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Toolkit

Building the value case for complex care

Building the complex care field Funding & financing

Building the value case for complex care toolkit

This toolkit was designed to be a simple and accessible way to learn about one of the least understood and most challenging aspects of complex care: making the mission and margin align.

With support from The Commonwealth Fund, we interviewed more than 100 health and social system leaders and innovators to understand:

  • what matters most in creating the case for complex care,
  • how to adjust the case in times of crisis, and
  • ways to champion efforts in various environments.

View the full toolkit

Introduction

Learn the definition of complex care, the guiding principles of complex care programs, and why “making the case” is more important now than ever before.

Downloadable worksheets & materials

  • Building the value case summary tool (.doc): As you move through the toolkit, please use this tool as a resource to track ideas about applying the concepts to your system and community.

Additional reading & resources

View this section

Getting started in complex care

An important first step in “making the case” is to understand the population you will be serving. Learn about the different ways you can use data to visualize populations, and techniques for understanding their needs.

Key takeaways

  • Use data to visualize utilization across the system as a starting point and an annual evaluation point
  • Evaluate root causes of utilization to identify subpopulations to serve.
  • Individuals with similar characteristics who also have high frequency often point to systems failures that can benefit from process improvement
  • Use this analysis to identify potential inclusion and exclusion criteria for who will be served by your program

Downloadable worksheets & materials

  • Root cause analysis tool (xlsx): The root cause analysis tool gives you a resource to capture themes in the population that may be driving instability. Use the lessons from this analysis to inform your program approach and design.

Additional reading & resources:

View this section

Scaffolding the population

Understanding how your organization perceives the financial impact level of different populations helps you target and stage the populations you work with, generate buy-in and create financial sustainability for your program. Learn more about different value-based payment concepts and how different payment structures and levels can influence your programs’ financial impact and choice of population.

Key takeaways

  • Based on your understanding of your organization’s financial incentives, review the populations for whom reduced utilization is beneficial.
  • Consider equity in your choice of populations to serve.
  • Schedule time with leadership or CFO/financial analyst to discuss appropriate scaffolding of the population
  • Consider adapting the population you start with first to those whose utilization is most impactful to your system.

Downloadable tools & resources

  • Impact mapping tool (.pdf): Consider the distribution of populations by financial impact to your system. How do the populations scaffold at your organization?

Additional reading & resources:

View this section

Collaborating with finance

Your most effective champion for complex care can be your CFO if you work to understand what matters most to the organization and how you can position your program design to generate the outcomes that enhance both patient and organization success. For an effective collaboration, it’s vital to understand basic concepts in finance and budgets, and focus on costs.

Key takeaways

  • Meet with your CFO or finance team
  • Identify what financial metrics matter most in the organization
  • Identify what level of analysis the finance department could provide for your intervention

Downloadable tools & materials

Additional reading & resources

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Stakeholders and assets

Thinking about the values and challenges of your stakeholders will help you hone your processes and metrics to demonstrate a value proposition that has meaning for multiple partners.

Key takeaways

  • Evaluate the needs of stakeholders to identify key metrics for your program
  • Consider adapting your program to better meet the needs of stakeholders
  • Identify potential partners and champions from stakeholder analysis
  • Complete asset mapping to identify resources for the population you serve

Downloadable worksheets & materials

  • Evaluating the needs of stakeholders (.doc): Consider the needs of your stakeholders to inform design of your program and identify potential partners in delivery. Utilize this tool to capture your findings.

Additional reading & resources:

View this section

Demonstrating value beyond cost savings

It’s essential to choose a suite of metrics that are feasible to track and demonstrate value in several directions. By aligning your work across your community, and beyond healthcare, you may find that you can build support and access funding from multiple systems for the long-term.

Key takeaways

  • Develop a standard demographic measure set for your population
  • Choose 1-2 metrics in each quadrant that demonstrate the value of your intervention
  • Evaluate metrics 12 months before and after intervention
  • Complete annual analysis to evaluate your impact
  • Consider a paired evaluation of a population without intervention to further demonstrate the value of your intervention

Downloadable worksheets & materials

Additional reading & resources:

View this section as a PDF

Return on investment

Your best partner in developing ROI specific to your intervention and organization is your CFO or financial analyst. Using the metrics and outcomes you collaboratively identify, have finance complete an annual assessment of your progress.

Key takeaways

  • Create a plan with your CFO or financial analyst for ROI analysis
  • Identify your plan for reporting outcomes to multiple stakeholders
  • Based on the ROI analysis – Consider changes to be made to your intervention to generate ongoing support

Additional reading & resources

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Sharing your success

To continue to generate buy-in, partnership, support and sustainable funding, it’s important to develop a regular cadence of reporting in different formats that link back to what matters most to different stakeholder groups.

Key takeaways

  • Create a pitch deck to share your success
  • Create an annual plan for how and when you will report outcomes

Downloadable worksheets & materials

  • Sample pitch deck (.pptx): Creating a standard deck of slides to share your success will give you a great resource to share with your leadership team, payers, stakeholders and community partners. You can adapt this deck to describe your program and outcomes.
  • Patient AV consent form (.doc): Consider integrating a patient consent for audio or video recording in your intervention. Hearing the story directly from consumers is a powerful tool for helping people understand the impact of complex care.
  • Adventist Health case study (.pdf): Review these case studies to see how successful complex care programs applied the concepts and developed their value case.
  • Regional One Health case study (.pdf): Review these case studies to see how successful complex care programs applied the concepts and developed their value case.

Additional reading & resources

View this section

Funding sources and opportunities

A sustainable financial plan needs to be considered from the start of a new program and revisited annually for existing programs to ensure success.

Key takeaways

  • Create a budget for your program
  • Develop a short and long-term financial plan
  • Identify what level of staffing is needed for efficient delivery
  • Set a standard for visit cadence and delivery
  • Use your data to evaluate and adapt your program on an annual basis
  • Consider billing for your service

Worksheets and supplemental materials

  • Funder and opportunity resource map (.pdf): The following table contains important considerations when making a financial plan for your intervention. The source of funding will drive who you serve, how you present the case for complex care, and what metrics you track and report to demonstrate success. For a deeper dive into funding, Beyond the Grant is an excellent free resource with many tools and ideas you can use to explore this concept further.
  • Complex care budget tool template (.xlsx): This tool gives you an interactive resource to test the budget for your program and also model out potential impact and return on investment.
  • Complex care budget tool instructions (.docx): This tool allows you demonstrate the cost of running a complex care program. This tool contains the majority of the logic in the budget template design.
  • CAPC Population stratification tool (.pdf): This document gives guidance to “dosing” interventions, so that patients get the care they need when they need it, and the program may use its resources efficiently. The tool was adapted from the Center for the Advancement of Palliative Care. See CAPC’s Palliative Care in the Home: A Guide to Program Design for care delivery information.
  • Triage tool – Example (.pdf): Developing a standard for dosing and delivery of your intervention can strengthen the impact and value case. Adapt this tool to reflect the core components and standard for your intervention.
  • Triage tool – Blank (.doc): Download a blank triage tool to reflect the core components and standard for your intervention.
  • Billing resource (.pdf): Consider if your program should bill for services. This adds revenue to the value case and may help to support ongoing investment in the services you provide. Use this guide to explore various billing codes.

View this section

All worksheets and supplemental materials