Quality Improvement Efforts San Diego s Experience

Transcription

1 Quality Improvement Efforts San Diego s Experience LIHP 2 nd Evaluation Convening Meeting May 9, 2013 Peter I. Shih, M.P.H. Administrator, Health Care Policy County of San Diego

2 County of San Diego Population Million Payer County don t own hospitals or clinics Geographic Managed Care (GMC) structure (5 plans) One of 10 legacy counties (Started July 1, 2011) Within 133% of Federal Poverty Level 35,083 LIHP Enrollees as of March 31,

3 LIHP in San Diego County Clinical Network 17 Community Health Center (CHC) Organizations 58 Primary Care Sites located throughout the county 8 Mental Health Organizations including County Mental Health Services 20 Mental Health Sites throughout the county Pharmacy Network 100+ pharmacies Pharmacy Benefits Manager (PBM) 3

4 Live Well, San Diego! Building a Better Service Delivery System Provide Quality Efficient Care Integration of physical health, behavioral health, and social services to improve the quality of care and responsiveness to needs of customers Improve Access to Quality Care Access to the right care at the right time to achieve and maintain the health of an individual Improve Systems Refining programs to improve cost efficiencies, coordination, and quality of care 4

5 Pay for Performance Support the local safety net in meeting standard health outcomes and encourage Federally Qualified Health Centers to become certified as a Patient Centered Medical Home (PCMH), thus enhancing patient care coordination and quality health outcomes within the PCMH model Pay for Performance plan funded using the $3.3 million Community Clinic Primary Care Services (PCS) Fund and will be matched with LIHP reimbursement (increased PPS rate) 5

6 P4P Goals The plan consists of four sets of goals HEDIS improvement PCMH certification Care coordination improvement Mental health integration The goals are divided into three tiers, each tier building on the previous goals. Clinics would receive a predetermined PPS rate increase for each tier of goals successfully completed. 6

7 HEDIS (Healthcare Effectiveness Data and Information Set) Measures 1. Comprehensive Diabetes Care: HbA1c Control 2. Comprehensive Diabetes Care: Cholesterol Management 3. Comprehensive Diabetes Care: Controlling High Blood Pressure 4. Controlling High Blood Pressure 5. Cholesterol Management for Patients with Cardiovascular Conditions (CVC) 7

8 HEDIS (Healthcare Effectiveness Data and Information Set) Measures 6. Medical Assistance with Smoking Cessation: Advising Smokers to Quit 7. Persistence of Beta-Blocker Treatment After a Heart Attack 8. Use of Appropriate Medication for People with Asthma 9. Follow-Up After Hospitalization for Mental Illness 8

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10 Corrective Action Plan Process Any measures scored non-compliant requires a CAP ASO requests CAPs from FQHC/MH parent organizations CAPs include: goals, interventions, and evaluation process for the non-compliant measure for the upcoming quarter CAPs are due 30 days after the request Clinics are also requested to compare prior quarter with current quarter s results and evaluate the effectiveness of the interventions that were implemented

11 Best Practices/Keys to Success Commitment of Leadership to Quality Improvement Development of technology to support QI tracking and reports Establishment of a clinic QI committee Designation of an experienced QI staff person to interface with the ASO, conduct chart audits, implement QI interventions, etc. 11

12 Best Practices/Keys to Success Communication to clinical leads, physician leads, and providers of the clinical indicator benchmarks and program requirements Implementation of monthly peer review sessions to focus on disease processes including chronic disease and best practices Open and receptive communication between the clinic and the ASO 12

13 Best Practices/Keys to Success Cross-referencing pharmacy prescription data with the disease management lists from the monthly Medical Director report Sharing effective interventions identified by ASO Assistance/in-service on writing and follow up of Corrective Action Plan from the Council of Community Clinics Monetary reward to staff for outcomes achieved 13

14 Patient Experience/Satisfaction Access to Medical Home Access to Specialty Care Quality of Medical Care Chronic Care Management Program Perceived Overall Health 90% Satisfied 81% Satisfied 82% Satisfied 64% Satisfied 87% Satisfied 3% Not Satisfied 13% Not Satisfied 6% Not Satisfied 3% Not Satisfied 6% Not Satisfied 7% No Response 6% No Response 12% No Response 25% No Response 7% No Response 4,947 Surveys sent and 21% response rate

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16 econsult Specialties Endocrinology Cardiology Hepatology Neurology Neurosurgery Orthopedic Podiatry Pain Management Psychiatry 16

17 Expansion of econsult to the LIHP (Results as of Dec 2012) Approximately 84% reduction in wait time for appointments Out of 341 specialty face to face referral requests, nearly 60% (202) were appropriately addressed and resolved by econsult and did not result in face to face visits An average of 2.80 exchanges between specialist and PCP prior to close 17

18 Contacts Peter I. Shih, M.P.H. Administrator Health Care Policy Administration Health and Human Services Agency 8840 Complex Drive, Ste 255 San Diego, Ca Jennifer M. Tuteur, M.D., FAAFP Medical Director LIHP UnitedHealthcare Community & State 8840 Complex Drive, Ste 300 San Diego, Ca