board strategic & facilities planning committee full-board … · update to board on staff...

BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL-BOARD MEETING

*

TUESDAY, JUNE 17, 2014 5:30 p.m. Buffet for Committee members & invited guests GRAND AVENUE CORPORATE OFFICES 6:00 p.m. Meeting BOARD CONFERENCE ROOM 456 E. GRAND AVENUE, ESCONDIDO, CA 92025 ___________________________________________________________________________________________________

Form A

Time Page Target

CALL TO ORDER 6:00

Public Comments 6:05

5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room.

Information Item(s)

1. * Approval: Minutes – February 18, 2014 (ADD A-Pp7-13) ……………....………..………… .....3 .…..1 6:08

2. Review: Year-End FY14 Initiatives (ADD B-Pp15-20) ….…………………………….....……. ….30 …...2 6:38

3. Review: IT Update (ADD C-Pp22-33) ………………………………………………..…………. ….15 …..3 6:53

4. Review: Innovation Move Update (ADD D-Pp35-39)….….…………………..……………….. ….20 ……4 7:13

5. Review: Integra Center Update (ADD E-Pp41-45)….….…………………..………………….. ….20 …...5 7:33

ADJOURNMENT TO CLOSED SESSION …………………………………………………..… ...…5 7:38 ~ Pursuant to California Government Code §54954.5(h)

REPORT INVOLVING TRADE SECRET Discussion will concern proposed new service Estimated date of public disclosure: July, 2015

RESUMPTION OF OPEN SESSION ………………………………………………………… Immediately following end of closed session

Action Resulting From Closed Session Discussion – IF ANY………………………… ...…5 7:43 FINAL ADJOURNMENT………………………………………………………………………………… 7:44

Board Strategic & Facilities Planning Committee Members

Steve Yerxa, Chair Linda Greer, RN Bruce Krider, MA

Michael Covert, FACHE Alternate: Jeff Griffith

NOTE: If you have a disability, please notify us by calling 760-740-6375 72 hours prior to the event so that we may provide reasonable accommodations

__________________________________ Asterisks indicate anticipated action. Action is not limited to those designated items.

Minutes Strategic & Facilities Planning Full Board

Tuesday, February 18, 2014

TO: Board Strategic & Facilities Planning Committee MEETING DATE: Tuesday, June 17, 2014 FROM: Debbie Hollick, Committee Secretary Background: The minutes of the Strategic & Facilities Planning Full Board meeting held on Tuesday, February 18, 2014 are respectfully submitted for approval (Addendum A). Budget Impact: N/A

Staff Recommendation: Staff recommends approval of the Tuesday, February 18, 2014 Strategic & Facilities Planning Full Board meeting minutes. Committee Questions: COMMITTEE RECOMMENDATION Motion: Individual Action: Information: Required Time:

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Fiscal Year 2014 Quarter 3 Strategic & Operational Initiatives

TO: Board Strategic & Facilities Planning Committee MEETING DATE: Tuesday, June 17, 2014 FROM: Debbie Hollick, Committee Secretary Background: Quarterly, the Full Board reviews progress made on organizational strategic and operational initiatives against targets set at the beginning of the current fiscal year (Addendum C). Budget Impact: N/A

Staff Recommendation: N/A Committee Questions: COMMITTEE RECOMMENDATION Motion: Individual Action: Information: Required Time:

2

Information Technology Update

IT Update_FormA.doc

TO: Board Strategic & Facilities Planning Meeting MEETING DATE: Tuesday, June 17, 2014 FROM: Prudence August, Director Information Technology

Background: Status update of the Information Technology department since ITWorks partnership with Cerner one year ago (Addendum B).

Budget Impact: N/A

Staff Recommendation: N/A Committee Questions: COMMITTEE RECOMMENDATION: (Replace this line with Committee Recommendation information) Motion: Individual Action: Information: Required Time:

3

Update to Board on Staff Moves out of Innovation

Form A Template - innovation move.doc

TO: Board Strategic & Facilities Planning Meeting MEETING DATE: Tuesday, June 17, 2014 FROM: David Tam, CAO Pomerado

Background: As Escrow continues to proceed on the sale of Innovation, Administration is coordinating / implementing moves of staff out of the building to new spaces in the District.

Budget Impact: No impact anticipated as this is funded through proceeds from the sale of the property to space currently owned by Palomar Health

Staff Recommendation Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

4

Update to Board on Integra Center

Form A Template - integra center.doc

TO: Board Strategic & Facilities Planning Meeting MEETING DATE: Tuesday, June 17, 2014 FROM: David Tam, CAO Pomerado

Background: Palomar Health is finalizing plans for a three way collaboration with the Department of Defense / Naval Medical Center and the Integra Center, to create a West Coast Amputee / Prosthetics Treatment Center of Excellence.

