700 E. Jefferson Street, Suite 100 Phoenix, AZ (602)
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1 700 E. Jefferson Street, Suite 100 Phoenix, AZ (602)
2 History of Health Care Quality Models History of Quality Initiatives/Models are all over the Board! Statistical Quality Control (Manufacturing or Business model) Quality Assurance Quality Improvement Managed Care Total Quality (PDCA/PDSA) Collaborative Initiatives/Rapid Cycle Improvement (Don Berwick- IHI) Best Practices/Benchmarking Disease Management Population Management IPAs Triple Aim Health Care Value Proposition MU/PCMH/ACO/Care Management
3 History of Quality Models
4 History of Quality Models
5 History of Quality Models
6 History of Quality Models
7 History of Quality Models
8 History of Quality Models
9 History of Quality Models
10 History of Quality Models
11 History of Quality Models
12 History of Quality Models
13 History of Quality Models
14 History of Quality Models
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16 History of Quality Models
17 History of Quality Models
18 Current Health Outcomes Initiative Today we are moving towards Accountable Care Models that involved healthcare outcomes and financial measurements on a global scale for a given populations of patients
19 Alliance for Community Health Centers - AACHC The AACHC Experience as an Example: Moving Towards Implementation of an Independent Practice Association (IPA) or Statewide ACO
20 AACHC Network 2013 Member sites are located in 14 of the 15 counties in Arizona. AACHC members serve patients in 213 statewide locations. Over 161 of those sites are FQHCs and FQHC look-alike. Community Health Centers served over 540,000 patients throughout Arizona with over 1.7 million patient visits in Each dot represents a city that has member services available to the public.
21 Arizona Federally-Qualified Health Centers Payer Mix* (average) *Excludes Neighborhood Outreach Access to Health
22 Community Health Centers Range of Coordinated Services-Medical Home Clinical Family Medicine Ancillary Counseling Pediatrics Radiology OB/GYN Laboratory Prenatal Physical Therapy Pharmacy (340B drug formulary) Enabling Dental Translation Dieticians Eligibility Behavioral Health Transportation HIV/AIDS Outreach Immunizations Mobile programs Health Education Programs Chronic Disease Management Referrals for Specialty Services Nutrition Counseling
23 Federal Measurement Tools for FQHCs Uniform Data Set - HRSA Reporting (Demographics, clinical/quality, financial) % Hypertension patients with BP <140/90 AZ = 70.6 compare to national rate 57.8% % Adults assessed for tobacco is 68.6% or higher AZ =100% compared to national 93.8 Medical Homes o 67% of FQHCs have achieved level 3 PCMH accreditation o 100% of FQHCs have adopted EMR
24 Community Based Measurement tool for Community Health Centers CHiR -The Center for Health Information and Research- ASU CHiR fosters collaboration for public health, public policy, computer science, economics, health information Technology and consumer knowledge CHiR uses well-founded research methods in order to provide objective health care services/insurance coverage information for the private and public sectors
25 Value of CHiR Results CHiR preliminary results for FQHC QUALITY based on 128 *HEDIS Measures (Healthcare Effectiveness Data and Information Set) o 65% of the 128 measures FQHC s scored significantly better than non-fqhc s o 26% of the 128 measures there was no strong statistical variance o 9% of the 128 measures Non-FQHC s scored better 70 HEDIS Measures of Prevention/Screening (well woman, prenatal care, immunizations, screens) o 84% of the 70 measures FQHCs scored better than non-fqhcs o 6% of the 70 measures there was no statistical variance o 10% of the 70 measures non-fqhcs scored better than FQHCs Note:.01 Strong and.05 Moderate * External Quality Reports Organization (EQRO) HEDIS in not comparable to CHiR due to collection and reporting design
26 Alliance for Community Health Centers INDEPENDENT PRACTICE ASSOCIATION (IPA) DEVELOPMENT
27 Integrated Provider Association (IPA) Messenger Model IPA: A model of contracting on behalf of multiple, independent practices that could be considered competitors. The Messenger acts on behalf of each practice without sharing any competitive information between the CHCs. Messenger Model provides economies of scale in the time and effort necessary to prepare for negotiation of CHC contracts. Messenger Model supports non-exclusivity of contracting where CHCs each hold individual contracts and may negotiate with payers independently.
28 Integrated Provider Association (IPA) Integrated IPA Model: Can negotiate contracts around integrated quality of finances A network of health care providers/organizations which provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for clinical outcomes and health status of the populations served. Creates more healthcare value by adopting evidenced-based guidelines, sharing best practices, and setting quality and performance expectations Provides the opportunity to pool covered lives to improve outcomes for population management and use scale to achieve a better set of terms for all practices.
29 AACHC and CVN - Collaborative Alignment FQHC-LAs FQHCs RHCs FQHC-LAs FQHCs RHCs Associate Members AACHC Sponsors CVN Primary Care Association Represent BPHC Grantees Support CHC Services throughout AZ Assistance, Education & Training Peer Networking Integrated Services Network Integrated Data Management Quality Improvement Initiatives Best Practice Performance Integrated Provider Association
30 Integrated Health Care Patients, Services, Culture and Community
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