COMMUNITY PRIMARY CARE - SFDPH€¦ · Got urgent care appt when needed in past year 57% 32% 801...
Transcript of COMMUNITY PRIMARY CARE - SFDPH€¦ · Got urgent care appt when needed in past year 57% 32% 801...
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COMMUNITY PRIMARY CARECOMMUNITY PRIMARY CARETHE HERE AND NOW AND WHERE WE’RE HEADED
Report to Health Commission Community & Public Health CommitteeFebruary 2013
Lisa Johnson MDLisa Johnson, MDMedical Director, Community Oriented Primary Care
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Community Oriented Primary Care Principlesy y p(from CPC Rules and Regulations)
• Public health services that focus on the health of the community• a commitment to working with the community as a partner• a multi‐disciplinary model of carea multi disciplinary model of care
• Access to care is not adversely affected by race, sex, religion, l h d l dnational origin, age, handicap, sexual orientation, diagnosis, or
source of payment.
• Medical Staff and Affiliated Professional members maintain high quality performance of their professional duties.
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Newmodels: Patient CenteredMedical HomeNew models: Patient Centered Medical Home 88 CHANGE CONCEPTS CHANGE CONCEPTS Safety Net Patient Centered Medical Home Initiative
1010 BUILDING BLOCKS BUILDING BLOCKS (T. (T. BodenheimerBodenheimer, M.D. , M.D.
Patient Centered Medical Home www.safetynetmedicalhome.org1. Empanelment2. Continuous, Team‐based Healing Relationships
http://www.chcf.org/publications/2012/04/building‐blocks‐primary‐care
1. Mission and Goals 2. Data‐driven ImprovementRelationships
3. Patient Centered Interactions4. Engaged Leadership 5. QI Strategy 6 E h d A
3. Empanelment4. Team‐based Care 5. Population‐based Care 6 Continuity of Care6. Enhanced Access
7. Care Coordination8. Organized, Evidence Based Care
6. Continuity of Care7. Prompt Access to Care8. Template of the Future9. Coordination of Care
i d i d d hi
NCQA Recognition standards for
10. Conscious and Trained Leadership
Patient Centered Medical Home www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx
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COPC Active Panel• 40,739 Active Pts
FY 2011‐2012
DEPRESSION
7%
OBESITY5% TOBACCO
USE 3%
Top 10 Diagnoses
FY 2011 2012• 36,377 Undup Pts• 115,376 Med Visits• 197,056 Total Visits
eCW Roll Out• 4 clinics live • Target: 9 by 6/13
HYPERTENSION24%VACCINE
8%
Payor
• Target: 9 by 6/13
DIABETES14%
HEALTH EXAM -CHILD
8%
CHN Capitated
29%
LIHP/SF PATH16% HYPERLIPID
EMIA12%
CHRONIC PAIN 10%
HIV DISEASE
9%
Medi-Cal
Healthy SF
18%
New Programs, New Leadership COPC‐wide • Jennifer Elton, RN ‐ Nurse Manager, Complex Care
ManagementMedi-Cal FFS9%
Medi CalMedicare
Sliding Scale8%
• Anna Robert, RN, MSN, DrPH ‐ Nurse Manager, Nurse Advice Line & New Patient Appointment Unit
• Albert Yu, MD, MBA, MPH ‐ Chief Medical I f ti Offi COPCMedi-Cal
Managed Care4%
16% Information Officer, COPC• Lisa Golden, MD ‐Medical Director, Quality
Improvement, Community Programs
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COPC Primary Care Providers (PCPs)
FTEs(# of bodies)
Part Time status of COPC Continuity PCPsProviders (PCPs) (# of bodies)
Staff MDs 43.8 (61)
NP/PA 20 (32)% PCPs > 0.5 FTE
60%
80%
100%Continuity PCPs
Aging PCP base Age 60 and over
Physician 14 of 43NP/PA 7 of 20
% PCPs > 0.7 FTE20%
40%
60%
Total 21 of 63
New Clinician Team Members since 2010
0%03/11 09/11 03/12 09/12
PCP‐Patient Continuity: 73‐77%
PCBH Clinicians 9 COPC Clinics
PC Behaviorists 13
Behaviorist Assistants 11 Current Target
COPC7 Support Staff FTE per 1.0 PCP FTE
PCBH vacant positions 3 Nursing 0.65 0.9
Clinical 1.72 2.0
Clerical 1 77 1 6Pharmacists 2.0 Clerical 1.77 1.6Dieticians 1.5
RN Case Managers 3.0
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• Quarterly Meetings:• ProvidersM t T• Management Teams
• Monthly/Bi‐Weekly Meetings:• Medical Directors• Nurse Managers• Principal Clerks
• Quality Culture SeriesQ y• QI & Leadership Academy• Center for Excellence in Primary CareColeman Rapid DPI• Coleman ‐ Rapid DPI
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PCMH‐A Results – Average ScorePatients see own provider or care team
Roles defined and tasks distributed across team according to skills abilities and credentials
0 2 4 6 8 10 12
according to skills, abilities and credentials
Team trained & cross trained to ensure patient needs met
0 2 4 6 8 10 12
2013 Trainings & Staff Development• Nursing Leadership Academy• Quality Improvement 101• Service Excellence• QI & Leadership Academy
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PANEL MANAGEMENTPANEL MANAGEMENTPAN MANAG M NTPAN MANAG M NTPrepared Prepared Proactive Proactive Effective Effective
IDENTIFY IDENTIFY PATIENTS WITH PATIENTS WITH outreach and in‐
reach ENGAGE PATIENTSCARE GAPSCARE GAPS reach
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SFDPH Primary Care ‐Quality Council GoalsOct Oct Oct 2012 2013Measures Oct2010
Oct2011
Oct2012
2012 Goal
2013Goal Benchmark
Blood Pressure Documentation 56% 85% 91% 90% or
