The following is a transcript of a technical assistance conference entitled Innovations Exchange held on October 13, 2010.
Margie Shofer: I'm Margie Shofer in the Office of Communications and Knowledge Transfer at the Agency for Healthcare Research and Quality, otherwise known as A-H-R-Q or AHRQ. Thank you for joining us for this Web conference on the AHRQ Health Care Innovations Exchange.
This Web conference is the fifth and final event in the series highlighting several AHRQ tools created to help you identify and support areas for health care quality improvement. We have held Web conferences on HCUP and HCUPnet, MONAHRQ's Preventable Hospitalization Cost and Mapping Tools, the State Snapshots, and the Asthma Return-on-Investment Calculator. If you are interested in learning about these tools but missed the event, they will eventually be posted on AHRQ's Web page. I am pleased to announce that the HCUP Web conference is now on our site.
Today we will be discussing the AHRQ's Health Care Innovations Exchange. To download today's slide presentation, please go to the file share box in the bottom left-hand corner. Speaking of slides, if you want to maximize a slide during this Web conference, please click on the tab that says "Full screen" at the bottom left-hand side of the slide. Once in full screen, you can click on the same tab to take you back to the previous view with the captioning. Please note that you cannot use the full screen feature if you need the captioning.
The Health Care Innovations Exchange is a comprehensive program designed to accelerate the development and adoption of innovations in health care delivery. Everyday, health care practitioners find better and more effective ways of delivering health care; however, the diffusion of their innovative ideas is slow and rarely reaches beyond institutional walls or across health care settings. As a result, health care providers unnecessarily duplicate each other's work.
AHRQ's Health Care Innovations Exchange aims to address this issue by providing a central repository of searchable innovations and quality tools that enable health care decisionmakers to quickly identify ideas and tools that meet their needs and offering opportunities for learning and networking with like-minded adopters of innovations. The Innovations Exchange has the following components: searchable innovations, searchable quality tools, learning opportunities, and networking opportunities.
We will begin today's presentations with an overview of the Innovations Exchange, where Judi Consalvo will walk us through the site. We will take some questions after her presentation. We will then move on to the Web conference's next component, a discussion of how the Iowa Department of Public Health and the Pennsylvania Department of Aging have contributed to the Innovations Exchange. After those presentations conclude, we will have a final question-and-answer period.
Today's presentation on the Innovations Exchange will be given by Judi Consalvo, a Program Analyst in AHRQ's Center for Outcomes and Evidence. The Innovations Exchange project presentations will be given by DeAnn Decker, who is a Bureau Chief for Substance Abuse Treatment and Prevention at the Iowa Department of Public Health, and Tom Snedden, the Director of PACE and PACENET at the Pennsylvania Department of Aging.
We would appreciate your active participation in today's event, as the primary purposes are to introduce you to the Innovations Exchange, get your feedback on the resource, and explore practical applications for the resource. Related to this last point, we hope you will let us know about the types of technical assistance that you might need in order to make full or better use of the Innovations Exchange.
As I mentioned, this Web conference has two question-and-answer periods, one after Judi gives an overview and a final one after DeAnn Decker and Tom Snedden present. There are two ways you can ask a question of our presenters this afternoon. You may submit a question at any time throughout this Web conference by typing your inquiry into the Q&A box on your screen. These questions will be entered into a queue and answered during the question-and-answer period. So feel free to submit them at any point during the presentation.
Or, during the question-and-answer period, we encourage you to ask live questions. In order to ask a live question during one of the Q&A sessions, please raise your hand, and the producer will unmute your line and you can ask you question. As those of you who have participated in the earlier Web conferences in this series will know, while we encourage questions regardless of their format, asking a live question can be easier if you have any followup questions or if the presenters need clarification from you.
If you have remaining questions after the Web conference ends, please E-mail them to us. This E-mail address will be posted on the final slide. So I would now like to turn this over to Judi.
Judi Consalvo: Thank you, Margie. Margie gave you a little bit of background. The Health Care Innovations Exchange does address a major challenge in health care delivery, and that is the slow diffusion of innovative activities and tools across health care providers. The program supports the Agency's mission to improve the safety, efficiency, and effectiveness of health care for all Americans, with a particular emphasis on reducing disparities in health care and health among racial, ethnic, and socioeconomic groups.
