Latino Health Summit Presentation Doug Spegman MD, MSPH, FACP Chief Quality/Medical Innovations Officer 2/16/13
Established in October of 1970; Tucson, AZ • Federally Qualified Health Center • 16 clinic sites • Special Population Care: HIV/AIDS, Hepatitis C, Homeless Services (Healthcare for the Homeless) Vision: To be a national model of excellent healthcare.
Our Patients • 76,190 Patients • 312,198 Encounters • 58% of our patients are female • 32% of our patients are children age 14 or younger • 62% of our patients had incomes at or below the federal poverty level • 60% Hispanic/Latino * 2011 Data
Performance Improvement @ El Rio • Joint Commission Accreditation • NCQA: Patient Centered Medical Home: Level 3 Designation • Arizona Connected Care: ACO partner • Next Gen EMR: Patient Portal Project • i2i Panel Management: Preventive Services/Chronic Disease Management • Kaizen Event: Patient Communications Redesign: PC 2.0 • Patient Driven Scheduling: Open Access Scheduling • Service Excellence: Patient Satisfaction Teams • Post Discharge Case Management • Medication Adverse Event Reporting Pilot @ NW clinic • Performance Improvement Team Pilot @ Congress location using logic model • Cultural Transformation Project
Data Management • Performance Goal and/or benchmark for the process measured • Details of how the data was obtained • Numerator/Denominator description of data • Timeframe of measurement • Interpretation of the data presented • Action plan based on the analysis of the data
Aligning Goals and Incentives Not Aligned Aligned
Specific Alignment Strategies • Start with process measures and migrate to outcome measures • Make it an iterative process of data vetting • Allow limited autonomy for clinician discretion
Current El Rio Alignment Strategies • Quality: Mammograms and Childhood Vaccinations Missed Opportunities • Financial: Panel Reports • Patient Experience: Teamwork Metric Incentive
Teamwork Incentive – a Three Tiered Approach • Tier One: $100,000 of incentive for all employees (~$200 per employee), if as a system El Rio increases the percentage of “Excellent” responses for teamwork by 5%. • For El Rio: 58.0% to 60.9% (by March 31, 2013) • Tier Two: If Tier One goal is met, then an extra $200 per employee incentive may be obtained by reaching individual site/department goal. • Tier Three: If Tier One and Two goals are met, then a final extra $200 per employee incentive may be obtained by reaching individual site/department “stretch” goal.
Examples of Action Plans • “Manage Up”: All members of clinical team refer to each other by name and tell the patient that they are being cared for by a ‘team’. • At end of visit tell patient that they may be surveyed by phone because “We strive for excellence and want to know what they think so that we can continue to improve.” • Then ask “Was there anything we could have done better during today’s visit to make it an excellent visit?”
Changing Paradigms In Delivery of Care • Patient Driven, Not Physician Driven • Team Approach • Redesigned Workflows • Right Work by the Right People at the Right Time • Actively Manage Transitions of Care
El Rio Community Health Center Transitional Care Model • Hospital Discharge Approach • Collaboration with 3rd Party Payer: Hospitalizations, ED visits, High Risk Registries • Incorporating Chronic Disease Management with Population Management towards our goal of Complete Care Management
Assessment of Criticality(2012 Data/1,501 Hospitalizations) • Status 3: Patient requires intense care with PCP follow-up within 24-48 hours • Post-hospital PCP appointment rate = 82% • Status 2: Patient requires moderate care with PCP follow-up within 3-6 days • Post-hospital PCP appointment rate = 89.7% • Status 1: Patient requires minimal care with PCP follow-up within 2 weeks • Post-hospital PCP appointment rate = 87%
High Risk Patients • Defined as having ≥ 3 hospitalizations in 2011 • Cohort of 50 patients • 72.1 % reduction of readmissions through 2012 (from 237 admissions to 66 admissions)
Thank you! Name: Doug Spegman MD, MSPH, FACP Email: DouglasJS@elrio.org