Budget Impact: No impact anticipated as this is funded through an External Resource Sharing Agreement

Staff Recommendation Committee Questions: COMMITTEE RECOMMENDATION Motion: Individual Action: Information: Required Time:

5

ADDENDUM A

6

2014.02.18 Board Strat & Facil Planning Cmtee Mtg Min.doc 1

BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL BOARD MEETING MINUTES – TUESDAY, FEBRUARY 18, 2014

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP/RESPONSIBLE PARTY

DISCUSSION

CALL TO ORDER

The meeting – held in the Palomar Health Administration Office 1st Floor Conference Room, 456 E. Grand Ave, Escondido, CA 92025 – was called to order at 6:00 p.m. by Board Chair Ted Kleiter

ESTABLISHMENT OF QUORUM

Quorum comprised of Directors Kleiter, Greer, Kaufman, Wickes Remote attendance: Director Griffith Excused Absences: Directors Krider, Yerxa

PUBLIC COMMENTS

There were no public comments

INFORMATION ITEMS

BI-ANNUAL ENVIRONMENT OF CARE REPORT Information only

Director Facilities Operations Dan Farrow noted that security at Palomar Health has taken on a whole different life over the past few years, highlighting the following elements:

o Limiting access to sensitive areas o Active patrolling o Cross departmental Security Integrated Teams (SIT) looking at security at each campus (endorsed by EMT Safety and Service Committee) o Enhanced life safety and disaster communication utilizing Everbridge emergency notification solutions o Ongoing communication with other local hospitals, county representatives and fire departments

o Creation of a “fire response” containment system that creates negative air spaces at key entry points to keep smoke out of the building while maintaining access

MAYO AFFILIATION UPDATE

Information only

7




DISCUSSION

Chief Clinical Outreach Officer Della Shaw reported on the status of the Palomar Health / Mayo Clinic Care Network relationship

o Dr. Roger Acheatel to serve as Palomar Health physician sponsor o Steering committee meets monthly

o 29 physicians currently participating in e-consults

o 11 e-consults completed since September, with an additional 20 top-of-mind consults with our physicians o Secure network and portal anticipated to go live in early March

o Participation in Mayo’s beta on a new physician leadership program

o Dr. Conrad working with Mayo on their Maintenance of Certification program, which will be rolled out to Palomar Health

o Chief Nurse Executive Lorie Shoemaker participating in ongoing CNO organizational activities o Currently receiving calls from patients who have seen our televised advertisements during the Olympics o Only identified risk is that we are receiving a lot of enthusiasm but do not have sufficient number of physicians in the network due to portal issues

President and CEO Michael Covert noted that Mayo has expressed interest in our Google Glass project

3. NOVEMBER 19, 2013 BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FULL BOARD MEETING

MINUTES

MOTION: By Director Kaufman, 2nd by Director Greer and carried to approve the November 19, 2013 Board Strategic & Facilities Planning Committee meeting minutes as submitted. Roll call voting was utilized. In favor – Directors Kleiter, Griffith, Greer, Kaufman, Wickes. None opposed. None abstained. Absent – Directors Krider, Yerxa

No discussion

ANNUAL REVIEW OF BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE BYLAWS

MOTION: By Director Greer, 2nd by Director Kaufman and carried to recommend approval of the Board Strategic & Facilities Planning Committee Bylaws as presented. Roll call voting was utilized. In favor – Directors Kleiter, Griffith, Greer, Kaufman, Wickes. None opposed. None abstained. Absent – Directors Krider, Yerxa

Forwarded to March 6, 2014 Board Governance / Audit & Compliance Committee meeting with a recommendation for approval

No changes recommended

ANNUAL REVIEW OF BOARD MEMBER POSITION DESCRIPTION MOTION: By Director Kaufman, 2nd by Director Greer and carried to recommend approval of the Board Strategic & Facilities Planning Committee Position Description as presented. Roll call voting was utilized. In favor – Directors Kleiter, Griffith, Greer, Kaufman, Wickes. None

Forwarded to March 6, 2014 Board Governance / Audit & Compliance Committee meeting with a recommendation for approval

8




DISCUSSION

opposed. None abstained. Absent – Directors Krider, Yerxa


ADOPTION OF BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE SCHEDULE FOR CALENDAR

YEAR 2014 Information only Forwarded to March 10, 2014

Board of Directors meeting as informational only


ANNUAL COMMITTEE STANDING AGENDA ITEMS FOR CALENDAR YEAR 2014 Information only Forwarded to March 10, 2014 Board of Directors meeting as informational only