The primary goal is to facilitate the exchange of information through content and design. Both reflect our efforts to make it easy for users to find information on innovations and tools and share their own experiences and perspectives. The Innovations Exchange was launched in 2008. The core content is composed of innovations and attempts, quality tools, and articles and perspectives. It's published on a biweekly basis, with new content added to the site with every new publication. Today, there are over 500 innovations. As you can see, there's more than what's on my slide. It's increasing rapidly to over 1,500 tools.
The home page is designed to achieve three goals: To let users immediately see what's new on the site; to spotlight special content like expert commentary or stories or new features; and to enable users to quickly find whatever they need; that is, to browse the site using specified terms or search, using their own terms. A user can search or browse by categories, which you see on the slide. Patient population, stage of care, setting of care, et cetera, and the search function uses a thesaurus to find suitable matches.
This is a screen shot that displays to you the results of a search on Medicaid managed care. For instance, if you would put a term in the search box—and I used Medicaid managed care—this is what would pop up. The results are 15 innovation profiles and 5 quality tools. You can then click onto each one of these innovation profiles and/or tools, and it would pull up detailed innovations on each.
Some of the profiles have associated commentary written by experts. These commentaries might discuss the importance and generalizability of innovations or cautions and issues connected to that particular profile. Profiles may also have an associated human interest story discussing the patient impact or how the innovation was developed or perhaps the experiences of staff and those who may have participated in the innovation.
The Innovations Exchange also hosts what we refer to as "attempts." These are innovations that did not succeed. What is very well known in the world of innovation is that failures are important. There are many valuable lessons to learn, what to do and what not to do. Most innovations start out as failures, but we refer to them as "attempts." These attempts have the same format as the other profile content in the exchange. As you might guess, we don't have very many attempts posted. It's extremely hard to get people to discuss their failures.
Quality tools: Note that the Innovations Exchange is not limited to innovations but incorporates the quality tools that used to be a separate AHRQ product. There are similar options for searching and browsing the large database of tools, and we make the relationships, whenever they occur, between innovations and tools.
We set up the Learn and Network section of the site to provide users with alternative ways of learning and interacting. In the Learn box, you see a number of written pieces on a variety of topics, most authored by experts in innovation. We expect to add to this area every other month. In the Participate box, you will see upcoming and archived events, which are likely to include Webinars, brief lectures, sometimes in the form of podcasts, and discussion groups centered around specific innovations.
Then in the next box over—and on this particular slide you're only seeing headings—but in the network box, you will see a list of ongoing learning networks where members can work collaboratively to address a shared concern. We presently have a learning network on coordinating care at the community level.
I want to show you an example of how the content is displayed when doing a search. This is a search result when I searched on Medicaid, and the results are 137 profiles, 1 innovation attempt, 49 quality tools, 1 expert commentary, and 3 resources. Of course, not every search term will pull up this number. Some may not have resources associated with it. Sometimes there are no quality tool associated with it. Most of the times there are, though.
Actually, the next three slides are examples of content in the Innovations Exchange that might be of interest to this audience. This particular profile is a public-private partnership that supports medical homes and managing Medicaid enrollees via disease case management and other initiatives, which leads to higher quality and significant cost savings. You can go through the next two slides. It's a quality tool, and that's the same profile I just spoke about with a quality tool and an expert commentary associated with it.
An example of a tool that you might find useful is the customized State Medicaid fact sheet. You would search on Medicaid to get to this tool and there's a link within the tool, which would take you to this display. This tool produces customized Medicaid fact sheets by comparing each State to the United States or to any other State in terms of demographics, health resources, and Medicaid enrollment. You could download an E-mail or print a PDF of the facts sheet, create Medicaid fact sheets for all 50 States and DC, or create a Medicaid fact sheet with State lows and State highs. Again, I'm giving you an example of when you go to a quality tool how you would drill down within that tool. There would be a link that would take you to the actual connecting tool itself.
Moving on, we're moving on to the learning section of the Innovations Exchange. The intent here was to provide opportunities for learning and networking among the Innovations Exchange users. We presently have a learning network that was established in March 2007. It's called the Community Care Coordination Learning Network, and this is based on the philosophy of the communities of practice, also known as learning networks, which intends to help connect potential implementers of the community care coordination models with innovation innovators.
We do host a series of participatory learning events that support our users in developing and adopting innovations. This slide tells you about recent Web events we have hosted, focusing on a particular profile in the Innovations Exchange. As you can see, we had a chat on change, a Web conference, another chat on change. There are different forms that we have used. These events are announced on the site in advance, and they are always open to everyone, and we usually host one every 2 months.