50% IOB Retired Meaningful Use: 50%
DM Blood Pressure Control 67% New for
2013New: 70% or10% IOB N/A
Smoking Status Assessed 51% 73% 79% 80% or
50% IOB 80% Meaningful Use: 50%Assessed 50% IOB
Colorectal Cancer Screening 44% 47% 57% 60% or
10% IOB70% or10% IOB
HEDIS 2011 HMOCommercial: 62%Medicare: 60%
DM HgA1c Control <8 62% 74% 72% 70% Retired
HEDIS 2011 HMOCommercial: 68%Medicaid: 58%
Pt Experience: New for New:Pt Experience:Phone Access 34% New for
2013New:41% CA Average: 56%
IOB = Relative Measure Sep
2012HEDIS 2011
HMO MedicaidHEDIS 2011
HMO Commercial
Improvement Over Baseline
Breast Cancer Screening 66% 50% 71%Cervical Cancer Screening 72% 67% 77%DM HgA1c 83% 83% 90%DM LDL Testing 74% 75% 85%
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March 2012 CRC Awareness Month Outreach• Joint effort: SFDPH‐PC, with ACS, Center
for Excellence in Primary Care, SF Health PlanPlan
• 10 SFDPH clinics: registry, mass mail out, training, and phone bank
• In time training on registry use and• In time training on registry use and scripts for talking to patients about CRC screening
• 4900 postcards mailed ‐ 4 languages• 4900 postcards mailed ‐ 4 languages• 35 clinic staff members at the phone
bankScreening rate for the 10 participating• Screening rate for the 10 participating clinics have increased from 49% to 57% age points from 02/2012 to 10/2012.
Slide Courtesy of Lisa Golden, M.D.
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Road to Reform – AccessRoad to Reform Access
BehavHlt
Inpt, ED/CDU, UCC
Shadow
New Patients Existing
Shadow Panel
Primary Care AppointmentsAppointments
October 2012, Source> Primary Care Report Registry > 02_Patient_Panels\Shadow Panels\2012‐10> 02_Patient_Panels\Panel Stats
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CG-CAPHS Patient Experience Survey Results Plans to Improve Accesspe e ce Su ey esu s
• Staff the Team (PCPs, RNs, MEA’s/HW’s)
When they finally get to us, they like us:• “This is great clinic, but the wait time to speak to
a nurse is way too long.”“ • Working with HR
• PCP Recruitment• Enhanced RN role
PositiveRating(CA avg)
PositiveRating
(SFDPH PC)n Size
• “Everything is good but the waiting time is too long”
• System-wide Standing Orders• Nurse Advice Line (NAL)
improvements
Provider seen within 15 min of appt time in past year
29% 16% 1,476
Got urgent care appt when needed in past year
57% 32% 801improvements
• Develop Operational Metrics DashboardC l R id D ti
p yGot routine care appt when needed in past year
60% 33% 1,292
Got answer calling during office hrs in past year
56% 35% 680
• Coleman Rapid Dramatic Performance Improvement
p yProvider knew medical history
79% 77% 1,484
Provider explained things understandably
88% 81% 1,486understandablyProvider listened carefully 90% 84% 1,486Provider showed respect for what patient said
92% 87% 1,486
Integrate, Innovate , Coordinate
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eCW Go Live
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Challenges g• Primary Provider Shortage: Recruitment difficult • Civil Service and Union Environment: challenges for recruiting, rewarding, promotingPhysical Plant: Need more attractive design design to facilitate team care workflow• Physical Plant: Need more attractive design, design to facilitate team care workflow
• Patient Experience & Service Excellence:• Access: we need:
A i t i t t t ffi ti t t d d d t i i ti ti t• Appropriate, consistent staffing ratios to meet demands and retain existing patients• Spread of QI methods for improving access across system• Further development of / support for team based care to increase capacityT i i d C hi i f t t f P ti t C t d M di l H• Training and Coaching infrastructure for Patient Centered Medical Home • Effective clinical care teams require training infrastructure for these new skills.
• Operations Infrastructure N C t Di t / C t M i COPC li i• No Center Director/ Center Manager in COPC clinics
• Small central COPC administration team • Supply / Demand mismatch for medical services: need decisions about scope of SFDPH Delivery System going into 2014 with planning matched to those decisionsDelivery System going into 2014, with planning matched to those decisions
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2013: Initiatives2013: Initiatives • Year of the Nurse ‐ Enhanced Role of the RN in Primary Care clinics
• Dynamic and leadership‐focused training program• Complex Care Management Program
• Continue to Get Better at Team‐based Care • Co‐location of team members, Role and responsibility definition• Training: MEA/HW skills in panel mgmt, QI tools for improving team care • Expand the team – BH‐PC integration, Pharmacists and dieticians in clinic, NAL and NPAU as part of the teamNAL and NPAU as part of the team
• Access• eCW implementation complete in 2014O ti M t i D hb d j t• Operations Metrics Dashboard project
• Coaching • Coleman DPI for more clinics?? • Coaching Program through the SFHP / Metta Grant – 10 Building Blocks
• Prop C Funding for consultation on transition to PCMH in DPH