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Alaska Native People Shaping Health Care SCF - 2011 Baldrige Winner CEO 2004 McArthur Genius Winner Copyright © 2011 Southcentral Foundation. All Rights.

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Presentation on theme: "Alaska Native People Shaping Health Care SCF - 2011 Baldrige Winner CEO 2004 McArthur Genius Winner Copyright © 2011 Southcentral Foundation. All Rights."— Presentation transcript:

1 Alaska Native People Shaping Health Care SCF Baldrige Winner CEO 2004 McArthur Genius Winner Copyright © 2011 Southcentral Foundation. All Rights Reserved. NOTICE: Unless otherwise indicated, this work represents copyrighted material protected by United States and international law. This work may not be used, reproduced, downloaded, disseminated, published, transferred or transmitted, in whole or in part, in any form or by any means, electronic or mechanical, including photocopying, recording or information storage and retrieval, except with the express written permission of the publisher. This work may not be edited, altered, or otherwise modified, in whole or in part, except with the express written permission of the publisher. Doug Eby, MD, MPH, VP of Medical Services Denise Morris, Compliance Administrator

2  If you could own completely your own healthcare system, what would you do –as a customer-owner?  We had that choice – and chose to fundamentally rethink and redesign every single thing in the entire system.  We kept the best that modern medicine has to offer and we kept the medical professionals, but we redefined the fundamental understandings, redefined the ‘core concepts’, and changed dramatically the whole system platform.  Customer Control at both the macro and micro level – shared partnership, commitment to quality, family wellness.  The Triple Aim – population health, optimal individual experience, with long term affordable cost. Customer Control Copyright © 2011 Southcentral Foundation. All Rights Reserved.

3 Customer Ownership Copyright © 2011 Southcentral Foundation. All Rights Reserved.

4  Evidenced-based generational change reducing family violence  Over 50% drop in ER visits, Hospital Days, and visits to Specialists  Significant change in primary care utilization – less visits, more other  75-90%ile on most HEDIS outcomes and quality  Benchmarked data nationally and internationally showing top in class performance in utilization, quality, satsifaction  Employee Turnover rate less than 12% annualized (very low)  Customer and staff overall satisfaction over 90%  In an urban Alaska Native community with huge challenges  Sustained for over a decade and continually improving  Very long list of external recognitions – Malcolm Baldrige National Quality Award this year. Why listen to our story Copyright © 2011 Southcentral Foundation. All Rights Reserved.

5  Personal, trusting, accountable long term, first name, whole person partnering with knowledge, advice, support – woven into life – in family/context – for a lifetime  Specialists – rebuilt around longitudinal, ever present, personal partnering – 5 min response time  Inpatient Care – 50% optimizing self care and family care  ‘Pull’ Discharges and Immediate Follow-Up support  Niche Populations w intensive support layered on  Rebuilding systems around how people experience them – 3 Year Gestation, adolescence, elder care Rethinking The Whole Thing Copyright © 2011 Southcentral Foundation. All Rights Reserved.

6 Baldrige Health Care Criteria for Performance Excellence Framework - A Systems Perspective 2011–2012 Health Care Criteria for Performance Excellence Copyright © 2011 Southcentral Foundation. All Rights Reserved.

7 Control: Who really makes the decisions Acuity “Control” The “System” Patient/Family 0 LowHigh Control – who makes the final decision influencing outcome? 2.Influences – family, friends, co-workers, religion, values, money 3.Real opportunity to influence health costs/outcomes – influence on the choices made – behavioral change 4.Current model – tests, diagnosis, treatment (meds or procedures) Copyright © 2011 Southcentral Foundation. All Rights Reserved.

8 Low High Complexity - Variables Complexity Low High Certainty or Agreement Protocols & Stds Chaos Some simple rules for improvement Complexity Diagram Experimenting Get together and have dialogues Allowing positive environment Multidimensional improvements with target focus Creativity Copyright © 2011 Southcentral Foundation. All Rights Reserved.