How can you participate? We welcome you to participate by perhaps submitting an innovation or using the comment feature, which appears on all of the profiles, and/or signing up for E-mail updates. As I have previously mentioned, we publish new content every 2 weeks, and you can subscribe to this and you would receive an E-mail update every 2 weeks, letting you know what's new and highlighting our new content. We usually add six new profiles on innovations and six new quality tools.
I might also add that we will soon launch a redesign that will include new enhanced features such as a new home page with some streamlined navigation, enhanced browse by subject and narrow by topic features, and a Stay Connected box featuring social media tools. One of our new features is also going to be the AHRQ State Snapshots linking to related innovations within our content. So stay tuned. I encourage you, if you haven't already done so, to visit the Innovations Exchange. The links appear up on your site, and if you have further questions, you can E-mail those to email@example.com. Thank you.
Margie Shofer: Thanks, Judy. We have now entered our first Q&A session, and as I mentioned earlier, there are two ways you can ask a question of our presenters. You may submit a question by typing your inquiry into the Q&A box located on the right-hand toolbar of your screen beneath the participants, or you can ask a live question by raising you hand, and then we will unmute your line and you can ask your question.
Cheryl has her hand raised. Go ahead, please.
Cheryl: O.k. Thank you for doing this Web conference. I had a question. You briefly mentioned something about AHRQ's priority populations, and I'm curious to know whether or not there are other areas that are considered or given priority when determining whether or not an innovation or tool would be a good fit for the Innovations Exchange?
Judi Consalvo: Thank you. That's a good question. Yes, there are a few additional areas. Preference is given to innovations that are likely to have a significant effect on the overall value of health care; for example, the innovation may affect a broad population, address a critical health issue, or demonstrate large cost savings. Also, all else being equal, AHRQ gives priority to innovators who express a strong interest in becoming involved in the Health Care Innovations Exchange activities. A third area of priority is innovations that AHRQ has funded or is funding. Yes, those are a few of the additional priority areas. Thank you.
Margie Shofer: O.k. There's another question. Who is the major audience for the Health Care Innovations Exchange?
Judi Consalvo: Well, there's a diverse group of individuals that uses the Innovations Exchange, and that ranges from nurses and health administrators to policymakers and students. Nurses make up the largest numbers of users. Let's see, followed by quality improvement professionals and then health administrators and so on. So, yes, it is quite a diverse group.
Margie Shofer: Thanks, Judi. I have another question. What are some of the challenges presented when developing a site such as this?
Judi Consalvo: The first major one that comes to mind is—and I mentioned this in my presentation—getting people to submit what we call "attempts," what we call the failures. I cannot emphasize how important it is to have this content up on this site because it's a learning experience. People learn what may work in one situation isn't going to work in another, or if it did not work in one situation, why didn't it? Maybe you could tweak just part of it to adapt it to your situation. I would say that is our major challenge is getting people to submit. They already know the value, but as I said, it's very hard for folks to submit a quote/unquote failure.
Margie Shofer: Thanks. I have another question for you, Judi. Does the Innovations Exchange help teach adoption of health systems innovations?
Judi Consalvo: There's an adoption guide that we have posted here on the site, and it helps you to walk through. It takes you through step-by-step what you need to ask yourself, what you need to consider when adopting, if you want to adopt something that's on the site or if you're aware of something. But I would say that's a very helpful tool that would help folks see whether they should adopt something and how to adopt it.
Margie Shofer: Thank you, Judi. There's also a general question on here about if past presentation materials are archived. The HCUP conference is archived on AHRQ's Web site, and eventually all the Web conferences in the series will be archived on AHRQ's Web site. I think it is now time to turn this over to DeAnn.
DeAnn Decker: Hello, everyone. My name is DeAnn Decker, and I am Bureau Chief for Substance Abuse Prevention and Treatment with the Iowa Department of Public Health here in Des Moines, Iowa. I wanted to thank everyone for getting on the phone call today.
What I'm going to talk about is an administrative overhaul that we did in Iowa, starting in about 2004, with a process improvement model that's called "NIATx," and NIATx stands for the Network for the Improvement of Addiction Treatment. Basically, it's housed through the University of Wisconsin in Madison, Wisconsin, and in Iowa we got involved in it starting in '04 with one of our substance abuse treatment providers who began the process by receiving a grant.
I want to real quickly just give a background on what NIATx is before I get started into my slides. NIATx is a model for process improvement, and it focuses on four "aims," they call them. This is for substance abuse treatment clients, and it's for reducing wait times for clients to get into treatment, reducing no shows for clients to get into treatment, increasing admissions into treatment centers, and also increasing continuation or retention of clients in substance abuse treatment overall. This model focuses on those four aims.
