Building Confidence: What to do Before Implementing a Population Health System

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Co-authored by Suzanne Kunze, RN, CCM, MBA and John Miller


After using a care management system with its unique nuances, familiarity, and what everyone’s comfortable with, a health plan decides it is time to adopt new tools to help manage and run its population health operations.

Change can be difficult for people, but with our guidance and leadership, you and your organization will become confident with the new population health system. We understand that many clients have not been through a system implementation of this kind in a number of years. They’ve known the same system and have come to appreciate its unique nuances. They’ve used the same Utilization Management (UM) and Care Management (CM) system. Because change can be difficult, the focus should be on the transformative nature of the population health system implementation, setting expectations, and addressing pain points along the way and how they can be lessened, or in some instance, eliminated altogether.

Maximizing project’s success

Here are some suggestions to maximize the success of the project, prior to implementation ‘kick-off:’

Develop a communication plan - We all know that change can be difficult. So, one way to set-up your organization for success prior to implementation, is to work with your leadership (clinical, business and IT) at the three to six-month mark to develop a communication plan to all stakeholders.

Like telling a good story, use the opportunity to address the Who? When? and How? of the change that’s about to take place. When introducing the concept of replacing the care management system, in-person meetings are recommended as this allows participants to ask questions of leadership.

The communication can be done in the training environment, a monthly newsletter, during staff meetings, or some combination thereof. Letting those affected by the change `play in’ the new training environment is a good way for users to adapt to the system. You may also want to have a reward connected to the amount of hands on experience a person participates in the training environment. Another best practice is to demo the system, rotating it through departments, so everyone can learn by doing.

Vehicles for change communication - After the initial announcement, include in your communication plan the mode and frequency for project updates, such as a quarterly newsletter or staff meeting. It’s important for staff to know about the project and achieving milestones, or if there are unanticipated implementation delays.

Transparency is key to success. And, don’t communicate until you’re sure the implementation is going to start. There’s no reason for false starts, as this will only defeat confidence in the system. Keep the flow of communication and information going.     

Invite end users to crash the party early - One oversight many health plans make when transitioning to a new system, is not involving front-line staff early enough in the process.

This should occur `before’ implementation begins. Not only does early involvement get the support and buy-in from staff, it assists the organization in developing a more effective, efficient system that aligns with the organization’s unique care management processes. This also makes for a fun adventure for all staff, and conveys the importance of their participation in the project. 

Things to think about prior to implementing the new system:

  • Gather input from end users
  • Develop time studies so you don’t negatively affect static turnaround times, or requirements for state or federal reporting. Health plans have a specific number of days to turnaround documentation or claims, based on contract requirements. These studies should consider the new system to make sure there’s no effect on the reporting requirements
  • Review accreditation standards: NCQA, URAC, the Centers for Medicare & Medicaid Services, so the population health system will support the compliance
  • Review policies and procedures, models of care, and program descriptions
  • Consider the trainer and those being trained and their existing workflow, because everyone has another job that they’re responsible for, which may not be related to the system being implemented

Things to consider to engage end-users, include:

  • Select `ambassadors’ who will represent the unit or department, and will provide input on behalf of their peers. Ambassadors can help the organization create a positive buzz around the transformation.
  • The ambassadors are typically `high performers’ or staff who have a genuine interest in information technology. Select from all staff levels and areas who will be using the product (i.e., clinical and non-clinical staff, UM, CM, and Appeals).

Prior to implementation, the organization should make sure they have developed a project charter, which outlines absolutely everything that needs to be in place and will get them live on the new system.

Did you achieve what you set out to do? The organization should make sure they’re measuring their metrics. It’s not enough to say you need to implement a new population health system, you need to know why you’re making all this effort. Is it to reduce FTEs? Is it a way to better manage a specific population in your health plan? When the project is completed, you need to demonstrate to the organization that the metrics they wanted to achieve were actually met.

Making the new system even better

When a new population health system is implemented, the health plan should know that there will be new automation that can change its workflow. For example, instead of filling in a note on the screen, the new system may auto-populate the information. And while an organization may not like some aspect of the previous system, they need to make sure that while they may need to carry some things over into the new system, they need not carry it over and have a negative experience with the new system.

This involves pre-planning to make sure that you’re carrying over what needs to be done, but also eliminating the things that can drive the new system implementation down. Keep what’s good in the previous system and leave the bad behind.  

In our next blog, we’ll explore what should be done as your organization prepares to implement a new population health system.


Co-author Suzanne Kunze is an associate director with HighPoint's Population Health Management practice. Co-author John Miller is a senior manager with HighPoint.

Tags: healthcare, CMS, population health, URAC, automation, care management, NCQA, population health system, care management system

  

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