CollaborativeWake Durham Project AccessDurham First Health of the Carolinas/ Moore Health/ Moore and Montgomery Counties HealthNet Moore and Montgomery Franklin Health Care CollaborativeFranklin Healthcare Access/ Forsyth Healthcare, Inc.Forsyth, Davie, Stokes, Yadkin, Davidson HealthNet GastonGaston HealthNet ExpansionAlbemarle Region

Measures Collected during SOM Pilot Project 1.Total # of unduplicated, low-income, uninsured individuals who are enrolled in the Network 2. Total # of active unduplicated, low-income, uninsured patients in the Network 3. Number of visits by Network enrollees 4. Number of enabling health services provided to Network enrollees 5. Total number of unduplicated, low-income, uninsured individuals enrolled in the Network with access to primary care/ medical home

Measures Collected during SOM Pilot Project 6. Number of prescriptions filled for Network enrollees 7. Number of individuals screened for Network eligibility 8. Number of providers participating in the Network 9. Estimated cost of donated care

SOM Pilot Project Lessons Learned - Data Collection and Reporting Networks have a wide range of data collection and reporting capacity, dependent upon: –Stage of development (including collaboration among partners) –Number and type of partners –Resources Data collection challenges: –Most Networks do NOT have centralized/ linked system of data collection or reporting –Partners use different electronic and manual data collection systems Challenge to merge this data into one system –Duplicate patients – hard to “de-duplicate”

SOM Pilot Project Lessons Learned - Data Collection and Reporting Data collection challenges (continued): –Partnership challenges Time-intensive to collect data from all partners Need to build relationships/ trust Data sharing agreements need to be in place

Lessons Learned Standard Measures Overall, Network partners feel that collecting/ reporting Standard Measures is at least “somewhat useful” (among those surveyed) Networks feel that Standard Measures are important for reasons including: –To report to funders, document outcomes for grant writing, demonstrate value, compare with other Networks, improve Networks Networks current data collection/ reporting systems are not able to track/ capture all measures with current definitions

Standard Outcomes and Measures – Moving Forward in 2011 Collaborative Network Committee will continue to refine current standard measures and definitions with assistance of Best Practices and Innovation (Evaluation) Committee Collaborative Network Committee will also begin identifying additional measures, definitions, and reporting templates for networks to use Standard measures will be developed to support local networks capacity to: Improve and maintain the health of people they serve Improve network performance and outcomes by sharing best practices and facilitating shared learning Identify data to prepare community/ network for Health Reform implementation

Health Education Patient engagement Wellness/Prevention Health/Care Navigation Medical/Primary Care Home Specialty Hospital Urgent Care Dental Behavioral Health Medications Labs & Diagnostics Durable Medical Equipment Chronic Disease Management Community Support Services Department of Social Services Homeless Shelters Food Banks/Pantries Interpreter/translation services Transportation Churches, civic clubs Economic Development Consumer Credit Counseling Affordable Care Education Collaborative Network Access to Care Safety Net Improved health Individual behavior Community Economic

Care Share’s TA Values & Principles Collaboration is fundamental Inclusive of all stakeholders Collaborative and working relationships are at the core of improving systems Responsiveness to all communities Focus on those communities that invite us to work with them Connecting with communities to create opportunities for improving health Understanding that each community is unique Each community has its own assets and challenges Considering the context is key to successful efforts Sustainability Valuing and drawing upon diverse local assets and resources Recognizing the long term value Applying useful tools and resources Innovative and creative practices Learning from peers and other places Outcomes focused A practical focus on reaching outcomes Forward looking to accomplish goals Supporting local capacity Community driven and defined Everyone is an expert in one’s own experience

Tools to implement SOM in Your Network Contact TA person in your region On-site TA available to: 1.Facilitate data-sharing agreements among your partners 2.Map and assess your current data collection process 3.Training about how to use standard outcomes and definitions Standard Measures Web Portal – an online and centralized data collection tool your network can use to enter quarterly data Collaborative Network Committee to begin identifying report templates to be used with Web Portal Care Share IT Committee is creating IT Assessment Toolkit and identifying IT systems / products for networks

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