Southcentral foundation nuka

Southcentral FoundationTh SCF N k M d l f CThe SCF Nuka Model of Care

Customer-Owners Driving Healthcare

Charles Clement, Vice President Operations, Chief O ti Offi Operating Officer

April Kyle, Human Resources AdministratorSteve Tierney, Medical Director Quality Improvement

Michelle Tierney Vice President Organizational Michelle Tierney, Vice President Organizational Development and Innovation

Today…yShare the SCF Story

Transformation of our system Transformation of our system –resulting SCF Nuka Model of CareDescribe how a customer-owner Describe how a customer owner system shapes and improves health performance in outcomes,

ti f ti i f d satisfaction, experience of care, and overall cost.Describe some of our key Describe some of our key improvements to our systems transformation

Southcentral FoundationSouthcentral Foundation

25+ years of history Innovative, relationship based, customer

d t owned systems 1,400 staff 140,000 statewide customers55,000 ‘local’ customer-owners including 10 000 i 50 t ill10,000 in over 50 remote villages

Expanding local population

Southcentral Foundation

Medical Services – Primary Care, Women’s Health, Pediatrics, Optometry, Urgent CareCareDentalBehavioral Health clinics residential Behavioral Health – clinics, residential treatments, after-care, youth, eldersFamily Wellness Warriors – abuse and Family Wellness Warriors abuse and neglect treatment and preventionTribal and Traditional ServicesChiropractic, massage, acupuncture

SouthcentralFoundation

Alaska Native Medical Center

150 Bed HospitalOver 400,000 outpatient visits last yearLocal primary care, regional community hospital, and tertiary care statewide hubLevel II Trauma Center, Magnet StatusCombined project of SCF and ANTHCFull system – includes medications, etc.

SouthcentralFoundation

Our ChoiceOur Choice

The Alaska Native people were given this choice and we chose to assume the responsibility for our own health care

Change everythingTotal redesigngWith our choices, values and ……

Where we were in Jan. 1993100 % increase in Native population in 10 yrs

Long waits for scheduled appointments, 4 to 6 hour waits in ER/Urgent Care commonLong waits on phone pharmacy Long waits on phone, pharmacy, everywherePoor continuity, little coordination across depts,Increase age, illness burden, space issues Littl t i t t d i l iLittle customer input, not used in planningSystem not designed around the customer

Everyone was frustrated…y

Customers frustrated – waiting Customers frustrated – waiting, impersonal, paternalistic, crowded, unfriendlyyClinical staff frustrated – too many people, not enough time, no personal p p , g , prelationship, too many demandsManagement frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, poor f ilitifacilities

What IfWhat If….

What would a healthcare system based on What would a healthcare system based on Alaska Native community values look like? What if you actually threw out EVERYTHING in th di l t d t t d ith Al k the medical system and started with Alaska Native community structures and strengths as the base?Asset based philosophy, structures, systemsSo…..We declared nothing would remain the way it was unless we decided to do it that way.

SoSo

d l k i lWe wanted Alaska Native people to own their own healthcareWe wanted to have a system where the We wanted to have a system where the values, goals, and strengths of the customer drove the system designWe wanted to get to whole person care We wanted to get to whole person care –physical, mental, emotional, spiritualWe wanted family and community to y ymatter & to be known personallyAnd – we wanted the best that modern medicine has to offer medicine has to offer

Why is Customer Owned Importanty p

Efforts of “experts” who know o ts o e pe ts o owhat is best for Alaska Native people (healthcare professionals, missionaries, government officials)

Result has been loss of self esteem d fid l di t and confidence leading to

dependency Healing and progress on the journey Healing and progress on the journey towards health only is possible when the customer/owner takes control

d l d h hand leads the change.

