southcentral foundation nuka
DESCRIPTION
South central foundation Alaska If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory If you are in a messy, human, complex, adaptive environment it is like throwing a bird at a target – it is all about the ‘attractor’ Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the targetTRANSCRIPT
Southcentral FoundationTh SCF N k M d l f CThe SCF Nuka Model of Care
Customer-Owners Driving Healthcare
Charles Clement, Vice President Operations, Chief O ti Offi Operating Officer
April Kyle, Human Resources AdministratorSteve Tierney, Medical Director Quality Improvement
Michelle Tierney Vice President Organizational Michelle Tierney, Vice President Organizational Development and Innovation
Today…yShare the SCF Story
Transformation of our system Transformation of our system –resulting SCF Nuka Model of CareDescribe how a customer-owner Describe how a customer owner system shapes and improves health performance in outcomes,
ti f ti i f d satisfaction, experience of care, and overall cost.Describe some of our key Describe some of our key improvements to our systems transformation
Southcentral FoundationSouthcentral Foundation
25+ years of history Innovative, relationship based, customer
d t owned systems 1,400 staff 140,000 statewide customers55,000 ‘local’ customer-owners including 10 000 i 50 t ill10,000 in over 50 remote villages
Expanding local population
Southcentral Foundation
Medical Services – Primary Care, Women’s Health, Pediatrics, Optometry, Urgent CareCareDentalBehavioral Health clinics residential Behavioral Health – clinics, residential treatments, after-care, youth, eldersFamily Wellness Warriors – abuse and Family Wellness Warriors abuse and neglect treatment and preventionTribal and Traditional ServicesChiropractic, massage, acupuncture
SouthcentralFoundation
Alaska Native Medical Center
150 Bed HospitalOver 400,000 outpatient visits last yearLocal primary care, regional community hospital, and tertiary care statewide hubLevel II Trauma Center, Magnet StatusCombined project of SCF and ANTHCFull system – includes medications, etc.
SouthcentralFoundation
Our ChoiceOur Choice
The Alaska Native people were given this choice and we chose to assume the responsibility for our own health care
Change everythingTotal redesigngWith our choices, values and ……
Where we were in Jan. 1993100 % increase in Native population in 10 yrs
Long waits for scheduled appointments, 4 to 6 hour waits in ER/Urgent Care commonLong waits on phone pharmacy Long waits on phone, pharmacy, everywherePoor continuity, little coordination across depts,Increase age, illness burden, space issues Littl t i t t d i l iLittle customer input, not used in planningSystem not designed around the customer
Everyone was frustrated…y
Customers frustrated – waiting Customers frustrated – waiting, impersonal, paternalistic, crowded, unfriendlyyClinical staff frustrated – too many people, not enough time, no personal p p , g , prelationship, too many demandsManagement frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, poor f ilitifacilities
What IfWhat If….
What would a healthcare system based on What would a healthcare system based on Alaska Native community values look like? What if you actually threw out EVERYTHING in th di l t d t t d ith Al k the medical system and started with Alaska Native community structures and strengths as the base?Asset based philosophy, structures, systemsSo…..We declared nothing would remain the way it was unless we decided to do it that way.
SoSo
d l k i lWe wanted Alaska Native people to own their own healthcareWe wanted to have a system where the We wanted to have a system where the values, goals, and strengths of the customer drove the system designWe wanted to get to whole person care We wanted to get to whole person care –physical, mental, emotional, spiritualWe wanted family and community to y ymatter & to be known personallyAnd – we wanted the best that modern medicine has to offer medicine has to offer
Why is Customer Owned Importanty p
Efforts of “experts” who know o ts o e pe ts o owhat is best for Alaska Native people (healthcare professionals, missionaries, government officials)
Result has been loss of self esteem d fid l di t and confidence leading to
dependency Healing and progress on the journey Healing and progress on the journey towards health only is possible when the customer/owner takes control
d l d h hand leads the change.
