Leveraging Baldrige to Build a Value-Based Services Organization

With the help of peer feedback, face-to-face knowledge sharing, and coaching, Baldrige Executive Fellows work on a capstone leadership project to drive strategic results improvement. To do this, they use Baldrige concepts and what they learned from the best practices of Baldrige Award recipients they visited during their year-long fellowships. Their capstone projects are intended to yield significant, systemic impact in their own organizations. 

For Cindy Bo, Chief Strategy and Business Development Officer for Nemours Children’s Health System, part of the Alfred I. duPont Hospital for Children in Wilmington, Del., strategic results improvement meant helping her organization move to a value-based care model that centers on patient outcomes and improving the quality of care based on specific measures. Such a value-based care model focuses on quality over quantity, moving away from a traditional fee-for-service model.

What inspired your capstone project for the Baldrige Executive Fellows? Substantial changes within the marketplace are driving U.S. children’s hospitals to re-evaluate how they approach billing, payment, physician alignment, care delivery, and care quality measurements. Moreover, there is a continuing trend among states to transition their fee-for-service programs to accountable-care models. These programs demand greater provider coordination of care and clinical integration in order to demonstrate quality achievement and to replace fee-for-service payments with prospective payment or risk-based models.

To thrive in this environment, children’s hospitals will be pressured through economic incentives to focus on value-based care: managing population health, preventing avoidable readmissions, and reducing costs to elevate the value of the care they deliver. Furthermore, states and employers will increasingly require that children’s hospitals accept additional financial risk in order to have more control over marketplace variables that impact their performance. Nemours is moving into value-based care, and as we transition, we will be forming a new value-based services organization. My capstone project for the Baldrige Executive Fellows is to help Nemours with this transition to value-based care.

What was the desired goal of your capstone project?

The desired goal of my capstone project is to build the value-based services organization. This entails forming a new department at Nemours that would integrate primary care, care management, information technology and data analytics, finance and contracting population health, and the clinical network. All these areas will be integrated to drive the value. For example, in order to drive evidence-based care, we will rely on our Care Management Team to support care coordination, social work, and patient navigation. Data Analytics will be the underlying resource to bring visibility to our Care Management Team and administrators, as well as to patients and their families. We will need to rely on data to be able to coordinate care, manage financials, and determine our risk/gain impacts. Analytics investment will be essential to support the value-based care payment and delivery models that require insights to support more effective decision making. Additionally, we will start building out our primary care network with community primary care practices, as well as with specialists and other key stakeholders (e.g., durable medical equipment, skilled nursing facilities, post-acute care, and behavioral health).

In the first year of standing up the value-based services organization, there would be key recruitments as well as alignment to how we deliver care. We will continue to transform to value-based care while using continuous improvement principles and processes. Building a value-based service organization will help Nemours achieve the Quadruple Aim (optimizing the patient experience, population health, the cost of care, and the well-being of the provider).

What results have you seen?

Since my Baldrige Executive Fellows capstone project presentation in April 2017, we have been busy focusing on recruiting staff, engaging in various upside risk-payment models, and aligning various departments and divisions under the value-based services organization. It is too early to see results, but most of the work is underway.

What are the future milestones of your project (i.e., what do you hope will happen next)?

The future milestones of the capstone include the following:

• Hire a value-based executive director and a medical director, as well as fill other key roles (e.g., in care management and data analytics) to stand up the value-based services organization.
• Finalize the structure of a value-based services organization and agree on capabilities to be developed in the short and long terms.
• Align on a care management assessment and agreement to build a “no-regrets” infrastructure and program for children with medical complexities.
• Engage in additional risk-payment models that diversify the portfolio (e.g., upside risk only, bundled payments, total cost of care).
• Complete the care management platform diligence: select a tool to understand data integration and financial diligence, calculation of total cost of care, and implementation cost.

How have you/your organization continued using Baldrige resources, including the Baldrige Excellence Framework?

Attribution: Nemours Children's Health System, https://www.nemours.org/

At Nemours, we have started to use Baldrige resources, including the Baldrige Excellence Framework, which I leveraged for my capstone project. For example, during the initial phases of the capstone, I would adapt the framework questions to finetune the planning and thinking (please see green bubble):

In my daily strategy development role, it is important that I use the framework to ask questions such as “How does Nemours conduct strategic planning? What are Nemours’ key strategic objectives and timetable for achieving them?” Furthermore, for implementation, I would ask “What are Nemours’ key short- and longer-term action plans?” The framework has been extremely helpful in structuring my thinking.

What was the value for you in completing the Baldrige Executive Fellows Program?

I had long been a fan of the Baldrige Excellence Framework. Having the opportunity to learn from Baldrige experts and colleagues provided the best learning laboratory. Being able to dive in deeply to the background and philosophy, as well as the opportunity to see the framework in action at Nemours, is remarkable. From the onset of the Baldrige Executive Fellows Program, I was able to take elements of Baldrige to make my capstone a reality at Nemours, as we make one of the biggest transformations for the organization. Finally, it is an honor to be in the company of my Executive Fellows. We have built a network that will continue to grow stronger even after the program has ended. We have become colleagues for life. It has been such a rewarding and enriching experience.