PRIMARY CAREPRIMARY CARESTRATEGIES FOR SUCCESS

V BIN A VALUE-BASEDPAYMENT ENVIRONMENT

Kenneth Tai, MDChief Medical Officer

North East Medical ServicesMarch 1, 2018

AGENDA

North East Medical Services (NEMS) as high-( ) gperforming primary care clinic

San Francisco Health Plan (SFHP) Comparison of NEMS and SFHP Healthcare

Effectiveness Data and Information Set (HEDIS) scoresscores

Strategies to improve NEMS Hedis scores utilizing essential elements of primary care

NORTH EAST MEDICAL SERVICES (NEMS)

Private, nonprofit Federally Qualified Health Center (FQHC) since 1971; Based in San Francisco; Expanded services to 12 clinic sites in 3 counties serving over 69,000 patients. 

NCQA PCMH Level 3 recognition; one of the largest health centers serving Asians in the U.S.

90+ providers with services in Primary Care Ob/gyn 90+ providers with services in Primary Care, Ob/gyn, Dental, Optometry, Lab, Radiology, Pharmacy, Behavioral Health, Physical Therapy and Specialty Care.R i b d l FFS d C i i Reimbursement model – FFS and Capitation.

SFHP delegated over 37,000 lives to NEMS, which represented 27% of network.  

NEMS 2017 PATIENT MIXPrivate

Insurance, 13%

Medicare,15%

Medicaid, 62%Uninsured, 10%

69,009 Active Patients; ~ 302K Encounters; 61% Medicaid Patients, enrolled in MCPs; 48% below 100% FPL; 81% speaks little or no English; 81% speaks little or no English; 10% uninsured/self-pay; 19% Elderly (age 65+);

MMC RISK DELEGATION IN SF COUNTY

90% 10%

RBO #1

DPH

RBO #2

Kaiser

RBO #3

UCSFRBO #4 NEMS

RBO #5

IPA

RBO #6

IPA

RBO #7

IPA

FFS

DPH H

Kaiser SF UCSF

Sutter Hosp.

Sutter Hosp. Comm.

HospHosp. SF UCSFSutter Hosp.

DPH Hosp.

Hosp. 2

p3 Hosp.

SFHP MMC MEMBERSHIP BY NETWORK

136 099 136,099 Members

NEMSRBO #1

DPH

43.2%

RBO #2 Kaiser

6.4%

RBO #3 UCSF

8.9%

NEMS37,172

Members

RBO #5 IPA

3.2%

RBO #6 IPA

3.3%

RBO #7 IPA

7.7%43.2% 6.4% 8.9%27.3%

3.2% 3.3% 7.7%

Data Source: SFHP Membership Report July 2017

Received 2017 Outstanding Performance in gQuality Care from the California Department of Health Care Services (DHCS) for the Medi-Cal program for the 9th time in the last 10 years program for the 9th time in the last 10 years

Third highest ranked Medi-Cal plan based on aggregated 2017 HEDIS scores

Award rankings are determined by performance in the Healthcare Effectiveness Data and Information Set (HEDIS) a national set of Information Set (HEDIS), a national set of measures for clinical care delivered to health plan members, developed by NCQA

MEDI-CAL MANAGED CAREPERFORMANCE DASHBOARDPERFORMANCE DASHBOARD

ADULT MEASURES2016 HEDIS YEAR

95.1% 96.1% 96.7%86 9% 87 9% 90 90%100%

77.8%71.0%

86.9% 87.9% 90.90%

70%80%90%

Medi-Caid90th

Medi-Caid90th

40%50%60% Medi-Caid

90th

10%20%30%40%

0%10%

Hypertension Control

Annual Monitor Diuretics

Annual Monitor ACE/ARB

Adult BMI

NEMS NEMS NEMS Clinic SFHP

NEMS ClinicN = 3497

SFHPNEMS Clinic

N= 777

NEMS Clinic

N=1654

SFHP SFHPSFHP

DIABETES MEASURES2016 HEDIS YEAR

93.6%

76.1%83.5% 85.3%

90.7%

70.5%

88.4%

80%90%

100%Medi-Caid90th

Medi-Caid90th

63.1%

50%60%70% Medi-Caid

90thMedi-Caid90th

20%30%40%

0%10%

A1c Testing A1c Control (<8%) Eye Exam NephropathyNEMS SFHP NEMS SFHP NEMS NEMS Clinic

