Pursuing the Triple Aim in a Higher Education Setting: A ... … · Adoption and Application of Triple Aim in Diverse Settings Leading health systems Health plans Public and private

LEARN. NETWORK. IMPROVE. LEAD.

Pursuing the Triple Aim in a Higher Education Setting:

A Learning and Action Collaborative

Informational WebinarApril 30, 2018


Agenda

� Introduction and Welcome

�Why Now?

�What Are We Working On?

�How Will We Work Together?

�Collaborative Activities, Timeline,

Expectations

�Questions


SPONSOR

CONVENERS


Expert Panel

Carlo CiotoliNYU

Allison SmithNYU

David FreedNYU

Aaron KrasnowArizona State Univ.

Lindsay PeaseConsolidated Health Plans

Sandra JohnsonRochester Institute of Technology

Harold PincusColumbia University & RAND Corporation

Niñon LewisIHI

John WhittingtonIHI

Afiesha McMahonIHI

Brandon BennetIHI

Matthew Guy IHI

Kim MitchellIHI

Catherine CraigIHI

Amelia ArriaUniv. of Maryland College Park

David ArnoldNASPA

Don GoldmannIHI

LZ GrandersonNYU

Richard KeelingKeeling & Associates, LLC

Martin MrozSimon Fraser University

Chris PayneCornell University

Jim SchausUniv. of Central Florida


Today’s Presenters

Niñon Lewis, MSIHI

Afiesha McMahon, MHAIHI

Brandon Bennett, MPHIHI Faculty &

Carnegie Foundation Fellow

Matthew Guy, MPAIHI Faculty &

Accelerated Transformation Associates

Carlo Ciotoli, MD, MPANYU


Why Now?

� Student health, mental health, and wellbeing are now

understood to be critical factors influencing learning,

retention, academic achievement, and overall

success

� Accountability for management of increasingly

complex and costly health issues on campuses

� Increasing diversity of student population; significant

health inequities

� Increasing resource allocation toward traditional

models for health, mental health, and health

promotion while still not meeting the need

� Increasing cost of tuition


What Are We Working On?


Definition of Population Health

“The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations, such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons.”

David Kindig,MD, PhD, and Greg Stoddart, PhD, American Journal of Public Health. March 2003.


Population Health Approach

The aim of this broader approach is to improve health outcomes for a large population, with shared accountability and a commitment to addressing upstream determinants of health.

Saranya Loehrer, MD, Niñon Lewis, Molly Bogan. Improving the Health of Populations: The need for a common language is key. Healthcare Executive. MAR/APR 2016


CHAT IN

Which populations

on your campus

are not thriving?

Be sure to send chat to “All Participants”


Introduction to the Triple Aim


Definition

System designs that simultaneously improve three dimensions:

- Improving the health of the

populations;

- Improving the patient

experience of care

(including quality and

satisfaction); and

- Reducing the per capita

cost of health care.


Adoption and Application of Triple Aim in Diverse Settings

� Leading health systems

�Health plans

� Public and private employers

�Grassroots coalitions

� Social services agencies

�Geographic regions such as communities or even entire countries


Getting Started on the Triple Aim

Aim: Apply the Triple Aim to a population served by your college or university.

� Choose a relevant Population for improved health, care and lowered cost

� Articulate a Purpose that will hold your stakeholders together

� Choose Measures that will show improvement for the population

� Develop a Portfolio (group) of projects that will yield Triple Aim results

� Identify and develop the Leadership and Governance for a Triple Aim effort

� Develop a brisk and realistic plan for Execution on projects and accountabilities for results


The Triple Aim ina Higher Education Setting

�HOW programs and services are delivered is a major determinant of our students' health, experience, value, at every level across the institution…

�WHAT is delivered must include much more than health services and should address the underlying socio-ecological factors that impact health as well…

�WHO drives change critically determines how effectively our systems can meet the wants and needs of our students.

Creating our “best possible health…”


Bus Pass $23 versus ED $1400

� “Member was seen in the ED 21 times in Dec.

2007.”

� “History of heroin use, transportation barriers to

receiving Methadone treatment and from seeing

her PCP on a regular basis.”

� “We bought a bus pass.”

