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

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.

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?

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…

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

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

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?

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

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

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

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

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

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)

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

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

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

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.

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

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

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

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

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