The GI Lab at Denver Health General intro AIDET Today we’re here to share a little bit about DH, the GI Lab and some of the exciting things we have going on. We’ll talk a little bit about growth, capacity and how you can get in and fit in with what we’re doing Brian Listy, RN – GI Lab Manager Diogo Barbosa – GI Lab Care Navigator

Denver Health… A comprehensive, integrated health system providing level one care for all, regardless of ability to pay Twenty-five percent of all Denver residents receive their health care at Denver Health Provide access to the highest quality health care, whether for prevention, or acute and chronic diseases, regardless of ability to pay Basic intro to DH We been doing this for a very long time – 157 years Clearly, we don’t care if you have the ability to pay

Denver Health… Start with basic intro to DH “We been doing this for a very long time” Clearly, we don’t care if you have the ability to pay

The New Look of Denver Health… Start with basic intro to DH “We been doing this for a very long time” Clearly, we don’t care if you have the ability to pay

The GI Lab at Denver Health… Direct Access endoscopy: colonoscopy, flexible sigmoidoscopy and EGD Our dedicated team of Doctors and Nurses provides expert, patient centered care ~3000 colonoscopies annually (5,000 total procedures) In-house, patient centered scheduling Increasing capacity for new patients GI Lab intro, 12 pre-post bays, 4 procedure rooms Team of 6 MDs, 14 RNs, techs, scheduling team; we’re a pretty typical OP endoscopy center Our doctors are DH employees, not outside group Scheduling is probably the most exciting thing we’ve been doing for the past year or so, If you’re looking for a way to have the greatest positive impact on your clinic, look at scheduling We’re actively growing and hiring and this is almost completely related to improvements in our scheduling process and other changes to process and workflow

GI Lab Timeline… <4,000 procedures No growth plan Stable capacity Not staffed for growth CCSP funded Navigation started 2014 New leadership Strategic plan developed Scheduling identified as key process Stable volume & capacity 2015 New EMR Scheduling pilot Staff expansion Increased volume Capacity action plan developed Navigation capacity increase 2015-16 2016 Patient centered, creative scheduling New hours of operation Aggressive volume expansion (+7.5%) Aggressive capacity expansion (+11%) External referral focus 2017 Continued Capacity expansion Focus on access 500+ additional procedures Strengthening existing partner relationships Building new partner relationships 80% by 2018 2018 Overview of growth and capacity 80 by 18 adds value to department, organization and SOC

Key Changes in the GI Lab… 2016 Epic implementation Internalized scheduling Stable capacity (avg. ~108 appts./week) Small increase in volume Increased navigation volume Epic = simplified internal referral process, better/faster communication and easier, more reliable scheduling Scheduling = full control of appts. & schedule fill, flexible, patient centered, quality control, experimentation, piloting Schedulers that are a part of the team, bought in to the mission, work directly with clinical staff, fully vested in completed procedure Navigation has exploded, started 3 years ago with 200 patients and this last year we navigated 700+ (2015=200, 2016=300, 2017=700+)

Key Changes in the GI Lab… 2017 Scheduling fully functional Patient centered, creative scheduling New hours of operation Aggressive volume growth plan (+7.5% YTD over 2016) Aggressive capacity expansion (+11% YTD over 2016) External referral focused Started the year with a brand new scheduling team which has been THE key to success in 2017 We ask every patient when THEY need to have their procedure We give them options, Flexible days/times Real time adjustments Work directly with clinical staff/MDs Aligned patient schedule with staff schedule, over time these had gotten off track Planned for +5% volume Planned for +3% capacity Revisiting/improving existing partnership, looking for opportunities to improve Streamlining external referral process Improving existing relationships Looking for new opportunities to partner Open to feedback on current process

Navigation in the GI Lab… DH and CCSP have partnered for more than 10 years CCSP grant funded patient navigation started 2014 Denver Health’s CCSP funded Patient Navigator has navigated over 1,250 patients to date Average of 450 GI patients navigated per year 2016 was a BIG year! 700+ patients navigated

Navigation in the GI Lab… Navigation continuity (10 patients diagnosed with CRC) It’s all about Patient relationships Clinical relationships are crucial too (MD, RN, navigators, etc.) Navigating YOUR patient to and through Denver Health

Capacity in the GI Lab… Capacity increase due to scheduling changes and procedural efficiency gains Aligned MD and RN schedules with patient schedule Greatest capacity gained from 4th procedure room Average 119 appointments/week (+11%) Planned additional 2-4 appointment slots per week Adding a 4th procedure room allowed us to reduce average procedure time by 6 minutes We actually gained 11 slots per week, almost triple our target Looking to add an additional 2-4 (or 11) additional slots in the coming year

External referrals to the GI Lab… YES! The GI Lab does accept external referrals Colonoscopy, EGD, flex sig, ERCP, EUS Medicare, Medicaid, commercial, uninsured* Timely follow-up communication Detailed report with HD images given to patient at DC Detailed report with HD images faxed or emailed to provider Scheduling In-house, responsive, flexible, creative and patient centered How do you refer to the GI Lab at DH? *Must be a resident of the City and County of Denver and meet financial criteria Diogo should cover the insurance piece on this slide

Link: Direct Access Referral Form Accessing services in the GI Lab… REQUEST FOR ELECTIVE DIRECT ACCESS FLEXIBLE SIGMOIDOSCOPY, COLONOSCOPY, OR UPPER GI ENDOSCOPY Link: Direct Access Referral Form Demo, open link and brief discussion of form Important to complete accurately Patient and provider contact info crucial Symptom vs. asyptom Major reasons for denial other than UNDER AGE = incomplete/illegible form, missing contact info (pt or provider)

GI Lab Contacts and Connections… GI Lab Key Contacts GI Lab Scheduling 303.602.1926 Brian Listy, RN Manager brian.listy@dhha.org 303.602.1980 Joel Levine, MD Chief Gastroenterologist joel.levine@dhha.org 303.602.5018 Diogo Barbosa Care Navigator diogo.barbosa@dhha.org 303.602.6814 Visit Digestive and Liver Health For more information

Other Denver Health Contacts Denver Health Contacts and Connections… Other Denver Health Contacts Website: DenverHealth.org Main Hospital: 303.602.4000 Enrollment Office: 303.602.2310 Enrollment Van: 303.912.0263 Community Cancer Resource Center 303.602.6809 For your convenience, Denver Health accepts a variety of insurance plans including: Medicaid, Medicare and many more

Thank you! Questions?