Running head: IMPLEMENTATION PLAN PAPER Implementation Plan Paper Richard Smith University of Arizona Measuring Performance Standards HCS 345 Lawrence Jones September 14, 2009 Implementation Plan Paper Change is an inevitable part of business and organizations should prepare to meet the challenge of adapting the quality of their product to match the needs of their customers. This goal can be met by establishing a vision for this change and by defining the exact outcomes the organization hopes to achieve for the final product.
Depending on the scope of the change, the implementation process can vary widely in time, required resources, and complexity but the basic steps involved to achieve the vision are the same.
The steps include identifying and defining the problem, analyzing data, creating a plan, measuring the outcomes, and reevaluating the final product (Dlugacz, Greenwood, & Restifo, 2004). An actual process improvement and implementation plan for CIGNA Onsite Health or COH will provide an example to illustrate how this process works in the real world.
Core Performance Measure
The vision for this implementation plan is to improve the management of diabetic patients who use the onsite health clinics. This core performance measure is an important part of the COH mission, which includes maintaining health and lowering the cost of health care. Diabetic patients who manage their health can avoid many of the more serious and costly problems associated with the disease. Figure one analyzes this core performance using a Hoshin Tree diagram. Figure One. Data Indicators Improving the management of diabetes requires that COH understand and evaluate the current process in order to produce the desired change.
How does COH know if they are managing their diabetic population better than before or even if they are managing their health well at all? An important part of this process is to define the data that provides a reasonable assumption that the program is successful. These data points are often called performance indicators. In most cases, measuring performance requires several performance indicators to define the level of quality and this is true for measuring diabetic management. Biometric Results One of the easiest measures to define quality for this plan is biometric results.
Biometric testing is performed on diabetics to monitor and assess the status of the disease. Although some some debate exists over biometric values and there correlation to disease risk, they are generally recognized as a good indicator of health. Some examples of biometrics diabetic biometrics include glucose levels, HbA1C results, cholesterol and urine micro albumin testing. Numbers, like biometric values, are easy to measure, compare and trend over time. This makes biometrics an excellent performance indicator. Medication Compliance
Another performance indicator is medication compliance. Medications are prescribed because the provider believes that it will improve their patient’s health. For many diseases, the consequences of not taking recommended medications can be severe. This is true for diabetes and why it is important to ensure that they are compliant with their recommended medication regiment. Health Care Utilization Diabetes is a chronic illness and is best maintained through regular preventive care from a health care professional familiar with their disease.
While visits to a PCP or specialist are generally considered indicators of good health maintenance, visits to an ER or inpatient hospital are usually viewed as negative indicators of overall health. Using this methodology to determine a correlation between health maintenance and visit type would seem flawed due to the number of unknowns associated with the data. Utilizing the ER for a broken arm or a car accident probably have nothing to do with diabetes and therefore should not be viewed as a negative indicator of health.
This is true when the population has a small sample size or where the utilization data is limited to a short period of time but as both of these variables are increased, the statistical significance of the data becomes more valuable. Health care utilization can best be measured through claims data where cost can be measured and compared against like populations to establish a benchmark for defining quality. COH has access to claims data from CIGNA Healthcare, which is the insurance carrier for the majority of their patients.
Wellness Programs An important part of managing diabetic health is through education and wellness programs designed to promote good health through prevention and individual participation in managing disease. COH providers should be referring identified pre-diabetics and diabetics to wellness programs that fit the patient’s disease management needs. Measuring the rate of diabetic referrals against the diabetic population would serve as an indicator the provider is proactively managing their patient’s disease. Data Collection Methods
Once the key performance indicators are defined, the source and method of collecting the data will need to be mapped to ensure the indicators can be measured. Some of the data may be difficult or impossible to obtain with the current resources available to the organization. This process will identify those gaps and provide an opportunity to establish new data collection methods and tools. Electronic Health Record Electronic health record systems have opened the door to a level of medical reporting that was impossible with paper charts. COH will use this data collection tool as a major source of clinical reporting.
Discrete data including biometric values, referral statistics, diagnoses and charge data and many other forms of clinical can be captured and reported from this system. CIGNA Informatics Data Exchange COH is owned by CIGNA Healthcare and this partnership allows the sharing of data between partners. Two valuable pieces of data that CIGNA Healthcare can share with COH are claims and aggregated cost analysis. COH will setup a data exchange process to import claims data from the CIGNA informatics department. This data can be stored in a data warehouse for future reporting.
Expected Outcomes to Measure Performance Once all the performance indicators are defined and the data collection methods and sources are established, COH will need to determine how they will interpret the results and define quality. Improved Biometric Results The results of biometric testing over time will show trends that will help providers to establish pre, post and delta values for their diabetic population. Positive indicators of performance would include healthier glucose, cholesterol and HbA1C levels in comparison to values measured for the same group with values from the past.
