Patient-Centered, Physician-Efficient Care: Enhancing the Healthcare Experience

1. Michael K. Magill, MD, Executive Medical Director Robin L. Lloyd, MPA, Executive Director Welcome to Learning Day

5. Community Clinics and Physicians Group Locations

6. Redwood Health Center and Urgent Care

7. Greenwood Health Center

8. Westridge Health Center Redwood Health Center and Urgent Care

9. South Jordan Health Center

10. Stansbury Health Center Redwood Health Center and Urgent Care

11. ParkwayHealthCenter Redwood Health Center and Urgent Care

12. RedstoneHealthCenter Redwood Health Center and Urgent Care

13. Redwood Health Center and Urgent Care CentervilleHealthCenter

14. FacultyPractices Redwood Health Center and Urgent Care • Madsen • Family Medicine • Sugarhouse • Family Medicine

15. SouthwestHealthCenter

17. MissionStatement Together, we create a better life for our patients and community through compassionate, knowledgeable care. Values Respect: We affirm the individual worth of each patient in our care. Excellence: We dedicate ourselves to thoroughness, innovation, and education that result in excellent medical care for our patients. Integrity: We deal honestly and fairly with our patients, families, and each other. Teamwork: We work together to create a cohesive, trusting, and responsive organization that effectively serves our patients.

19. Personnel Providers 171 MD, DO, DPM 47 PA, NP, CNM 12 U of U Specialists 28 Moonlighters 27 OD 9 Sugarhouse 21 (9 MD, 12 Residents) Madsen 27 (15 MD, 1 PA, 11 Residents) Support staff 552 Total 723

20. Patients Visits / year (FY08): 317,000 Active patients: 157,000

21. Services: Clinical Primary care FM, IM, Ped, OB/Gyn Specialty care Gastroenterology Cardiology Orthopaedics Podiatry Neurology, Dermatology Urology, PM&R Urgent Care Vision Ophthalmology, Optometry, Optical Pharmacy Laboratory Radiology Plain CT Mammography Nuclear U/S Endoscopy Physical Therapy Dexascan

22. Services: Business Administrative Executive Leadership Executive Medical Director Executive Director Chief Operating Officer Group Medical Director Clinic Medical Directors Clinic management team Support Services Central billing services Marketing Compliance Payer contracting Facilities management Human resources

23. Patient CenteredPhysician Efficient Care “A different system is needed, one that is reliable, proactive, efficient and engages patients in ways that ensure the best outcomes” *Innovations in Planned Care Series 2006, Institute for Healthcare Improvement

24. Culture of Change Shared mission and values Business imperative—burning platform Change agents Disruptive Innovation Talented, experienced management team Effective physician leadership Aligned incentives Control overall functional areas

25. Culture of Change Market driven Lean design Quality driven EMR Investment in training Strong financial reporting model Culture of accountability

26. Culture of Change Separate but a part of … Sponsorship Group Sense Right-sized before growth and development Consensus vs. leadership Standardization – tail of the dog Focus on revenue – “the game is won on the revenue side”

27. Measures of Success ↑ Patient Satisfaction 64%, 75%, 84% ↑ Appointment lag time ↓ Third available appointment ↓ No show dropped by 50% ↓ Cycle time 1.5 hours to 45 minutes or less ↓ Wait for appointment

28. Measures of Success ↑ Financial performance ↑ Staff & provider satisfaction ↓ Staff cost comparison (% of NPR) ↑ Visit Growth ↑ Patient confidence in managing their care ↑ Quality measures

29. Bottom Line: Clinics & Vision Operations Trend

30. What’s Next …. Medical Visit Lunch Orders Break

31. “It’s About Time…” “The Patient Centered, Physician Efficient Visit”

32. “It’sAboutTime…”“The Patient Centered, Physician Efficient Visit” To focus on the patient’s experience and expectations To enhance the efficiency and effectiveness of the physician To take action Beta site design and implementation System implementation

33. SouthJordanHealthCenter The BetaSite

34. Patient CenteredPhysician Efficient Care “A different system is needed, one that is reliable, proactive, efficient and engages patients in ways that ensure the best outcomes” *Innovations in Planned Care Series 2006, Institute for Healthcare Improvement

35. Began as an Advanced Access initiative in 2003. Implementation was fairly swift and broad. Experience, patient feedback and monitoring of measurement tools compelled us to refine the processes and definition to “Appropriate Access”.

36. Advanced AccessMeasurement – Definition & Methodology • Patient Zip Code Distribution • Visits Per Patient Distribution • Appointment Lag Distribution • Patient ICD9 Diagnosis Distribution • Patient Responsible Party • High Frequency Patient Analysis • Patient Appointment Trend • Percent of filled Appointments • Daily Demand Counts • Cycle Time Counts • 3rd Available – Current • Provider Productivity Trend & Productivity Current

37. Sample Reports for Advanced Access Lag Report Time from appt. made to arrival 0 = Same Day Each provider at each location worked for FY 2003 Visits per Patient Distribution Report for each provider for FY 2003

38. Appropriate Access: • Acute care when it is needed • Care when the patient requests it • Chronic care that provides the right care every time • Continuity of care

39. This initiative began in 2004 with the opportunity to open a new South Jordan clinic that was the beta site for “It’s About Time” care team. The six core principles were defined, agreed upon and implemented. Implementation across the CC progressed over the next four years. Progress is measured and efforts continue to refine and ingrain the core principles.

40. Patient Experience Pre-Registration – Call Center Messaging – Call Center Teamwork Don’t move the patient Accompany the patient After Visit Summary “They value my time” “That was an excellent visit”

41. Right Person / Right Job Consolidation of Care Teams Medical Practice Assistant (MPA) Clinical Data Entry Revenue Process Laboratory/Phlebotomy Radiology/X-Ray Reallocation of Job Functions Defined Patient Flow Efficient Provider Utilization “If the Doc doesn’t have to do it – make it so.” Micro System Concept Off Site Support Services

42. Standardization EMR Exam Room EMR and printer Supplies for scope of practice Order Protocols Scheduling Documentation X-Files for intake Smart Texts Smart Forms Training, Coaching, Cross Training Scripting for “Excellent” Service

43. Facility Design Reception “Kiosk” Design Minimize Lobby Area Proximity of exam, lab, nurse, physician, x-ray Front Stage – Back Stage Supplies in Rooms – minimize central storage areas Digital Radiography Pharmacy and Vision Services

44. Exploit Technology Robust EMR Intra & Inter Net Access Across System Radios - Pagers Cordless Phones - Vocera Call Center – Appt./Reg./Message Standards, Statistics, Scripting, Call Recording Pharmacy Protocols, Refills Registry Use & Follow-up

45. Communication Stand Up Meetings Team Huddles Phone Pools – EMR Messages Radio and Headset Protocols Call Center Protocols Bulletin and Staff Photo/Bio Boards

46. In 2005 and 06, we were asking what’s next, what’s missing, what have we learned? The improvements made through Appropriate Access and the efficiencies of Care Teams led us to focus on visit planning and eventually to the broader idea of Planned Care. Planned Care encompasses and enables many of the objectives and tools needed to participate in future Medical Home opportunities.

47. Accountability in systems • Standardization • Measurement • Benchmarking • Communication / Sharing • Community Clinic Council • Leadership & Sponsorship • Growth • Visits, revenue, services, sites