Scotland Alaska C i d i S i d b il Caring and compassionate staff and services
Clear communication and l f d d
Services and systems built on strengths of Alaska Native culturesNot complicated but simple and easy to use explanation of conditions and
treatmentEffective collaboration
and easy to use
Together with the customer as an active partner
Continuity of care
Good access
Relationships between customer owner, family and provider must be fostered and supported A i ti i d d it Good access
Clinical excellence
Access is optimized and wait times are limited Outcome and process measures to continuously evaluate and improveevaluate and improve
Scotland AlaskaPerson Centeredness
Shared Responsibility
Safety of Patients Commitment to lQuality
Clinical Effectiveness
Family Wellness
Why Listen to our storyComplete system redesign on Alaska Native values
Decrease in ER/Urgent Care over 40%Decrease specialty care by over 50%Decrease in primary care visits by 20%Decrease in primary care visits by 20%Decrease in admissions and days by over 35%
Improved health outcomesImproved health outcomesImproved satisfaction indicators –customer and employeecustomer and employee
Question AssumptionsQuestion Assumptions
Medical Model not questioned in 100 years, but optimally effective for population healthpopulation health‘Healthcare’ tries to build on one philosophy – why? Span is so hugep p y y p gKnowledge – clinical, system design, change management, operational
t h l d h l b t management – have evolved hugely – but not the basic healthcare paradigm – why?
Analogy - Hitting the targetAnalogy Hitting the target…
If you are in a mechanical manufacturing If you are in a mechanical, manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out
d t j t tspeed, trajectory, etc.If you are in a messy, human, complex, adaptive environment – it is like throwing a adaptive environment it is like throwing a bird at a target – it is all about the ‘attractor’Healthcare mostly throws birds at targets and
l thi k b t th th i tonly thinks about the throwing part…
Reality – various ‘platforms’Reality various platformsHealthcare has several ‘platforms’
ICU/ER/OR – high tech, linear, mechanicalProcedures – linear, mechanicalConsultative – time limited specific issue Consultative – time limited, specific issue focused, additive expert supportLongitudinal relationship over time –h i diti t ti t id ti l chronic conditions, outpatient, residential,
behavioral health, primary care
One size does not fit all – first two are product, manufacturing efforts – second two are service and knowledge efforts primarilyare service and knowledge efforts primarily
Control: Who really makes the decisions
Patient/Family100
“Control”
The “System”
Acuity
y0
Low High
1. Control – who makes the final decision influencing outcome?1. Control who makes the final decision influencing outcome?2. Influences – family, friends, co-workers, religion, values, money3. Real opportunity to influence health costs/outcomes – influence
on the choices made – behavioral change4 C t d l t t di i t t t ( d d )4. Current model – tests, diagnosis, treatment (meds or procedures)
Realityy
Health is a longitudinal journeyg j yAcross decadesIn a social, religious, family contextHi hl i fl d b l b li f h bit Highly influenced by values, beliefs, habits, and many ‘outside’ voices.
Office visits are brief, reactive stop-gapsHospitalizations are brief, intense interruptionsMUST fix basic, underlying primary care platform first or nothing else will work wellplatform first or nothing else will work well
Purpose of Primary Carep y
Is a Service Industry – NOT a product industry Is a Service Industry NOT a product industry – coaching, teaching, partnering are central –pills and procedures supportiveChanges what we think we do, who we hire, how we train, how we structure, how we reward, and how entire system is constructed reward, and how entire system is constructed as a system.We must optimize relationship – personal, t ti t bl i i i b itrusting, accountable – minimize barriers
The General Framework
Vision, Mission, Key PointsLeads to Operational Principles –Leads to Operational Principles –these are specific enough to be used to evaluate and even score new to evaluate and even score new ideas for whether to implement them into SCF or notthem into SCF or not
Mission, Vision, Key Points
Vision: A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission: Working together with the ss o o g toget e t t eNative Community to achieve wellness through health and related oug a a d a dservices.
