Performance Improvement Archives - CARF International https://carf.org/blog-programs/performance-improvement/ Commission on the Accreditation of Rehabilitation Facilities Wed, 22 Nov 2023 22:18:00 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.1 https://carf.org/wp-content/uploads/2023/08/cropped-carf-favicon.png?w=32 Performance Improvement Archives - CARF International https://carf.org/blog-programs/performance-improvement/ 32 32 218515885 Social Workers: Generations Strong https://carf.org/blog/social-workers-generations-strong/ Tue, 31 Mar 2020 15:00:11 +0000 https://carf.org/?p=6753 March is Social Work Month. This year’s theme, Social Workers: Generations Strong,...

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March is Social Work Month. This year’s theme, Social Workers: Generations Strong, honors the powerful, positive impact the profession has had on society.

During this unprecedented pandemic, CARF acknowledges all social workers during National Social Work Month in collaboration with our International Advisory Council member, the National Association of Social Workers (NASW). We deeply value the courageous work of those in the field who continue to serve their communities and connect persons in need to essential services. We echo the combined statement of solidarity by NASW and the Canadian Association of Social Workers (CASW) in supporting our network of social services. Read the statement.

During the month of March, CARF recognized social workers across health and human services. Following this year’s Generations Strong theme, we reached out to social workers at various stages of their careers in the aging services field. Below are their insights on the social work profession.

Q: Briefly describe your career in the social work field. How did you get started? What motivated you?

I started in the social work field to make a lasting impact on individual lives one little victory at a time. We know there are significant system-related issues; however, it motivated me to start this career to be the bridge for patients’ access to services and counseling. 
—Jonathan Moore, M.S.W., Clinical Social Worker, Maple Health Centre, Maple, ON

I was working in geriatrics as a psychiatric treatment assistant in the summers while I completed college. I was thinking at first of environmental studies, but the head nurse on my unit strongly encouraged me to be in a “people field” like social work. I listened to her advice.
— Karen Appel, LICSW, Director of Social Services, Heritage Health Care Center, Utica, NY

I was motivated to serve at a young adult age—after someone provided local agency support for my maternal grandparent who received dialysis services that required a lot of care coordination by a case manager. This was gratifying to learn that someone cared about a member of my family that much when we lived three hours away. The support services were in place, and this gave my family members advocacy services that allowed us to focus on the caregiver role more. 
— Andrea Mckie-Bradley, Social Services Director, ACTS Retirement-Life Communities, Charlotte, NC

I have always had an interest in working with people in a helping profession. I started by working in community services and quickly realized that in order to better serve my clients as well as to develop myself professionally, I would need formal training and education. 
— Devora Waxman, Director, Social Work and Care Coordination, Better Living Health and Community Services, Toronto, ON

I studied social work in college with a concentration in gerontology and graduated in 1985. I originally wanted to work with children; however, I was required to do an internship in a nursing home. After that, I never left the long-term care setting. 
— Linda Unger, Social Service Coordinator

I have been in the field for almost 21 years, all in geriatrics. I got into the field because my grandmother lived with Alzheimer’s disease, and I wanted to help others who are affected. Now I am providing dementia education to other staff in my community. 
— Catherine Nakonetschny, LCSW, Social Services Coordinator, The Evergreens, Philadelphia, PA

While getting my undergraduate degree, I rented housing from an 86-year-old woman, and we became friends. I saw her spirit, her strength, and her challenges. She taught me to grow roses and bake bread, how to keep house and to go on adventures. I changed my major from music to social work, graduating in 1974 with a B.S.S.W., and going on to attain an M.S.W. in 1978, obtaining my LCSW, and finding a long, satisfying career in geriatrics. I have loved every job, some more than others, but have always learned and grown. I am very near retirement, and I could be considered a peer counselor at this point, but my passion for the work is stronger than ever. I love coming to work each day, feeling strong and committed, and going home knowing I connected, supported, and helped clients and team members. 
— Barbara Bolin, M.S.W., LCSW, Social Worker, Goodwin House, Alexandria, VA

I started my career in 1996, working at a children’s residential facility as mental health home-based clinician, then as a case manager, helping others to help themselves and advocating for those who do not have a voice.
— Teri Miskowski, Assistant Administrator, Rice Manor, Parma, MI

Q: What was it like to be a social worker when you began your career?

It was quite the experience as I was only 22 when starting my career. I was assisting individuals a lot older than me, but over time I gained confidence. I started to see the impact of my work and of my fellow social workers. That is what pushed me to complete my M.S.W. to create further systemic change.
— Jonathan

I started in [redacted] and worked in subsidized housing for senior citizens. I was a jack of all trades there, calling Bingo, taking residents on trips, etc. After a few years, I returned to [redacted], but as a social worker, having completed my B.S.W. and a master’s degree in geriatrics as I knew it was my profession of choice. 
— Karen

It was hard. There was not a lot of guidance when I first started, but that has improved over the years. 
— Catherine

When I began my career, the field of geriatrics was fairly new. Services for behavioral health were more comprehensive and Medicare coverage was more comprehensive. There seemed to be more community-based programs for mental health, in-home support, and activism. On the bright side, there is so much more knowledge about aging, dementia, and abilities in the aging person. People are living longer; have a “younger opinion” of themselves; and have access to information about fitness, diet, and healthy aging.  
— Barbara

Q: How has social work changed over your time in the field?

