UT Medicine Clinical Programs Strategic Plan 2011 2013
Vision Mission Values To be recognized as the best multi-specialty, academic practice in the region. The mission of UT Medicine s Clinical Programs is to provide excellent patientcentered care that is built on what we teach and discover. Expert patient-centered care consistent with latest medical evidence Compassionate, professional, and ethical High quality, accessible, and convenient customer service Integration with education & research missions Community responsiveness Market Differentiators 40-year history of providing medical education, research, and clinical care to the region. Faculty members with clinical, teaching, and research expertise. The largest integrated multispecialty group in the region. Academic practice in partnership with affiliated teaching hospital systems. One of four NCIdesignated Cancer Centers in Texas. A medical practice built on what we teach and discover. 2
Patient- Centered Care Culture and Communication Clinical Operations and Infrastructure Primary Care Education and Research External Relationships System Redesign 3
Patient-Centered Care Provide consistent, high quality, and patientcentered care at all locations. Improve systems for accessible and convenient appointments. Provide an electronic means for patients and referring physicians to access their records and communicate with their physicians. Empower medical directors to play a critical role in all practice locations. Culture and Communication Expect all clinicians to provide outstanding service to each other. Provide practice management literacy training for all faculty and staff. Improve communication between chairs, departments, division chiefs, faculty, and clinics. Design a reward system that supports our efforts for culture change. Create a culture of maximum transparency. Minimize referral of patients outside system. Improve communication between Dean s Office, Chairs, Division Chiefs, faculty, and staff and develop culture of partnership in meeting goals. Develop a compensation and incentive system recognizing contributions from clinical care, teaching, and research. Develop a marketing plan for UT Medicine. 4
Clinical Operations and Infrastructure Develop a service line strategy in collaboration with our hospital partners. Optimize revenue cycle. Maximize physicians productivity. Primary Care Build internal primary care base as an integral part of our UT Medicine strategy. Partner with Community Medical Associates to be their preferred source for specialty providers. Develop program for outside MD s to implement EPIC. Communicate between EPIC and other hospital electronic medical record systems. Identify, hire, and train the support personnel to deliver quality customer service. Provide interviewing training and decrease length of time to fill positions. Acquire patient-centered medical home recognition for all UT Medicine primary care practice locations and hospital-based primary care locations as appropriate. 5
Education and Research Integrate medical students and trainees into all clinical care locations. Create mechanisms to expose non-md graduates to the clinical environment. Create opportunities for medical students to learn more about organizational and system aspects of care delivery. Use data from clinical practice for quality improvement, professional education, and health services research in partnership with the Center for Patient Safety and Health Policy, Center for HSR, REACH, and Center for Health Disparities. Begin pilots regarding payment systems/delivery systems with a goal. Expand clinical research. External Relationships Recognize University Health System, the South Texas Veterans Health System, and CSR as our primary teaching hospitals. Improve UT Medicine market position as the only integrated academic physician practice in the region. Use EMR to align outside physicians. Develop partnerships with local employers to provide medical services and educational programs to their workforce. Build relationships with local physicians and exceed expectations for referrals and evidence-based care. 6
System Redesign Implement mechanism for access to data across organizations on patient and aggregate levels. Build infrastructure to allow providers to understand their utilization in all settings and improve our ability to define performance based on quality metrics. Develop hospital alignment strategies to pave the way for ACO model of care. Develop partnership with payers and employers. 7
Provide consistent, high quality, and patient-centered care at all locations. Use data to improve the patient experience and processes. Ask UT Medicine medical directors to improve two areas of concern in patient satisfaction surveys each year. Medical directors with CMO oversight Begin first quarter Obtain regular reports of patient satisfaction in hospital-based locations. Work collaboratively with hospital partners to achieve patient satisfaction of 90% or higher. Luci Leykum Luci Leykum FY 2013 Implement parallel patient-centered operational processes at UT Medicine locations in hospitals and UT Medicine locations. Will start work on front-end processes in UHS-based clinics. Integrate medical directors at UHS locations into clinical operations. Dale Flowers, Luci Leykum, Carlos Rosende Dale Flowers, Luci Leykum, Carlos Rosende Provide customer service training for all UT Medicine employees with implementation of ongoing monthly activities for UT Medicine managers. Barb Cordell FY 2013 Call patients the day after procedures in UT Medicine locations. Barb Cordell Ongoing 8