� “No ED visits for two months and she is much more

engaged in CD treatment and her PCP

relationship.”


What Does it Take to Pursue the Triple Aim?

�Creating the right foundation for population management.

�Managing services at scale for the population.

� Establishing a learning system to drive and sustain the work over time.


How Will We Work Together?

LEARNING DESIGN AND ACTIVITIES


The Typical Approach…


The Quality Improvement Approach


The Collaborative Method

A collaborative is a short term (approximately18-24 months) learning system that brings together multiple sites to seek improvement toward a common goal.


How we will work together

(October 2018 – Winter 2021)

LearningSession

3

Winter

2020

LearningSession

2

Summer

2019

Virtual LearningCongress

Winter 2021ACTION PERIOD

1

LearningSession

4

Summer

2020

ACTION PERIOD

2

ACTION PERIOD

3

ACTION PERIOD

4

LearningSession

1

Winter

2019

Action Period SupportCoaching | Monthly Calls | Monthly Reports | Resource Center | Listserv | Data Support

Onboarding and Laying

the Foundation (begins October 2018)


Model for Improvement

Source: Langley GL, Nolan KM, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). San Francisco, CA: Jossey-Bass Publishers; 2009.


GoalsIn collaboration with institutions of higher education and

subject matter experts, we intend to develop innovative

approaches to:

1. Accelerate the progress of colleges and universities on

their transformative journey in pursuit of the Triple Aim

2. Prototype innovative models in a higher education

setting to achieve the Triple Aim

3. Develop and test approaches to measuring the Triple

Aim dimensions of campus-level health and wellbeing,

students’ experience of care and services, and cost of

producing health – in a way that stimulates

improvement, reflects progress, and is balanced and

practical.


Intended Results

Over this two year collaborative, partner

colleges and universities should be able to:

- successfully build a robust Triple Aim infrastructure

for measurement and improvement;

- define and advance key projects within their

portfolio to the level of measurable project results;

and

- some campuses will attain measurable progress on

all three dimensions of the Triple Aim, at least for

pilot populations of strategic importance.


Collaboratives: “Have to Haves” for Accelerating Improvement

�Will – Motivation comes from learning that it is possible and from bonding with colleagues working on the same problem.

� Ideas – Acquire great ideas for change using the evidence base, tried and tested changes, faculty, and colleagues

� Execution – Learn a method for making lasting changes and begin using it


Will: Senior Leadership Support

Campus leaders see that the Triple Aim is, or will be, strategic for their institution.

Leaders should stay actively connected to the improvement work of the collaborative.


Ideas: Example Areas of Focus

� Emotional Distress and Mental Illness

� Prevention of High Risk Substance Use and Substance Use Disorders

� Health Literacy

� Preventive Services (e.g., immunization, screenings)

� Health Behaviors (e.g., diet, exercise, tobacco cessation)

�Wellbeing (e.g., resilience, purpose, acceptance, social connections)

� Health Impediments to Learning and Academic Achievement


CHAT IN

Identify potential partners to engage in efforts to improve student health, mental health, and wellbeing on your campus.

Be sure to send chat to “All Participants”


Examples of Triple Aim Measures*Dimension Measure

Population Health 1. Health Outcomes:

� Mortality: Years of potential life lost; Life expectancy; Standardized mortality rates

� Health/Functional Status: single question (e.g. from CDC HRQOL-4) or multi-domain (e.g. SF-12)

� Healthy Life Expectancy (HLE): combines life expectancy and health status into a single measure, reflecting remaining years of life in good health

2. Disease Burden: Incidence (yearly rate of onset, avg. age of onset) and/or

prevalence of major chronic conditions

3. Risk Status: Behavioral risk factors include smoking, alcohol, physical activity, anddiet. Physiological risk factors include blood pressure, BMI, cholesterol, and blood

glucose. (possible measure: a composite Health Risk Appraisal (HRA) score)

Experience of Care

1. Standard questions from patient surveys, for example:

� Global questions from US CAHPS or How’s Your Health surveys� Experience questions from NHS World Class Commissioning or

CareQuality Commission

� Likelihood to recommend

2. Set of measures based on key dimensions (e.g., US IOM Quality Chasm aims:

Safe, Effective, Timely, Efficient, Equitable and Patient-centered)

