65,000 voices. What We ll Cover

Transcription

1 Internationally Heralded Approaches to Population Health Driven by Alaska Native/American Indian/Native American Communities IHI 28th Annual National Forum Doug Eby, MD, MPH VP of Medical Services Leandra Ross Senior Director 65,000 voices What We ll Cover How/Why SCF Created the Nuka System of Care Engagement with communities of customer-owners, and specifically how SCF s builds the Nuka System of Care around their feedback The basics of SCF s primary care system, including behavioral health integration, building design and population health The application of the Nuka System to Complex Individuals 1

2 Why listen to our story Evidenced-based generational change reducing family violence 75-90%ile on many HEDIS outcomes Benchmarked data nationally and internationally showing top in class performance in utilization, quality and satisfaction Employee turnover rate decreased 15% from Baldrige Award Years Service 13 Years Service 7 Years Service 16 Years Service 34 Years Service 12 Years Service 7 Years Service Southcentral Foundation Board of Directors 2

3 Alaska Native People Shaping Health Care 591,000 square miles Alaska is larger than Texas, California and Montana combined 3

4 Nuka Reach 4

5

6 Alaska Native people chose to assume responsibility Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission Working together with the Native Community to achieve wellness through health and related services 6

7 Goals S hared Responsibility C ommitment to Quality F amily Wellness Who really makes the decisions? 100% Control 0 Low Acuity High 1. 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) 7

8 Certainty or Agreement 12/1/2016 Hitting The Target: Rock vs. Bird Some simple rules for improvement Low High Experimenting Chaos Get together and have An dialogues allowing/positive Complexity environment Multidimensional improvements with Protocols target focus Creativity & Stds Low complexity - variables High complexity diagram 8

9 Customer Ownership Operational Principles 9

10 How to apply all of this Transition Management Advice given to us minimize disruption in order to keep confidence high (shift to tribal ownership, elimination of unions, new facilities) We decided to maximize disruption create a bold new reality We were ready to go, but we instead paused and listened very deeply for six months Huge Customer input Many staff discussions and interviews Lots of time with the Board and other key organizations All done very visibly 10

11 The Big Transition 6 Months First Steps Create Relationship Based System Create Panels and provide a Data Mall with performance reports Create Case Management one CM for every PCP Provide Same Day Access full open access visit, phone, , text Created a detailed plan covering initial 6 months of transition Managing expectations staff, customer-owners - roles changed - defined in detail Milestones predicted difficulties, improvements Executing the plan well core elements, managing capacity/leave, management present Providers and Customer Owners in Shared Responsibility 11

12 Key Improvement Customer-owner changes Actively involved in partnership with your Primary Care Provider Take responsibility for your health Get information about your health Ask questions about advice Ask for options Key Improvement Health care provider changes No longer a hero, but a partner Control Compliance Replace blaming with understanding Give customers options, not orders Providers customers with resources Make it simple 12

13 Story Behind Our Eyes Objective system design/flow 13

14 Re-Assessment of Work Flow Business Demand Estimates 3,500-4,000 physical visits per year per FTE Process rate limited through physical visits Nearly 50% of encounters had some behavioral health component Traditional Methods of Managing Workflow Preventive Med Intervention Chronic Disease Monitoring Medication Refill New Acute Complaint Test Results Provider Healthcare Support Team Case Manager Mental Health Provider Referral to Specialist after Assessment Certified Medical Assistant 14

15 Parallel Work Flow Redesign Medication Refill Chronic Disease Monitoring Test Results New Acute Complaint Preventive Med Intervention Point of Care Testing Acute Mental Health Complaint Chronic Disease Compliance Barriers Healthcare Support Team Case Manager Provider Certified Medical Assistant Behavioral Health Consultant Primary Care Clinic EAGLE How Break does it really work? 15

16 The Integrated Care Team Primary care provider - MD, DO, NP/PA Nurse Case Manager Case Management Support Certified Medical Assistants Behaviorists Dieticians Pharmacist Nurse Midwife Coverage NP/PA/CMs Co-located Psychiatry Integrated Care Team Ratios Primary Care Provider (1,100-1,400 empaneled customers) 1 RN Case Manager : 1 PCP 1 CMA : 1 PCP 1 CMS : 1 PCP 2 BHC : 6 PCP 1 PharmD : 6 PCP 1 RD : 6 PCP 1.5 CNM : PCP 2 Coverage PA/NP : 6 PCP 16

17 Integrated Care Team #1 CMA BHC Case Management Support RN Case Manager PCP Coverage NP/PA Dietician Integrated Care Teams Manager 17

18 BH Everywhere BHC Primary Care BHC in MH clinics Counseling Talking Circles Family Wellness Warriors Traditional Healing Elders Program, Nutaq Psych Co-Location Suboxone Addictions BURT Inpt Consult Liason Q-Clubhouse CMI Child-Adolesc Psych Crisis Team Wellness Care Plans Residential youth, pregnant, adults, etc. 4 Directions SCF s Story of Integrated Psychiatry Where we started Integrated BHCs Where we are Co-location of psychiatry Where we are headed Actively working on increased integration 18