FY14 Q1 STRATEGIC & OPERATIONAL INITIATIVES UPDATE Information only

The Executive Management Team initiative sponsors presented the Fiscal Year 2014 Quarter 2 Strategic & Operational Initiatives updates FY14 Operational Initiative 1: Build and operate a decision analytics structure that supports the real time availability and standardized use of information and expertise for knowledge management and measurement of value based metrics of care

Milestone A - Chief Quality Officer Opal Reinbold reported that elements 1 – 3 are on track. Element 4 to begin shortly o Decision support advisory group will ensure that data going into warehouse is clean and current o Key focus is to use this data for our centers of excellence

Milestone B - Ms. Reinbold reported that elements 1 – 7 are on track. Element 8 to commence on April 1st

o Our partnership with VHA allows us access to the following Truven tools: 1. Core measures submissions to the Joint Commission 2. New benchmarking data for productivity against the top 100 hospitals in the country; as well as access to their best practices 3. Normalized data that allows us to do comparatives with top 100 hospitals 4. Access to top 100 hospitals best practices

o Truven acts as intermediary and clearing house for filtering data and allows Palomar Health to do comparatives with like hospitals o President and CEO Michael Covert noted that we now have an effective productivity management tool. Truven will enable us to get our arms around the

checks and balances needed for productivity and timecard management; this and it’s other advantages are all critical for the organization to manage itself strategically, clinically and financially

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DISCUSSION

FY14 Operational Initiative 2: Create a positive experience for all key stakeholders by improving clinical and business throughput and efficiency through all transitions of care

Chief Nurse Executive Lorie Shoemaker reported that all 4 milestones are on target o Milestone I – Pilot project for Patient Flow Phase 1 is complete – have begun implementing InterQual Criteria to assist with appropriateness of care

Phase II will consist of 4 focus areas: Rollout unit based discharge process to all 3 campuses ED TAT for discharged patients Urinalysis TAT Imaging TAT ED to inpatient bed TAT

o Milestone 2 – Developed several Apple modules; created consolidated dashboards for dyads

o Milestone 3 – IHI portion of the collaborative complete; will commence with VHA West Coast partnerships House wide rollouts starting with hourly rounding and bedside shift report. Executive leadership to also round on patients, family and staff

o Milestone 4 – Chief Administrative Officer Palomar Health Downtown Campus Sheila Brown led the first Patient and Family Advisor Steering Committee meeting, which included patients, families and physicians; committee to develop what this role will look like

o The Press Ganey Employee Engagement concluded on February 14th; results to be shared through the Board Human Resources committee. Physician satisfaction survey currently under way

FY14 Operational Initiative 3: Develop and implement a strong physician integration and alignment model that allows for effective communication, partnership and accountability in the management and care of patient

Physician Leadership Development Officer Dr. Duane Buringrud reported that all physician leadership modules and initiative goals are on track o Medical directors and unit nurse leaders meet monthly and round weekly; also meet monthly with all three campus administrators to share information o Currently building physician orientation program; will flesh out over the next two years. Stage 1 launched December 2013, with new physicians receiving

orientation to Clarity and IT processes as well as facility tours; currently averaging 15 new physician orientations per month o Completing policy and procedure revision for upcoming Greeley Institute pilot o Completed Mayo alignment

Dr. Buringrud commended the medical staff for providing the Chiefs of Staff and Chiefs of Staff-elects with Greely Institute training

Dr. Buringrud noted that we can expect to see a significant change in culture coming within the next year vis-à-vis partnerships between physicians and nursing, stating that a palpable positive shift is already taking place

o Mr. Covert allowed that we will move forward with solidifying these partnerships to garner the hearts and minds of Palomar Health physician and nurse leaders

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DISCUSSION

FY14 Strategic Initiative 1: Achieve and maintain Center of Excellence (COE) status in orthopedics/spine, rehabilitative care, cardiac and cardiovascular care, neuroscience and women's services

Chief Clinical Outreach Officer Della Shaw reported that both milestones are on target o Managed care payers have decided to stop accepting Center of Excellence (COE) applications for two years, however we will continue to work towards our

selected designations as the organization considers this a high priority o Non-COE areas now also have plug-and-play service line standards they can adapt for usage o Looking to implement cash pricing for certain service lines o Submitting COE application for minimally invasive gynecological surgeries

Ms. Brown noted that the OB/GYN medical staff at PHDC are actively involved and excited to create this COE, as are nursing and support services. They look forward to the facility becoming a destination location for this service line; a COEMIG site visit will be conducted on May 20th

