Arroyo-FrescoOrganizational Strategy

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Arroyo Fresco

Community Health Center:

Enhancing the FOCUS model

Study Group B members:

Beatrice Toyin Babalola

Ibrahima Diallo

Shalini Gund

Shereese Maynard

CJ Spann

Arroyo FrescoMission

To serve all patients; regardless of their ability to pay; against tight fiscal environments at federal, state, and local level, including:

- an increasing percentage of uninsured patients (one of the highest in the United States),

- no growth in federal grant payments for uninsured patients, and

- cutbacks in Medicaid eligibility at the state level

VisionThrough our leadership in health care design and delivery, education and training, and community involvement, the people of western Arizona will become the healthiest in the state.

Values

◦ Respect

◦ Trust

◦ Relationship

◦ Performance

◦ Accountability

FOCUS model

Financial performanceServe all patients regardless of their ability to pay

Organizational learningAddress workforce gaps

Clinical Excellence◦ Low incidence of prevention & screening

◦ Higher incidence of communicable disease

UtilizationMechanisms to provide specialty care and unmet service needs

Satisfaction◦ Staff recruitment & retention challenges

◦ Maintain/enhance relationships with patients, community, & external partners

Arroyo Current Patient Data

Fewer patients are reporting they could not get an appointment when wanted, however, La Paz & Yuma are still at almost 10% each.

Unfortunately, wait

times increased from

the previous year,

showing little

improvement over the

past 4 years

Arroyo Current Patient Data

A large percentage

(30% on average) of

patients feel as

though their

questions are not

answered.

Fewer patients are reporting their medications were not explained so they could understand them, however, all counties have room for improvement.

Arroyo Current Employee

Satisfaction

Daily huddles to determine staffing needs

Workforce mirrors community demographics

Staff members meet with supervisors twice annually

STAR and Superstar recognition

Teamwork culture

Succession plans evaluated annually

Employee training and development

Decreased staff turnover

Arroyo Current Clinical Data

•Results for community confidence show

improving results over the last three years

among users and nonusers in all counties,

with overall, pediatric, and senior care

performance that is the best in the state for

2005.

•These results demonstrate AF’s progress

toward the key customer and stakeholder

requirement that AF have a reputation as a

high-quality health center.

Arroyo Current Clinical Data

In 2005, performance results for communicable diseases—influenza and pneumococcus immunizations met Arizona’s Healthy People 2010 goals in all three counties.

These results link to AF’s efforts to provide preventive services and address challenges related to low incidences in prevention and screening and high incidences of chronic and communicable disease.

Arroyo Current Clinical Data

Figure 7.5-3 shows all counties’ performance is meeting the goal and equal to the state best CHC performance levels for office visit cycle time.

Arroyo Current Clinical Data

These measures of clinical outcomes show favorable trends for the past four to five years, with levels that approach, equal, or

surpass the state and/or national comparisons.

Arroyo Current Clinical Trends

Challenges

Low incidence of prevention and screening

High incidence of chronic and communicable diseases

Areas of Improvement

While results from various patient and other customer surveys relative to satisfaction are described, results related to patient-and other customer-perceived value, such as patient dissatisfaction and retention, are absent.

Also lacking are results stemming from the service experience survey or complaints from patients and other stakeholders. Without this information, it may be difficult for AF to determine the effectiveness of its patient complaint and relationship-building processes.

Objectives

Increase the overall ratio of patient visits to staff

Increase the number of new patients served by developing internal and external resources to address unmet health care needs in the area.

Arroyo Fresco Financial Data

Current Financial Performance 37% increase net income (2001 – 2005)

Significant Increases across several metrics including:

◦ Amounts collected from Accounts Receivable

◦ Development funding and Donation values

◦ Capital Appreciation

◦ Grant rates

◦ Market Share

Annual Cost Saving

◦ Purchasing Consortium

◦ Expansion of Clinical microsystems

◦ Training staff to perform the tasks that reduce the costs of audits and inspections

ROA = Relative Value Units (RVU’s)/ 1000 net asset value

◦ 15% - 19%, from 2001 to 2004

◦ 16.5% 2004 ROA; Under benchmarks of 18%-20%

Assuring Adequate Resources/ Fiscal Responsibility

◦ Zero based budgeting process linked to the five year capital and funding plans developed during the Strategic Planning Process

◦ Consideration for productivity standards, external benchmarks and desired technological implementations

◦ Risk Reduction: by conservatively projecting revenues, managing the timing of revenue realization and expenses, paying careful attention to cash management, and requiring a continuous and detailed budget-monitoring process

◦ Reduce expenditures of non-mission-critical expenses if needed

External Contributing Factors

◦ Medicaid

◦ Arizona’s Budget Deficit

◦ 1115 Medicaid Waiver, Brewers Healthcare

Reform Plan

◦ PPACA - threats of repeal

◦ Depleting 303 Funding

◦ Immigration

◦ Discontinuation of Medicare Part B

External Contributing Factors

Impact

Hemorrhaging Revenue◦ Transient Populations – Lack of accounting

Loss of Market Power◦ Yuma County (36%) of AF annual budget

◦ La Paz County – Rural Health loss of ability to care for Native American pop.