Scotland Alaska C i d i S i d b il Caring and compassionate staff and services

Clear communication and l f d d

Services and systems built on strengths of Alaska Native culturesNot complicated but simple and easy to use explanation of conditions and

treatmentEffective collaboration

and easy to use

Together with the customer as an active partner

Continuity of care

Good access

Relationships between customer owner, family and provider must be fostered and supported A i ti i d d it Good access

Clinical excellence

Access is optimized and wait times are limited Outcome and process measures to continuously evaluate and improveevaluate and improve

Scotland AlaskaPerson Centeredness

Shared Responsibility

Safety of Patients Commitment to lQuality

Clinical Effectiveness

Family Wellness

Why Listen to our storyComplete system redesign on Alaska Native values

Decrease in ER/Urgent Care over 40%Decrease specialty care by over 50%Decrease in primary care visits by 20%Decrease in primary care visits by 20%Decrease in admissions and days by over 35%

Improved health outcomesImproved health outcomesImproved satisfaction indicators –customer and employeecustomer and employee

Question AssumptionsQuestion Assumptions

Medical Model not questioned in 100 years, but optimally effective for population healthpopulation health‘Healthcare’ tries to build on one philosophy – why? Span is so hugep p y y p gKnowledge – clinical, system design, change management, operational

t h l d h l b t management – have evolved hugely – but not the basic healthcare paradigm – why?

Analogy - Hitting the targetAnalogy Hitting the target…

If you are in a mechanical manufacturing If you are in a mechanical, manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out

d t j t tspeed, trajectory, etc.If you are in a messy, human, complex, adaptive environment – it is like throwing a adaptive environment it is like throwing a bird at a target – it is all about the ‘attractor’Healthcare mostly throws birds at targets and

l thi k b t th th i tonly thinks about the throwing part…

Reality – various ‘platforms’Reality various platformsHealthcare has several ‘platforms’

ICU/ER/OR – high tech, linear, mechanicalProcedures – linear, mechanicalConsultative – time limited specific issue Consultative – time limited, specific issue focused, additive expert supportLongitudinal relationship over time –h i diti t ti t id ti l chronic conditions, outpatient, residential,

behavioral health, primary care

One size does not fit all – first two are product, manufacturing efforts – second two are service and knowledge efforts primarilyare service and knowledge efforts primarily

Control: Who really makes the decisions

Patient/Family100

“Control”

The “System”

Acuity

y0

Low High

1. Control – who makes the final decision influencing outcome?1. Control who makes the final decision influencing outcome?2. Influences – family, friends, co-workers, religion, values, money3. Real opportunity to influence health costs/outcomes – influence

on the choices made – behavioral change4 C t d l t t di i t t t ( d d )4. Current model – tests, diagnosis, treatment (meds or procedures)

Realityy

Health is a longitudinal journeyg j yAcross decadesIn a social, religious, family contextHi hl i fl d b l b li f h bit Highly influenced by values, beliefs, habits, and many ‘outside’ voices.

Office visits are brief, reactive stop-gapsHospitalizations are brief, intense interruptionsMUST fix basic, underlying primary care platform first or nothing else will work wellplatform first or nothing else will work well

Purpose of Primary Carep y

Is a Service Industry – NOT a product industry Is a Service Industry NOT a product industry – coaching, teaching, partnering are central –pills and procedures supportiveChanges what we think we do, who we hire, how we train, how we structure, how we reward, and how entire system is constructed reward, and how entire system is constructed as a system.We must optimize relationship – personal, t ti t bl i i i b itrusting, accountable – minimize barriers

The General Framework

Vision, Mission, Key PointsLeads to Operational Principles –Leads to Operational Principles –these are specific enough to be used to evaluate and even score new to evaluate and even score new ideas for whether to implement them into SCF or notthem into SCF or not

Mission, Vision, Key Points

Vision: A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission: Working together with the ss o o g toget e t t eNative Community to achieve wellness through health and related oug a a d a dservices.

Key PointsKey PointsShared Responsibility We value working together with the individual, the family, and g g , y,the community. We strive to honor the dignity of every individual. We see the journey to wellness being traveled in shared responsibility and partnership with those for whom we provide services.pCommitment to Quality We strive to provide the best services for the Native Community. We employ fully qualified staff in all positions and we commit ourselves to recruiting and training Native and we commit ourselves to recruiting and training Native staff to meet this need. We structure our organization to optimize the skills and contributions of our staff.Family Wellness

l h f l h h f h CWe value the family as the heart of the Native Community. We work to promote wellness that goes beyond absence of illness and prevention of disease. We encourage physical, mental, social, spiritual and economic wellness in the i di id l h f il h i d h ld i hi h individual, the family, the community, and the world in which we live.

