Transcript Slide 1

Advancing Quality in Health Centers:
An overview of BPHC’s Quality Strategy
MSCG Consultant Training Series
May 1, 2012
Overview
• Introduction
• BPHC Quality Strategy
• Alignment of Program Resources to
Advance Quality
• Quality Priorities & Goals
• Quality Oversight & Accountability
• Resources
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Primary Health Care Mission
Improve the health of the
Nation’s underserved
communities and
vulnerable populations
by assuring access to
comprehensive,
culturally competent,
quality primary health
care services
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
COMPREHENSIVE
SERVICES
ACCESS
Coordination & integration of patient
information and services among HCs and
other community-based providers of
services
Coordination and Integration
services within a Health Home
Provision of full scope of primary health
services, including dental, behavioral
health, and enabling services
Ability of patients to be seen in a
timely, affordable and culturally
competent manner
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
Strategy Implementation
INTEGRATED
HEALTH SYSTEM
Priorities & Goals
1.
Implementation of QA/QI Systems
All Health Centers fully implement their
QA/QI plans
2.
Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs
across all sites & providers
3.
Patient Centered Medical Home
Recognition
All Health Centers receive PCMH
recognition
4.
Improving Clinical Outcomes
All Health Centers meet/exceed
HP2020 goals on at least one UDS
clinical measure
5.
Workforce/Team-Based Care
All Health Centers are
employers/providers of choice and
support team-based care
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1. Programs/Policies
2. Funding
3. Technical Assistance
INTEGRATED
SERVICES
4. Data/Information
5. Partnerships/Collaboration
COMPREHENSIVE
SERVICES
ACCESS
BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
Strategy Implementation
1. Programs/Policies
INTEGRATED
SERVICES
2. Funding
3. Technical Assistance
COMPREHENSIVE
SERVICES
4. Data/Information
5. Partnerships/Collaboration
ACCESS
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Quality Strategy Implementation:
Programs/Policies
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
ACO
INTEGRATED
HEALTH SYSTEM
Beacon,
HCCN
INTEGRATED
SERVICES
PCMHHI,
CMS Demo
Public Health
Integration
Collaboration
PIN
COMPREHENSIVE
SERVICES
Expanded
Services
Program
Requirements
ACCESS
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Quality Strategy Implementation:
Funding
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
• $150M for Health Center New Access Points (~220 to 230
awards)
• $15M for Expanded Services, including Expanded HIV
INTEGRATED
SERVICES
Services and Support for Health Center Recruitment and
Retention Strategies, including the Health Center Veterans
Hiring Challenge
• $20M for Health Center Controlled Networks (~25 to 30
awards)
COMPREHENSIVE
SERVICES
ACCESS
• Capital Development:
o
$630M for Building Capacity
o
$100M for Immediate Facility Improvements
o
$75M for School-Based Health Center Capital program
(~150 awards)
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Quality Strategy Implementation:
Technical Assistance
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
COMPREHENSIVE
SERVICES
• National Cooperative Agreements
o Homeless, Farmworkers, Public Housing, AAPI,
LGBT
• Primary Care Associations
• Health Center Controlled Networks
• HRSA Resources
o Quality Improvement, HIT, Oral and Behavioral
Health
ACCESS
• SAMHSA/HRSA Center for Integrated
Health Solutions (CIHS)
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Quality Strategy Implementation:
Partnerships/Collaboration
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
• National Partners
o Federal: White House, HHS, Other Federal
agencies
o Non-Governmental Partners
• State Partners
o
Primary Care Associations
o Primary Care Offices
o Medicaid
COMPREHENSIVE
SERVICES
ACCESS
• Local Partners
o
o
o
o
HCCNs
Other Safety Net Providers
Hospitals
CBOs
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their QA/QI
plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all
sites & providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH recognition
COMPREHENSIVE
SERVICES
ACCESS
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020 goals
on at least one UDS clinical measure
5. Workforce/Team-Based Care
All Health Centers are employers/providers of
choice and support team-based care
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their
QA/QI plans
INTEGRATED
SERVICES
COMPREHENSIVE
SERVICES
ACCESS
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all sites
& providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH recognition
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020 goals on at
least one UDS clinical measure
5. Workforce/Team-Based Care
All Health Centers are employers/providers of choice
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and support team-based care
Quality Priority:
Implementation of QA/QI Systems
• OIG study of quality assurance and care
provided at health centers recommendations:
– Provide additional guidance on:
• Elements of QA/QI program
• Information required in patient records
• Required primary health services
– Establish procedures to independently assess
patients’ receipt of services and patient records
• Draft QI PIN
• Site Visits
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FTCA Program Updates
• FTCA Deeming Application enhancements
• Focus is on implementation of risk
management and quality improvement
systems
• FTCA site visits
• Training and Technical Assistance
Available - https://www.ecri.org/clinical_rm_program
• FTCA Claims Management
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their QA/QI plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs
across all sites & providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH recognition
COMPREHENSIVE
SERVICES
ACCESS
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020 goals on at
least one UDS clinical measure
5. Workforce/Team-Based Care
All Health Centers are employers/providers of
choice and support team-based care
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Quality Priority:
Adoption and Meaningful Use of EHRs
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Source: Uniform Data System, 2010 data as of 5/10/11.
