Small Physician Groups Aim
High
Arch Health Partners
• A medical foundation in San Diego formed by Palomar Health and PIMG, a 20 year old
multi-specialty medical group formerly known as Centre for Health Care.
• Currently, Arch Health Partners has over 60 providers, including 24 PCPs and multiple specialties in 7 locations.
• Approx. 16,500 managed care lives • 40-60 split HMO - FFS
Competitive Market
• Sharp
• Scripps
• UCSD
• Kaiser
AHP Vision
“Arch Health Partners will bring together the best physicians, hospitals, and employees to
provide care of the highest clinical quality. Our focus will be to provide an exceptional patient experience where healing begins and
Balanced Scorecard for
Providers
Clinical
Quality
Patient
Experience
Appropriate
Resource
Use
Professional
Development
AHP Quality Improvement
Our goal is to be a Top Performing
medical group in terms of quality,
patient experience and appropriate
High Value Organization
Q
V = ----
C
In the
Beginning,
there was …
The P4P Program
Our initial clinical scores did not represent the type of care we felt we were delivering, nor what our patients deserved.
Clinical Quality Program
• Validate the data
• Engagement Strategies: Patient, Physician and Staff, including Balanced Scorecard Reporting
Primum non nocere
(First, Validate the Data)
• Initial results based on health plan data
• We developed our own Clinical Registries for the P4P metrics to validate health plan data using Intelligent Health Care
• 2009 supplemented by EMR
• Discovered better to self report in California as health plans in California may not receive all the clinical data with claims (improving).
Patient, Physician and Staff
Engagement
• Personalized phone outreach by primary care offices for evidence-based care and screenings
based on clinical data registries which identify gaps in care
• Education of Providers and staff
• Balanced Scorecard reporting for MDs
Care Management Services
• Team composition
– RN Performance Improvement Director
– RN Case Managers (one vacant position)
– RN Disease Manager – Registered Dietician
– New: SNF Nurse Practitioner
– New: Shared Palomar Health
Safe Transitions
• Hospitalist program, including Palliative Care Board Certified Physician
• Inpatient Case Management – liaison with inpatient, ambulatory, and disease management teams
– supplements hospital case management program. • SNF Nurse Practitioner
• Post-discharge continuity of care program to ensure follow up post ER, SNF and inpatient stay.
• Identify high risk patients
• Assessment and close coordination of care
• Tracked and reported monthly
Arch Health Partners: Final 2011 Clinical P4P Results
Target: Exceed 75th % ile Statewide
18 out of 24 exceeded 75th %ile (vs 15/24 in 2010) 14 out of 24 exceeded 90th %ile (vs 10/24 in 2010)
16/24 or 67% showed improvement (vs. 13/18 or 72% in 2010)
Measure AHP 2010 Score: % Com pliant 2011 Score: % Com pliant 50th %ile Cutpoint 75th %ile Cutpoint 90th %ile Cutpoint CARDIOVASCULAR CARE
Cholesterol Management for Patients w ith Cardiovascular Conditions:
LDL-C Screening 92.68 97.44 89.47 94.45 95.76
Cholesterol Management for Patients w ith Cardiovascular Conditions:
LDL-C Control <100 mg/dL 87.8 82.1 65.69 73.71 76.69
Annual Monitoring for Patients on Persistent Medications: Overall 78.09 79.85 80.52 83.55 87.87
DIABETES CLINICAL MEASURES:
Diabetes Care: HbA1c Screening 95.06 94.82 87.24 91.3 93.23 Diabetes Care: HbA1c Poor Control > 9.0% 16.36 18.13 29.59 21.42 18.43
Diabetes Care: HbA1c Control < 8.0% 74.03 72.5 61.31 67.34 71.06 Diabetes Care: HbA1c Control < 7.0% 51.02 54.4 40.17 45.73 51.91 Diabetes Care: LDL-C Screening 94.03 92.49 84.19 88.9 92.22
Diabetes Care: LDL-C Control <100 mg/dL 65.19 65.54 46.33 55.79 64.27 Diabetes Care: Nephropathy Monitoring 94.29 95.34 81.9 88.77 93.02
Diabetes Care: Blood Pressure Control <140/90 mm Hg 68.57 67.1 23.95 64.9 79.01 Optimal Diabetes Care Combination Rate 1: A1c < 8%, LDL-c
<100mg/dL and Nephropathy monitoring 50.65 50.77 28.13 41.64 46.92
Optimal Diabetes Care Combination Rate 2: All Combo 1 and BP Control
<140/90 mm/Hg 38.7 39.12 7.69 27.87 39.41
RESPIRATORY AND MUSCULOSKELETAL CARE
Asthma Medication Ratio 74.07 83.78 68.42 73.53 77.44 Appropriate Testing for Children w ith Pharyngitis 97.14 85.19 65.9 86.59 93.54
Appropriate Treatment for Children w ith Upper Respiratory Infection 97.78 100 93.75 97.61 98.47 Avoidance of Antibiotic Treatment for Adults w ith Acute Bronchitis 65.63 54.1 37.48 50.9 61.87
Use of Imaging Studies for Low Back Pain 80.65 82.55 79.86 84.85 88.24
PREVENTIVE CARE:
Childhood Immunization Status: All Antigens (by Age 2) 79.37 88.88 71.19 82.16 88.02 Immunizations for Adolescents: All Antigens (by Age 13) 53.07 72.37 41.35 54.51 62.7 Chlamydia Screening: Age 16-24 42.51 51.6 53.29 62.86 69.27