9  It is THE core clinical service that we offer  It is THE key set of skills we train every person on – Core Concepts  It is THE way that we manage personnel  It is THE core priority for how we design services, improve flow, decrease waste, design facilities, measure success, and recognize and reward excellence  The ability to genuinely connect requires skilled ability to connect in story and walk in trusting, accountable, personal, long-term relationships with barriers removed It’s all about Relationships Copyright © 2011 Southcentral Foundation. All Rights Reserved.

10 Relationships between customer-owner, family and provider must be fostered and supported Emphasis on wellness of the whole person, family and community (physical, mental, emotional and spiritual wellness) Locations convenient for customer-owners with minimal stops to get all their needs addressed Access optimized and waiting times limited Together with the customer-owner as an active partner Intentional whole-system design to maximize coordination and minimize duplication Outcome and process measures continuously evaluated and improved Not complicated but simple and easy to use Services financially sustainable and viable Hub of the system is the family Interests of customer-owners drive the system to determine what we do and how we do it Population-based systems and services Services and systems build on the strengths of Alaska Native cultures Operational Principles Copyright © 2011 Southcentral Foundation. All Rights Reserved.

11  ALL SCF employees – 3 day training – led by CEO and team – re-define the true core skills and priorities – with training – for everyone  Understand how we impact others by: Understanding your relational style – shapes, 5 dynamics, CDR Understanding how your experiences contribute to how you approach others  Words and Tools – 4 player, ladder, left hand column  Learn how to articulate your story from heart Understand the power of empathy and compassion for your self and others Develop THE core skill of deep, effective listening Core Concepts (Relationships) Copyright © 2011 Southcentral Foundation. All Rights Reserved.

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13  Align with corporate and department goals and objectives  Detail each of the goals and accountabilities  Include quantitative and qualitative data  Developed with employee input and feedback Performance Development Plan Copyright © 2011 Southcentral Foundation. All Rights Reserved.

14 Information to Knowledge Copyright © 2011 Southcentral Foundation. All Rights Reserved.

15  PCP – primary care provider - MD, DO, NP/PA  Nurse Case Manager  Case Management Support  Certified Medical Assistants  Behaviorists and Dieticians  Pharmacist (partially implemented)  Nurse Midwife (partially implemented)  Coverage NP/PA/CM’s  Co-located Psych  Coders, data entry, etc The Integrated Care Team Copyright © 2011 Southcentral Foundation. All Rights Reserved.

16  Advanced Access – appointments when the customer wants – same day primary care  Case Management/Care Coordination  Max Packing  Service Agreements between departments  Mind/Body back together – BHC - Behaviorists  Hospitalists in Pediatrics and Internal Medicine  Bring services to them – BH, Dietician, Pharmacist, Midwife – fully integrated high volume specialists  Data Mall, Improvement Staff to learn and drive  Facility Design – at all levels supporting philosophy Some Improvement Specifics - Clinic Copyright © 2011 Southcentral Foundation. All Rights Reserved.

17  Expanded BHC role – really expanded  Wellness Care Plans for the highest utilizing 5% - facilitated by BHC’s and placed in the E.H.R to drive whole system behavior  Full integration of Midwives and Clinical Pharmacists in PCP location/team  Experimentation with expanded teams  Decrease in panel size  Chronic Pain and Addiction support  Suboxone support for narcotic addiction  Co-Located Psychiatrist and MH care coordination for long term co-management of CMI population ICT Current Work Copyright © 2011 Southcentral Foundation. All Rights Reserved.

18  Nutaqsiivik – intensify/reduce the case load – 30 mos  Prenatal Care - Declaration of a three year gestation  Wellness Care Plans (WCP) - positive/asset based  Clinician Mentor Program - CDR/Five Dynamics  CMS – Case Management Support Redefinition  Patient Portal – Our version  Data Mall – Revitalization/Full Transparency  Transitions in Care Project More Current Improvements Copyright © 2011 Southcentral Foundation. All Rights Reserved.

