Latino Health Summit Presentation Doug Spegman MD, MSPH, FACP Chief Quality/Medical Innovations Officer 2/16/13

Vision: To be a national model of excellent healthcare. Established in October of 1970; Tucson, AZ Federally Qualified Health Center 16 clinic sites Special Population Care: HIV/AIDS, Hepatitis C, Homeless Services (Healthcare for the Homeless) Vision: To be a national model of excellent healthcare.

Our Patients 76,190 Patients 312,198 Encounters 58% of our patients are female 32% of our patients are children age 14 or younger 62% of our patients had incomes at or below the federal poverty level 60% Hispanic/Latino * 2011 Data

Performance Improvement @ El Rio Joint Commission Accreditation NCQA: Patient Centered Medical Home: Level 3 Designation Arizona Connected Care: ACO partner Next Gen EMR: Patient Portal Project i2i Panel Management: Preventive Services/Chronic Disease Management Kaizen Event: Patient Communications Redesign: PC 2.0 Patient Driven Scheduling: Open Access Scheduling Service Excellence: Patient Satisfaction Teams Post Discharge Case Management Medication Adverse Event Reporting Pilot @ NW clinic Performance Improvement Team Pilot @ Congress location using logic model Cultural Transformation Project

Data as Foundation

Measure What is Measurable and Make Measurable What is Not So

Too Much Data?

Avoid DRIP

Data Management Performance Goal and/or benchmark for the process measured Details of how the data was obtained Numerator/Denominator description of data Timeframe of measurement Interpretation of the data presented Action 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 Strategies Start with process measures and migrate to outcome measures Make it an iterative process of data vetting Allow limited autonomy for clinician discretion

Current El Rio Alignment Strategies Quality: Mammograms and Childhood Vaccinations Missed Opportunities Financial: Panel Reports Patient 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 Driven Team Approach Redesigned Workflows Right Work by the Right People at the Right Time Actively Manage Transitions of Care

Nursing Workflow Redesign

Pre-Visit Summaries

El Rio Community Health Center Transitional Care Model Hospital Discharge Approach Collaboration with 3rd Party Payer: Hospitalizations, ED visits, High Risk Registries Incorporating 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% Follow-up success defined as Discharge Care RN was able to contact and complete the initial post-hospital follow-up with the patient and/or responsible party in the process timeframe

High Risk Patients Defined as having ≥ 3 hospitalizations in 2011 Cohort of 50 patients 72.1 % reduction of readmissions through 2012 (from 237 admissions to 66 admissions)

Continuing Our Journey To Excellence

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