There are also five principles that it's built around. It's understanding and involving the customer, which is the client; fixing key problems that would help the CEO sleep at night. A lot of times throughout this process improvement work we did, that was one of the first questions we asked: What keeps the director or the CEO up at night? And you start kind of looking at things through their eyes and start doing change projects through that thought process. Finding a powerful change leader in the agency is another principle. Getting ideas from the others such as referral sources to see how things are working from the outside, not only from the inside but also from the outside, and also using rapid cycle testing. That's what we call the "PDSA" or Plan, Do, Study Act.
Throughout this process when we began it, we started doing walk-throughs. We were State-level agency staff going in as fake clients into substance abuse treatment centers and documenting our experiences as we did it, which was kind of interesting and fun. Basically, you start by making the first phone call from outside of the agency to make your appointment, and you document how long you were on hold. Was the person friendly, did he or she hang up, did he or she give you directions, tell you if there's parking, things like that? And you document that process.
Then the next thing is to go in and do a walk-through at the actual agency by being the client and walking through as an a kind of fake client. They know that you're not an actual real client. So that's kind of the process we use as we have done now for almost 6 years of really using this NIATx model in all of our treatment centers in Iowa to find a model that helps improve client access and retention.
Let me get into my first slide. I just want to give you a little background. How we started was back in, I believe the end of 2003, Prairie Ridge, one of our bigger treatment centers here in Iowa, received a grant called the "Pathways to Recovery Grant." That was through the Robert Wood Johnson Foundation, and that kind of started Iowa's interest in doing this process improvement model called NIATx.
In the State of Iowa, the Department of Public Health is where the single State authority for substance abuse is housed. We applied to do a payer/payee State payer pilot project in '04, and we received that. There was really no funding involved in it, but they would allow some travel to get some technical assistance on the model, and they did some coaching. They paid for coaching for us, and they kind of taught us and peer mentored us through the beginning, the learning period of what NIATx was all about. We had four providers and the managed care company in Iowa that became involved in doing walk-throughs at all of the agencies that were involved to try to get an idea of what it was like to be a client at a treatment center in Iowa.
There were a lot of things that came up. We went in to do these, and the director and I would be sisters or, you know, cousins or things like that. We went to sessions together, and one kind of documented the experience while the other one actually did a full assessment, and you realize how much paperwork comes in. Sometimes you would be given a pack of papers that took you a half hour to fill out, and you didn't even know if you really needed to continue after that day. So it seemed like kind of a waste of time to be filling out 30 pages or reading a manual of some kind, which had nothing to do with your assessment that day.
Sometimes you would be waiting in a lobby that was just too small, looked bad. Sometimes the front doors were locked, we found out. There were just a lot of things that we started to experience in documenting and we went back to the directors and said here's some feedback on that. We had a really interesting 2 years of kind of beginning to learn this process and really learning some of the barriers that were happening at some of our treatment centers. It was a great eye-opening experience for all of us.
Then our next point was how to remove the barriers, and that was when you start to use this NIATx model. In June 2006, then, the Department of Public Health was invited to be part of a cross-systems financing project through the Robert Wood Johnson Foundation, and it was a project on blending and braiding funding. The population we chose was mental health and substance abuse, so co-occurring clients, looking at the financing, training, and development of programs and how to blend some of the funding with Medicaid and substance abuse block grant.
We did that for about 2 years, and we started to use that model through some of our co-occurring work too and trying to move it into other places and not only substance abuse treatment clients. We started to go in to be real clients that may have mental health depression, as well as alcoholism and other things. That was a very interesting experience to do a walk-through as a co-occurring client too.
In 2006, we applied for a Federal grant through SAMHSA, the Substance Abuse and Mental Health Services Administration, and the grant is called the "STAR-SI Grant," and it's Strengthening Treatment Access and Retention State Incentive grant. We received that grant in 2006, and it was basically to continue to use the model of NIATx. It's a 3-year grant. It was $325,000 per year for 3 years, and we have 24 block grant-funded agencies, so we chose to start with 8 for year 1, do 8 year 2, and 8 year 3. It was very specific in working with clients on access and retention.
The providers were required to use this NIATx model and to do change projects, to do walk-throughs, to do PDSA, those Plan, Do, Study Act short planning processes to see what was working. First you have to find the problem. Then you try to do your process improvement to find out how to get clients in sooner and to keep clients longer, because research proves those are the two things that improve success rates. We had a lot of providers doing a lot of things at the same time, and we were pulling data, trying to get clients in on the same day.