SCF Operating Principles

Relationships between the customer-owner, the family, and provider must be fostered and family, and provider must be fostered and supportedEmphasis on wellness of the whole person, family, and community including; physical y, y g; p ymental, emotional, and spiritual wellnessLocations that are convenient for the customer-owner and create minimal stops for the pcustomer-owner.Access is optimized and waiting times are limitedTogether with the customer-owner as an active partnerIntentional whole system design to maximize y gcoordination and minimize duplication

Operating PrinciplesOperating PrinciplesOutcome and process measures to continuously e al ate and imp o eevaluate and improveNot complicated, but simple and easy to useServices are financially sustainable and viableyHub of the system is the familyInterests of the customer-owner drive the system to determine what we do and how we do system to determine what we do and how we do itPopulation-based systems and servicesServices and systems build on the strengths of Alaska Native cultures.

Customer-owner Changes for Effective Relationships

Be active not passiveTake responsibility for your health Take responsibility for your health Get information about your health Ask questions about advice Ask for optionss o opt o s

Healthcare Provider Changes for Effective Relationships

No longer a hero but a partner Control does not equal compliance Control does not equal compliance Replace blaming with understanding understanding Give customer options not orders Provide customer with resources Make it simplep

Some of our improvementsLeadership

Mission, vision, key points, principles –making t f f b i f d t d kpart of fabric of day to day work

Functional structure Training and development – succession Training and development succession planningStandardize Improvement Processes and ToolsFacility Design

Some of our improvements

Strategic PlanningContinuous planning cycle p g yLinkage from 20 years to today Automated planning tool and reports p g pMeasurement of how we are doing at macro and micro levels

Some of our improvements

Customer focusListening posts continuously updated g p y pand evaluated Benchmarked feedback tool for satisfaction Gatherings, listening conferences, customer service reps, and family

Some of our Improvementsp

Measurement and Analysis yDevelopment of Balanced Scorecards and Dashboards for every department coordinated and connected throughout the

i ti organization Data Mall for segmentation, understanding performance and understanding performance and registry type information

Tab Based FunctionalityTab Based Functionality

Segmentation of Data

Comparison Charts to Identify Best Practices

Condition CenteredAction List

Fictitious Patient Info

Some of our Improvementsp

Workforce improvements Recruitment Processes: group interviewing, behavioral based interviewing, change how we recruit, online tool for applications,

d ffsame day offersOn-boarding including orientationCore Concepts training on building effective p g grelationships Job progressions and career ladders Development Center p• Upfront training for administrative support and

Certified Medical Assistants • Learning centers tied to workforce competencies

Some of our ImprovementsSome of our Improvements

Process and clinical improvements Process and clinical improvements Microsystem Optimization -teams• Primary Care: MD, RN, Certified Medical y , ,

Assistant, Admin Support• Human Resources, HR Generalist and Assistants

Redefine work Redefine work • Move from episodic, reactive care to long-term

relationshipM f l t i it t f • Move from only one-to-one visits to use of groups, phone, email, fax

• Move from doctor-centric to team based approach i l ti hiin relationship

Some of our ImprovementsSome of our Improvements

Process and clinical improvementsocess a d c ca p o e e tsCustomer-owner choice of healthcare providerBehavioral Health Consultants Case management and chronic illness management•Depression, asthma, chronic pain, di b t HIV tdiabetes, HIV, etc.

Advanced Access – appointments when the customer wantswhen the customer wants

Parallel Work Flow Redesign

Some of our ImprovementsSome of our ImprovementsProcess and clinical improvements

Integration of Complementary MedicineTelehealth, telepharmacy and t l di itelemedicineFamily Wellness Warriors InitiativeS i A tService AgreementsHospitalists

Southcentral FoundationVISION

A Native community that enjoys A Native community that enjoys emotional, physical, mental, and

spiritual wellness.