Improved compliance with medication Improved Preventive Care and Maintenance Diabetic patients should be seeking regular care and actively involved in managing their own disease. The increase in compliance for standard diabetic testing including eye, foot, and dental exams, lab work and biometric testing would be a positive indicator that the disease is managed successfully. This value can be translated into a percentage showing the rate of compliance, which can then be trended over time. A higher rate of compliance would be a sign of success.
Increased Participation in Wellness Programs Providers are encouraged to refer diabetic patients to wellness and education programs. An increase in the number of referrals as well as the rate of engagement in those programs would indicate positive performance in this area. Lower Health Care Cost Lower health care costs over the long run would indicate that diabetics are using less expensive forms of the care such as the ER or inpatient visits. Effective prevention should result in lower utilization for both of these types of care. Performance Improvement Proposal
The necessary steps have been taken to define the key performance indicators, identify data sources and collection methods and understand the expected outcomes for positive performance. Using these tools, the next step is to develop a plan of action to improve the management of diabetic patients at COH. Marketing and Promotion A marketing and promotion campaign should be developed to raise the awareness of the COH clinics and the care that is available to employees at each site. Emails, posters, health fairs, wellness challenges are a good way to help broaden the awareness of the programs available to diabetics.
EHR Documentation Training for providers to accurately and consistently document health data in the EHR would be a goal for performance improvement. Regular EHR training sessions or refresher courses would be scheduled on a regular basis with attendance as a requirement for providers and all other staff who use the system. The staff would be given clear instructions on what data points are essential for documenting the EHR. Dashboards would also be created and distributed to providers on a monthly basis to track trends in clinical data entry.
The dashboard would include referral rates, testing compliance rates and utilization rates. Health Care Referrals Providers will be required to refer all their diabetic patients to health and maintenance programs and resources at least one time per patient. These referral attempts and their status will be documented in the EHR as part of the patient’s record. A process will also be developed to ensure that providers are following up with their patients determine and document the status of each diabetic referral. Onsite Wellness Program
COH would develop and implement diabetic health and wellness programs located at each site location. Diabetic educators would be hired to conduct each class and follow an established curriculum designed to improved health behaviors. Providers at the onsite clinics could refer their patients to these classes as part of their referral requirements. Create a follow up process for health management Automate Data Exchange The exchange of data from multiple sources will be automated and stored in a data warehouse. Automate Reporting
The generation of reports to present the trends of key performance indicators to management will be automated as well. Communication Improvement Monthly staff meetings will be established for all personnel involved in the diabetic management process. This group would include providers, upper management and IT staff. Rationale for Proposed Change The proposed changes will help increase clinic utilization, ensure effective data collection, standardize provider expectations, and provide timely analysis to measure the success of the program.
Marketing and promotion will establish a presence in the potential customer base and help increase the number of diabetics utilizing the onsite clinics. COH would like to reach as many diabetics at each site as possible. This goal will help increase health and lower cost for each individual but also the site as a whole. Standardizing data collection methods will ensure that the measurements for performance indicators are reliable and accurate. If two patients are compliant with their foot exams but only one is documented in the EHR, the data for that metric is inaccurate.
The dashboards created for providers will help them see trends in their work, identify problems and make corrections to improve data consistency and reliability. Standardizing the referral process will ensure that providers are accountable for promoting health and wellness and not just treating acute conditions. If diabetic patients are not encouraged to participate in wellness programs, they may never take the steps needed to maintain their health. If every diabetic patient is referred to a program, the rate of enrollment should be much higher than passive attempts to promote health.
The rate should increase even more if providers follow up on their referrals to document the status of enrollment. Provider feedback to patients on their progress will also help encourage health maintenance and build relationships between the provider and patient. The referral and enrollment rates will also benefit from established wellness programs conducted by COH health educators. The convenience of having a program at the workplace should increase the rate of participation.
Onsite wellness programs conducted by COH will also provide direct proof that employees who need help are getting it. Any biometrics, labs, wellness test scores can be recorded in the EHR to track trends and increase the depth of data available for analysis and patient education. The automation of data exchange will create a more efficient, consistent, and accurate way to receive data for reporting. Automation reduces manual work, requires fewer resources, and allows for scaling of operations. Automating the reporting process will produce the similar results.
Automated reports will also enable management and clients to evaluate the quality and effectiveness of the program more efficiently. Active communication between departments provides a way for the organization to understand the bigger picture. Better communication also helps define responsibilities, avoid repetition of work and establish accountability for everyone in the organization. Reference Dlugacz, Y. , Greenwood, A. , & Restifo, A. (2004). The Quality Handbook for Health Care Organizations (1 ed. ). New York: John Wiley & Sons, Inc..
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