We found that some of our providers had some wait times that were just unacceptable. We had one provider with 90-day wait times. I think that might have been a data entry problem, but we were finding that some of these things that were happening were just completely unacceptable. So we started looking at how to decrease wait times. If a client is out there waiting to get in for a first assessment and they're waiting 6 weeks, what's happening in those 6 weeks? What's happening in 3 weeks? Why can't these clients come in the day when they're wanting their appointment or the next day or next week when they want to get in?
We started looking at some of those processes to do reminder calls or walk-ins or things like that. We started looking at all of our providers to start looking at new ideas in getting clients in and keeping them longer. This grant was a 3-year grant. We did a lot of peer mentoring in this grant too with this NIATx model. We developed, with the help of our coach that we have through this grant, a peer mentor curriculum, and it was used throughout the United States. We were asked for it all the time. It was peer mentoring where you would pair up a person who had been trained as a peer mentor with a provider. They would come in and look at their data, look at their wait times, look at their client admissions, look at their client discharges, and they kind of mentored them through the process of using this model. It was a great thing that we had and we still use this quite a bit.
Toward the end of that 3 years, we were asked to continue with this NIATx model in a program called the "Communities of Commitment," and we really started looking at system transformation for Iowa. Not only do we have issues with our substance abuse treatment in Iowa, but also we have problem gambling, and we have tobacco in Iowa. We started looking at alignment of all these different things. How does prevention work into this?
As we move into health care reform, we really need to start looking at where we're moving in the future. We took part in a program called the "Communities of Commitment" with NIATx for about 6 months, and then we were asked to keep coming back for the whole systems change project. This was really looking at advancing a recovery-oriented system of care, which is where our system is moving.
Then about a year ago, we were awarded the application, and we were given technical assistance and some travel funding for our NIATx SI, which is State implementation for NIATx. We took part in that for another 8 months, and some of our focus was on the recovery-oriented system of care, looking at our data, and we're really heavily moving forward in pay for performance with some of our block grant funding and looking at people who are getting clients in sooner and keeping them longer. We're going to start paying for performance rather than just giving out incentive funding for really doing nothing. We're really looking at how we pay for that performance, which has been a lot of work behind that, those three small words, but we're trying to develop a model that will work for us using the NIATx principles and aims.
We have also moved NIATx into our gambling programs in Iowa. All of the gambling programs have had a walk-through, and they all are using the NIATx model to continue to get clients in sooner and to keep them longer. We have actually been one of the first States to use NIATx within prevention, because you realize with prevention services you don't really focus on a client walking in a door for a treatment assessment or for any type of treatment services. What we have done with prevention is we have looked at how to find ways for prevention agencies to charge for services. There's different programming that they can maybe increase profits through different ways to make it more of a business case and to get different ways of financing for these agencies. We've also looked at NIATx for the prevention folks for reducing paperwork, because there's a ton of paperwork for all of the different programs, so we're looking at that.
Again, here, I talk about peer mentoring. That's been a huge thing we've done, and we continue to do that. We've been asked to come present on our peer mentoring curriculum and we're very proud of that too. About a month ago we were awarded another NIATx project that came out. It was the business application, and our goal in that one is for 65 percent of the Iowa block grant providers to implement contracting with third parties as we move forward into this health care reform and try to find new ways of keeping all of our treatment centers strong. We're going to take part in that and we're excited to be chosen for that too.
We found through this model, this process improvement model, that we really had some significant reductions in wait times. Some of our agencies had 62.4 percent. We had other folks that were increasing services in 30 days, 12.5 percent. We're doing this alignment, as I talked about, with treatment, prevention, and gambling, and tobacco is also becoming part of that. They have that division downstairs all their own, but now we're trying to start working with them to look at some efficiencies through that.
One of our main things is trying to keep this process improvement work going through the system transition as we move forward into health care reform by 2014. That's all I have for this. I am used to doing this presentation in about an hour and a half, so I could keep going on and on about all the things we've done. It's a really great model. It's not only just for substance abuse treatment. You can really use it in different places.
I would encourage anybody to go to their Web site, and I didn't put that on there but it's www.niatx.net, and there are just tons of resources there. They give you charters, and they can give you forms, and you can see tons of examples of what States have done to improve access and retention at their treatment centers. I encourage everybody to look at their Web site and see all the resources and tools that they do have.
Margie Shofer: Thank you, DeAnn.
DeAnn Decker: You're welcome.