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

2. 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.

3. 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

4. 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 NW clinic
Performance Improvement Team Congress location using logic model
Cultural Transformation Project

5. Data as Foundation

6. Measure What is Measurable and Make Measurable What is Not So

7. Too Much Data?

8. Avoid DRIP

9. 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

10. Cascading Transparent Meaningful Data

11. Well Child

12. VIP Patient Letters

13. Immunizations: Combo 10

14. Drill-Down Report

15. Aligning Goals and Incentives
Not Aligned
Aligned

16. 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

17. Current El Rio Alignment Strategies
Quality: Mammograms and Childhood Vaccinations Missed Opportunities
Financial: Panel Reports
Patient Experience: Teamwork Metric Incentive

18. 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.

19. El Rio – Tier 1 Goal (60.9%)

20. 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?”

21. 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

22. Nursing Workflow Redesign

23. Pre-Visit Summaries

24. 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

26. Assessment of Criticality (2012 Data/1,501 Hospitalizations)
Status 3: Patient requires intense care with PCP follow-up within 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

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

28. Continuing Our Journey To Excellence

29. Thank you! Name: Doug Spegman MD, MSPH, FACP