Key PointsKey PointsShared Responsibility We value working together with the individual, the family, and g g , y,the community. We strive to honor the dignity of every individual. We see the journey to wellness being traveled in shared responsibility and partnership with those for whom we provide services.pCommitment to Quality We strive to provide the best services for the Native Community. We employ fully qualified staff in all positions and we commit ourselves to recruiting and training Native and we commit ourselves to recruiting and training Native staff to meet this need. We structure our organization to optimize the skills and contributions of our staff.Family Wellness
l h f l h h f h CWe value the family as the heart of the Native Community. We work to promote wellness that goes beyond absence of illness and prevention of disease. We encourage physical, mental, social, spiritual and economic wellness in the i di id l h f il h i d h ld i hi h individual, the family, the community, and the world in which we live.
SCF Operating Principles
Relationships between the customer-owner, the family, and provider must be fostered and family, and provider must be fostered and supportedEmphasis on wellness of the whole person, family, and community including; physical y, y g; p ymental, emotional, and spiritual wellnessLocations that are convenient for the customer-owner and create minimal stops for the pcustomer-owner.Access is optimized and waiting times are limitedTogether with the customer-owner as an active partnerIntentional whole system design to maximize y gcoordination and minimize duplication
Operating PrinciplesOperating PrinciplesOutcome and process measures to continuously e al ate and imp o eevaluate and improveNot complicated, but simple and easy to useServices are financially sustainable and viableyHub of the system is the familyInterests of the customer-owner drive the system to determine what we do and how we do system to determine what we do and how we do itPopulation-based systems and servicesServices and systems build on the strengths of Alaska Native cultures.
Customer-owner Changes for Effective Relationships
Be active not passiveTake responsibility for your health Take responsibility for your health Get information about your health Ask questions about advice Ask for optionss o opt o s
Healthcare Provider Changes for Effective Relationships
No longer a hero but a partner Control does not equal compliance Control does not equal compliance Replace blaming with understanding understanding Give customer options not orders Provide customer with resources Make it simplep
Some of our improvementsLeadership
Mission, vision, key points, principles –making t f f b i f d t d kpart of fabric of day to day work
Functional structure Training and development – succession Training and development succession planningStandardize Improvement Processes and ToolsFacility Design
Some of our improvements
Strategic PlanningContinuous planning cycle p g yLinkage from 20 years to today Automated planning tool and reports p g pMeasurement of how we are doing at macro and micro levels
Some of our improvements
Customer focusListening posts continuously updated g p y pand evaluated Benchmarked feedback tool for satisfaction Gatherings, listening conferences, customer service reps, and family
Some of our Improvementsp
Measurement and Analysis yDevelopment of Balanced Scorecards and Dashboards for every department coordinated and connected throughout the
i ti organization Data Mall for segmentation, understanding performance and understanding performance and registry type information
Tab Based FunctionalityTab Based Functionality
Segmentation of Data
Comparison Charts to Identify Best Practices
Condition CenteredAction List
Fictitious Patient Info
Some of our Improvementsp
Workforce improvements Recruitment Processes: group interviewing, behavioral based interviewing, change how we recruit, online tool for applications,
d ffsame day offersOn-boarding including orientationCore Concepts training on building effective p g grelationships Job progressions and career ladders Development Center p• Upfront training for administrative support and
Certified Medical Assistants • Learning centers tied to workforce competencies
Some of our ImprovementsSome of our Improvements
Process and clinical improvements Process and clinical improvements Microsystem Optimization -teams• Primary Care: MD, RN, Certified Medical y , ,
Assistant, Admin Support• Human Resources, HR Generalist and Assistants
Redefine work Redefine work • Move from episodic, reactive care to long-term
relationshipM f l t i it t f • Move from only one-to-one visits to use of groups, phone, email, fax
• Move from doctor-centric to team based approach i l ti hiin relationship
Some of our ImprovementsSome of our Improvements
Process and clinical improvementsocess a d c ca p o e e tsCustomer-owner choice of healthcare providerBehavioral Health Consultants Case management and chronic illness management•Depression, asthma, chronic pain, di b t HIV tdiabetes, HIV, etc.