19 Collaborative Team Approach Adapted from Jurgen Unutzer s presentation on the IMPACT program, AIMS Center, University of Washington Wellness Care Plan Why do we need this approach to care? System centered around Shared Responsibility Can t just use the language, need to operationalize Complexity of our customer-owner population Emotional, physical, geographical challenges, etc. Resource rich environment but still high levels of burnout Use resources well and share the responsibility Accountability is key you don t have to be the hero 19

20 Partnering with Customer Owners Living with Chronic Pain Data Mall Action Lists Controlled Medication Agreement Controlled Medications - 12 month Opiate snapshot Integrated Pain Consultant PM&R State of Alaska Drug Monitoring Website Controlled Medication Agreement & Opioid Guidelines Wellness Care Plans EHR & SharePoint Integrated Care Team members Opiate Review Committee Multidisciplinary Pain Team Support Clinics Comp Med, PT, exercise, Traditional Healing, Health Ed. Behavioral Health all integrated Key Improvement Basic Fundamentals Same day access to Primary Care Provider and Entire Team Primary Care Teams and Integrated Care Teams highly skilled in team Culturally appropriate care, Mind-Body reconnected Max-Packing, Data Mall, Virtual Care, Redefined specialist relationships Improvement Advisors, Annual plans, Mentors, Coaches, Team Development 20

21 Extended Services HIV Advisor Nutaqsiivik / FNP Home Health Waiver Care coordin. Dena A Coy Medical Social Worker Elders Program RAISE program ECHO style telemed Neurodevel. Family Wellness Warriors Initiative 21

22 Key Improvement Building redesign Culturally appropriate Meet clinical and administrative needs Clean and beautiful 22

23 Key Improvement Organizational Structure Divisions Office of the President Executive and Tribal Services Medical Services Behavioral Health Resource and Development Organizational Development and Innovation Functional Committees 1. Operations effective day to day operations 2. Quality Assurance compliance with standards etc. 3. Process Improvement improving systems and structures 4. Quality Improvement improving clinical and educational services 23

24 Baldrige Health Care Criteria for Performance 24

25 Created SCF Strategic Planning Cycle SCF Links EVERYTHING TOGETHER! 25

26 Key Improvement Workforce Development More than 50% of Southcentral Foundation s employees are Alaska Native / American Indian people 65% of managers are Alaska Native / American Indian people Workforce development programs and scholarships help Southcentral Foundation grow our own SCF Data Mall Deploying our Approach 26

27 Source: Central Pharmacy-Pharmacy tic-sheet /1/2016 Information to Knowledge 50% % SCF Central Pharmacy customer-owners requesting other medications at dispensing Better 40% 30% Change Tested Change Implemented 20% 10% Percent Average 0% 8/5/10 8/12/10 8/19/10 8/26/10 9/2/10 9/9/10 9/16/10 9/23/10 9/30/10 % Employees with Current Annual Disaster Tng % SCF Industry Best (100%) SCF Data Mall 27

28 Action List: Turning Knowledge into Action Fictitious customer-owner information Provider Performance Over Time 28

29 SCF Data Mall SCF Data Mall Learning from our Approach 29

30 SCF Balanced Scorecard Number of Visits Anchorage Area Customer-owner Visits to ER/Urgent Care Per Anchorage Area Patients Visits to ER/Urgent Care Per 1000 Native ownership begins Better Year Day per 1000 Night per

31 Emergency Department Utilization Beginning in 2008 Benchmarking to HEDIS 80 Anchorage Area Customer-owner Anchorage Area Patients Admits per Number of Admits Native ownership begins Better Year Admts per 1000 Excludes Newborns and Delivery Moms and Length of Stay must be more than 1 day 31

32 Inpatient Utilization Beginning in 2008 Benchmarking to HEDIS % Employee Satisfaction 2015 Sustained Improvements 23 % Reduction ER Visits 2008 to 2015 % Customer Overall Satisfaction % Reduction Primary Care Visits 2008 to

33 Exceeds 90 th percentile compared nationally in HEDIS (measured ongoing) Board certification Diabetes LDL <100 Diabetes care annual testing Asthma appropriate medications Tobacco screening and quit rates Cardiovascular disease control <100 Sustained Improvements 75 th - 90 th percentile compared nationally in HEDIS (measured ongoing) Cervical and breast cancer screening rates Cardiovascular disease LDL screenings Feedback from the People 33

34 What We Covered SCF discovering customer-ownership and relationships based care - creating the Nuka System of Care Engagement with communities of customer-owners, and specifically how SCF s builds the Nuka System of Care around their feedback The basics of SCF s primary care system, including behavioral health integration, building design and population health How this all applies to complex individuals Would you want to work for a company like SCF? 34

35 Would you like to live in Alaska? Are you sure? 35

36 Questions? 36

37 Site Visits, Consulting, Tours, and more! Qaĝaasakung Aleut Thank You! Quyanaa Alutiiq Quyanaq Inupiaq Awa'ahdah Eyak Mahsi' Gwich in Athabascan Quyana Yup ik Igamsiqanaghhalek Siberian Yupik Tsin'aen Ahtna Athabascan T oyaxsm Tsimshian Háw'aa Haida Gunalchéesh Tlingit Chin an Dena ina Athabascan 37