MISSIONWorking together with the Native

community to achieve wellness through health and related services.

Specifics on improvements

R l ti hi B d S tRelationship-Based System

Tribal Governance RelationshipsEmployee RelationshipsEmployee RelationshipsCommunity RelationshipsProvider RelationshipsProvider Relationships

Customer/Owner Listening Customer/Owner Listening

P l 24 h h tli

Not just one method of listening

Personal interaction with staff

24-hour hotlineListening Conference

Group visitsComment cardsC t

Conference Governing boardAdvisory Customer

Satisfaction surveys

Advisory committees Focus groupsy

SCF internet Annual Gathering

g pService agreements

Gathering

Using the Voice of the Using the Voice of the Customer/Owner

54% of SCF employees are Alaska Native and American Indian people, we bring the voice of the customer interactions throughout the organization Alaska Native and American Indian people Alaska Native and American Indian people recognize our families will utilize these services for generations to comeg

Core ConceptsCore Concepts

W ork together in relationship to learn and W ork together in relationship to learn and growE ncourage understanding L isten with an open mind L augh and enjoy humor throughout the dayN ti th di it d l f l d N otice the dignity and value of ourselves and othersE ngage others with compassion E ngage others with compassion S hare our stories and our hearts S trive to honor and respect ourselves and others

Listening Conference Yearly Since 2003Panel of Board Members, Panel of Board Members, President/CEO and Vice PresidentsOpen microphone Open microphone All customer/owners, community invited invited No agenda

Listening Conference continued

Starts with a small presentation SCF HistoryListeningSetting PrioritiesLooking to the futureLooking to the futureDriving change We’re owning the systemWe re owning the systemYour voice mattersThank you /explain the process y p p

Listening ConferenceMicrophone is passed around the room to customer/owners

Ask questionsOpportunities for improvementC li t Compliments Suggestions

Notes are taken during the whole conferenceconference

Listening ConferenceTranscripts are reviewed Entered into our customer comment databaseForwarded to appropriate department/committee/employeeEvery customer comment is followed up on Tracking and trending

The Gatheringl i 99Yearly since 1997

Convention center161 Booths of all kinds161 Booths of all kinds

Education Healthy life stylesSCF departmentsCommunity (Education, Regional Native Corporations, etc.)p )

Activities Entertainment

The GatheringgInteractions with employeesFeedback from customer/owners

Examples• More help for elders• Parking • More cancer support • More cancer support • Better customer service when checking in for an

appointment • Helping the homeless/emergency financial situation

I f ti f ll th h lt b Information follow through on survey results by committee/managers

Tracked through electronic feedback systemkensure appropriate action is taken

Website

Strategic Planning Cycle

What are we trying to accomplish?

How will we know that achange is an improvement?

What changes can we makethat will result in improvement?

ACT PLAN - What changes - Objective are to be made? - Questions and

Predictions (why) - Next Cycle? - Plan to carry out

the cycle (who, what, where, when)

STUDY DO - Complete the - Carry out the plan analysis of the data - Document problems - Compare data to and unexpected

di ti b ti predictions observations - Summarize what - Begin analysis was learned of the data

Planning and Improvement LinkagesPlanning and Improvement Linkages

August 2006

Corporate Goals ESTABLISHED AT CORPORATE LEVEL

Established by Vice President Leadership Committee and approved by Board of Directors and are derived from the Mission Vision, Key Points and Operational Principles

Mission, Vision, Key Points, Operational PrinciplesEstablished by Vice President Leadership Committee and approved by Board of Directors Annual Planning Process

and Cycle, Baldrige Process, Improvement Cycle, and Committee

Str ct re are the

Green = Core foundation Pink = Initiatives

Orange = Work Plans/Action ItemsRose = Employee Evaluation

Blue = Improvement ToolsGrey = Other Useful Tools

Double Line Box = Part of Annual Planning Tool

Balanced Scorecard (BSC)Linked to Corporate Objectives and

Planning and Improvement Linkages

Corporate ObjectivesESTABLISHED AT CORPORATE LEVEL

Reviewed and updated annually by Vice President Leadership Team as part of Planning Cycle with input from employees/customers

Division Initiative DepartmentCorporate Functional Structure Project or Project

Team Charter

Because initiatives tie to Objectives and they are longer term, they

should be linked to BSC.

