doug spegman md, msph, facp chief quality/medical innovations officer 2/16/13
TRANSCRIPT
Latino Health Summit
Presentation
Doug Spegman MD, MSPH, FACPChief Quality/Medical Innovations Officer
2/16/13
Established in October of 1970; Tucson, AZFederally Qualified Health Center16 clinic sitesSpecial Population Care: HIV/AIDS, Hepatitis C, Homeless Services (Healthcare for the Homeless)
Vision: To be a national model of excellent healthcare.
76,190 Patients312,198 Encounters58% of our patients are female32% of our patients are children age 14 or younger62% of our patients had incomes at or below the federal poverty level60% Hispanic/Latino
* 2011 Data
Our PatientsOur Patients
Performance Improvement @ El RioJoint Commission Accreditation
NCQA: Patient Centered Medical Home: Level 3 DesignationArizona Connected Care: ACO partnerNext Gen EMR: Patient Portal Projecti2i Panel Management: Preventive Services/Chronic Disease ManagementKaizen Event: Patient Communications Redesign: PC 2.0Patient Driven Scheduling: Open Access SchedulingService Excellence: Patient Satisfaction TeamsPost Discharge Case ManagementMedication Adverse Event Reporting Pilot @ NW clinicPerformance Improvement Team Pilot @ Congress location using logic modelCultural Transformation Project
Data as Foundation
Measure What is Measurable and
Make Measurable What is Not So
Too Much Data?
Avoid DRIP
Data ManagementPerformance Goal and/or benchmark for the process measuredDetails of how the data was obtainedNumerator/Denominator description of data Timeframe of measurementInterpretation of the data presentedAction plan based on the analysis of the data
Cascading Transparent Meaningful Data
Well Child
VIP Patient Letters
Immunizations: Combo 10
Drill-Down Report
Aligning Goals and Incentives
Not Aligned Aligned
Specific Alignment StrategiesStart with process measures and migrate to outcome measuresMake it an iterative process of data vettingAllow limited autonomy for clinician discretion
Current El Rio Alignment StrategiesQuality: Mammograms and Childhood Vaccinations Missed OpportunitiesFinancial: Panel ReportsPatient 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.
El Rio – Tier 1 Goal (60.9%)
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 DrivenTeam ApproachRedesigned WorkflowsRight Work by the Right People at the Right TimeActively Manage Transitions of Care
Nursing Workflow Redesign
Pre-Visit Summaries
El Rio Community Health Center
Transitional Care ModelHospital Discharge ApproachCollaboration with 3rd Party Payer: Hospitalizations, ED visits, High Risk RegistriesIncorporating 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 PatientsDefined as having ≥ 3 hospitalizations in 2011Cohort of 50 patients72.1 % reduction of readmissions through 2012 (from 237 admissions to 66 admissions)
Continuing Our Journey To Excellence