19  Data Analysis – MegaData – Social/Situational  Elders Program and Wellness Care Coordination Program  Redesigned Behavioral Health – Learning Circles, Tribal Doctors, FWWI  Intensive youth suicide intervention group  Healthy Lifestyles Clinic – Family/Children  IA/IS Capability  Service Level Agreements Some More…

20 Copyright © 2011 Southcentral Foundation. All Rights Reserved Native ownership begins Anchorage Area Patient Visits to ER/Urgent Care Per 1000

21 Beginning in 2008 Benchmarking to HEDIS Emergency Department Utilization Copyright © 2011 Southcentral Foundation. All Rights Reserved.

22 Excludes Newborns and Delivery Moms and Length of Stay must be more than 1 day Native ownership begins Copyright © 2011 Southcentral Foundation. All Rights Reserved. Anchorage Area Patients Admits per 1000

23 Inpatient Utilization Beginning in 2008 Benchmarking to HEDIS Copyright © 2011 Southcentral Foundation. All Rights Reserved.

24 Southcentral Foundation Cumulative Per Capita Expenditure Changes

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31  The Goal – Triple aim  The Framework for Excellence – Baldrige Categories  Customer-Ownership – Customer Driven  It’s all about Relationships  Longitudinal Partnering – Shared Responsibility – on THEIR terms – and layering in all other services  Weaving Services INTO their lives  Workforce Development – in all dimensions  Improvement Capability – Learning Organization  Transparent data and accountability Change Everything

32 It’s All About Customer- ownership and Relationships Copyright © 2011 Southcentral Foundation. All Rights Reserved.

33  No longer a hero but a partner Control does not equal compliance Replace blaming with understanding Give customer options, not orders Provide customer with resources Make it simple Health care provider changes Copyright © 2011 Southcentral Foundation. All Rights Reserved.

34  Be active, not passive  Take responsibility for your health  Get information about your health  Ask questions about advice  Ask for options Customer-owner changes Copyright © 2011 Southcentral Foundation. All Rights Reserved.

35 Thank You! Qaĝaasakung Aleut Quyanaq Inupiaq Háw'aa Haida ‘ Awa'ahdah Eyak Mahsi' Gwich’in Athabascan Igamsiqanaghhalek Siberian Yupik Tsin'aen Ahtna Athabascan T’oyaxsm Tsimshian Gunalchéesh Tlingit Quyana Yup’ik Chin’an Dena’ina Athabascan Quyanaa Alutiiq Copyright © 2011 Southcentral Foundation. All Rights Reserved.

36 Frank Frank is a 79 year old widower with Chronic Obstructive Pulmonary Disease (COPD), Heart Failure and Diabetes. He lives alone. Frank is very anxious as he is often very breathless and feels unable to manage. He has phoned the practice of his primary care physician on several occasions requesting a home visit and over the last year he has frequently been taken to the local emergency department, after he has dialled 911. He has been admitted to hospital on 7 occasions in the last year and now keeps a small packed suitcase by his chair.

37 Frank’s Medical Diagnosis  COPD  CHF  Diabetes  Frank’s Healthcare providers Primary Care, Cardiologist, Pulmonologist, Endocrinologist, Nutritionist, Physical Therapist, Pharmacist, Home Health.

38 Realities about Frank  Frank IS in control Getting and taking meds Using inhalers Eating, sleeping, exercising, socializing Calling 911  Frank is costing a great deal of money  Frank is getting worse  No one ‘knows’ Frank

39 Nuka – a different look at Frank  Primary Diagnosis Anxiety, Loneliness/isolation, insecurity, confusion, dependency, lack of confidence  Secondary Diagnosis COPD, CHF, Diabetes  Primary interventions Personal care coordination, integration of care by PCP team, determination of motivators, behavioral based motivational interventions, consolidation of meds/tx.

40 Please contact: Erica Srisaneha Southcentral Foundation Or log onto our website at Questions? Copyright © 2011 Southcentral Foundation. All Rights Reserved.


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