Structure are the approaches and systems in which these tools are

deployed.

InitiativesStrategic activities identified that are longer term (occur in 1-2-3 years) to

p jmeasure progress on achieving Corporate

Objectives

4 Oval Structure

Division Initiative InitiativeInitiative Committee Initiative

W k Pl A ti It

Developed for most initiatives to outline the details of the initiative.

PDSA Developed for work plans that involve

improvement activities to outline the details of the

Division Work Plan/Action

Item

Department Work Plan/Action Item

Functional Structure Committee Work Plan/

Action Item

Functional Structure Committee

Work Plan/Action Item

Department Work Plan/Action

Item


Item

longer term (occur in 1-2-3 years) to achieve the corporate objectives. Initiatives may be developed at all

levels of the organization.

Work Plan or Action ItemDetails the short term action items (tests of change

or less than quarter in duration) that will be completed and/tested to achieve an initiative. Work

plans may be developed at all levels of the organization

outline the details of the work plan. Changes are tested in Rapid Cycle, with one cycle building

on another.


Item

Employee Performance Action

Plan


Plan


Plan


Plan

Link to Improvement

ToolsEmployee Performance Action PlanDetails for each employee their action items for the year linked to initiatives

Dashboards (DB)Operational Measures that monitor the day to day operations. These

measures inform where improvement may be targeted. If the

annual plan is used as an operational work plan in addition to a

strategic plan, DB items may be linked to these operational initiatives/

OTHER USEFUL TOOLS Project Team Charter Assessment Conference Lessons Learned BSC/DB DefinitionsMedelearnIntranet Tools

Improvement ToolsOperational Principles: Used to test ideas or concepts to ensure consistency with MVKP&Corporate Goals Measurement Rules Template: Developed to assist with defining BSC / Dashboards measures. Part of the intranet toolCommittee Manager: Used to develop Project Team in order to communicate changes, meeting minutes etc

corporate wideADLI Approach, Deploy, Learning, Integration: From Baldrige used to evaluate PDSA cycles. Change Concepts: Change concepts are used in improvement to assist in generating new ideas when

Plan Plan Plan Planand work plans.

Data and Information drives all aspects of the Improvement Process and is part of all tools. Data are reviewed from the 4 perspectives: Finance/Workload, Organizational Effectiveness, Customer, & Workforce including National Research Corporation-Customer Satisfaction; Morehead Associates-Employee Satisfaction; BSC/DB, Hedis etc.

linked to these operational initiatives/work plan items. including forms

Policy & Procedure TemplatesCommittee Reporting Form

Change Concepts: Change concepts are used in improvement to assist in generating new ideas when making changes

Survey Monkey: Used to measure success for process changesBaldrige Assessment and Feedback: Survey that can be used to assess where the organization/department/committee is based

on Baldrige Criteria Measurement Rules Template

Measurement LinkagesMeasurement Linkages

Improvement Model:

From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by Langly, Nolan K., Nolan T., Norman, and Provost

Continuous ImprovementContinuous Improvement

PA

Situation as it Should

P DSABe

P

P

D

D

S

SA

A

ImprP

DS

A rovemennt

Situation as it isFrom The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by Langly, Nolan K., Nolan T., Norman, and Provost

SCF Facilities Supporting Health

The key determinant of health (and success in education and finances) is Self ConfidenceSelf Confidence draws from pride, Se Co de ce d a s o p de,honor, dignity, respectOutstandingly beautiful facilities are Outstandingly beautiful facilities are a key piece of improving Alaska Native pride honor dignity - self Native pride, honor, dignity self confidence

Customer-Owner Design

Easy to find, welcoming spacesBeauty, light, comfort, colors and Beauty, light, comfort, colors and textures that are familiarNative feel but not any specific one Native feel, but not any specific one cultureDignity pride respect honor Dignity, pride, respect, honor, relationshipP i ti li t iPrivacy, time, listeningFamily and friends welcome

