JPS HEALTH NETWORK • 537 bed hospital, Level 1 Trauma Center

5/27/2015
Improving the Patient Experience
Alignment Strategies at the JPS Health Network
JPS HEALTH NETWORK
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537 bed hospital, Level 1 Trauma Center
Tarrant County’s Safety Net Hospital
15 primary care clinics
20 school‐based clinics
8 specialty clinic sites
338 active medical staff
100 primary care providers
6000 employees
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Healthcare in a Safety Net System
• Ever increasing population of underinsured/uninsured patients
• Aging population with increasing chronic conditions
• More to know, more to do, more to manage, more to watch, more people involved than ever before!!
ORGANIZATIONAL ALIGNMENT
• Patient Quality, Satisfaction & Safety starts with Culture
• Physician alignment is the key to changing culture
• Improvement in patient, provider and employee satisfaction is a journey
• Engage Providers as stakeholders • Envision a culture of excellence
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Where did our journey begin?
• Establishing vision
• Reviewing current state »
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Physician compensation was fee for service
Quality assumed but not measured
High ED utilization
Barriers to access
Patient satisfaction in the less than 5%
Developing a Strategic Plan: 7 steps
1. The Organization would need to develop a Strategic Initiative Plan 2. Adopt an EMR platform
3. Develop Departmental Metrics that aligned with the JPS Strategic Initiatives
4. Transparency with the Data
5. Engage Physicians Directly with action planning to achieve metrics
6. Establish a PCMH as a care delivery model
7. Develop a compensation plan that incentivizes outcomes
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1. JPS Pillars – A good starting place
Hurdle 1 Developing Strategic Initiatives • Service
• Quality
• Stewardship
• People Engagement • Population Health
• Academics
Hurdle 2 Aligning Initiatives with Medical Staff
2. Adopt an EMR platform
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3. Developing Clear Measures
• Metric alignment with JPS Strategic Initiatives
• Relevant and Achievable
• Communicate results regularly
4. TRANSPARENCY
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6. Provider Feedback System
• Physicians are data driven driven
• Providing high quality care to patients • Accomplishing organizational objectives 6
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Accountability: #1 reason why
execution is not accomplished
Chairman
• Share the vision, set the tone and pace
• Meet quarterly with regional directors
• Meet monthly with all medical directors for larger strategy
Regional Directors
• Meet monthly with operational and medical leaders
• Discussion and action planning
• Translate the vision
Site Directors
• Create transparency for patients and staff
• Further refine action planning for unique sites
• Display data on the Strategic Initiative Board
6. PCMH Care Delivery Model
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PCMH Care Delivery team:
Diabetes Action Plan
Population Care Manager
to Classify patient zone
Schedule visit with
Health Care Coach
1.HGBA1C
greater
than 12
2. Those
patients
recommended by
pcm that
need
coaching
Enroll in Diabetic Group Classes. Health Care
Coaching as trained. Ensure that patient has
glucometer and supplies. Assess readiness for
change, develop care plan.
Affordability
an issue ?
Visit with Social Worker.
Consider appointment
with Pharm D.
Follow up Q 3
month visit or at
PCP discretion
Ensure that patient
has BS log and will
check BS regularly
Short interval visits with
Health Coach as indicated,
report glucose results to pcp
for med. adjustments. App.
With pcp every 3 months or
with PCP till patient in yellow
zone or sooner appointment
if patient with excessive high
or low glucose readings.
7. COMPENSATION PLAN
• Competitive compensation plan, 50% MGMA mean
• Compensation is salary based, signing into a culture
• 10% of compensation is at risk, based on achieving 3/5 metrics in each Strategic Pillar. • Pillars are weighted based on Organizational priorities
• Bonus based on excelling with 5/5 metrics
• Medical Directors with 50% of the at risk salary based on Clinic performance. 8
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RESULTS
Service: Average days to 3rd next
available new patient appointment
Target is 30 days
70
60
Good
50
40
Average 3rd Next New Patient
Appointment
30
20
10
Apr‐15
Mar‐15
Jan‐15
Feb‐15
Dec‐14
Oct‐14
Nov‐14
Sep‐14
Jul‐14
Aug‐14
Jun‐14
Apr‐14
May‐14
Mar‐14
Jan‐14
Feb‐14
Dec‐13
Nov‐13
0
Updated: 5/01/2015
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Service Pillar: Patient Satisfaction
Feb
Mar April May June July
72.7
70 77.6
77
72
Aug
73.7
Sep
Oct
72.5 77.6
Nov
74.9
75
Dec‐13Jan
Feb
Mar
72 73.1 74.7
April May Sept Oct
75.8 79.5
78
Nov
74 76.9 80.7
Dec‐14Jan
76.2 80.1
82
80
78
76
74
72
Series1
70
68
66
64
Updated: 4/1/2015
Quality Pillar: Pneumococcal Vaccine
Pneumococcal Vaccinations
(Higher is better)
90
Good
85
80
Pneumococcal Vaccinations
(Higher is better)
75
70
Updated: 5/01/2015
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Quality Pillar: Colorectal Screening
Colorectal Cancer Screening
(Higher is better Target 60)
60
Good
55
50
45
40
35
30
Colorectal Cancer Screening
(Higher is better)
25
20
15
10
5
0
Updated: 5/01/2015
Quality: Cervical Cancer Screening
Cervical Cancer Screening
(Higher is better Target is 70)
70
68
66
64
62
60
58
56
54
52
50
Good
Cervical Cancer Screening
(Higher is better)
Updated: 5/01/2015
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Population Health: Diabetes B/P
Blood Pressure Good Control (<140/90)
(Higher is better Target is 68)
70
Good
65
60
55
Blood Pressure Good Control (<140/90)
(Higher is better)
50
45
40
Updated: 5/01/2015
Population Health: Diabetes eye exam
Retinal Eye Exam
(Higher is betterTarget is 52%)
70
60
Good
50
40
30
Retinal Eye Exam
(Higher is better)
20
10
0
Updated: 5/01/2015
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Population Health: Diabetes foot exam
Foot Exam
(Higher is better Target is 58)
80
70
Good
60
50
40
Foot Exam
(Higher is better)
30
20
10
0
Updated: 5/01/2015
Population Health: Diabetes HGBA1C
A1C Poor Control
(Lower is better Target is 43)
44
42
Good
40
38
36
34
32
30
**A1C Poor Control (>9.0%)
(Lower is better)
28
26
24
22
20
Updated: 5/01/2015
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Lessons Learned
Nothing ventured, nothing gained
Start with data that is readily available Metrics need to be RELEVANT and ACHIEVABLE
Transparency as the goal for all data
Communicate ahead of time proposed changes to those effected downstream. Allow plenty of time for discussion with stakeholders. • Medical Director’s need to be leaders & coaches
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Contact Info
• Dr. Robert Richard, Chairman Community Medicine
» rrichard@jpshealth.org
• Dianna Prachyl, VP Community Health
» dprachyl@jpshealth.org
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