1 community health integrated partnership maryland community health resources commission april 23,...
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Community Health Integrated Partnership
Maryland Community Health Resources Commission April 23, 2007
Maryland’s Community Health Center Quality Improvement Initiative
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Nation’s Health Center Program
Created in 1965 as part of the “War on Poverty”
Goal to provide primary care services to the un/underinsured via the Health Centers Consolidated Care Act of 1996
Consolidated Health Center Program includes:
Federally Qualified Health Centers
Migrant Health Centers
Health Care for the Homeless
Public Housing Primary Care Programs
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Nation’s Health Center Program
Annually serve 14 million unduplicated patients and provide 55+ million patient encounters
>91% of health center patients are at/below 200% of poverty
52% of health centers are located in rural areas and 48% are in urban and suburban areas
Center size ranges from 4,000 - 19,000 patients
Health centers serve diverse populations:
37% white, 36 % Hispanic/Latino, 24 % African-American, 3% Asian Pacific Islander and >1% American Indian/Alaskan Native
45% of health center patients are newborn to age 24, 48% 25 – 64, and 7% are age 65 and up
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Maryland’s Health Center Program Sixteen health centers located throughout the state
Thirteen federally qualified health centers
One Health Care for the Homeless
Two federally qualified look-alike health centers
Within these sixteen health centers
Three health centers are also Migrant Health Centers
Three health centers operate 26 school based health centers
Three health centers provide HIV/AIDS services through the federal Ryan White Program
Health centers are highly regulated primary care facilities
Must meet DHMH guidelines for Freestanding Clinics
Undergo a periodic review by federal Office of Performance Review
Re-accredited every three years by JCAHO
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Maryland’s Health Center Program 80% of the health centers’ 173,089 patients are uninsured or covered by public
“insurance” program
30% are uninsured
40% are Medicaid beneficiaries
1% are covered by other public programs
9% are Medicare beneficiaries
20% are covered by private insurance
MD health center patients are as diverse as the nation’s
59% are African American
33% are white
7% are Hispanic/Latino
1% are Asian/Pacific Islanders
<1% American Indian
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Maryland’s Health Center Program Health centers contribute to Maryland’s health care environment
Health centers contribute $37.7 million annually to health care system
Improve access through site & service expansion in medically underserved areas
Provide health care regardless of an ability to pay
Provide high quality, comprehensive primary care
Expanded “primary care” services to include pre-natal care & delivery services, behavioral health, and oral health
Proactively work to reduce disparities in health care delivery
Health center clinical providers are either board certified or licensed in their respective discipline & health centers are JCAHO accredited
Provide case management for chronically ill facilitative services such as translation, transportation, eligibility for publicly-funded health and social programs
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CHIP - Health Center Controlled Network Non-profit (501c3) membership organization of eight federally
qualified health centers
Designated (HRSA) as a health centered controlled network 100% owned and governed by FQHCs (51% minimum requirement)
Governed by 8 member board of health center CEOs
Provide operational support and technology services to member health centers
Clinical quality & operational performance improvement initiatives
Technology access & enhancement
Establish partnership & collaborations to strengthen community health system
Three health centers in rural areas – five in urban/suburban areas
67 sites - serve 132,716 patients annually – provide 515, 169 encounters
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Need to Improve Health Outcomes
Maryland’s population tends to have higher rates of disease especially among those “lifestyle” diseases such as diabetes, heart disease and hypertension that could be managed through access to routine primary and preventive care including chronic disease management programs
Maryland United States
• Cardiovascular Diseases 251 248.6
• Malignant Neoplasms 204.8 195.5
• Cerebrovascular Diseases 60.0 58.4
• Influenza and Pneumonia 22.4 22.8
• Diabetes 30 25.2
Rates are age-adjusted per 100,000 population
Source: Maryland Vital Statistics Annual Report 2002
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CHIP Quality Improvement Initiatives 1999 – CHIP commits resources to improve health care delivery
Health Disparities Collaborative (HDC)
