1. Dennis McCarty And the National Evaluation Team Washington, DC January 15, 2010 Using the AR Levers: Payer Strategies

2. AR Change Model Four Conditions for Change Understand Customer Needs Commitment from Leadership Clear Aim and Purpose Supportive Business Case Five Levers for Change Financing and Contracting Analysis Regulatory and Policy Analysis Inter-organizational Analysis Operations Analysis Customer Impact Analysis 1/15/2010 2 AR Change Model

3. AR Model (continued) Three Supports for Change Partnership Between Payer and Providers Use of PDSA Rapid Change Cycles Training, Technical Assistance, Coaching, and Learning Circles 1/15/2010 3 AR Change Model

4. Financial Analysis Identified resources Access to Medicaid Expanded benefits and services Reallocated resources Set rates and reviewed rates Provided financial incentives Released RFPs Contract requirements 1/15/2010 4 AR Change Model

5. Regulation and Policy Analysis Counselor certification standards Standardized processes and guidelines Assessments Referrals and linkages Periodic case review Create and amend regulations 1/15/2010 5 AR Change Model

6. Inter-organizational Analysis Relationship building Collaborations Work flow efficiency Links to prescribers Add providers 1/15/2010 6 AR Change Model

7. Operations Analysis Improve referrals to level of care Use data to identify problems Standardize patient transfer processes 1/15/2010 7 AR Change Model

8. Patient Impact Analysis Create medication support groups Promote parent advocacy Use focus groups 1/15/2010 8 AR Change Model

9. AR Lever Analysis Payers use financial analysis most frequently Multiple options and strategies Regulatory and policy analysis focused on enhanced standardization (efficiency and quality) Inter-organizational analysis used frequently Payers are less likely to use operations and patient impact analyses 1/15/2010 9 AR Change Model

10. Benign Paternalism: Payers Use the tools you have Encourage individuals (providers) to do the right thing – use evidence- based practices Actively structure the financial and regulatory environment to promote evidence-based practices 1/15/2010 10 AR Change Model

11. Benign Paternalism: Providers 1/15/2010 AR Change Model 11 Providers can help patient do the right thing Evidence-based care is the default choice Frame choice more attractively Increased abstinence versus reduced relapse Perceived social norms also critical – family expects you to use evidence based treatment Structure the therapeutic environment to support use of pharmacological and behavioral evidence- based practices