Improve systems for accessible and convenient appointments. Benchmark of same or next-day appointments for primary care. Benchmark of specialty visits. Implementation of evening and weekend care at all UT Medicine clinical locations and at hospitals as appropriate. Track the number of patients referred outside UT Medicine, the reasons, and provide feedback to decrease outside referrals. Primary care clinic managers Specialty care clinic managers with support from Chairs and Barb Cordell Primary care clinic directors & managers (see culture and communication metrics) : 2 weeks without prior review FY 2013: 1 week without prior review Provide an electronic means for patients and referring physicians to access their records and communicate with their physicians. Introduce electronic medical records to all patients with access to My Charts. Andrew Krecek December, 2011 Provide read-only access to EPIC for referring physicians, 9
Empower medical directors to play a critical role in all practice locations. Develop a medical director training program for all directors. Include medical directors in all staff hiring decisions. Carlayne Jackson with assistance from Luci Leykum, Carlos Rosende, Adam Ratner Carlayne Jackson and Barb Cordell Design: Implementation: FY 2012-2012 10
Expect all clinicians to provide outstanding service to each other. Develop a survey for internal use at the specialty level. Track turnaround time for outpatient referral letters with expectation that referral notes will be sent to referring physicians in a timely manner. Develop a mechanism to track consultation times in hospital setting starting with the Emergency Departments. Create a performance improvement plan to continuously improve customer service for staff at UT Medicine locations. Carlayne Jackson and Barb Cordell Barb Cordell with relevant directors, chairs Luci Leykum, Kevin King (see patient centered care section metrics) Development Implementation FY 2013 2 days of date of service starting in FY 2012. -2013 Provide practice management literacy training for all faculty and staff. Develop a program plan to include domains of revenue cycle, leadership, and conflict management. Barb Cordell and Dale Flowers December, 2011 11
Improve communication between Dean s office, Chairs, Division chiefs, Medical Directors, Faculty, and Staff, developing a culture of partnership in meeting goals Establish regular update meetings between Dean s Office, departments, and divisions. Create annual survey of faculty and staff to determine understanding of clinical initiatives. Carlos Rosende, Luci Leykum Carlos Rosende, Luci Leykum, Adam Ratner Design a staff reward system that supports our efforts for culture change. Bi-annual meetings Work with Human Resources to develop a staff incentive plan, with funding to come from PDF or departments depending on program and employee. Create an internal recognition program to celebrate our success. Dale Flowers and Barb Cordell Carlayne Jackson and Barb Cordell Develop a faculty compensation and incentive system recognizing contributions from clinical care, teaching, and research. Implement Chartis recommendations. Compensation committee /Dean s office 12
Create a culture of maximum transparency. Disseminate information regarding UT Medicine budget and financial performance to all faculty through the clinical website. Gabe Hernandez Ask all departments to develop a process to share financial performance results. Minimize referral of patients outside system. Develop reports to track referrals outside of UT Medicine clinics and provide feedback to directors and chairs. Reduce leakage from UT Medicine practice with goal of 0, excluding patients with established outside care. Increase referrals from Westover Hills and Downtown with goal of <5% outside referrals. Develop a marketing plan for UT Medicine. Chairs, monitored by Gabe Hernandez Barb Cordell Chairs and medical directors, oversight by UTM Board Medical directors & clinic managers First half FY 2012-2013 Establish UT Medicine as the name for all clinical activity in the School of Medicine across all location. Create internal awareness campaign with benchmarks for the success of marketing activities. Jan Wilson FY 2011 Jan Wilson FY 2011-2012 13
Develop a service line strategy in collaboration with our hospital partners. Form relevant working groups with UHS adult programs and CSR pediatric programs. Optimize revenue cycle. Achieve performance goals for revenue cycle metrics. Luci Leykum, Tom Mayes Gabe Hernandez, Marti Pons ongoing Eliminate curb-side consults and bill for all work. Chairs Start now Educate faculty and staff on revenue cycle processes through department and division meetings. Maximize physicians productivity. Create expectations for performance by specialty and location. Communicate productivity expectations to clinic managers and staff and include achievement of goals in manager and staff incentive program. (see culture and communication metric) Chairs in partnership with Dean s office Chairs in partnership with Carlayne and Barb Cordell Implement effective scheduling and templates to meet goals. Chairs & directors Determine staff and support required in UT Medicine locations. Leverage the EpicCare investment by assisting providers in their optimal use of the HER. Barb and clinic managers / directors -2013 Mysti Schott -2012 14
Communicate between EPIC and other hospital electronic medical record systems. Implement HIE. Andrew Krecek January, 2012 Identify, hire, and train the support personnel to deliver quality customer service. Produce regular reports on department turnover rate, reasons for leaving, and trends. See other relevant metrics in Culture and Communication section. Barb Cordell with HR Provide interviewing training and decrease length of time to fill positions. See metric related to medical directors in Patient-Centered Care and metric in Culture and Communication regarding training. Work with Human Resources to reduce time positions are unfilled. Barb Cordell, Dale Flowers underway 15