SFHP NEMS Clinic

N=1785

NEMS Clinic

N=1785

SFHP SFHP NEMS Clinic

N=1785

SFHP

CANCER SCREENING2016 HEDIS YEAR

100%

79.8%70.0%68.7%

62 7%70%80%90%

Medi-Caid90th 62.7%

40%50%60%

90th

10%20%30%

0%

0%10%

Cervical Cancer Breast CancerNEMS SFHP NEMS SFHPClinic

N=8613Clinic

N=3753

PULMONARY MEASURES2016 HEDIS YEAR

100%85.5%

77.8%66.7%

80.0%85.0%

58 8%70%80%90%

100%

Medi-Caid90th 58.8%

40%50%60%70%

Medi-Caid90th

90th

10%20%30%40%

0%10%

Asthma Medication Ratio

COPD-Bronchodilator COPD-Systemic CorticosteroidsNEMS

Cli iSFHP NEMS

NEMS SFHP

Clinic ClinicN=9

NEMS Clinic

N=9

SFHP

PEDIATRIC MEASURES (1)2016 HEDIS YEAR

100%88.7%

77.4%65.3%

83.2%

62 4%70%80%90%

100%

Medi-Caid90th

62.4%

39.3%40%50%60%70%

Medi-C id

10%20%30%40% Caid

90th

0%Childhood Immunization

Combo3Childhood Immunization

Combo10Adolescent

ImmunizationNEMS SFHP NEMS NEMS SFHP

SFHPNEMS Clinic

SFHP NEMS Clinic

N=467

ClinicN=356

SFHP

PEDIATRIC MEASURES (2)2016 HEDIS YEAR

92 0%100% 92.0%84.7% 84.0%82.2%

87.6% 84.1%

70%80%90%

100%Medi-Caid90th

Medi-Caid

M di

40%50%60%70% 90th Medi-

Caid90th

10%20%30%40%

0%Well Child Visit Counseling for Nutrition Counseling for Physical

ActivityNEMS Clinic

SFHP NEMS Clinic NEMS

SFHP SFHPClinic ClinicN=5659 Clinic

N=5659

OB/GYN MEASURES2016 HEDIS YEAR

93.4% 89 7%85 2%100% 89.7%85.2%

70.8%70%80%90% Medi-Caid

90th

Medi-Caid90th

40%50%60%

90th

10%20%30%

0%0%

Prenatal Care Postpartum CareNEMS C

SFHP NEMS SFHPClinic Clinic

N=337

SHARED VISION DRIVING OBJECTIVE GOALS:

B li T g t

2018 CLINICAL ORGANIZATIONAL GOALS

2018 Organizational Goals

BaselineWhere we were

as of 11/30/2017

TargetMUST PASS

11/30/2017Clinical Goal: NEMS will improve cervical cancer screening rates for all women age 24-64 t 76% f b li f 74 4%

74.4% 76%to 76% from a baseline of 74.4%.

Clinical Goal: NEMS will improve colorectal cancer screening rate for patients age 51-75 to 81.3% 82%82% from a baseline of 81.3%.

Clinical Goal: NESM will improve smoking cessation intervention from 90.5% to 95% for all 90.5% 95%patients age 18 and over.

SFHP PRACTICE IMPROVEMENT PLAN(PIP) PROGRAM(PIP) PROGRAM

Launched in 2011 A financial incentive system to reward:

clinical quality patient experience patient experience data quality system improvement

Cli i l b d HEDIS Clinical measures based on HEDIS type measures.

Quality improvement scores are reported Q y p pquarterly with points and rewards earned quarterly.

Measures are evaluated annually with new Measures are evaluated annually with new measures added and some retired.

ALIGNING GOALS AND INCENTIVES2017 Q3Q4 ADULT MED PHYSICIANPERFORMANCE BASED INCENTIVESPERFORMANCE BASED INCENTIVES

QuarterlyIncentive:

Patientsatisfaction-friendliness

Panel Size Quality: departmen

l

Corporatecitizenship:NP

Chart documentaifriendliness

and courtesy

t goals NPMentorshipLeadership

tion

94% alwaysand usually

110% of ideal panel size

Lab for persistent meds

NP/PAmentorship; committee, timely PAQ

Updated chronic problist, med module timely PAQ

completion, punctuality

module, PAQ completion

100% =/>94% =/>110% panel

=/> 92% Please see attached

80% 92-93% 100% 90.8-91.9% 2 of above

19

80% 92 93% 100% 90.8 91.9% 2 of above criteria

60% 90-91% 90% 88-90.7% 1 of above criteria

DATA DRIVEN IMPROVEMENT:QUARTERLY PHYSICIAN REPORT CARD

TEAM BASED CARE:CHEAT SHEET FOR MORNING HUDDLES

ACCOUNTABILITY AND TRANSPARENCY:TEAM RESULTS POSTED IN CLINICS

POPULATION MANAGEMENT: MONTHLYWORKGROUP MEETINGS ON HEDIS MEASURES

For example: labs for persistent medsp p Generate standing lab orders and mail to non-

compliant patients Aligned to adult medicine department goals and Aligned to adult medicine department goals and

physician performance incentive metrics Team receive a list of non-compliant patients via

il thl d t h t t i d email monthly and outreach team to remind

MONTHLY OUTREACH REMINDER CALLSFOR COLORECTAL CANCER SCREENING

OUTREACH TRACKING PROGRAM

IMPLEMENTATION OF CHRONIC CAREMANAGEMENT (CCM) PROGRAM

Reimbursable by Medicare for non face-to-face yphone calls conducted by non clinician staff for services such as medication reconciliationAt l t 20 i t f t d ti b li i l At least 20 minutes of aggregated time by clinical staff time per month for Medicare patients with 2 chronic medical conditions expected to last for 12 months and have significant risk of death, acute exacerbation or functional decline

Chronic conditions such as HTN DM 2 COPD Chronic conditions such as HTN, DM-2, COPD, CHF, etc…

G0511, replacing 99490, for FQHC reimburses , p g , Qapprox $61.37 in 2018

COMPREHENSIVE SERVICES ANDINTEGRATION OF DATA

Primary care and specialty services including y p y gancillary services like laboratory, radiology, and pharmacy to improve coordination and compliance with “one stop shop” modelcompliance with one stop shop model

Integration of lab and radiology information systems with EHR system improve data collection and accuracy

Business Analytic tools for better data capturing and visualizationand visualization

EHR CUSTOMIZATION TO CREATE EFFICIENCYWITH CUSTOMIZED LAB ORDERING MODULE

Easy to locate historical FOBT/FIT test resultstest results

PATIENT ENGAGEMENT AND EDUCATIONTO RAISE AWARENESS

HEALTH EDUCATION WORKSHOPS

SETTING QI GOALS FOR HEALTH PLANS

Active participation in the Health Plan’s p pPhysician Advisory/Quality Improvement Committee for both SFHP and HPSMP id l d hi f h lth l ’ i QI Provide leadership for health plans’ ongoing QI Program

Review and approve the annual QI Evaluation Review and approve the annual QI Evaluation and subsequent year’s Work Plan

LEARNING AND SHARING BEST PRACTICESFROM HEALTH CENTER ASSOCIATIONS AND

HEALTH PLANS

San Francisco Community Clinic Consortium y(SFCCC)

Health Plan of San Mateo Learning C ll b ti CPT 2 d b i iCollaborative-CPT 2 codes submission

California Primary Care Association (CPCA) Association of Asian Pacific Community Health Association of Asian Pacific Community Health

Organizations(AAPCHO) National Association of Community Health

Centers(NACHC)

DEVELOP RISK-BEARING NETWORKS WITHHOSPITALS TO ACHIEVE SAVINGS

Partnership with California Pacific Medical Center since 2000 with a Full Risk managed care network

Partnership with Zuckerberg San Francisco General since 2015, formed the 2nd Full Risk managed care network

NEMS Management Service Organization(MSO) performs full risk medical management services for 37,000+ MMC enrollees

Achieve savings via better coordination and current claims’ data with access to hospitals’ EHR and provider alert systems

Enhance referral relationships with hospitals by reduce readmission, avoidable ER visits, reduce OON admissions; post-discharge home RN visits

USING TECHNOLOGY TO IMPROVE CARE: PROVIDER WAIT TIME SCREEN SHOT

VIRTUAL CARE VIA TELEMEDICINE CART

ELECTRONIC BEHAVIORAL ANDDEVELOPMENTAL QUESTIONNAIRES ON IPAD

JOINT VENTURE HEALTHPEDIATRIC BEHAVIORAL AND DEVELOPMENT

SCREENING PROGRAM

AGES AND STAGES9 MONTH QUESTIONNAIRE9 MONTH QUESTIONNAIRE

QUESTIONS?