Transcript Frank - Amazon Web Services

Alaska Native People Shaping Health Care
• SCF - 2011 Baldrige Winner
• CEO 2004 McArthur Genius Winner
Doug Eby, MD, MPH, VP of Medical Services
Denise Morris, Compliance Administrator
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
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Customer Control
 If you could own completely your own healthcare system, what
would you do –as a customer-owner?
 We had that choice – and chose to fundamentally rethink and
redesign every single thing in the entire system.
 We kept the best that modern medicine has to offer and we kept
the medical professionals, but we redefined the fundamental
understandings, redefined the ‘core concepts’, and changed
dramatically the whole system platform.
 Customer Control at both the macro and micro level – shared
partnership, commitment to quality, family wellness.
 The Triple Aim – population health, optimal individual experience,
with long term affordable cost.
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Customer Ownership
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Why listen to our story
 Evidenced-based generational change reducing family violence
 Over 50% drop in ER visits, Hospital Days, and visits to Specialists
 Significant change in primary care utilization – less visits, more
other
 75-90%ile on most HEDIS outcomes and quality
 Benchmarked data nationally and internationally showing top in
class performance in utilization, quality, satsifaction
 Employee Turnover rate less than 12% annualized (very low)
 Customer and staff overall satisfaction over 90%
 In an urban Alaska Native community with huge challenges
 Sustained for over a decade and continually improving
 Very long list of external recognitions – Malcolm Baldrige National
Quality Award this year.
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Rethinking The Whole Thing
 Personal, trusting, accountable long term, first name, whole
person partnering with knowledge, advice, support – woven
into life – in family/context – for a lifetime
 Specialists – rebuilt around longitudinal, ever present,
personal partnering – 5 min response time
 Inpatient Care – 50% optimizing self care and family care
 ‘Pull’ Discharges and Immediate Follow-Up support
 Niche Populations w intensive support layered on
 Rebuilding systems around how people experience them – 3
Year Gestation, adolescence, elder care
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Baldrige Health Care Criteria for Performance
Excellence Framework - A Systems Perspective
2011–2012 Health Care Criteria for Performance Excellence
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Control: Who really makes the decisions
100
Patient/Family
“Control”
The “System”
0
Low
Acuity
High
1. Control – who makes the final decision influencing outcome?
2. Influences – family, friends, co-workers, religion, values, money
3. Real opportunity to influence health costs/outcomes – influence
on the choices made – behavioral change
4. Current model – tests, diagnosis, treatment (meds or procedures)
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Some simple rules for improvement
Complexity Diagram
Low
Chaos
Certainty or
Agreement
Experimenting
Get together and have
dialogues
Allowing positive
environment
Complexity
Multidimensional
improvements with
target focus
Protocols
High & Stds
Low
Complexity Variables
Creativity
High
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
It’s all about Relationships
 It is THE core clinical service that we offer
 It is THE key set of skills we train every person on – Core
Concepts
 It is THE way that we manage personnel
 It is THE core priority for how we design services, improve
flow, decrease waste, design facilities, measure success, and
recognize and reward excellence
 The ability to genuinely connect requires skilled ability to
connect in story and walk in trusting, accountable, personal,
long-term relationships with barriers removed
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Operational Principles
Relationships between customer-owner, family and provider must be fostered and
supported
Emphasis on wellness of the whole person, family and community (physical, mental,
emotional and spiritual wellness)
Locations convenient for customer-owners with minimal stops to get all their needs
addressed
Access optimized and waiting times limited
Together with the customer-owner as an active partner
I ntentional whole-system design to maximize coordination and minimize duplication
Outcome and process measures continuously evaluated and improved
Not complicated but simple and easy to use
Services financially sustainable and viable
Hub of the system is the family
I nterests of customer-owners drive the system to determine what we do and how we do
it
Population-based systems and services
Services and systems build on the strengths of Alaska Native cultures
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Core Concepts (Relationships)
 ALL SCF employees – 3 day training – led by CEO and
team – re-define the true core skills and priorities –
with training – for everyone
 Understand how we impact others by:
• Understanding your relational style – shapes, 5 dynamics, CDR
• Understanding how your experiences contribute to how you approach others
 Words and Tools – 4 player, ladder, left hand
column
 Learn how to articulate your story from heart
• Understand the power of empathy and compassion for your self and others
• Develop THE core skill of deep, effective listening
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Performance Development Plan
 Align with corporate and department goals and
objectives
 Detail each of the goals and accountabilities
 Include quantitative and qualitative data
 Developed with employee input and feedback
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Information to Knowledge
50%
% SCF Central Pharmacy customer-owners requesting other
medications at dispensing
40%
Change
Tested
Better
Change
Implemented
30%
20%
Percent
Average
10%
0%
8/5/10
8/12/10 8/19/10
8/26/10
9/2/10
9/9/10
9/16/10 9/23/10
9/30/10
Source: Central Pharmacy-Pharmacy tic-sheet 9.27.10
% Employees with Current Annual Disaster Tng
100
94
98
100
2007
2008
2009
74
%
53
50
0
2005
2006
SCF
Industry Best (100%)
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
The Integrated Care Team




PCP – primary care provider - MD, DO, NP/PA
Nurse Case Manager
Case Management Support
Certified Medical Assistants