Ms. Shaw shared information re: the Total Joint Replacement COE, noting that even though the organization may not always obtain payer designation around a particular COE (which increases reimbursement rates) the accomplishments in our clinical care result in better payments to us in many other ways; plus they are now hard-wired for lasting returns

o Chief Administrative Officer Palomar Medical Center Gerald Bracht reported that an implant fair was recently held to good attendance; the fair promoted a “one-vendor-one-price” ideology. Spine surgeons also agreed to pursue co-management as their alignment strategy. Cardiologists working to provide service enhancements to diagnostics we already provide so primary care physicians can send their patients for additional treatment if need is identified

o Ms. Brown reported that the Commission on Accreditation of Rehabilitation Facilities (CARF) has scheduled a March 10th and 11th site visit to PHDC

Ms. Shaw reported that the organization has achieved AOF volume growth of 8.1% over projected targets. Implementation of the Crimson Data System will allow us to drill into primary care physician data to focus on their referral patterns and track the progress our physician loyalty initiatives are achieving. This market intelligence also allows us to tie into the initiatives around connecting better with our primary care doctors so Palomar Health will be their system of choice

FY14 Strategic Initiative 2: Become the dominant provider of primary care in support of the total patient health experience provided, including the expansion and growth of Arch Health Partners, effective affiliations with local providers and development of a strong regional primary care network in the secondary markets

Ms. Shaw reported that this initiative is currently being reassessed vis-à-vis a better mechanism to track and measure primary care physician loyalty (Crimson data will

enable us to do this) and how we can facilitate the alignment shift o Created a standardized registration process that alerts primary care physicians when their patients are admitted to a Palomar Health facility o Working with Crimson data to create alignment / affiliation with health plans, systems and physicians recognized for high quality o Currently below target on Milestones 2 or 3 (awaiting Crimson data)

Medical Staff Development Officer Dr. Robert Trifunovic reported that a primary care physician advisory group is being created

o Will reach out to primary care physicians to get their feedback on how we can better serve their needs o A menu of services will then be created specific to those needs o Quarterly mixers with primary care physicians and specialists will develop linkage

Dr. Trifunovic also noted that the hospitalist and skilled nursing facility program is hitting all its performance parameters

Mr. Covert stated that, with the implementation of Covered California, patients will have greater opportunity for individual choice of physicians and caregivers; therefore it

is key that the organization develops relationships with insurance providers, primary care physicians and specialists. Doing so will allow Palomar Health to better manage the population and become the dominant player in this as well as secondary markets

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DISCUSSION

DEBBIE HOLLICK

13

ADDENDUM B

14

6/10/2014

Initiative Status:

EDW

• Initial build for Phase I (Cerner Data) nearly complete

• Started Business Objects training for analysts reporting across multiple divisions

• Completion of Phase I scope now targeted for March 1.

• Phase One is complete – planning for Phase 2 with Decision Support Steering

Truven

• First Core measure submission to CMS using Truven complete

• Action 0I hand-off to Finance/Human Resources complete

• CareDiscovery Advance down load complete. Planning for next steps through Decision Support Steering

Initiative Risks:

• Full implementation of the Decision Support Steering Structure to assure a thoughtful roll-out of EDW and Truven tools to maximize success of the decision support process

Outcome Measure:

• Threshold: Implement Phase 1 scope of EDW or achieve Phase 1 parallel go-live for Truven Analytics

• Target: Implement Phase 1 scope of EDW and achieve Phase 1 parallel go-live for Truven Analytics

• Maximum: Implement Phase 1 scope of EDW and achieve Phase 1 final go-live for Truven Analytics*

Milestones:

A. Initiate development of an Enterprise Data Warehouse (EDW)

1. Select EDW solution partner

2. Create a decision support advisory group, reporting to IT Governance

3. Develop work plan to achieve Phase 1 scope

4. Implement Phase 1 Scope

B. Partner with VHA/Truven and implement analytic toolset

1. Hold stakeholder presentations and determine required resources

2. Develop implementation project plan and allocate resources

3. Begin build of Care Discovery Quality Measures (CDQM) and Action OI

4. Begin submitting CY13Q3 data into CDQM parallel with Premier and validate accuracy

5. Begin build of CareDiscovery Advance

6. Begin submitting CY13Q4 data using CDQM and exit Premier contract

7. Submit FY14Q1 data into Action OI (data available for use within 45 days)

8. Submit data into CareDiscovery Advance (available for use within 30 days)

Report Date: June 6, 2014

Reporting Committees: Board Finance, EMT Systems and Resources

EMT Sponsors: Bob Hemker, Opal Reinbold Initiative Managers: Ryan Olsen (EDW), Chris Bryan (Truven) Physician Leader(s): Kolins, MD, Lee, MD, Kanter, MD Outcome Measure: Develop and implement an Enterprise Data

Warehouse and Analysis Tool kit

July 13 June 14

Initiative Budget: To be included in FY14 Budget

Budget Status:

Jan 14 Mar 14 Sept 13 Nov 13

A2 A4 A3 A1

May 14

B6

B2

B3 B4 B5 B1

FY14 Operational Initiative 1: Build and operate a decision analytics structure that supports the real time availability and standardized use of information and expertise for knowledge management and measurement of value based metrics of care.