Facility designSmaller, quieter, more personal feelingNot on top of each other spreading infection and being disruptiveinfection and being disruptiveAccommodates family and privacy bothComfortable exam spaces and on the Comfortable exam spaces and on the same level as the clinical people – respectSelf management, customer-owner Self management, customer owner controlVisual, sharing, listening, professional

Facility DesignGroup sociology – Family dynamics - max Group sociology Family dynamics - max 15 people, Team dynamics up to 65, over 65 – bureaucracy Back to smaller ‘team’ practices – 6 ‘primary care’.D t li d H lth I f ti C t Decentralized Health Information Centers into every waiting areaShared specialty rooms and equipment -Shared specialty rooms and equipment -central spineExtensive use of glass, natural light, semi-g , g ,privacy

Facility DesignEmphasis shifted towards more team Emphasis shifted towards more team space and more importance of integrated team spaceg p

More and more team care, ‘virtual’ care (email and phone and home visitors), l i itless visits.No ‘nurses station’CMS and CMA’s with teams phone CMS and CMA s with teams – phone traffic direct to teamsShared resources – behaviorists, Shared resources behaviorists, dieticians, pharmacists, coverage staff -visible/accessible

Facility Design

Structural alignment with shift in power to be more balanced – spaces d di li dde-medicalized

Family roomsG Group rooms

Co-located Mental Health therapistsh dExperiments with merged

pharmacist, pregnancy and pediatric carecare

Data Slides

Diabetes: Annual HbA1C

88.1 88.2 87.3 86.7 88.8 91.0 90.5 91.9100

50

100

%

0Mar Jun Sep Dec Mar Jun Sep Dec

2008 2009

SCF 2008 HEDIS 90th Percentile (88.81)

Diabetes: HbA1C Poor Control

23.0 24.2 26.9 26.5 23.7 22.5 22.5 22.820

40

%

0Mar Jun Sep Dec Mar Jun Sep DecMar Jun Sep Dec Mar Jun Sep Dec

2008 2009

SCF 2008 HEDIS 10th Percentile (32.60)SCF 2008 HEDIS 10th Percentile (32.60)

Diabetes: LDL < 100mg/dl

100

50.3 49.8 48.5 49.1 48.3 52.1 54.0 52.950

100

%


2008 2009


Diabetes: B/P < 130/80

34.0 39.4 39.850

100

%

0Mar Jun Sep Dec Mar Jun Sep DecMar Jun Sep Dec Mar Jun Sep Dec

2008 2009

SCF 2008 HEDIS 90th Percentile (41.30)SCF 2008 HEDIS 90th Percentile (41.30)

Cardiovascular: LDL < 100mg/dlg

49 2 51 0 50 3 49 1

100

40.3 49.2 51.0 50.3 49.1

0

50%

0Dec Mar Jun Sep Dec

2008 2009


Asthma: Appropriate Meds96 96 97 95 96 9587 86 87 96 96 97 95 96 95 84 82 83

50

100

%

0

Oct

Nov

Dec Oct

Nov

Dec Oct

Nov

Dec Oct

Nov

Dec

SCF Overall 5 to 9 yrs 10 to 17 yrs 18 to 56 yrs

2009

SCF 2008 HEDIS 90th Percentile (Overall 91.94)

Cancer Screening: ColorectalCancer Screening: Colorectal(Flex sig and Colonoscopy)

48 9 50 3 52 2 55 6 57.0 57.8 58.2 58.6

100

48.9 50.3 52.2 55.6 57.0 57.8 58.2 58.6

0

50%


2008 2009


Cancer Screening: Cervical

73.4 73.6 73.8 73.6 74.1 75.3 75.5 75.2100

0

50%

Mar Jun Sep Dec Mar Jun Sep Dec

2008 2009


Cancer Screening: Breast

59.0 58.2 57.5 56.5 56.5 56.1 56.6 57.4

100

0

50%

Mar Jun Sep Dec Mar Jun Sep Dec

2008 2009


Complex Utilizer: Annual Behavorial Visit

58 4 59 0100

52.3 53.2 55.6 58.4 59.050%

0Dec Mar Jun Sep Dec

2008 20092008 2009

SCF SCF Target (75%)