Adoption and Meaningful Use
of EHRs
• 2012 UDS includes additional EHR
adoption questions
• Participation in CMS Meaningful Use
Incentive Payment Program
• Beacon Supplemental
• FY12 HCCN Funding Opportunity
• HRSA’s Network Guide - The guide, currently
including information on 46 networks, is available at
http://www.hrsa.gov/healthit/networkguide/index.html
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
COMPREHENSIVE
SERVICES
ACCESS
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their QA/QI plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all sites &
providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH
recognition
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020 goals on at least
one UDS clinical measure
5. Workforce/Team-Based Care
All Health Centers are employers/providers of choice
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and support team-based care
PCMH Recognition by Region
% PCMH Recognized
% PCMHHI Participants
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC
2013 Goal:
25% Health
Centers
Recognized
as PCMH
2012 Goal:
13% Health
Centers
Recognized
as PCMH
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their QA/QI plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all sites
& providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH recognition
COMPREHENSIVE
SERVICES
ACCESS
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020
goals on at least one UDS clinical
measure
5. Workforce/Team-Based Care
All Health Centers are employers/providers of choice
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and support team-based care
Health Center Performance
2009 Health Center Patient Survey
o Over 80% reported the overall quality of services
received at the health center were “excellent” or
“very good.”
o Over 80% reported that they were “very likely” to
refer friends and relatives to the health center.
o Over 75% reported the main reason for “going to
the health center for healthcare instead of
someplace else” was because it was convenient
(28%), affordable (25%), and provided quality
healthcare (22%).
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Health Center Performance
Health Disparities
•
•
•
•
•
Access to Primary Health Care
– No racial/ethnic differences in the proportion of HC patients who are
satisfied with the overall care received (98% overall).
Preventive Services Counseling
– No racial/ethnic differences in the proportion of HC patients who
receive weight management counseling.
Diabetes
– Patients were more likely to be current with their A1c testing and
see or talked with an eye doctor if they received diabetes
management support from HC staff.
Hypertension
– Patients reporting unmet healthcare needs in past year were more
than twice as likely to have a hypertension-related ED visit or
hospitalization.
Cancer Screening
– African American and Hispanic/Latino colorectal cancer screening
rates are higher than national average.
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Quality Priority:
Improving Clinical Outcomes
2012
Goal:
10% of
Health
Centers
Meet or
Exceed
HP 2020
Goals
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Source: 2010 UDS and Healthy People 2020
2012 UDS Reporting
Changes to CY 2012 UDS:
1. New staff tenure table;
2. Three new clinical measures;
– Coronary Artery Disease (CAD): Lipid Therapy
– Ischemic Vascular Disease (IVD): Aspirin Therapy
– Colorectal Cancer Screening
3. Reporting on all (versus primary) diagnoses for selected
conditions; and
4. Questions about electronic health record capabilities and
national quality recognition
Refer to the UDS website for more information:
http://bphc.hrsa.gov/healthcenterdatastatistics/index.html
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BPHC Quality Strategy
Better Care ⃘ Healthy People & Communities ⃘ Affordable Care
INTEGRATED
HEALTH SYSTEM
INTEGRATED
SERVICES
Priorities & Goals
1. Implementation of QA/QI Systems
All Health Centers fully implement their QA/QI plans
2. Adoption and Meaningful Use of EHRs
All Health Centers implement EHRs across all sites
& providers
3. Patient Centered Medical Home Recognition
All Health Centers receive PCMH recognition
COMPREHENSIVE
SERVICES
4. Improving Clinical Outcomes
All Health Centers meet/exceed HP2020 goals on at
least one UDS clinical measure
5. Workforce/Team-Based Care
ACCESS
All Health Centers are employers/providers of
choice and support team-based care
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Quality Priority:
Workforce/Team-Based Care
• Student/Resident Education &Training (Bureau of Health
Professions)
o Teaching Health Centers
• Recruitment and Retention (Bureau of Clinician Recruitment and
Services)
o NHSC
o Loan Repayment
• Training and Development
o Guidelines & Best Practices
• Inter-Professional Team-Based Care
o Integrated within Medical/Health Home
o Enabling Services Providers
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Shared Accountability for Quality in
Health Centers