1

B7 B8

15

6/10/2014

FY14 Operational Initiative 2: Create a positive experience for all key stakeholders by improving clinical and business throughput and efficiency through all transitions of care.

Outcome Measure:

1. HCAHPS real time top box results for Rate Hospital 0-10 for each hospital

2. Press Ganey survey results for physicians and employees

Initiative Status: • Five Patient Flow sub-groups formed with active pilot projects underway in all

groups; dashboard created for ongoing monitoring; centralized patient placement pilot underway for PMC/Pom with permanent staffing plan effective July 1st .

• Dyad development Modules 2, 3, 4, 5, and 6 of AAPL are complete; AAPL “gala” and report out on project team work scheduled for June 11th.

• Employee Engagement Survey closed at 76% response rate with a 50th percentile overall score. Physician Engagement Survey closed with 54% response rate and an 18th percentile overall score.

• Hourly rounding, bedside shift report, and executive rounding improvement bundles from the IHI/VHA Collaborative have been implemented. Weekly audits have been developed and are being conducted. Too soon to identify any trends.

• Three Patient and Family Advisor Focus Groups conducted in April; eight Patient and Family Advisors identified and are currently being on-boarded for official kick-off meeting in June.

Milestones:

1. Create a standardized patient flow process to enhance efficiency and satisfaction for all key stakeholders

2. Engage the medical staff to maximize efficiency and to enhance patient care, safety and service (Dyads)

3. Implement and spread best practices across the health system from activities learned by participation in the IHI/VHA Collaborative

4. Further the plan to engage the hearts and minds of the staff and medical staff in developing respectful partnerships with patients/families and each other (Patient/Family Advisor Role)


Reporting Committees: Board Quality Review Committee, EMT Safety and Service

EMT Sponsor: Sheila Brown, Opal Reinbold, Lorie Shoemaker

Initiative Manager: Tina Pope, Leslie Solomon, Maria Sudak

Physician Leader: Pasha, MD, Kolins, MD, Buringrud, MD, Martin, MD

Initiative Risks

• Competing priorities

• Financial constraints

Jul 13 Jun 14

Initiative Budget: To be included in FY14 Budget

Budget Status:

Outcome Measures:

• HCAHPS Target: 80% top box percentage for both hospitals

• Press Ganey Physician Engagement Target: 35% Overall Score

• Press Ganey Employee Engagement Target: 75% Overall Score

Overall Outcome Measure: * Likely Not Met

Threshold: 1 of 3 met at target level

Target: 2 of 3 met at target level

Maximum: 3 of 3 met at target level

2

Sept 13 Nov 13 Jan 14 Mar 14 May 14

1 2 3 4

HCAHPS Results: PMC Q1: 79% PMC Q3: 81% POM Q1: 66% POM Q3: 66% PMC Q2: 76% PMC Q4: POM Q2: 69% POM Q4:

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6/10/2014

FY14 Operational Initiative 3: Develop and implement a strong physician integration and alignment model that allows for effective communication, partnership and accountability in the management and care of patient.

Initiative Risks:

• Medical staff participation

• Competing priorities

• Financial constraints

Milestones:

1. Implement Phase I

• Physician Leadership Module 3

• Physician Orientation (Stage 1)

• Complete for policies and procedures assessments for perioperative and cardiology services

• Form Physician Advisory Council for external relationships

2. Implement Phase II

• Physician Leadership Modules 4 and 5

• Physician Orientation Evaluation (Stage 1)

• Develop web-based summary leadership Modules 1 & 2

• Procedure revisions complete for Greeley pilot

3. Implement Phase III

• Physician Leadership Module 6

• Launch Action Team Pilot

• Develop web-based summary physician Modules 3 and 4

• Establish plan for next phase of policies and procedures assessment

• Establish relationship with one external organization for physician engagement


Reporting Committees: Board Human Resources, EMT Safety and Service

EMT Sponsors: Duane Buringrud, David Tam, Brenda Turner Initiative Managers: Leslie Solomon, Brad Krietzberg, Maria Sudak Physician Leader: Conrad, MD, Kolins, MD, Fadul, MD, Martin, MD,

Cloyd, MD, Buringrud, MD, Flinn, MD, Lee, MD Outcome Measures: Press Ganey, HCAHPS, Physician Engagement

Jul 13

Initiative Budget: Included in FY14 budget

Budget Status: Operating within budget

Initiative Status:

• Module 6 completed April 26. Applied dyad projects (Action team projects) will be presented June 11 at mid-point gala celebration.

