Latino Health Summit

PresentationDoug Spegman MD, MSPH, FACP

Chief 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 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 IncentivesNot 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

Thank you!Name: Doug Spegman MD, MSPH, FACPEmail: DouglasJS@elrio.org