The New York State Department of Health launched the Medicaid Accelerated eXchange (MAX) Series to redesign the way care is delivered for the state’s most vulnerable residents. Fondly named ‘Mad’ MAX by Care Compass Network (CCN) staff, the team has conducted several workshops over the last two years throughout CCN’s 9-county region in conjunction with local health systems. The series provides tools to restructure processes in a way that takes into account the needs of the medical institution and the patients. The goals of the series are to reduce readmissions and Emergency Department utilization.
The MAX series is based on Rapid Cycle Continuous Improvement (RCCI) methodology. RCCI is a data and results-driven approach to making systems more efficient for those who work in them and those who are affected by them. The goals, as CCN Project Manager and MAX Facilitator, Juned Mohammed describes it is to ” provide the right care, at the right time, at the right place.”
This is done by understanding and eliminating waste within the Health System’s workflow. “When not as much time is spent duplicating work and you start to eliminate waste you realize that you can do your job more efficiently, care for patients more efficiently, and you’re happier because you’re not being bogged down by all of the administrative tasks,” says Emily Balmer, CCN Project Manager and MAX Facilitator.
The MAX series also looks at strengthening collaborations between different departments within the Health System as well as with community-based organizations across the region where the patient is receiving care. The MAX facilitators help the organizations examine the patient’s drivers of utilization and determine possible collaborations. “We try to identify what organizations can help patients receive appropriate care outside the Health System and direct them towards the resources that they need. For example, transportation or food needs,” says Mohammed.
While each MAX series is unique to the organization and community it is serving, the structure remains the same. There are three phases: assessment and preparation (phase I), workshops and action periods (phase II), and reporting (phase III).
Phase I focuses on the specific challenge or topic that will be addressed and what staff will be part of the Action Team. The team needs to be comprised of individuals who are open to change, can hold the team accountable and who have decision making power, and should include members from all areas of expertise as well as the organization’s key players to the topic identified. The Action Team can evolve over the course of the program based on determination of needs.
Phase II is the core of the program and is based on Plan-Do-Study-Act principles. Three workshops are held throughout this phase during which action plans are created (Plan). After each workshop an action period occurs where changes are implemented (do), and progress is monitored and measured (study). At the next workshop the team determines the next best steps for achieving their goals (act).
In between workshops weekly status calls are held with key staff and the CCN MAX Facilitator. This helps the facilitator understand the progress the team is making in reaching their goals and allows them to provide support or guidance, if needed. Success stories, challenges, and data are also shared during these calls.
During the first workshop the Action Team comes away with a better understanding of the responsibilities of other departments within the Health System and where communication barriers lie. “The first workshop is all about being really vulnerable,” explains Balmer. “That’s where we start picking apart processes and identifying where duplications and gaps are happening.” The action plan is born from having a better understanding of challenges and gaps and trying to find a solution to overcome them. Because the action period following the first workshop has a turnaround of 30 days the action plan generally contains broad, easy to implement, high impact ideas.
The second workshop goes further in depth and the team creates more specific action plans. “At this point they have the advantage of having more data under their belt,” says Rachael Haller, West RPU Lead and MAX Facilitator with CCN. “By the second workshop their action plans speak to the fact that they are thinking about the commonalities between the people that are being readmitted.” The action period is 60 days, making high impact, potentially harder to implement ideas more feasible.
By the third and final workshop the action team is usually working together cohesively, with an understanding of how they can support one another better. The goal is to be making these new plans concrete by brainstorming ideas to ensure they are happening 100% of the time. “As a facilitator you’re encouraging the ideas that, in the first workshop, the group was hesitant to take on,” says Haller. This workshop is less scripted and more about the group coming to the table with the best ideas and working through ways for implementation.
Phase III concludes the series. Teams report on the results achieved and develop a continuous improvement plan to sustain the changes they have made within their Health Systems. One person is assigned as the leader, taking the role that the MAX Facilitator had, coordinating meetings to touch base on a regular basis to discuss the high utilizer patients being seen.
“We have heard an outpouring of positivity around the fact that we took the time to work with these Health Systems for six months,” Balmer shares. Because the team works consistently for this amount of time, with weekly meetings, the process of Plan-Do-Study-Act becomes hardwired, leading to further process improvements post MAX workshops.
The MAX series that the Care Compass Network team have facilitated year-to-date are Cayuga Medical Center, Cortland Regional Medical Center, Lourdes Hospital Inpatient Services, Lourdes Hospital Emergency Department, and United Health Services. Stay tuned for additional articles on each of the Health Systems MAX workshops.