Trained staff on chronic disease management (Care Model)
Identified “populations of focus” & captured data to measure improvement in patient health outcomes
JCAHO accreditation
Facilitated each health centers’ initial accreditation/reaccreditation
Patient satisfaction surveys
Developed bi-lingual surveys & administered semi-annually
Performance improvement
Using staff feedback & patient survey results undertook process improvement projects
Began using tools such as “Balanced Scorecard” to measure and report results
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CHIP’s Quality Improvement Initiatives
2000 - Health centers recognized the need for better tools to support improvement efforts
Current improvement efforts required dual data entry & relied on manual data collection for evaluation
Current systems had limited management reporting capability
Health centers were using multiple systems that did not “talk” to each other to manage business operations
CHIP Board made strategic decision to acquire more robust technology that better met needs & deploy in a single platform, integrated, centrally managed environment
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CHIP’s Quality Improvement Initiatives
2000 launched Technology Improvement Project
Phase I – 2001 – 2003 – implemented new practice management system
Standardized business rules across health centers
Central IT management ensures application integrity & performance
HIPAA compliant
Reporting capability allows centers to benchmark performance on variety of dimensions & measure performance improvement
Phase II – electronic patient record system (EPRS)
2006 – developed system specifications & requirements, issued RFP, evaluated multiple EPRS, selected vendor & began pre-implementation process
2006 – 2007 – working to identify funding for EPRS installation in 8 health centers
Public sources - HRSA, Community Health Resources Commission
Private sources – foundations, insurers, corporations
Health centers
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CHIP’s Quality Improvement Initiatives
2000 launched Technology Improvement Project (continued)
Phase III – 2008 & beyond - Health Center RHIO
Establish interoperable linkages
Hospitals - particularly emergency departments
Community partners – other service providers to which we refer/receive patients
Reporting agencies
Funding agencies
Research organizations
Other RHIOs – regional health information organizations
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CHIP’s Quality Improvement Initiatives
BUT – its not about the technology – its about QUALITY
Strategic goals are to:
Improve the quality of the health care we deliver
Reduce disparities in the access to & deliver of health care
Improve patient safety
Decrease medical & prescription drug errors
Increase efficiency of our delivery systems
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CHIP’s Quality Improvement Initiatives EPRS is the tool that will enable CHIP & health centers to:
Identify areas for delivery system improvement & measure the results of performance improvement initiatives
Identify variances, by race, ethnicity, age, gender in health care access/ delivery & measure our efforts to close those gaps
Ensuring patient safety by having 24/7/365 access to patients’ records, from any location, to ensure that clinical decisions are based on real time, accurate information
Reducing the opportunity for medical/drug errors by giving providers access to a real time, comprehensive, organized system that clearly documents patients’ health history vs. a cumbersome, complex paper medical record
Improving patient care & compliance by having tools/reminders that alert providers when diagnostic tests, immunizations, follow up visits, script refills, etc. are due
Improving delivery system efficiency by replacing paper patient records, avoiding duplication, providing tools for proactive patient management, reducing emergency department visits, etc.
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Next Steps Readiness
Completed planning phase & vendor selection - advanced to pre-implementation phase
Benefited from one CHIP health center being operational on an EPRS for 3 years – used as a “learning lab” throughout planning and pre-implementation process – as well as HRSA pilot sites & technical assistance
CHIP has developed a sustainability plan to support the on-going operation of the EPRS
Used existing practice management system support financial model in place since 2001
Health centers have made commitments & are prepared to proceed to implementation
Finalizing vendor contract terms
Continuing pre-implementation activities
Working to secure funding - $2.3 million/8 health centers/69 sites
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Contact Information
Salliann Alborn, Chief Executive Officer
Community Health Integrated Partnership, Inc.
804 Landmark Drive, Suite 128
Glen Burnie, Maryland 21061
Telephone – 410-761-8100 X202
Facsimile – 410-761-5835