Advanced Access – appointments when the customer wantswhen the customer wants
Parallel Work Flow Redesign
Some of our ImprovementsSome of our ImprovementsProcess and clinical improvements
Integration of Complementary MedicineTelehealth, telepharmacy and t l di itelemedicineFamily Wellness Warriors InitiativeS i A tService AgreementsHospitalists
Southcentral FoundationVISION
A Native community that enjoys A Native community that enjoys emotional, physical, mental, and
spiritual wellness.
MISSIONWorking together with the Native
community to achieve wellness through health and related services.
Specifics on improvements
R l ti hi B d S tRelationship-Based System
Tribal Governance RelationshipsEmployee RelationshipsEmployee RelationshipsCommunity RelationshipsProvider RelationshipsProvider Relationships
Customer/Owner Listening Customer/Owner Listening
P l 24 h h tli
Not just one method of listening
Personal interaction with staff
24-hour hotlineListening Conference
Group visitsComment cardsC t
Conference Governing boardAdvisory Customer
Satisfaction surveys
Advisory committees Focus groupsy
SCF internet Annual Gathering
g pService agreements
Gathering
Using the Voice of the Using the Voice of the Customer/Owner
54% of SCF employees are Alaska Native and American Indian people, we bring the voice of the customer interactions throughout the organization Alaska Native and American Indian people Alaska Native and American Indian people recognize our families will utilize these services for generations to comeg
Core ConceptsCore Concepts
W ork together in relationship to learn and W ork together in relationship to learn and growE ncourage understanding L isten with an open mind L augh and enjoy humor throughout the dayN ti th di it d l f l d N otice the dignity and value of ourselves and othersE ngage others with compassion E ngage others with compassion S hare our stories and our hearts S trive to honor and respect ourselves and others
Listening Conference Yearly Since 2003Panel of Board Members, Panel of Board Members, President/CEO and Vice PresidentsOpen microphone Open microphone All customer/owners, community invited invited No agenda
Listening Conference continued
Starts with a small presentation SCF HistoryListeningSetting PrioritiesLooking to the futureLooking to the futureDriving change We’re owning the systemWe re owning the systemYour voice mattersThank you /explain the process y p p
Listening ConferenceMicrophone is passed around the room to customer/owners
Ask questionsOpportunities for improvementC li t Compliments Suggestions
Notes are taken during the whole conferenceconference
Listening ConferenceTranscripts are reviewed Entered into our customer comment databaseForwarded to appropriate department/committee/employeeEvery customer comment is followed up on Tracking and trending
The Gatheringl i 99Yearly since 1997
Convention center161 Booths of all kinds161 Booths of all kinds
Education Healthy life stylesSCF departmentsCommunity (Education, Regional Native Corporations, etc.)p )
Activities Entertainment
The GatheringgInteractions with employeesFeedback from customer/owners
Examples• More help for elders• Parking • More cancer support • More cancer support • Better customer service when checking in for an
appointment • Helping the homeless/emergency financial situation
I f ti f ll th h lt b Information follow through on survey results by committee/managers
Tracked through electronic feedback systemkensure appropriate action is taken
Website
Strategic Planning Cycle
What are we trying to accomplish?
How will we know that achange is an improvement?
What changes can we makethat will result in improvement?