Controlled Medications: Annual Behavorial Visit

32 8 35 450

100

% 30.3 28.8 30.4 32.8 35.4

0

50%

Dec Mar Jun Sep Dec

2008 2009

SCF SCF T (50%)SCF SCF Target (50%)

Access to Recovery: 6 Month Follow-Up of Intakes

94.080.7100

50%

02008 (N=151) 2009 (N=657)

SCF A All G (2008 64 % 2009 63 %)SCF Avg All Grantees (2008:64.7% 2009: 63.7%)

Access to Recovery: Alcohol & Drug Abstinence

72.7

50 066.4 65.5

76.862.8

70.9100

46.1 50.050%

0Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo

FY09 Q1 FY09 Q2 FY09 Q3 FY09 Q4FY09-Q1n=128

FY09-Q2n=122

FY09-Q3n=142

FY09-Q4n=86

Access to Recovery: Employment & Education

39 1 37 350

100

%

18.8

39.123.8

33.6 28.237.3

29.1 34.9

0

50%

0Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo

FY09-Q1 FY09-Q2 FY09-Q3 FY09-Q4n=128 n=122 n=142 n=86

00

Crude Rate: AN SuicidesAnchorage & MatSu Residents

46.7050

100

er 1

00,0

0

24.60

0

50

uici

des

pe

2004#Suicides=16

2006#Suicides=9

2008#Suicides=3

Su

Emergency Dept Visits per 1000 Member MonthsEmergency Dept Visits per 1000 Member Months

100

00

42.76 43.9750

ts p

er 1

00

02008 2009

Vis

it

2008 2009

SCF HEDIS 10th Percentile (40.59)

M thl ED Vi it P 1000 C tMonthly ED Visits Per 1000 Customers(Historical)

80

39

48

40per 1

000 19% Decrease Since 2000

0

Vis

its

2000

2001

2002

2003

2004

2005

2006

2007

Total Outpatient Visits per 1000 Member Months

4000

299.35 322.25

200

400

ts p

er 1

000

02008 2009

Vis

it

SCF HEDIS 50th Pctile (324.01)HEDIS 25th Pctile (274.04)

Qrtly Outpatient Visits Per 1000 Customers(Historical)

10771200

00 36 % Decrease Since 1999

693

400

800

its p

er 1


0

400

99 00 01 02 03 04 05 06 07

Vis

199

200

200

200

200

200

200

200

200

Total Inpt Days per 1000 Member MonthsTotal Inpt Days per 1000 Member Months

50

00

27.00 26.8225

ays

per 1

00

02008 2009

Da


Qrtly Hospital Days per 1000 CustomersQrtly Hospital Days per 1000 Customers(Historical)

81.5100

000

71 % D Si 1999

23 3

50

ays

per 1


23.3

0

99 00 01 02 03 04 05 06 07

Da

199

200

200

200

200

200

200

200

200

Total Inpt Discharges per 1000 Member MonthsTotal Inpt Discharges per 1000 Member Months

10

1000

5.72 5.98

5

arge

s pe

r

02008 2009

Dis

ch


Qrtly Hosp. Admissions Per 1000 Customers(Historical)

19.0320

per 1

000

75% Decrease Since 1999

4.72

10

mis

sion

s p 75% Decrease Since 1999

0

1999

2000

2001

2002

2003

2004

2005

2006

2007

Adm

Customer Satisfaction (Top Box %)

71.268.2100

0

50%

02008 2009

SCF **Mayo 69% **Clev. 66% **JH 75%y

Customer Satisfaction (Top Box %)

70 74 73 73 83 9166

100 70 74 73 7353 56 66 66

50%

008 09 08 09 08 09 08 09 08 09

Clinics Dental Home Hlth Emerg. Outpt BHgServ.

p

SCF

BSC Customer Satisfaction (Positive Response)91.788.5100

50%

02008 2009

SCF BSC 2009 Target (85%)SCF BSC 2009 Target (85%)