Health Centers
NCAs
PCAs
HCCNs
Project Officers
•
•
•
•
Site Visits – integration and support of Quality Priorities (with
Consultants)
UDS Data and Performance Reports
Annual Progress Reviews
Discuss Quality Priorities and progress during quarterly calls
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Quality Improvement Resources
• National Quality Recognition
– Accreditation:
http://bphc.hrsa.gov/policiesregulations/accreditation.html
• AAAHC, TJC
– NCQA recognition:
http://bphc.hrsa.gov/policiesregulations/policies/pal201101.html
– Comparison chart:
http://bphc.hrsa.gov/policiesregulations/policies/qualrecogn.pdf
• ECRI Institute Resources
– Available to all Health Centers and FQHC LALs
https://www.ecri.org/clinical_rm_program/Pages/default.aspx
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Quality Improvement Resources
• HRSA
– FTCA Resources http://bphc.hrsa.gov/ftca/index.html
– BPHC QI Plan Learning Series and Modules
http://bphc.hrsa.gov/policiesregulations/quality/index.html
– BPHC Training and Technical Assistance
http://bphc.hrsa.gov/technicalassistance/tatopics/qualitymanagementimproveme
nt/index.html
– HRSA Office of HIT and Quality
http://www.hrsa.gov/quality/toolsresources.html
– HIV/AIDS Bureau Quality Resources
http://nationalqualitycenter.org/
• Safety Net Medical Home Initiative
http://www.qhmedicalhome.org/safety-net/qistrategy.cfm
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HIT Resources
• HRSA’s HIT Web Page (http://www.hrsa.gov/healthit/)
– HIT Health IT Adoption Tool Boxes: http://www.hrsa.gov/healthit/toolbox/
– HIT Health IT and Quality Webinars:
http://www.hrsa.gov/healthit/toolbox/webinars/index.html
– HRSA Network Guide, currently including information on 46
networks: http://www.hrsa.gov/healthit/networkguide/index.html
• The Office of the National Coordinator for Health
Information Technology: http://healthit.hhs.gov
– HIT Regional Extension Center program:
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/14
95
– 2010 report on HIT in Underserved Communities:
http://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-healthdisparities.pdf
• The AHRQ National Resource Center for HIT:
http://healthit.ahrq.gov
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Data Resources
• HRSA Data Warehouse:
http://datawarehouse.hrsa.gov/
• Public site for UDS Data:
http://bphc.hrsa.gov/healthcenterdatastatistics/index.html
• UDS Performance Reports:
⁻ Health Center Trend Report (National/State/Grantee)
⁻ Health Center Summary Report
(National/State/Grantee)
⁻ Performance Profile (National/State) – Performance
on Key Indicators
• UDS Mapper:
http://www.udsmapper.org/
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PCMH Resources
• PCMH Readiness Assessment Tools
– Primary Care Development Corporation (PCDC):
http://www.pcdc.org/resources/patient-centered-medical-home/pcdc-pcmh/ncqa-2011-medical-home.html
– PCMH Assessment (PCMH-A) from the Safety Net
Medical Home Initiative: http://www.safetynetmedicalhome.org/practicetransformation/assessment
– Medical Home Implementation Quotient Assessment
(MHIQ) from TransforMED:
http://www.transformed.com/userLogin.cfm
• PCMH Change Concepts: http://www.safetynetmedicalhome.org/change-concepts
• Patient-Centered Primary Care Collaborative
(PCPCC): http://www.pcpcc.net/content/pcmh-outcome-evidence-quality
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PCMH Resources
• Agency for Healthcare Research and Quality
(AHRQ) PCMH Resource Center:
http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483
⁻ Clinical Practice Guidelines: http://www.ahrq.gov/clinic/cpgsix.htm
⁻ US Preventive Services Task Force:
http://www.uspreventiveservicestaskforce.org/tools.htm
⁻ Consumer Assessment of Healthcare Providers and
Systems (CAHPS patient experience survey):
https://www.cahps.ahrq.gov/default.asp
⁻ Innovations Exchange: http://www.innovations.ahrq.gov/
⁻ Patient Health Literacy Toolkit: http://www.ahrq.gov/qual/literacy/
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Behavioral Health Resources
• HRSA BH website: www.hrsa.gov/publichealth/clinical/BehavioralHealth/index.html
• Center for Integrated Health Solutions:
– Motivational Interviewing for Better Outcomes
– Peer Support Wellness Respite Centers
– Screening, Brief Intervention, and Referral to
Treatment (SBIRT) in Clinical Settings
– Person-Centered Health Homes
– Introduction to Effective Behavioral Health in
Primary Care http://www.thenationalcouncil.org/cs/center_for_integrated_health_solutions
• SAMHSA SBIRT page http://www.samhsa.gov/prevention/SBIRT/index.aspx
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Contact Information
MSCG Point of Contact for
additional information or questions:
Sheri Hughes
[email protected]
301-577-3100
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Evaluation
Here is the link to the online evaluation survey
for the session below:
http://www.surveymonkey.com/s/B3DHFMF
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