ACT PLAN - What changes - Objective are to be made? - Questions and
Predictions (why) - Next Cycle? - Plan to carry out
the cycle (who, what, where, when)
STUDY DO - Complete the - Carry out the plan analysis of the data - Document problems - Compare data to and unexpected
di ti b ti predictions observations - Summarize what - Begin analysis was learned of the data
Planning and Improvement LinkagesPlanning and Improvement Linkages
August 2006
Corporate Goals ESTABLISHED AT CORPORATE LEVEL
Established by Vice President Leadership Committee and approved by Board of Directors and are derived from the Mission Vision, Key Points and Operational Principles
Mission, Vision, Key Points, Operational PrinciplesEstablished by Vice President Leadership Committee and approved by Board of Directors Annual Planning Process
and Cycle, Baldrige Process, Improvement Cycle, and Committee
Str ct re are the
Green = Core foundation Pink = Initiatives
Orange = Work Plans/Action ItemsRose = Employee Evaluation
Blue = Improvement ToolsGrey = Other Useful Tools
Double Line Box = Part of Annual Planning Tool
Balanced Scorecard (BSC)Linked to Corporate Objectives and
Planning and Improvement Linkages
Corporate ObjectivesESTABLISHED AT CORPORATE LEVEL
Reviewed and updated annually by Vice President Leadership Team as part of Planning Cycle with input from employees/customers
Division Initiative DepartmentCorporate Functional Structure Project or Project
Team Charter
Because initiatives tie to Objectives and they are longer term, they
should be linked to BSC.
Structure are the approaches and systems in which these tools are
deployed.
InitiativesStrategic activities identified that are longer term (occur in 1-2-3 years) to
p jmeasure progress on achieving Corporate
Objectives
4 Oval Structure
Division Initiative InitiativeInitiative Committee Initiative
W k Pl A ti It
Developed for most initiatives to outline the details of the initiative.
PDSA Developed for work plans that involve
improvement activities to outline the details of the
Division Work Plan/Action
Item
Department Work Plan/Action Item
Functional Structure Committee Work Plan/
Action Item
Functional Structure Committee
Work Plan/Action Item
Department Work Plan/Action
Item
Department Work Plan/Action
Item
longer term (occur in 1-2-3 years) to achieve the corporate objectives. Initiatives may be developed at all
levels of the organization.
Work Plan or Action ItemDetails the short term action items (tests of change
or less than quarter in duration) that will be completed and/tested to achieve an initiative. Work
plans may be developed at all levels of the organization
outline the details of the work plan. Changes are tested in Rapid Cycle, with one cycle building
on another.
Department Work Plan/Action
Item
Employee Performance Action
Plan
Employee Performance Action
Plan
Employee Performance Action
Plan
Employee Performance Action
Plan
Link to Improvement
ToolsEmployee Performance Action PlanDetails for each employee their action items for the year linked to initiatives
Dashboards (DB)Operational Measures that monitor the day to day operations. These
measures inform where improvement may be targeted. If the
annual plan is used as an operational work plan in addition to a
strategic plan, DB items may be linked to these operational initiatives/
OTHER USEFUL TOOLS Project Team Charter Assessment Conference Lessons Learned BSC/DB DefinitionsMedelearnIntranet Tools
Improvement ToolsOperational Principles: Used to test ideas or concepts to ensure consistency with MVKP&Corporate Goals Measurement Rules Template: Developed to assist with defining BSC / Dashboards measures. Part of the intranet toolCommittee Manager: Used to develop Project Team in order to communicate changes, meeting minutes etc
corporate wideADLI Approach, Deploy, Learning, Integration: From Baldrige used to evaluate PDSA cycles. Change Concepts: Change concepts are used in improvement to assist in generating new ideas when
Plan Plan Plan Planand work plans.
Data and Information drives all aspects of the Improvement Process and is part of all tools. Data are reviewed from the 4 perspectives: Finance/Workload, Organizational Effectiveness, Customer, & Workforce including National Research Corporation-Customer Satisfaction; Morehead Associates-Employee Satisfaction; BSC/DB, Hedis etc.
