1 / 49

The Concept of Value in Mental Health Services

Discussion with the NJ Mental Health Planning Council Tom Pyle, January 10, 2013 www.psychodyssey.net. The Concept of Value in Mental Health Services. The Stakeholders. In 10 months…. $100,000?... Still Counting…. The Family Experience. “…Business Models...”.

beate
Download Presentation

The Concept of Value in Mental Health Services

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Discussion with the NJ Mental Health Planning Council Tom Pyle, January 10, 2013 www.psychodyssey.net The Concept of Valuein Mental Health Services

  2. The Stakeholders

  3. In 10 months…

  4. $100,000?... Still Counting…

  5. The Family Experience

  6. “…Business Models...”

  7. Value in Mental Health Services

  8. What is the Problem? (Kaplan & Porter, 2011) “…almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved.” Robert Kaplan & Michael Porter

  9. What is the Goal? • Access? • Availability? • Equity? • Cost containment? VALUE for the Consumer

  10. Value: Definition (Oxford English Dictionary) The regard that something is held to deserve; the importance, worth, or usefulness of something: your support is of great value • the material or monetary worth of something • the worth of something compared to the price paid or asked for it

  11. Value in Health Care

  12. Value: A Calculation (Porter, 2010) Value =

  13. Outcomes (Porter, 2010) • Multidimensional • By steps… • Over time…

  14. Outcomes Measures Hierarchy (Porter, 2010)

  15. Challenges of Health Care Costing (Porter, 2010) • Complexdelivery • Many resources • Each with different capabilities and costs • Fragmenteddelivery • “Idiosyncratic” (i.e., “Individualized”) • Highly customized “job shop”

  16. Costs: How To Measure? (Kaplan & Porter, 2011) Track the… sequence and duration 0f the… clinical and administrative processes used by the… individual patient Time-Driven Activity-Based Costing (TDABC)

  17. Time-Driven Activity-Based Costing(Kaplan & Porter, 2011) Patient Jones’ outpatient visit…

  18. Time-Driven Activity-Based Costing(Kaplan & Porter, 2011) Capacity Cost Rate for Resourcei =

  19. TDABC(Kaplan & Porter, 2011) ❶ Capacity Cost Rate for Resourcei = ❶ ❶❶❷❷❸❸

  20. TDABC(Kaplan & Porter, 2011) ❶ Capacity Cost Rate for Resourcei = ❷ ❶ ❷

  21. TDABC(Kaplan & Porter, 2011) ❸ ❶ Capacity Cost Rate for Resourcei = ❷ ❶ ❷ ❶❶❷❷❸❸ ❸ Nurse’s Capacity Cost Rate = $7,280 -:- 112 hrs = $65/hr

  22. TDABC(Kaplan & Porter, 2011) Patient Jones’ outpatient visit… ❸

  23. TDABC(Kaplan & Porter, 2011) Patient Jones’ outpatient visit… $84.50

  24. Value Measurement (Porter, 2010) What is the proper unit? All services and activities that jointly determine success in meeting a set of consumer needs. “Integrated practice units”

  25. Value Measurement, 2 (Porter, 2010) • Separately for each condition …with other conditions “risk adjusted”. • Not separately by department or billing unit

  26. Costing: The Whole Process (Kaplan & Porter, 2011) • Select the condition • Define the care delivery value chain (CDVC)

  27. 2. Care Delivery Value Chain (Kaplan & Norton, 2011)

  28. 2. Care Delivery Value Chain (Kaplan & Norton, 2011)

  29. Costing: The Whole Process (Kaplan & Porter, 2011) • Select the condition • Define the care delivery value chain (CDVC) • Map each activity

  30. 3. Map the Process (Kaplan & Porter, 2011)

  31. Costing: The Whole Process (Kaplan & Porter, 2011) • Select the condition • Define the care delivery value chain (CDVC) • Map each activity • Obtain time estimates • Estimate resource supply cost • Estimate resource capacity; calculate capacity cost rate

  32. 5. Capacity Cost Rate(Kaplan & Porter, 2011) ❸ ❶ Capacity Cost Rate for Resourcei = ❷ ❶ ❷ ❶❶❷❷❸❸ ❸ Nurse’s Capacity Cost Rate = $7,280 -:- 112 hrs = $65/hr

  33. Costing: The Whole Process (Kaplan & Porter, 2011) • Select the condition • Define the care delivery value chain (CDVC) • Map each activity • Obtain time estimates • Estimate resource supply cost • Estimate resource capacity; calculate capacity cost rate • Calculate total cost

  34. 6 Strategic Objectives (Porter, 2012) • Organize system around patient • Measure outcomes and costs • Pay in “bundles” • Affiliate better(less all-service stand-alone) • Expand beyond narrow geographies • Build IT, but not for a broken system

  35. Obj. 1: Organize around patient…(Porter,2012)

  36. … Throughout Continuum of Care (Porter, 2012)

  37. Obj. 2: Measure…the whole chain… (Porter, 2012)

  38. …and up and down the hierarchy (Porter, 2012)

  39. Obj. 3: Pay in bundles NB 

  40. Obj. 4: Affiliate better

  41. Obj. 5: Expand…

  42. Obj. 6: Build IT • …but not for an unreconstructed delivery system!

  43. Implications for Government (Porter, 2012) • Establish universal measurement and reporting • Shift reimbursement systems  bundled • Medicare to lead… • Remove obstacles to integration • Stark Laws limiting referrals (“conflict of interest”)? • Separate payments to hospitals and doctors? • Illegal to hire a doctor as an employee? • Open competition • Encourage patient responsibility • Set standards and mandate EMR adoption

  44. Application to Mental Health Opportunities… Challenges… Medical model Localization (120 agencies) Reimbursement rates Political barriers Length of “continuum” Individualization Scaling State v. Federal Excessive dehospitalization Funding limits • PsyR model • Wellness focus • Recovery ideal • PACT team model • Behavioral Health Homes • Hospital consolidation • Funding limits • …

  45. YouTube: Porter on Health Care • Big Think: http://bigthink.com/ideas/14761 • Porter & Kaplan interviewed by HBR (9 mins): http://www.youtube.com/watch?v=Y7HMHiv7xRg • Lecture at Center for Public Policy (90 mins): http://youtu.be/Z3fKyWydweo

More Related