• Midpoint evaluation indicates significant improvement in Physician/Nursing perception of skills Modules 1-4 (p<.001)

• Physician Engagement survey completed: 55% response rate and 18th percentile system wide ranking

• Physician Orientation Stage 1 launched December, 2013 – Clarity 2.0 Major focus area January – March 2014

• Mayo Grand Rounds completed April 17: Mayo Leadership

• Greeley process improvements ongoing and integrated into established interdisciplinary teams/committee work: Informatics, Lucidoc, and Interventional Platform /SCA Consultant work.

Outcome Measure:

• Press Ganey Physician Engagement Target: 35%

• Press Ganey Physician Engagement Response Rate Target: 50%

• PG Patient Satisfaction Physician Questions Target: 50%

• HCAHPS Care from Doctors Listening carefully: 60%

• Establish one relationship with one external organization for physician engagement

Overall Outcome Measure:

Threshold: 3 of 5 met at target level

*Target: 4 of 5 met at target level

Maximum: 5 of 5 met at target level

Sept 13 Nov 13 Jan 14 Mar 14 May 14

2 1 3

3

Jun 14

17

6/10/2014

Initiative Budget: To be included in FY14 budget

Budget Status:

Initiative Status:

• Complete COEMIG COE application submission and site visit on May 20, 2014

• Developed outcomes scorecard for CT Surgery and completed Mayo scoping for CABG program

• Developed and implemented structured physician outreach model

• Created cardiology physician education plan and process for ACC data submission

• Secured strong pricing proposals for joint and spine implants to achieve decreasing cost objectives

• Created automated extraction and scorecard process for BDPI team

• Achieved target go-live data for Crimson site March 2014

• Achieved AOF volume growth of 7.3% over projected targets through April 2014

Initiative Risks:

• Health plans not requiring COE application in FY14

• Inability to manage data requirements

• Lack of departmental alignment to achieve common goals

• Payor approval

• Lack of physician engagement

Outcome Measure: No submissions to date

Threshold: One COE application submission

Target: Two COE application submission

Maximum: Achieve one new COE designation*

FY14 Strategic Initiative 1: Achieve and maintain Center of Excellence (COE) status in orthopedics/spine, rehabilitative care, cardiac and cardiovascular care, neuroscience and women's services.

Milestones:

1. COE Designations

a. Finalize list COE payor designations and prioritize

b. Create process for acquiring and maintaining formal Request for Information (RFI) structure submission and tracking

c. Develop internal COE service line standards for non COE areas

d. Develop competitive pricing structure and analyze the impact of its implementation

e. Address deficiencies from the responses from payors and implement remedies to close gaps

f. Submit COE applications

2. Market Growth/Position

a. Complete environmental assessment using newly released data

b. Reassess opportunities to advance market position

c. Develop comprehensive business development, operations and marketing plan


Reporting Committees: Board Strategic Planning, EMT Business Development and Physician Integration

EMT Sponsor: Gerald Bracht, Della Shaw, David Tam, Sheila Brown, Vicky Lister

Initiative Manager: Natalie Bennett, Jill Swartz, Brian Cohen

Physician Leader: Malek, MD, McKinley MD/Bried MD, Esmaili, MD, Sahagian, MD, Revesz, MD, Cizmar, MD

Outcome Measure: COE designation (or equivalent)

Jul 13 Jun 14 Sept 13 Nov 13 Jan 14 Mar 14 May 14

2b 1a 1e 1b 1f 2a 1c 1d 2c

4

18

6/10/2014

FY14 Strategic Initiative 2: Become the dominant provider of primary care in support of the total patient health experience provided, including the expansion and growth of Arch Health Partners, effective affiliations with local providers and development of a strong regional primary care network in the secondary markets.

Milestones:

1. Conduct patient focus groups to understand and improve patient and primary care physicians satisfaction

2. Develop and implement a consistent and accurate method to identify and notify primary care physicians of their patient being admitted to Palomar Health facilities, in order to improve physician satisfaction and safety

3. Develop a long-term recruitment and retention plan and update related agreements

4. Analyze, review and develop a menu of services that enhance and attract physician alignments

5. Research and develop a plan for alignment or affiliation with physicians in solo practices and groups, health system and health plans, which are recognized for high quality

6. Establish a high-quality, metric-driven hospitalist and skilled nursing facility program demonstrated by the year 1 performance validation

7. Assess geographic need, determine and prioritize development of new primary care practice locations


Reporting Committees: Board Finance Committee, EMT Business Development and Physician Integration

EMT Sponsor: Michael Covert, Vicky Lister, Della Shaw

Initiative Manager: Robert Trifunovic, Hollie Garcia

Physician Leader: Scott Flinn, MD, Ken Altschuler, MD, 2 non-AHP MDs tbd

Outcome Measure: Net newly aligned primary care providers

Initiative Risks:

• Exclusionary narrow network development

• Financial strength deterioration

• Inability to affiliate with payers and care delivery groups

• Outside health system alignments driving patient flow

• Lack of physician engagement

Outcome Measure:

Threshold: 15 net newly aligned primary care providers

Target: 18 net newly aligned primary care providers

Maximum: 23 net newly aligned primary care providers


Budget Status:

Initiative Status: Primary Care physician and patient focus groups completed. Compiled

feedback into menu of services to implement for PCP community.

