Our Journey to the Acclaim Award David Gano, MSOD Regional Director Ambulatory Performance Improvement
Mission Statement: To Extend the Healing Ministry of Jesus Christ. Vision Statement: CHRISTUS Trinity Mother Frances Health System, a Catholic health ministry, will be a leader, a partner, and an advocate in the creation of innovative health and wellness solutions that improve the lives of individuals and communities so that all may experience God s healing presence and love. Values: Dignity, Integrity, Excellence, Compassion, Stewardship Purpose Statement: Achieving national prominence in clinical medicine though excellence in quality and safety, research, education and innovation.
CHRISTUS Trinity Clinic June 2018 Employed Physicians 409 Employed APCs 283 Total 692 42 Specialties 106 Ambulatory Clinics in Texas and Arkansas 1.3 Million Patient Visits in last 12 Months
Acclaim Workgroup 7 Primary Contributors -Executive Sponsor/SVP and Primary Care Institute Chair -Director of Population Health -Medical Director of Population Health -Director of Performance Improvement (Project Manager) -Director of Service Excellence and Patient Experience -Administrative Director -Medical Director of Quality
CHRISTUS Trinity Clinic Acclaim Award Timeline May 2018 Executive Sponsorship for Application Initiated and PM Assigned. Late May 2018- Acclaim Application Workgroup Formed and Meetings scheduled. June Initial Workgroup Meeting. Assignments of writing, due dates, and narratives determined. July First Rough Draft Completed Late July - Second Rough Draft Completed August Revision and One Voice editing Late August Review of Draft with Executive Leadership for Feedback September 3 rd Party Review of Application. Development of Appendices September 15 Final Review of Submission Document and Last Revisions September 20 Submission to AMGA w/ Confirmation Receipt December Notice of Recognition from AMGA Received.
Process 1. Identify those compelling items within your organization that meet the AMGA definition for attributes of a High Performing Healthcare System. 2. Identify the most impactful Narrative topics that your organization is doing to improve quality and the health of managed populations focusing on the IOM Triple Aim. 3. Show how technology and evidence based medicine is used to facilitate better patient care. 4. Give examples of how your organization has made significant strides to improve patient and physician engagement.
The Patient Centered Approach Cost Utilization Leadership Structure and Development Population Health Patient Centered Access Service
CHRISTUS Trinity Clinic Patient Experience Results (4/1/15) Percentile Rank: All Database / South / Texas Global DOMAIN Question n % All Sites N = 16992 All Facilities N = 831 AHA Region 7 N = 60 Access to Care 4149 61.4% 35 32 44 How often get urgent appt as needed 1905 68.3% 44 34 33 How often get appt soon as needed 3045 78.1% 75 66 74 How often get answer same day 1724 61.9% 36 33 44 Get answer as soon as needed 273 59.3% 28 22 33 How often see provider within 15min 4086 39.5% 28 41 46 65% of the Nation was achieving better results than we were!
Measurable Outcomes CGCAHPS Domain January 2015 Percentile Rank January 2018 Percentile Rank Overall Doctor Rating 58 91 Access to Care / 3 Month 29 70 Test Results / Care Coordination 93 96 Physician Communication Quality 49 82 Office Staff Quality 56 90 Based on 3 Months Received Date, All Facilities, All Respondents
Single Department
Current Results Access Questions Top Box, 3 Month Ending September 2017 Right Away Appt As Soon as Needed Routine Appt As Soon as Needed Primary Care 96.7 98.6 Surgical 92.1 96.2 Cardiovascular 95.1 96.7 Neuroscience 92.3 97.6 Orthopedic 92.2 96.4 System 95.1 97.7
Maintaining the Gain Create an access team whose responsibilities include oversight of access on a weekly basis Strong partnership with operational leadership teams Keep the project visible monthly reports to senior executives/ceo, middle managers and front line associates Celebrate successes
Manager s Council for Service Excellence Bridge to Senior Leadership Mentor new Managers Share Engagement Ideas Innovative Solutions
Close the Gap What you permit, you promote Close the Gap Weekly Improvements 120 100 80 60 40 20 0 Let go of the door Walked to the patient Acknowledge & Introduce Offered Help Week 1-2 Week 3-4 Week 5-6 Week7-8 Week 9-10
Office Staff Quality 26 th percentile 90 th percentile Data Source: Press Ganey, CGCAHPS Visit Date
Population Health Risk Stratification Health Care Spend Percentage of Total Cost Know your population Understand risk of utilization Deploy resources appropriately to expected utilization High 1% 2-5% 29% 27% Care management-nurse Navs Intensive Medical Home Moderate or Rising 6-15% 16-30% 23% 13% Care Coordination Program Preventive Care Screenings Chronic Illness Maintenance Education & Outreach & In-reach Clinical Decision Support Low or Unknown 31-100% Membership Distribution Percentage of Total 7% Objectives Increase PCP visits Improve Quality Reduced Utilization Reduced Cost of Care
Localized Multidimensional Risk Models
Strategies (Cost Utilization) Tools (Population Health) Decrease hospitalizations Decreased unnecessary ER use Decrease readmissions Decrease unnecessary imaging Decrease home health spending Increase Advanced Care Planning Decrease skilled nursing spending Increase patient adherence to treatment Reduce high dollar medication use Risk stratification (Vitreos), Nurse Navigation Educate, Nurse Navigation, Access Project, Intensive Medical Home Project Transitions of Care, Nurse Navigation, Care Transitions Workgroup EMR integration, Provider education Home Health navigation project, preferred partners Provider education, Advanced Care Planning clinic Preferred partners Nurse Navigation, Social determinants, Diabetes Grant Program for Employees Pharmacist review, targeted outreach
Cost Analysis by Provider The next frontier
Provider Dashboard
Health Maintenance
Embedded SmartSets
Clinical Decision Support Tools
Risk of Admission or ED Visit
IP Readmission Risk Score
Outcomes: Diabetes Grant Program Program Restarted Program suspended
Outcomes: Intensive Medical Home Clinic
Key Points to Remember Answer the criteria exactly as prescribed. Specificity is critical. Read what you are going to submit. Look for flow and ease of understanding. Have someone else read your submission for one voice. Provide data to support your outcomes. Make sure your graphs and appendices are understandable to someone outside of your organization. Don t wait till the last minute. This is a time consuming process.
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