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

Behaviorists and Dieticians
Pharmacist (partially implemented)
Nurse Midwife (partially implemented)
Coverage NP/PA/CM’s
Co-located Psych
Coders, data entry, etc
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Some Improvement Specifics - Clinic
 Advanced Access – appointments when the customer wants –
same day primary care
 Case Management/Care Coordination
 Max Packing
 Service Agreements between departments
 Mind/Body back together – BHC - Behaviorists
 Hospitalists in Pediatrics and Internal Medicine
 Bring services to them – BH, Dietician, Pharmacist, Midwife –
fully integrated high volume specialists
 Data Mall, Improvement Staff to learn and drive
 Facility Design – at all levels supporting philosophy
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
ICT Current Work
 Expanded BHC role – really expanded
 Wellness Care Plans for the highest utilizing 5% facilitated by BHC’s and placed in the E.H.R to drive
whole system behavior
 Full integration of Midwives and Clinical Pharmacists in
PCP location/team
 Experimentation with expanded teams
 Decrease in panel size
 Chronic Pain and Addiction support
 Suboxone support for narcotic addiction
 Co-Located Psychiatrist and MH care coordination for
long term co-management of CMI population
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
More Current Improvements
 Nutaqsiivik – intensify/reduce the case load – 30 mos
 Prenatal Care - Declaration of a three year gestation
 Wellness Care Plans (WCP) - positive/asset based
 Clinician Mentor Program - CDR/Five Dynamics
 CMS – Case Management Support Redefinition
 Patient Portal – Our version
 Data Mall – Revitalization/Full Transparency
 Transitions in Care Project
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Some More…
 Data Analysis – MegaData – Social/Situational
 Elders Program and Wellness Care Coordination
Program
 Redesigned Behavioral Health – Learning Circles,
Tribal Doctors, FWWI
 Intensive youth suicide intervention group
 Healthy Lifestyles Clinic – Family/Children
 IA/IS Capability
 Service Level Agreements
Anchorage Area Patient
Anchorage AreaCare
Patients Per 1000
Visits to ER/Urgent
Visits to ER/Urgent Care Per 1000
Number of Visits
1600
1400
Native
ownership
begins
1200
Better
1000
800
600
400
Year
Day per 1000
Copyright © 2011 Southcentral Foundation. All Rights Reserved
Night per 1000
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
200
Emergency Department Utilization
Beginning in 2008 Benchmarking to HEDIS
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Anchorage Area Patients
Anchorage Area Patients
Admits
per
1000
Admits per 1000
70
Better
60
Native
ownership
begins
50
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
40
1996
Number of Admits
80
Year
Admts per 1000
Excludes Newborns and Delivery Moms
and Length of Stay must be more than 1 day
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Inpatient Utilization
Beginning in 2008 Benchmarking to HEDIS
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Southcentral Foundation Cumulative
Per Capita Expenditure Changes
100%
80%
Percentage Increase (Decrease)
60%
SCF Cumulative Primary Care % Increase
(Decrease)
40%
SCF Cumulative Hospital Services % Increase
(Decrease)
National Health Spending & Increase
(Decrease)
20%
National Hospital Care Expenditures %
Increase (Decrease)
0%
FY1999
FY2000
FY2004
FY2005
FY2006
FY2007
FY2008
National Physician and Clinic Services
Expenditures % Increase (Decrease)
-20%
-40%
-60%
Fiscal Year
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Change Everything
 The Goal – Triple aim
 The Framework for Excellence – Baldrige Categories
 Customer-Ownership – Customer Driven
 It’s all about Relationships
 Longitudinal Partnering – Shared Responsibility – on THEIR
terms – and layering in all other services
 Weaving Services INTO their lives
 Workforce Development – in all dimensions
 Improvement Capability – Learning Organization
 Transparent data and accountability
It’s All About Customerownership and Relationships
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Health care provider changes
 No longer a hero but a partner
•
•
•
•
•
Control does not equal compliance
Replace blaming with understanding
Give customer options, not orders
Provide customer with resources
Make it simple
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Customer-owner changes
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
Be active, not passive
Take responsibility for your health
Get information about your health
Ask questions about advice
Ask for options
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Thank You!
Qaĝaasakung
Quyanaq
‘Awa'ahdah
Aleut
Inupiaq
Eyak
Mahsi'
Igamsiqanaghhalek
Háw'aa
Gwich’in Athabascan
Siberian Yupik
Haida
Quyana
T’oyaxsm
Gunalchéesh
Yup’ik
Tsimshian
Tlingit
Tsin'aen
Quyanaa
Chin’an
Ahtna Athabascan
Alutiiq
Dena’ina Athabascan
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Frank
Frank is a 79 year old widower with
Chronic Obstructive Pulmonary Disease
(COPD), Heart Failure and Diabetes. He lives alone.
Frank is very anxious as he is often very breathless and
feels unable to manage. He has phoned the practice
of his primary care physician on several occasions
requesting a home visit and over the last year he has
frequently been taken to the local emergency
department, after he has dialled 911. He has been
admitted to hospital on 7 occasions in the last year and
now keeps a small packed suitcase by his chair.
Frank’s Medical Diagnosis
 COPD
 CHF
 Diabetes
 Frank’s Healthcare providers
• Primary Care, Cardiologist, Pulmonologist, Endocrinologist, Nutritionist,
Physical Therapist, Pharmacist, Home Health.
Realities about Frank
 Frank IS in control
•
•
•
•
Getting and taking meds
Using inhalers
Eating, sleeping, exercising, socializing
Calling 911
 Frank is costing a great deal of money
 Frank is getting worse
 No one ‘knows’ Frank
Nuka – a different look at Frank
 Primary Diagnosis
• Anxiety, Loneliness/isolation, insecurity, confusion,
dependency, lack of confidence
 Secondary Diagnosis
• COPD, CHF, Diabetes
 Primary interventions
• Personal care coordination, integration of care by PCP
team, determination of motivators, behavioral based
motivational interventions, consolidation of meds/tx.
Questions?
Please contact:
Erica Srisaneha
Southcentral Foundation
907-729-8608
[email protected]
Or log onto our website at www.scf.cc/nuka
Copyright © 2011 Southcentral Foundation. All Rights Reserved.