Per Capita Cost 1. Total cost per member of the population per month

2. Hospital and ED utilization rate and/or cost

*Measures for this Collaborative will tailored to the student population and higher education setting


Collaborative Activities


How we will work together

(October 2018 – Winter 2021)

LearningSession

3

Winter

2020

LearningSession

2

Summer

2019

Virtual LearningCongress

Winter 2021ACTION PERIOD

1

LearningSession

4

Summer

2020

ACTION PERIOD

2

ACTION PERIOD

3

ACTION PERIOD

4

LearningSession

1

Winter

2019

Action Period SupportCoaching | Monthly Calls | Monthly Reports | Resource Center | Listserv | Data Support

Onboarding and Laying

the Foundation (begins October 2018)


Collaborative Improvement Process

Learning Session 1

Clarify your aim

Get Ideas

Get Methods

Get Started

Learning Session 4

and Beyond

Celebrate

Successes

Get ready to

Sustain and Spread

Learning Session 2-3

Get More Ideas

Get Better at

Methods

Get a “Stride”

Action Period

Test & implement all changes

Action Period

Test all changes on small scale


Timeline: Program Activities

Fall '18Winter

'18/'19

Spring

'19

Summer

'19Fall '19

Winter

'19/'20

Spring

'20

Summer

'20Fall '20

Winter

'20/'21

Onboarding and Laying the

Foundation Calls�

Learning Sessions

� � � �

Virtual Learning Congress

�

Monthly Reporting

� � � � � � � � �

Monthly All-Team Call

� � � � � � � � �

Improvement Coaching Call

� � � � � � � � �

*Timeline is based on the calendar year seasons, not semesters.


Expectations of Participating Sites� Triple Aim is a strategic priority supported at the senior level (at the level of VPSA or above)

� Meaningful populations (or segments) can be identified for improvement

� Key partners will need to be engaged

� Commitment to developing:

- data capabilities to generate measures for all elements of the

Triple Aim

- skills in executing improvement initiatives

� Resources are dedicated to driving progress on the site’s Triple Aim project portfolio (project management, data analyst,

executive oversight, etc.)

� Participating fully in collaborative activities (monthly reports, Learning Sessions, all team calls)

� All teach, all learn, all lead


Support For Participating Sites

�Customized guidance and coaching from expert faculty:

- setting up your Triple Aim portfolio of projects

- using the Model for Improvement to test,

implement, and scale up sustainable improvements

� Support around measurement strategies

�Access to an Online Resource Center

� Receive individualized feedback on your team’s improvement progress


Enrollment

�Competitive application process; selection on a

rolling basis; limited number of spots available

� Process

1. Submit application (available May 7)

2. Conversation with members of the Collaborative Expert Team

3. Submit institutional letter of commitment (standard template provided) from the Chief Student Affairs Officer, or equivalent position

� Enrollment closes on September 13, 2018, or when

all spots are filled to capacity -- whichever

happens first


Together, we will…

LEARN.

We will generate new understanding of how to improve the health of students not thriving, while exploring the value proposition for institutions of higher education tobalance focus on both upstream factors and downstream outcomes and consider the overall trajectory of health and wellbeing.

NETWORK.

We will share successes and failures to accelerate our journey in pursuit of the Triple Aim. We will collaborate with expert faculty and each other to leverage the synergies of our collective knowledge, skills, and experiences. We will test strategies for co-producing Triple Aim improvements with diverse disciplines and students on our campuses.

IMPROVE.

We will strengthen our quality improvement capability and capacity and use a structured process to advance transformational change at scale. We will develop and track “measures that matter” to assess our progress, benchmark, and drive continuous improvement.

LEAD.

We will be at the forefront in leading within and across our institutions to test innovative paradigms that improve health, wellbeing, and health equity of our students at lower cost while developing new knowledge toinform the field.


Thanks for Joining Us!Questions? Email [email protected]

More information and apply* at:collegehealthqi.nyu.edu/triple-aim *The application will available beginning May 7

Documents

Pursuing the Triple Aim in a Higher Education Setting: A ... … · Adoption and Application of Triple Aim in Diverse Settings Leading health systems Health plans Public and private