◦ Loss of Medicare payors – 6% of revenue

Utilization and purchasing behaviors◦ Loss of coverage

Loss of major revenue source

Decrease quality of care

◦ Increase in demand from competitor patients

◦ Increase market share

◦ Reduction in Access, Affordability

Recommendations

Patient Satisfaction & Retention:

Extended appointment availability

Increase throughput/decrease wait times

Improve explanation of medications

Improve consistency of answering patient’s

questions

Improve consistency of including patient’s

preferences in care decisions

Consider implementing patient advocates, case

managers, translators, and/or social work to

help address these concerns and bridge the

gaps.

Recommendations

Employee Satisfaction & Retention:

◦ Re-organization to ensure consistency

◦ Convert volunteers to employees and extend

offers of employment, even if part-time,

rather than volunteer positions to potential

candidates

◦ Modification to Rising Star program to

minimize embarrassment of new employees

◦ Expand promotional checklist program

◦ Expand health benefits and decrease

employee’s cost for said benefits

RecommendationsClinical Excellence:

In order to increase the screening process to prevent against the communicable and chronic diseases we need to take the measures below.

PEDIATRICS

Increase immunization rates for children and adolescents.

FEMALES

Increase screening rates for domestic abuse, depression, cervical cancer, and colon cancer.

Increase in mammography services

MALES

Increase screening rates for depression

Increase screening rates for colon cancer.

OTHERS

Increase screening and support in clinical preventive areas such as smoking cessation and obesity.

Increase immunization rates and promote influenza vaccines

Increase diabetic screening

Recommendations

Financial:

◦ Increase Grant Funding

◦ Developing Political Capital

◦ Mergers: Take Advantage of Economies

of Scale

◦ Partnership: CRIT Gaming Industry

◦ Lucrative Investment Practices

Endowment Portfolios/ Diversification

Investment in Securities Market

Accounts Receivable and Sweep

Accounts

Recommendations for

Organization

Learning•Reduce variance in processes through

improved work flow standardization,

leadership and staff training across county

lines.

•Strengthen grants and process for work-to-

learn programs across the board to develop

work skills and competencies across county

lines

•Ensure knowledge integration into work to

increase efficiency and effectiveness

•Ensure robust processes for scheduling

appointments, responding to employees,

communicating with patients and recording of

medical incidents and errors

Utilization

Services offered by AF include ambulatory

medical, family and pediatric care, and dental

services. AF also offers laboratory services, x-

rays, vision and hearing screenings,

behavioral health, drug screening, and

pharmacy services. The center ensures

access to services by its patients by

managing mobile operations six days a week,

making stops at churches, schools, and

community centers. Population Growth now

makes it necessary to expand access to

surrounding counties.

Service Population

Current

Mohave

La Paz

Yuma

Population

Native American

Retirees

Expansion

Three New Mobile

Sites

Lake Havasu

City

Saunders

Tucson

Internet &

Mobile Access

Expanded Access &

Engagement

Standardization of Patient Demographic data

Tele-radiology

SATScanTechnology integration

Tackling Disparities through

engagement & partnerships

Al-Anon & Alateen

American Diabetes Association

American Heart Association

Planned Parenthood

Community

partnerships to

address and

overcome

disparities

Social

MediaArgument

51% of Americans access health info. On-line

Women are more likely to contact health providers on-line than men

Americans preferring emailing physician↑3.6%

AF

Facebook will allow Arroyo to reach young, female population and promote health partnership programs. Services would be highlighted to include OBGYN services, trainings, and healthy eating

LinkedIn will be useful for attracting talented staff

Strategy & BenefitsFacebook page:

Security

Current Standard

Password protection

HIPAA compliance training for staff

EHR limited access

New Standard

Expanded duties for the CIO to include disciplinary action protocols & oversight of compliance program

System upgrades to increase protection of PHI: EHR interoperability

Annual Risk Analysis to detect breach vulnerabilities

Adoption of a Notification policy

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