1. Practice Management Improvement (PMI) Orientation Session

2. PMI Orientation Objective   Increase SBHC team’s knowledge and understanding of practice management   and practice management improvement process for SBHCs

3. Background to Practice Management Improvement

4. Quality Improvement Collaboratives California Colorado Connecticut Florida Illinois Louisiana Maine Maryland Massachusetts Michigan New Jersey New Mexico New York North Carolina Washington West Virginia Over 6 years, NASBHC has implemented quality improvement collaboratives with 99 SBHCs from 16 states. These efforts have positively effected the health care of over 150,000 students annually.

5. NASBHC’s SBHC Quality Improvement Collaboratives Adaptations of ● ● Institute for Healthcare Improvement’s (IHI) quality improvement model ● ● HRSA’s Bureau of Primary Care Health Disparities Collaboratives With funding from: ● ● CDC, Division of Adolescent and School Health ● ● HRSA, Maternal and Child Health Bureau ● ● HRSA, Bureau of Primary Health Care

6. NASBHC’s SBHC Quality Improvement Collaboratives Preventive Services Improvement (risk assessments, physical exams and STDs/HIV prevention): 3 cycles Mental Health Education and Training (mental health screening, interventions, and documentation): 2 cycles Practice Management Improvement (coding, chart documentation, clinic operations): 2 cycles Adolescent STD/HIV Avoidance Project (STD/HIV Prevention activities): 1cycle- four states

7. Cycle 1 - 2004-2005 Cycle 2 - 2005-2006

8. What is Practice Management Improvement? It is a process which describes the whole spectrum of operating an entire health care entity from then the patient walks in the door until the bill is paid.

9. Why Practice Management Improvement? PMI will improve the : ● ● Quality ● ● Efficiency ● ● Effectiveness /outcomes Of patient care

10. Why Practice Management Improvement? The PMI process will also help identify: ● ● Improvements in billing and coding Resulting in increased revenue through a billing system

11. How is Practice Management Improvement Accomplished? Through a series of: Steps Processes and Activities

12. Steps in the PMI Process

13. Orientation Data Gathering Self Assessment #1 (Pre-Assessment) SWOT skill building sessions and work plan implementation Self-Assessment #2 (Post Assessment #2) Document Results

14. Orientation and Data Gathering Familiarize staff with PMI process Complete staff profiles, demographic information, service and patient profiles, payors information and Gather data sources for use during self-assessment, such as charts, manuals, billing records, and encounter forms.

15. Self-Assessment #1 Includes the following: Completing the SCORE Model Conducing the chart review process Completing the coding compliance review

16. SWOT Analysis Analyzes the: S = strengths W = weakness O = opportunities T = threats That exist within and surround the SBHC

17. Practice Improvement Plan Includes producing a set of: 1 – 5 year short term, intermediate and long term objectives for the SBHC in the following areas: ● ● Facilities ● ● Business Operations ● ● Human Resources ● ● Care Management ● ● Practice Compliance

18. Skill building and Improvement Plan implementation Provide skill building and training sessions as identified in Pre- Assessment #1 Implement the Improvement Plan and do regular progress updates

19. Self-Assessment #2 (post assessment) After implementing the improvement plan for 6 months to a year, start the assessment process over to determine level of progress and change.

20. Document Success Time to Shine and Share Storyboards Articles in newsletters PowerPoint presentations Tell the story of your improvement to funders, foundations, press, parents, school, and community

21. Tools for the PMI Process Web Tutorial PowerPoint presentations Word Documents Excel Workbooks Instructions for sessions and processes Technical Assistance from NASBHC

22. Practice Management Improvement (PMI) Initiative - NASBHC 1 st Cycle (Beta Test)   6 school-based health centers from 4 states (California, New York, Texas, West Virginia) 2 nd Cycle   7 SBHCs in MA and 4 SBHCs in WV w/ 330 funded sponsoring organizations   In MA and WV learning sessions were open to SBHCs statewide

23. PMI Activities during the NASBHC initiative   3-4 Learning Sessions   2 Site visits (pre and post SCORE model, chart review, and coding compliance review)   1 Site visit (mission statement, SWOT analysis, outline practice management improvement plan)   Workplan for each objective   Quarterly progress reports   Monthly conference calls   Storyboards   Celebration

24. PMI Results for the NASBHC Initiative All 17 sites: Completed Strengths, Weaknesses, Opportunities, and Threats (S.W.O.T.) analysis of their SBHC Developed a practice management improvement plan/strategy with short and long term objectives to support the SBHC mission Demonstrated improvement in SCORE Model ratings on all 5 domains (facilities, business operations, human resources, care management, and practice compliance) from pre to post site visits

25. PMI Results for the NASBHC Initiative Demonstrated improvement from pre to post chart reviews /coding compliance audits in appropriate documentation and coding of evaluation and management visits, preventive health visits, and mental health visits Incorporated CQI tool sentinel conditions, chart audit criteria, and resources into the care management and practice compliance activities

26. PMI SCORE Model Ratings Cycle 1 (pre and post)

27. PMI SCORE Model Ratings Cycle 2 (pre and post)

28. PMI and NASBHC Web tutorial available September 2008 www.nasbhc.org

29. Questions and Evaluation