Promoting Primary Care for South Florida A Community Dialogue

1. Promoting Primary Care for South FloridaA Community Dialogue Presentation to : Health Foundation of South Florida November 15, 2007, 9:00 a.m. – 3:00 p.m. Jungle Island Miami, Florida HRSA/BPHC Quality and the National Landscape Vanessa Watters, MHA Chief, Quality Branch U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data

2. Presentation Purposes • Illustrate how quality is defined by HRSA/BPHC • Provide national examples of organizations that demonstrate the HRSA/BPHC Quality Strategy • Offer dialogue which supports organizational assessment and planning next steps

3. Some Key Questions • What is the HRSA/BPHC Quality model? • Based on this model, what is working for HRSA grantees and partners in other parts of the country? • How can South Florida health care organizations link with and benefit from the HRSA/BPHC quality strategies?

4. OFFICE OF QUALITY AND DATA OFFICE OF THE DIRECTOR Kay Felix, MD Quality Branch Vanessa Watters, MHA FTCA Risk Management Care Model Implementation Accreditation Oral Health Mental/Physical Health HIV Data Branch Angela Damiano-Holder Performance Measures UDS Data System Consolidation Patient Survey

5. HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE ACCESS REDESIGN PI MEASURES PT SAFETY RISK MGMT CONTROLS&MONITORS

6. HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE PI MEASURES CONTROLS&MONITORS

7. HRSA/BPHC Quality StrategyPerformance Improvement Measures BPHC Clinical Measures • National Clinical Performance Reporting Efforts • NQF, AQA and HEDIS alignment • Build upon clinical performance reporting efforts • HRSA’s Healthcare Disparities Collaborative – quality improvement approach that uses evidence based models to transform clinical, leadership, operational and community systems • The United Health Foundation/George Washington University Study – multi-site demonstration project which examines health centers against standard indicators of high quality performance • HRSA’s Office of Performance Review Measures – a menu of national performance measures for use during performance reviews of HRSA funded programs.

8. New Proposed Clinical Measures • New clinical measures • Cervical cancer screening • Childhood immunization • Childhood lead blood levels • Hypertension (blood pressure levels)* • Diabetes (HbA1c levels)* *Themeasures indicated with an asterisk would be reported by total, race/ethnicity and special population • Existing clinical measures • Prenatal Care • Low birth weight

9. Test Specifications: Childhood Clinical Process Measures

10. Test Specifications: Adult Clinical Process Measures

11. Test Specifications: Adult Clinical Outcome Measures

12. National Examples

13. HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE ACCESS REDESIGN CONTROLS&MONITORS

14. HRSA/BPHC Quality StrategyAccess/Redesign Access/Redesign Curriculum • Builds off of HDC successes • Patient-centered care through effectiveness and efficiency • Increases patient access to care • Increases the efficiency of the patient visit • Improves provider, staff, and patient satisfaction • Gets the waiting time out of the system • Decrease cost/visit • Improves the bottom line

15. HRSA/BPHC Quality StrategyAccess/Redesign Key Principles of the Model • Continuity of care - the patient routinely sees his own provider. • Provider Panel - each provider has an identified panel of patients for which he is accountable. • Demand and Supply of Appointments are in balance - patient demand for appointments from the provider and the number of provider appointments available are in balance.

16. National Examples Community Health Center, Inc. • Large, multi-sight HC in Connecticut; Medical, Dental, Mental Health, Ryan-White Services • Uses an open-access model where patients are encouraged to schedule same day appointments to reduce no-show rates, improve patient access and care continuity • Goal to minimize system waste by doing “today’s work today” • Increased patient and staff satisfaction while sustaining/slight improvements in productivity

17. National Examples White River Rural Health Center • Multi-site Health Center located in Rural Arkansas; Medical, Dental, and Pharmacy • Uses fiscal health and business operations to improve access and sustain the care model. • High emphasis on data to link financial outcomes with patient care outcomes - the “big picture” • Patient-focused visit with less waiting time and increased revenue

18. What about you….. • What are your insights and reactions to these quality examples? • What actions or next steps would you take? • What might you do to connect with these components of the HRSA/BPHC Quality Strategy?

19. HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE PT SAFETY RISK MGMT CONTROLS&MONITORS

20. HRSA/BPHC Quality StrategyFTCA Program Goals •  GOAL 1: Improve access to health care by eliminating the need to purchase professional liability insurance - savings to be used to increase the number of patients served. • GOAL 2: Minimize risk to the Judgment Fund through deeming process and health center oversight and monitoring.

21. FTCA Malpractice Incident SummaryNature of Allegation, 1992-2006 Source: KePRO, Harrisburg, PA, FTCA HC Med Mal Cases, September 30, 2006

22. HRSA/BPHC Quality StrategyPatient Safety and Pharmacy Initiative Goals • Improve Patient Safety • Increased Compliance w/ NQF Guidelines • Fewer Errors, Fewer Injuries, Less Harm • Possible Reductions in Size & Number of Tort Claims • Increase High Quality, Cost-Effective Pharmacy Services • Improve Health Outcomes

23. Patient Safety and Pharmacy Initiative 2 Phases of Work Phase 1: Study & Capability Development October, 2007 to April, 2008 Phase 2: Implementation, Action & Results May, 2008 to October, 2009

24. Patient Safety & Pharmacy Initiative Study Phase • Identify and learn from HRSA grantees and partners with results and successes – especially 2-fers and 3-fers • Patient Safety • Pharmacy Services • Outcomes in Core Measure Areas • Document best practices of high performers • Conduct HRSA Patient Safety Inventory to identify already existing tools and resources • Enroll high performers as faculty and leaders in national improvement initiative

25. Patient Safety & Pharmacy Initiative Implementation Phase • Establish quantitative aims to guide improvement • Enroll HRSA grantees and their partners in national peer-to-peer technical assistance & collaboration initiative • Help these teams generate rapid improvements

26. National Examples University Maryland Medical Center • DSH hospital and AMC located in Baltimore MD • Focus on pharmacy safety to reduce errors, adverse events and improve quality • Strong emphasis on the use of technology • Strike the balance between access and controls • Support the “shift to the right” where pharmacist has a heightened role in clinical care and greater time to focus on patient education

27. National Examples El Rio Health Center • HC located in Tucson, AZ with a pharmacist managed DM clinic • Focus on the appropriate use of medications and the tracking diabetes measures to generate positive health outcomes and demonstrate improvements • Increased patient access and improved patient outcomes in diabetes through pharmacy-based disease management

28. What about you….. • What are your insights and reactions to the Patient Safety & Pharmacy initiative? • What improvements or additions would you make to this plan? • What are your insights and reactions to the national examples? • What actions or next steps would you take? • What might you do to connect with this component of the HRSA/BPHC Quality Strategy?

29. Contact Information Vanessa Watters, MHA Chief, Quality Branch U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data 5600 Fishers Lane 15 C 26 Rockville, MD 20857 vwatters@hrsa.gov 301-594-0818