Ability to Give "Input" (Top Box %)

100

65.3 65.0

50%

008 0908 09

SCF CAHPS (Top Box) 2009 (53.5%)

FY Operating MarginFY Operating Margin

12.5 11.0 11.18.6 8.8 8.410 0

15.0

2.4 2.3

0.0

5.0

10.0%

-5.0

2002

2003

2004

2005

2006

2007

2008

2009

SCF SATO MGMA 90th %tile 2009 (1.3)

FY Total Revenue ($Millions)

174.6200

102.5 120.2 128.5 143.2 146.3 149.0174.6

150.3

100

200

0 2002

2003

2004

2005

2006

2007

2008

20092 3 4 5 6 7 8 9

SCF SATO MGMA 90th %tile 2009 (77.4)

SCF Customer Growth (# Empanelled)

80,00059,992

40 000

60,000

#

18,21620,000

40,000#

0FY 1999 FY 2009

Cumulative Per Capita ExpendituresRelative % Change with 2004 as BaselineRelative % Change with 2004 as Baseline

262726

25

30ba

selin

e

15

10

15

20

nge

from

b

5

0

5

10

tive

% c

han

-10

-5 2004 2005 2006 2007 2008Rel

at

SCF Cumulative Primary CareSCF Cumulative Hospital ServicesNational Health SpendingNational Hospital Care ExpendituresNational Physician and Clinic Services Expenditures

Workforce Commitment Indicator

3 83 3 91 3 92 4 0753.83 3.91 3.92 4.07

23

4S

core

01

2S

2003 2005 2007 2009

SCF Morehead Nat HC Ave 2009 (4.10)

Development Center Courses per 100 FTE

8 5910FTE

8.59

3.945

10s

per 1

00 F

0SCF Local HospitalC

ours

es

2010

% of Workforce Promoted

8 70

13.5011.80 12.60

20

8.70

0

10%

02005 2006 2007 2008

SCF 2008 Saratoga 90%tile (11.50)SCF 2008 Saratoga 90%tile (11.50)

% of AN/AI Workforce Promoted

20

9.5 9.2 9.5

14.1

10

20

%

0

10%

02006 2007 2008 2009

SCF 2008 Saratoga 90%tile (11.50)

"I understand mission & core values"

4 435 4.31 4.323.87

4.43

3

45

ore

01

2Sco

02003 2005 2007 2009


90 Day Turnover Rate

20

5 9 7.110% 5.93.4

02007 2008 2009

SCF 2008 Saratoga 90%tile (7.30)

"This org. cares about employee safety"

3 88 4.05 4.17 4.3053.88

23

4

Sco

re

01

2003 2005 2007 2009

S

2003 2005 2007 2009


Benefit Satisfaction & Organizational Support

3 69 3 66 3.89 3 67 3 73 3.87 3 68 3.93 4.0245

3.69 3.66 3.67 3.73 3.68

1234

Sco

re

01

05 07 09 05 07 09 05 07 09

I am Satisfied w/ Benefits

Org Support Work vs Pers.

Org Interested in Health\Wellness

SCF 2009 Morehead Natl HC Ave (Sat 3 66 Sup 3 82)SCF 2009 Morehead Natl HC Ave (Sat 3.66 Sup 3.82)

% Appointments Available at 0800for Whole Day (FMC/PEDS/VAL)

10047 48 58 62 55 59

41 42 43 35

0

50%

0

Ove

rall

Ove

rall

Ove

rall

Ove

rall

Ove

rall

Ove

rall

Ove

rall

FMC

PE

DS

VA

L

03 04 05 06 07 08 09 09

SCF SCF Innovative Target (50%)

Behavioral Health Urgent Response Capacityg p p y

2915

3984 3867

3000

4000

333

1176 1114

2005

1000

2000#

3330

2003 2004 2005 2006 2007 2008 2009

SCF

Continuity of Care with Primary Provider

83 76100

35

73 67647183 76

50% 35

0

50%

099 00 01 02 03 04 05 06 07 08 * 09

PEDS FMC VAL MHS (44.85%)

Southcentral foundation nuka

Health & Medicine

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