PCP identification completed; standardization implemented. Admission

notification to PCP begun with IT help. Primary Care Advisory Group created.

Notification process using Mobile App Cortext being tested.

Completed recruitment update. Completing mentoring and retention

planning with Arch physicians to extend out to total medical staff.

Menu of services completed and have begun implementation.

Began review of Crimson Market Advantage and developing alignment

strategies between District service lines and regional physicians.

Completed Hospitalist metrics to develop high quality performance. SNF

alignment model with Arch Health Partners created after fiscal review.

Initial location evaluation and prioritization underway for primary care

practice locations, developed for 78 and 56 corridors.


1 6 2 5 3 7 4

5 19

6/10/2014

FY14 Strategic Initiative 3: Develop a delivery model that supports care coordination and transitions across the continuum, with emphasis on chronic disease management, illness prevention, and patient involvement.

Initiative Status:

• Completed baseline survey assessment and qualitative phone interviews for data collection

• Received GAP analysis from Advisory Board and presented findings to Steering Committee

• Developed and approved strategic framework and roadmap to address identified GAPs from the analysis

• Identified population for initial strategy implementation- “10,000” and initiated data collection on baseline population metrics

• Developed list of value-based metrics and approved at Steering Committee

Milestones: 1. Establish an interdisciplinary team to identify the care

components and touch points across all transitions of care 2. Develop the vision of Palomar Health’s transitions of care across

the continuum 3. Obtain input and approval for the vision from appropriate

leadership and stakeholders 4. Develop value-based metrics to be used with the future

implementation of the care continuum 5. Perform gap analysis of services needed to meet the vision and

metrics 6. Develop framework which supports coordination of system care

components, addresses deficiencies as identified in the gap analysis, and supports the agreed upon vision and value metrics

7. Develop plan for phased implementation of transitions of care model for agreed upon disease conditions for FY15 and beyond.


Reporting Committees: Board Finance, EMT Business Development and Physician Integration Committee

EMT Sponsors: Della Shaw, Steve Gold

Initiative Manager: TBD

Physician Leader: Alan Conrad, MD, Teja Singh, MD, Brian Meyerhoff, MD, TBD

Outcome Measure: A plan for phased implementation of a system of coordinated transitions of care

Initiative Risks:

• Lack of focus and discipline around planning process needed to develop the plan

• Lack of participation by broad group of stakeholders across the continuum


Budget Status:

Outcome Measure:

Threshold: Achieve first five (5) milestones

Target: Achieve first six (6) milestones

Maximum: Achieve all milestones *


1 2 3 4 6 5

6

7

20

ADDENDUM C

21

Information Technology A Year in Review

22

In the beginning…

• 2002 – Began a new journey to our electronic health record.

• 2009 – Remote Hosted our Clinical Information System

• 2011 – Board approved a new 5 year Information Technology plan – Included a base plan and an enhanced plan

• 2013 - presented an alternate resource plan to execute through a partnership with Cerner

23

IT Department Year At a Glance •Physician Experience •Increase of overall onsite staffing by 18% •Help Desk Customer service •Clarity Production Level Support increased •HIMSS Stage 6 •Technical Infrastructure Optimization •Completion of the IT Base Plan (included Regulatory compliance) •Began Implementation of the IT Enhanced Plan

Celebrations

•Revenue Cycle Optimization •Non-Cerner production support •Non-Cerner Project Prioritization •Focus on Quality Measures, Core Measures

Opportunities

•Through evaluation in services – reviewing requirements around separation of duties – Palomar vs. Cerner

Challenges

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Accomplishments • ITWorks Transition to Cerner • Lawson Financials upgrade • Clarity platform Upgrade (foundation Cerner) • Nurse call system Upgrade • Remote Hosting of Payroll system • Remote Monitoring Room Decentralization • AirStrip EKG implemented • Extension Mobility implemented • Chart Search implemented • Care Management Implemented • Multiple Pharmacy applications, including electronic prescriptions • Multiple infrastructure projects • Multiple Revenue Cycle applications and technology • Patient Portal • Phase I Enterprise Data Warehouse • On-site Data Center RemediationS • Sotera Vital sign integration to the EMR

