INTEGRATED DELIVERY SYSTEM PLANNING PROJECT San Francisco Department of Public Health May 15, 2012
2 IDS Planning and Other Long-Range Planning Efforts Citywide Strategic Efforts Community Health Improvement Process Public Health Accreditation activities Health Care Services Master Plan Non-profit hospitals' Community Health Needs Assessment DPH Strategic Efforts Personal Health Care Services Integrated Delivery System (IDS) Project Public Health Services Population Health & Prevention Integration Public Health Accreditation Department-wide Five-year budget planning Information Technology Assessment and Master Plan Today s Discussion DPH Strategic Plan
IDS Timeline 3 June 2011 Launch IDS Planning We Are Here July 2012 Begin IDS Implementation Activities May 2012 Present IDS Recommendations June 2014 Complete IDS Implementation
IDS Definition 4 The San Francisco Department of Public Health s integrated delivery system (IDS) is a comprehensive system of care that is clinically and financially accountable to provide coordinated health services to the diverse and vulnerable individuals it serves and to improve the health of their communities.
Shared IDS Goals 5 Provide medical/health homes responsible for coordinating preventative, primary, and specialty care Reduce misuse, overuse and underuse of services Enhance information technology to improve quality of care and decision making Manage resources responsibly for the maximum benefit of clients Ensure service excellence Increase the number of insured patients served
6 Future State of Department IDS
We MUST Do Better in Key Areas 7 Patient-Level Integration Case Management Provider-Level Integration Clinical Leadership Health Promotion/Disease Prevention System-Level Integration Information Technology and Informatics Innovations in Healthcare Quality and Utilization Management
IDS Recommendations 8 Over 40 recommendations in the following categories: policy/strategic system development/change management organizational or operational /administrative Aligned with the Health Commission s current priorities
9 Recommendations Reflect Inclusive Planning Process Over 100 staff and community partners participated in the IDS planning groups Held forums/meetings to solicit input from staff and community stakeholders over 400 attendees 9 sessions for staff 5 sessions for community stakeholders Facilitation and planning support provided by Harder+Company
10 Case Management Key Recommendations Provide a range of services in a patient s care home where the care home could be one of the following: primary care clinic behavioral health clinic street for homeless or marginally housed Only one primary case manager (staff or contractor) will be assigned to each client in need of case management based on acuity criteria (from Department funded services ) Example: A DPH client in supportive housing has access to voluntary on-site case managers (CM). The client routinely receives case management services at a mental health clinic. The mental health CM is the primary CM while the supportive housing CM is the secondary CM. They coordinate on client issues to reduce and eliminate duplication of effort and services
11 Clinical Leadership Key Recommendations Establish a Clinical Leadership Group charged with promoting service excellence and integrating and aligning clinical practice across departments Make improving patient transitions a priority and promote the spread of the Quality Roadmap for Improving Patient Transitions
12 Health Promotion and Disease Prevention Key Recommendations Coordinate and facilitate linkages between IDS primary care clinic sites and community based resources for health promotion and disease prevention Optimize delivery of clinical preventive services for the populations it serves, including systematically measuring IDS performance in delivery of clinical preventive services and holding practices accountable for achieving targeted quality standards for preventive services
13 Innovations in Healthcare Key Recommendations Establish an internal Innovations in Healthcare Advisory Group Implement five innovation priority areas, each with a test project: Patient Level Improve patient and staff experience to become a provider and employer of choice Increase access to primary care to meet standard wait times for primary care appointments Provider Level Coordinate care and share accountability across the continuum of services in order to advance health outcomes System Level Integrate and provide relevant patient information to improve clinical decision-making, understand populations, and better design systems of care Create a transparent, engaged organizational culture aligned around a common mission and vision for DPH
14 Quality and Utilization Management Key Recommendations Establish common measures within a Triple Aim framework: clinical quality, cost efficiency and patient-centered care Based on cost, placement priority is given to lower level of care patients at SFGH and LHH patients who are appropriate for community placement
15 Information Technology and Informatics Key Recommendations IT system that integrates shared data systems (for example, can compare costs across settings/transition points, quality metrics, waitlists, lengths of stay, volume indicators, level of care availabilities, high users) A unique common client/patient identifier One centralized case management information technology system that can be used for: (1) patient treatment and (2) reporting. Can be achieved through modification of existing system or new system A common utilization management software program to support improved coordination of services, appropriate patient placement and efficiency of services
Next Stop - Implementation 16 Integration Steering Committee will have oversight role Form IDS Implementation Teams Create implementation work plans for project management Develop measures and metrics to track Department performance Implementation activities will begin 2012-13 fiscal year Can implement some recommendations more immediately Anticipate it will take two years to fully implement all recommendations Conceptualize and Develop IDS Recommendations Outline Framework for Department-wide IDS Implementation Work Plan Develop Recommendation Specific Work Plans that Flow into Department Work Plan Implement Recommendations and Track Performance Measures
Confronting Why? Why? Why? 17 It s not the progress I mind, it s the change I don t like. Mark Twain Structured change management approach to: communicate the need for the change confront the barriers that will be arise during the change process actively engage staff in the system improvements Communication strategy Communications Plan Core Messages IDS Communications Team
Core IDS Messages 18 Health care is changing its now about teamwork at all levels across all divisions Department must position itself as a provider of choice to help ensure that it continues serving its currently uninsured patients and to help retain funding Health care funding will be increasingly tied to meeting specified health outcomes all staff will have a role in helping achieve those outcomes Department must and can meet this challenge by better integrating the services it provides
19 QUESTIONS AND DISCUSSION