Build internal primary care base as an integral part of our UT Medicine strategy. Increase number of patient visits. Carlos Jaen, David Hillis / 10% FY 2013/ 10% Develop a competitive compensation and incentives package consistent with Chartis recommendations. Integrate mid-level providers at all locations. Carlos Jaen, David Hillis, and Dean s office Clinic medical directors Open a new UT Medicine primary care location that is geographically complementary to the MARC. Partner with Community Medical Associates to be their preferred source for specialty providers. FY 2013 Increase specialty referrals from Northwest and North Clinics. Luci Leykum : 25% FY 2013: an additional 10% Implement EPIC read-only access in CMA locations. Luci Leykum, Andrew Krecek 16
Develop program for outside MD s to implement EPIC. Sign up x # of practices on EPIC. Carlos Rosende & Andrew Krecek Acquire patient-centered medical home recognition for all UT Medicine primary care practice locations and hospital-based primary care locations as appropriate. Achieve patient-centered medical home recognition for all UT Medicine. Luci Leykum December 2011 17
Integrate medical students and trainees into all clinical care locations. Incorporate medical students and trainees into all clinical care locations. Develop strategy and mechanism to track student involvement in research. Increase the number of students involved in clinical research projects (after above accomplished). Chairs ongoing Paula Shireman Paula Shireman FY 2013 Create mechanisms to expose non-md graduates to the clinical environment. Include graduate students and postdoctoral fellows in grand rounds, ward rounds, etc. Develop observer status at UHS. All chairs Luci Leykum with Graduate School immediate Create opportunities for medical students to learn more about organizational and system aspects of care delivery. Integrate current programs into an overall program and integrate into new medical curriculum as it is developed. Luci Leykum, David Henzi - 2014 18
Use data from clinical practice for quality improvement, professional education, and health services research in partnership with the Center for Patient Safety and Health Policy, Center for HSR, REACH, and Center for Health Disparities. Evaluate implementation of a mechanism to track research projects generated in our clinical practice locations. Create forums for health services researchers and other Centers and clinicians to meet and share research ideas to integrate quality improvements, effectiveness, and outcomes research. Paula Shireman, Luci Leykum Luci Leykum, Paula Shireman Start Recurring meetings cosponsored by Clinical Affairs and Research. Begin pilots regarding payment systems/delivery systems with a goal of disseminating work (see systems redesign metrics) Obtain funding from payers and hospital partners. Luci Leykum Start Expand clinical research. Evaluate possibility of tracking clinical research done by SOM faculty. Paula Shireman 19
Recognize University Health System, the South Texas Veterans Health System, and CSR as our primary teaching hospitals. Highlight partnerships as appropriate in all web, print, and communication tools. Allow partnerships with other hospitals only with a designated rationale related to educational or research programs or due to resource constraints of primary hospital partners. Ensure ongoing strategic planning for all featured service lines with UHS. Jan Wilson Dean s office ongoing immediate Luci Leykum -2013 Improve UT Medicine market position as the only integrated academic physician practice in the region. Improve fee-for-service rates with base rate of 105% of MCR. Use EMR to align outside physicians. Implement EPIC in outside MD offices (see previous metrics related to this) Toby Kennerdell 20
Develop partnerships with local employers to provide medical services and educational programs to their workforce. Target 2-3 potential employers and implement programs. Carlos Rosende, Dale Flowers Employer identification: -2013 Implementation FY 2014-2015 Build relationships with local physicians and exceed expectations for referrals and evidence-based care. Build ability to track external referrals with regular feedback to providers. Barb Cordell Develop outreach plan based on referral data. Jan Wilson FY 2013 Increase referrals from CMA and capture percent of referrals (see previous CMA metrics) Luci Leykum FY 2013/70% FY 2014/80% 21
Implement mechanism for access to data across organizations on patient and aggregate levels. Implement electronic health records at UHS, UT Medicine, and CSR. Meet Level 1 Meaningful Use Criteria in all UHS and UT Medicine practice locations Andrew Krecek ongoing Andrew Krecek FY 2011 Implement HIE. Andrew Krecek FY 2011 Build infrastructure to allow providers to understand their utilization in all settings and improve our ability to define performance based on quality metrics. Develop internal capability to report HEDIS quality metrics in all locations. Adam Ratner Start Obtain financial support for additional personnel. Dean s office 22
Develop hospital alignment strategies to pave the way for ACO model of care. Develop 2 bundling and gainsharing medical and surgical products. Luci Leykum Begin joint planning with regard to healthcare reform with UHS. Dean s office Develop partnership with payers and employers. Develop bundling/aco project with CFHP and employers Communicate with faculty around healthcare reform and frame in terms of impact on reporting and reimbursement. Luci Leykum & Carlos Rosende Luci Leykum & Carlos Rosende FY 2013 23