System-Level Toolkit

Leadership Team

To effect system-level improvement in access, engagement, retention, transition, and ultimately recovery, the state must assert a key role—that of the convener—in creating payer-provider partnerships. By convening a process improvement learning collaborative involving those that pay for treatment services (payers) and those that deliver treatment services (providers) to implement both payer and provider process changes, system leaders facilitate performance improvement across the entire system.

Payers such as states, county or regional boards, and other purchasers of health care services have a primary responsibility for monitoring the funding process to prevent fraud and the inefficient use of funds. This regulatory role sometimes contributes to adversarial relationships between payers and providers. In a climate characterized by conflict and opposition, it’s no surprise that payer efforts to promote innovation often flounder or fail. A learning collaborative changes the payer-provider relationship from adversarial to collegial. Together, payers and providers exchange ideas and test practices that lead to successful adoption of innovative practices that improve access and retention.

A process improvement learning collaborative can be used as a vehicle for advancing a number of performance improvement goals such as:

  • Spreading the capacity to do process improvement (fundamental training)
  • Testing innovative solutions to system-level challenges
  • Clustering provider changes to improve a single aim
  • Improving the performance management structure for treatment delivery

Highly successful payer-provider collaboratives involve not only numerous provider agencies, but also various governmental departments (e.g., IT, regulation and licensing, health, welfare, corrections, criminal justice, etc.), patient advocacy groups, and others with a stake in the success of the collaborative’s goals. Payer involvement should not create a top-down demands for a certain change or achievement. Effective system change occurs when the both the payer and providers are active in setting collaborative goals and willing to actively test innovative changes to existing processes within each other’s institutions.

For states convening a learning collaborative, staff from the SSA’s office should assemble a team to assist in the organization of the collaborative and to build a list of stakeholders. Consider working with the following types of organizations to help gather interest, provide training, and make resources available:

  • State associations for behavioral health professionals
  • Regional Addiction Technology Transfer Centers
  • Other community resources

For example, several STAR-SI states built successful relationships with their state National Guard for logistical audio/visual support for learning sessions.

State/Payer Roles

The state or payer must commit staff resources to two areas to foster successful improvements:

  • The process improvement learning collaborative
  • The system-level Change Team

In particular, the state SSA or payer’s highest executive authority should focus on identifying an Executive Sponsor and the Change Leader for the system-level Change Team.

  • Executive Sponsor. The SSA or other representative of top-level leadership entity that purchases services and regulates funds serves as the Executive Sponsor.
  • Change Leader. The Change Leader must be a highly respected individual with a reputation for getting things done and an interest in trying out new methods in order to make a real difference.

The state or payer Executive Sponsor and Change Leader need to attend the informational meeting, orientation meeting, kick-off workshop, Change Leader meetings, and the completion conference. In addition, the Executive Sponsor and/or Change Leader must participate in all conference calls.

Generally these two individuals lead and coordinate both the collaborative and the system-level Change Team together. However both activities can be distinct enough that an Executive Sponsor and a Change Leader could be designated to implement each activity. Additional roles are played by:

  • Change Team members
  • Data coordinator
  • NIATx process improvement coaches
  • Local, experienced peer mentors

Change Team members, in addition to innovating new state-level process changes will also need to manage the functions of the learning collaborative:

Communication Management

  • Be the primary source of information about the status of the project to participating community agencies, local sponsors, and national/federal project officers.
  • Maintain a communication network by regularly sending updates, meeting minutes, and announcements of upcoming events.
  • Follow-up in a timely way with agencies that missed meetings or telephone conferences.
  • Disseminate the agenda or registration forms prior to each planned meeting or conference call.
  • Be accessible and respond in a timely way to inquiries from participants and sponsors.

Site Visits

  • Coordinate and schedule site visits.
  • Prepare an agenda and all site visit materials (including a CD-ROM with NIATx resources, progress tracking materials, reporting requirements, etc.).
  • Co-facilitate visits and serve as a process improvement coach.
  • Prepare detailed site visit summary reports.

Meeting Logistics

  • Coordinate details for a series of meetings (information session, orientation meeting for Executive Sponsors and Change Leaders, kick-off workshop, mid-way Change Leader meeting, and completion conference), including identifying adequate space at community centers/hotels, overseeing negotiation of contracts with venues, working with venue staff to ensure proper room set-up/specifications, handling participant registration, preparing participant hand-outs, and working with presenters to prepare content.
  • Assist in the development of meeting content, including goals, objectives, target audiences, topic areas, etc.
  • Prepare and distribute minutes and summary reports to meeting participants, as well as those who were unable to attend the meetings.

Conference Call Logistics

  • Send out reminder emails with call-in information and the call agenda for a series of Change Leader conference calls and one Executive Sponsor call.
  • Coordinate with agencies to choose two agency representatives per call to provide a brief summary of progress to date with Change Projects.
  • Prepare and distribute detailed call minutes to participants, as well as those who were unable to join the calls.

Miscellaneous Tasks

  • Maintain a project binder with all pertinent information.
  • Maintain strong communication links and affiliations with community-based treatment agencies and project co-sponsors.
  • Provide technical assistance with regards to PDSA cycles, ideas for new change cycles, progress tracking issues, agency presentations, etc.
  • Communicate regularly with the payer institution coordinator/analyst on issues related to progress tracking tools.

Progress Tracking

  • Develop a progress tracking protocol to be used for monitoring the impact of provider Change Projects on clients.
  • Provide necessary technical assistance on the proper administration of all forms.
  • Prepare and aggregate progress reports for use in presentations (i.e., Change Leader meeting and completion conference).

Budget Management

  • Maintain accurate documentation of expenditures.

Additional Information

Further Reading