linked to these operational initiatives/work plan items. including forms
Policy & Procedure TemplatesCommittee Reporting Form
Change Concepts: Change concepts are used in improvement to assist in generating new ideas when making changes
Survey Monkey: Used to measure success for process changesBaldrige Assessment and Feedback: Survey that can be used to assess where the organization/department/committee is based
on Baldrige Criteria Measurement Rules Template
Measurement LinkagesMeasurement Linkages
Improvement Model:
From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by Langly, Nolan K., Nolan T., Norman, and Provost
Continuous ImprovementContinuous Improvement
PA
Situation as it Should
P DSABe
P
P
D
D
S
SA
A
ImprP
DS
A rovemennt
Situation as it isFrom The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by Langly, Nolan K., Nolan T., Norman, and Provost
SCF Facilities Supporting Health
The key determinant of health (and success in education and finances) is Self ConfidenceSelf Confidence draws from pride, Se Co de ce d a s o p de,honor, dignity, respectOutstandingly beautiful facilities are Outstandingly beautiful facilities are a key piece of improving Alaska Native pride honor dignity - self Native pride, honor, dignity self confidence
Customer-Owner Design
Easy to find, welcoming spacesBeauty, light, comfort, colors and Beauty, light, comfort, colors and textures that are familiarNative feel but not any specific one Native feel, but not any specific one cultureDignity pride respect honor Dignity, pride, respect, honor, relationshipP i ti li t iPrivacy, time, listeningFamily and friends welcome
Facility designSmaller, quieter, more personal feelingNot on top of each other spreading infection and being disruptiveinfection and being disruptiveAccommodates family and privacy bothComfortable exam spaces and on the Comfortable exam spaces and on the same level as the clinical people – respectSelf management, customer-owner Self management, customer owner controlVisual, sharing, listening, professional
Facility DesignGroup sociology – Family dynamics - max Group sociology Family dynamics - max 15 people, Team dynamics up to 65, over 65 – bureaucracy Back to smaller ‘team’ practices – 6 ‘primary care’.D t li d H lth I f ti C t Decentralized Health Information Centers into every waiting areaShared specialty rooms and equipment -Shared specialty rooms and equipment -central spineExtensive use of glass, natural light, semi-g , g ,privacy
Facility DesignEmphasis shifted towards more team Emphasis shifted towards more team space and more importance of integrated team spaceg p
More and more team care, ‘virtual’ care (email and phone and home visitors), l i itless visits.No ‘nurses station’CMS and CMA’s with teams phone CMS and CMA s with teams – phone traffic direct to teamsShared resources – behaviorists, Shared resources behaviorists, dieticians, pharmacists, coverage staff -visible/accessible
Facility Design
Structural alignment with shift in power to be more balanced – spaces d di li dde-medicalized
Family roomsG Group rooms
Co-located Mental Health therapistsh dExperiments with merged
pharmacist, pregnancy and pediatric carecare
Data Slides
Diabetes: Annual HbA1C
88.1 88.2 87.3 86.7 88.8 91.0 90.5 91.9100
50
100
%
0Mar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (88.81)
Diabetes: HbA1C Poor Control
23.0 24.2 26.9 26.5 23.7 22.5 22.5 22.820
40
%