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Project Management Timeline

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN

Q1 - 2014 Q2 - 2014 Q1 - 2015 Q4 - 2014 Q3 - 2014 Q2 - 2015

MU Stage 1 Yr 2 MU Stage 2 365 days

ICD - 10 delayed OCT 2015

Cerner Direct

ICD-10- Dx Assistant

HUB Orders

PowerInsight EDW- Determine External Data Sources

Rehab

Quality Measure Uplift (NHIQM)

Clairvia

Health Sentry – Public Health Rrpt

POP HEALTH PLANNING

Dual Coding .28 Profile Service Package

Online Bill Pay

Quality Performance Improvement- Lighthouse

MU Stage 2 • Transition of Care/Direct/Tokens • eSubmit with CQCH (timeline?) • LOINC mapping

Mayo Phase 2 ARUP to Quest Lab Conversion

Crimson

Physician Experience Phase II •Specialty Playbooks •Depart PowerPlan

Windows 2008/IE10/eSIG/CPDI

Immunizations 2.5.1 Problem Migration (SnoMed)

FetaLink

5.2 Mpages Upgrade (blue)

DQR Pilot

Physician Experience o ePrescribe o Dynamic Doc o Dragon Pilot o Meds Rec o IMO/Problem & Dx o mCDS (Multum)

LightHouse SCIP/POP Mpage Key

Bottomline Upgrade

Lawson Security Migration Lawson LBI & MSCM Upgrade

Nuance Rad Upgr

Care Fusion ES Upgrades

Lawson ESS Remote

Teletracking Orders Intfc and Upgrade

Early Out Vendor

Balance Scorecard Upgrade

Lockbox- Mobile Device Mgmt-

Asset Mgmt

User Access Optimization

Meaningful Use

Converted

In Process

Physician focused

TBD.Planned

Upgrades

IT Security Optimization Balance Scorecard Upgrade

Project Management Timeline

Vigilanz

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Planned for FY15

• Clarivia – Patient scheduling and Acuity systems house wide. • Rehab Services – Paper charts to electronic • Patient Through-put/patient location system upgrade (Teletracking) • Document Quality Review for physician documentation • Additional Core Measures/NHIQM • IT Security Optimization • Operating and Capital Budget system • SNF EMR Enhancements • Mobile Device Management Solution • Additional Revenue Cycle Enhancements • Infrastructure projects

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Help Desk Success Story

• Help Desk Customer Satisfaction increased by 42% in the first year.

• Help Desk First Call Resolution increased by 2%.

• Abandon rate decreased by 8%

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Help Desk Data Post Go-Live

Avg. Client Sat/Month 09/2013 – 05/2014

97.94%

Help Desk Goal

Palomar Contracted SLA

Avg. First Contact Resolution/Month 09/2012 – 05/2013 09/2013 – 05/2014

66.40% 68.43%

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Physician Experience Dr. Ben Kanter

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Palomar Health EHR Adoption Levels

2008 HIMSS Stage 3+ 2011 HIMSS Stage 5 2014 HIMSS Stage 6 Certification Survey - June Top 12.5% of all Hospitals in US

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Meaningful Use

• Achieved Stage 1 Meaningful Use – June 2012

• Currently in Stage 1, Year 2 reporting period – Attest July 2014

• Stage 2 - 365 Day Reporting begins – October 2014 The final rule for meaningful use Stage 2 intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information

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Physician IT Update

2011 MIAA mobile platform announced 2011 Live with CPOE 2012 Live pilot with MIAA Feb 2013 Sotera live Nov 2013 Extension eDirectory Dec 2013 Airstrip live (Cardiology) Feb 2014 Sotera live with integration into the EHR March 2014 Electronic documentation, workflow views, Dragon, Sepsis Alert June 2014 Remote printing, improved remote access July 2014 Physician Workbooks, Handoff, Group management July 2014 AirStrip secure messaging August 2014 AirStrip ED-Cardiology STEMI pilot August 2014 AirStrip OB live September 2014 AirStrip patient monitoring, EMR, images, STEMI notifications live Q3-Q4 2014 Sotera continuous BP Jan 2015 AirStrip-One OB Not listed: Tagging, Intelligent Ordering, Powerplan name change, ED Call back, DQR

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ADDENDUM D

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ADDENDUM E

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Strategic Alliance: Integra Center

Palomar Health Naval Medical Center, San Diego

David Tam, MD MBA FACHE Captain, Medical Corps, USN (ret)

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Integra Center

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Integra Center

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NMCSD – C5

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The Strategic Alliance

Integra Center

Amputee Prosthetic COE

ERSA Clinic

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board strategic & facilities planning committee full-board … · update to board on staff...

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