Evidence-Based Cervical Cancer Screening - Appropriately Screened 28.63 32.72 35.05 43.58 72.91 Breast Cancer Screening: Ages 52-69 73.82 79.56 73.36 80.44 83.71 Colorectal Cancer Screening: Ages 51-75 62.77 69.99 55.87 69.42 72.94
Service Excellence Initiatives
• 2010 patient experience results were disappointing
• AHP Executive Leadership expressed a strong commitment to achieve long-term success in this domain and use it as a competitive differentiator • Improvement efforts targeting both physicians and
Service Excellence Initiatives
• Staff and Physician customer service training
• Physician shadowing/coaching
• Ongoing feedback and monitoring via Press Ganey
• Staff and physician incentives • Leadership rounding
Service Excellence
Committee Activities
• “
Prepare For Your Visit” Agenda Setting Tool• Service recovery protocols
• Cleanliness Survey/competition and reception area “distractions”
• S.M.I.L.E mnemonic from service excellence training posted in each exam room
• Commitment Form demonstrating our expectations signed by all staff and leadership team
Promise of Commitment
As a member of the staff at Arch Health Partners, I am committed to patient satisfaction. I will treat patients in a manner that is friendly, courteous and
compassionate, and will be attentive and responsive to patients’ needs. I will encourage patients to be actively involved in their healthcare. At all times, I will maintain patient confidentiality and dignity.
I am committed to communicating both honestly and openly. I will share information and knowledge in a clear and supportive manner. I will support our policies both internally and externally. When I disagree, I will do so in a professional and respectful manner.
I am committed to an active role in our organization. I will participate in continuous
improvement of our processes. I will take responsibility for problem solving. As a member of a healthcare team, I am responsible for providing well-coordinated services. I will keep myself informed about policies and procedures. I will continually strive to improve.
I am committed to personal achievement from my co-workers and myself. I will treat all staff with respect, friendliness, courtesy and compassion. I will take responsibility for my actions. I will maintain my appearance and conduct myself in a manner that well represents Arch Health Partners. These commitments will be in effect upon arrival at all Arch Health Partners locations each day.
Medical Practice Press Ganey
%ile Ranking Trends
2009
2010 2011 2012
Standard Overall 30th 37th 42nd 60th Standard Care Provider 35th 46th 51st 50th Likelihood of Recommending
Care Provider 32nd 40th 41st 44th Likelihood of Recommending
Variable Question Number of Responses Group Score 2011 Score Absolute Change Relative Change 10th 25th 50th 75th 90th Overall Ratings of Care
Overall rating of all health care (0 to 10 scale) PCP Q. 32 Specialist Q. 32 310 88.0 85.5 2.4 16.8% 82.0 84.0 86.0 87.6 88.4
Patient recommends doctor PCP Q. 24 Specialist Q. 24 311 87.9 85.8 2.1 15.0% 82.3 84.7 87.3 89.0 90.2
Patient-Doctor Interactions
Composite Score PCP Q. 10, 11, 12, 14, 15, 16
Specialist Q. 9, 10, 12, 13, 14, 15 311 89.2 86.5 2.6 19.7% 85.4 87.1 88.9 90.5 91.5
Patient Access to Care
Composite Score PCP Questions 4, 5, 6, 7, 8
Specialist Questions 4, 5, 6, 7 295 79.0 73.1 5.9 21.8% 71.3 73.9 76.7 79.3 81.3
Coordination of Care
Composite Score PCP Questions 20, 22
Specialist Questions 19, 21 295 78.2 72.5 5.7 20.6% 69.5 72.2 74.9 78.2 80.7
Office Staff
Composite Score PCP Questions 30, 31
Specialist Questions 30, 31 311 87.5 86.7 0.8 6.1% 81.6 83.6 85.7 87.6 89.0
Arch Health Partners
CCHRI PAS 2012 P4P Summary Results (Measurement Year 2011)
The following table displays the Provider Organization's 2012 Patient Assessment Survey (PAS) results for the Integrated Healthcare Association's Pay-for-Performance (P4P) measures. The display shows the group's score on each of the P4P measures, the absolute and relative change in scores from 2011, and the statewide scores of all groups at various percentile rankings. The results are mean scores, case-mix adjusted to account for patient population differences across groups.
Outcomes
IHA:
Bangasser Award 2009
Top Performer 2010, 2011
Top Performer and Bangasser Award 2012
DMHC – RCI:
Gold Performance Award 2011
CAPG:
SOE Exemplary status 2009, 2010
Balanced Scorecard for
Providers
Clinical
Quality
Patient
Experience
Appropriate
Resource
Use
Professional
Development
Where do we go from
here… ARU
• Challenges:
– Good consolidated data
– Engaging all the players
Meeting the New Challenge
• Continue PCMH journey
• Working the continuum of care
– Continue our successes: SNF NP,
hospitalists, Care Management Team – Addition of Pharmacist to help with med
reconciliation, optimal prescribing
– Coordination of referrals across multiple or non-existent IT platforms