I have been in the field for about eight years now. When I first started, it was very much based on advocacy. However, with systemic pressures and funding cuts, unfortunately clients suffer. However, over time, I learned when working in the healthcare system, the more informed the clients are, the more you can empower them. This is where I started to see the impact I wanted to have in society. I learned you have to change the system from within and celebrate the small victories along the way. As social workers, we continue to push for change and advocate for our clients. I foresee there will be a big shift in the coming years in healthcare especially. 
— Jonathan

As our population is aging and drawing more resources from the healthcare system, the system is becoming strained and struggling to meet the needs of patients. Social workers in the community are providing services to clients who years ago would have been in long-term care beds. Our clients are incredibly frail and complex, and our practice has needed to change in order to meet our clients’ needs. 
— Devora

I believe over time the role of the social worker has become more important in long-term care. 
— Linda

I think we have access to more resources, including colleagues from other states and backgrounds. It gives me different perspectives to consider. 
— Catherine

I see social work as leading the way in bringing attention and empathy to so many populations such as LGBTQ, transgender, immigrants, considering and calling out racial and religious discrimination, mental health, social media, and so many more realms. Social work has not shunned tough societal problems, and always seeks to assure dignity and respect for all. 
— Barbara

Q: If you could give a piece of advice to someone considering a career in social work, what would you tell that person?

I would tell them to consider a career in geriatric social work. With our aging population, there is tremendous professional opportunity as well as the opportunity for a very rewarding career! 
— Devora

Remember why you are a social worker. Some days are going to be really difficult, but if you remember why you do this work, it will make those days few and far between. 
— Catherine

Learn all you can about the art and craft of social work, keep your horizons as broad and diverse as possible, and seek knowledge and awareness from every place and everything. Keep asking ‘what if’ and ‘what next’ and ‘what more.’ 
— Barbara

Focus on the individuals you serve, speak your mind, and share your thoughts and concerns in advocating for them. They are our focus, and we work strictly for them and their well-being. 
— Teri

As we enter this new decade and Social Work Month comes to an end, CARF honors the powerful and positive impact social work has on society. We wish to thank those who contributed to this article as well as all social workers across the health and human services field.

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All about outcomes: Performance-based reimbursement is changing health and human services https://carf.org/blog/all-about-outcomes-performance-based-reimbursement-is-changing-health-and-human-services/ Thu, 29 Nov 2018 15:00:00 +0000 As the American healthcare system struggles to get its skyrocketing costs under...

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As the American healthcare system struggles to get its skyrocketing costs under control, many payers are exploring value- and performance-based payment models in which providers are reimbursed for positive outcomes. Most analysts believe such payment systems, which offer lower costs for payers, are the wave of the future.

The newer model encourages providers to better collaborate on care, provide treatments and services customized to each person receiving them, and to focus more on driving positive health outcomes. Aside from the lower costs and better care already resulting from the trend, it may also improve health literacy by making healthcare systems easier for people to navigate, understand, and use.

To illustrate, Cigna aimed to increase value-based payments to 90 percent of its spending in 2018. Aetna plans to funnel 75 to 80 percent of its spending into value-based contracts by 2020, with researchers there expecting value-based care to account for 59 percent now of all U.S. healthcare payments by 2021. And in a 2017 study, UnitedHealthcare announced its goal to tie $65 billion of spending to value-based U.S. contracts by the end of 2018.

“This is an important change from the traditional, 75-year-old health care system based on fee-for-service, whereby the more services providers delivered the more they got paid,” notes the UnitedHealthcare study. “Moving to value-based care can include different payment models, such as shared savings programs and bundled payments, as well as more integrated clinical models such as accountable care organizations and patient-centered medical homes.”

Likewise, The Department of Health and Human Services (HHS) is prioritizing value-based models. Secretary of HHS Alex Azar confirmed that the Center for Medicare and Medicaid (CMS) aims to incentivize this shift in focus.

“If you talk to any patient about what they want from healthcare, it’s outcomes, not process. Ultimately, that is what should drive providers, too,” said Azar.

Furthermore, the trend is not limited to primary care. So what are some outcomes-based initiatives being implemented or considered through Medicare and Medicaid in various areas?

  • Section 223 Demonstration Program for Certified Community Behavioral Health Clinics (CCBHCs):
    Section 223 of the Protecting Access to Medicare Act (PAMA) helps states establish certified clinics that must meet specific criteria emphasizing high-quality care. The CCBHC demonstration program is a two-year initiative across eight states. Participating CCBHCs must provide nine defined types of services and are removed from certain restrictions that exist under fee-for-service models.
  • Prospective Payment System (PPS) for Inpatient Rehabilitation Facilities (IRF):
    A PPS is a form of Medicare payment based on a predetermined, fixed amount related to patient characteristics rather than actual services provided. The IRF PPS will utilize information from a patient assessment instrument to classify patients into distinct groups based on clinical characteristics and expected resource needs. Separate payments are calculated for each group.
  • Bundled Payments for Care Improvement (BPCI) Advanced Initiative:
    Research has shown that bundled payments can align incentives for providers—hospitals, post-acute care providers, physicians, and other practitioners—allowing them to work closely together across all specialties and settings.
  • Oakland Community Health Network (OCHN) Outcomes-Based Service Models:
    This Michigan-based Medicaid Managed Care Organization is an early adopter of outcomes-based funding models. Over the past two years, it has developed service models for vocational services, services for persons with intellectual and developmental disabilities, targeted case management, Assertive Community Treatment, and several more. For example, payments for supported employment are now tied to outcomes metrics such as number of hours a person works and the person’s level of acuity. Case management payment is based on physical health metrics of the person receiving services, stable housing, employment status, etc.

    During the first year using the new models, OCHN has measured a reduction in acute care stays, more stable housing, and less involvement in the criminal justice system. The benefits have been clear enough that OCHN has begun advising other networks nationwide on implementing similar models.

This trend isn’t exclusive to funders. State regulatory bodies are also looking at performance-based models and criteria. They are increasingly interested in prevention and methods to address social determinants of heath. The future is undoubtedly in favor of providers that can implement strong performance management practices.

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