PHCPI framework: Presentation Crosswalk to Service Delivery Elements

C1. Facility Organization and Management

C1.a Team-based care organization

C1.b Facility management capability and leadership

C1.c Information systems

C1.d Performance measurement and management

C3. Access

C3.a Financial

C3.b Geographic

C3.c Timeliness

C4. Availability of Effective PHC Services

C4.a Provider availability

C4.b Provider competence

C4.c Provider motivation

C4.d Patient-provider respect and trust

C4.e Safety

C5. High Quality Primary Health Care

C5.a First Contact C5.b Coordinated C5.c Comprehensive C5.d Continuous C5.e Person-Centered

C2. Population Health Management

C2.a Local priority Setting

C2.b Community engagement

C2.c Empanelment

C2.d Proactive population outreach

C. Service Delivery

Community-Based Primary Care at the Southcentral Foundation Donna Galbreath, MD Southcentral Foundation

Southcentral Foundation Overview

Alaska Native People Shaping Health Care

Donna Galbreath| Senior Medical Director of Quality Assurance

65,000 voices

Evidenced-based generational change reducing family violence

36% drop in both ER visits and hospital admissions from 2000-2015

75-90%ile on many HEDIS outcomes

Benchmarked data nationally and internationally showing top in class performance in utilization, quality and satisfaction

Employee turnover rate decreased 15% from 2007-2015

96% customer satisfaction and 95% staff satisfaction

Baldrige Award 2011

Why listen to our story

Southcentral Foundation Board of Directors

13 Years Service

34 Years Service

13 Years Service

12 Years Service

16 Years Service

7 Years Service

7 Years Service

591,000 Square miles (951,000 Square km)

Alaska San Francisco

Charleston

Alaska is larger than Texas, California and Montana combined

Incorporated in 1982 Employees

• 1985: 24 staff • 2016: 2,000 staff

Operating Budget • 1985: $3 million • FY 2016: $323 million

Serving 65,000 Customer-owners • 55,000 Anchorage and Valley • 10,000 in 55 villages

From 1985 to 2016… Operating Budget

1985 FY 2016

$323 M

$3 M

Nuka Reach

More than 80 different programs and services including:

SCF Programs and Services

Primary care, OB, Peds Behavioral health Dental

Complementary medicine Traditional healing

Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness

Mission Working together with the Native Community to

achieve wellness through health and related services

Goals S hared Responsibility C ommitment to Quality F amily Wellness

Customer Ownership

Operational Principles

Ask the Community

Governing board Advisory committees Elders Council Annual Gatherings 24- hour hotline Personal interactions

Customer-owners Satisfaction surveys and comment

cards Employee survey and satisfaction

surveys Employee interactions (over 55% are

customer-owners)

We Changed Everything

Customer-owner changes We are active We are responsible We seek information We ask questions We seek advice and options We become a partner with the Provider

Key Improvement

Providers and Customer Owners in Shared Responsibility

No longer gives orders No longer just prescribes meds No longer our hero No longer controls

Gives customers options Provides customer with resources Provider becomes our partner

Health care provider changes

Key Improvement

Same day access to Primary Care Provider Created Integrated Care Teams Monitoring for culturally appropriate care Improvements in waiting times

SCF Changed Everything

SCF Links EVERYTHING TOGETHER!

People said: Cleaner, better facilities, Direct input into health care redesign

Feedback to the People

CELEBRATE!!

Leaderships Findings The Vision

• A vision created with the community and governance

• A vision that describes the end result

• A vision that is achievable • A vision you believe in

Alignment • Buy in of leadership • Customer-owner, employee and

governance

• Knowledge of achievement accomplished together

• Give the resources necessary • Create a safe environment for

change • Hedge them in

Selecting the right people • For key positions that drive change • Find champions for your cause

Do the right thing even if it costs • Change laws (Congress)

Integrated Care Teams

Information to Knowledge % SCF Central Pharmacy customer-owners requesting other

medications at dispensing

0%

10%

20%

30%

40%

50%

8/5/10 8/12/10 8/19/10 8/26/10 9/2/10 9/9/10 9/16/10 9/23/10 9/30/10

Percent

Average

Better

Source: Central Pharmacy-Pharmacy tic-sheet 9.27.10

Change Tested

Change Implemented

% Employees with Current Annual Disaster Tng

53

7494 98 100

0

50

100

2005 2006 2007 2008 2009

%

SCF Industry Best (100%)

200

400

600

800

1000

1200

1400

160019

96

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Num

ber o

f Visi

ts

Day per 1000 Night per 1000

Better

Native ownership begins

Anchorage Area Customer-owner Visits to ER/Urgent Care Per 1000

Excludes Newborns and Delivery Moms and Length of Stay must be more than 1 day

p

40

50

60

70

8019

96

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Num

ber o

f Adm

its

Admts per 1000

Better

Native ownership begins

Anchorage Area Customer-owner Admits per 1000

Thank You! Qaĝaasakung

Aleut Quyanaq

Inupiaq

Háw'aa Haida

‘Awa'ahdah Eyak

Mahsi' Gwich’in Athabascan

Igamsiqanaghhalek Siberian Yupik

Tsin'aen Ahtna Athabascan

T’oyaxsm Tsimshian

Gunalchéesh Tlingit

Quyana Yup’ik

Chin’an Dena’ina Athabascan

Quyanaa Alutiiq