0Mar Jun Sep Dec Mar Jun Sep DecMar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 10th Percentile (32.60)SCF 2008 HEDIS 10th Percentile (32.60)
Diabetes: LDL < 100mg/dl
100
50.3 49.8 48.5 49.1 48.3 52.1 54.0 52.950
100
%
0Mar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (42.31)
Diabetes: B/P < 130/80
34.0 39.4 39.850
100
%
0Mar Jun Sep Dec Mar Jun Sep DecMar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (41.30)SCF 2008 HEDIS 90th Percentile (41.30)
Cardiovascular: LDL < 100mg/dlg
49 2 51 0 50 3 49 1
100
40.3 49.2 51.0 50.3 49.1
0
50%
0Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (52.87)
Asthma: Appropriate Meds96 96 97 95 96 9587 86 87 96 96 97 95 96 95 84 82 83
50
100
%
0
Oct
Nov
Dec Oct
Nov
Dec Oct
Nov
Dec Oct
Nov
Dec
SCF Overall 5 to 9 yrs 10 to 17 yrs 18 to 56 yrs
2009
SCF 2008 HEDIS 90th Percentile (Overall 91.94)
Cancer Screening: ColorectalCancer Screening: Colorectal(Flex sig and Colonoscopy)
48 9 50 3 52 2 55 6 57.0 57.8 58.2 58.6
100
48.9 50.3 52.2 55.6 57.0 57.8 58.2 58.6
0
50%
0Mar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (65.72)
Cancer Screening: Cervical
73.4 73.6 73.8 73.6 74.1 75.3 75.5 75.2100
0
50%
Mar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (77.46)
Cancer Screening: Breast
59.0 58.2 57.5 56.5 56.5 56.1 56.6 57.4
100
0
50%
Mar Jun Sep Dec Mar Jun Sep Dec
2008 2009
SCF 2008 HEDIS 90th Percentile (61.17)
Complex Utilizer: Annual Behavorial Visit
58 4 59 0100
52.3 53.2 55.6 58.4 59.050%
0Dec Mar Jun Sep Dec
2008 20092008 2009
SCF SCF Target (75%)
Controlled Medications: Annual Behavorial Visit
32 8 35 450
100
% 30.3 28.8 30.4 32.8 35.4
0
50%
Dec Mar Jun Sep Dec
2008 2009
SCF SCF T (50%)SCF SCF Target (50%)
Access to Recovery: 6 Month Follow-Up of Intakes
94.080.7100
50%
02008 (N=151) 2009 (N=657)
SCF A All G (2008 64 % 2009 63 %)SCF Avg All Grantees (2008:64.7% 2009: 63.7%)
Access to Recovery: Alcohol & Drug Abstinence
72.7
50 066.4 65.5
76.862.8
70.9100
46.1 50.050%
0Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09 Q1 FY09 Q2 FY09 Q3 FY09 Q4FY09-Q1n=128
FY09-Q2n=122
FY09-Q3n=142
FY09-Q4n=86
Access to Recovery: Employment & Education
39 1 37 350
100
%
18.8
39.123.8
33.6 28.237.3
29.1 34.9
0
50%
0Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09-Q1 FY09-Q2 FY09-Q3 FY09-Q4n=128 n=122 n=142 n=86
00
Crude Rate: AN SuicidesAnchorage & MatSu Residents
46.7050
100
er 1
00,0
0
24.60
0
50
uici
des
pe
2004#Suicides=16
2006#Suicides=9
2008#Suicides=3
Su
Emergency Dept Visits per 1000 Member MonthsEmergency Dept Visits per 1000 Member Months
100
00
42.76 43.9750
ts p
er 1
00
02008 2009
Vis
it
2008 2009
SCF HEDIS 10th Percentile (40.59)
M thl ED Vi it P 1000 C tMonthly ED Visits Per 1000 Customers(Historical)
80
39
48
40per 1
000 19% Decrease Since 2000
0
Vis
its
2000
2001
2002
2003
2004
2005
2006
2007
Total Outpatient Visits per 1000 Member Months
4000
299.35 322.25
200
400
ts p
er 1
000
02008 2009
Vis
it
SCF HEDIS 50th Pctile (324.01)HEDIS 25th Pctile (274.04)
Qrtly Outpatient Visits Per 1000 Customers(Historical)
10771200
00 36 % Decrease Since 1999
693
400
800
its p
er 1
00 36 % Decrease Since 1999
0
400
99 00 01 02 03 04 05 06 07
Vis
199
200
200
200
200
200
200
200
200
Total Inpt Days per 1000 Member MonthsTotal Inpt Days per 1000 Member Months
50
00
27.00 26.8225
ays
per 1
00
02008 2009
Da
SCF 2008 HEDIS 10th Percentile (16.84)
Qrtly Hospital Days per 1000 CustomersQrtly Hospital Days per 1000 Customers(Historical)
81.5100
000
71 % D Si 1999
23 3
50
ays
per 1
0 71 % Decrease Since 1999
23.3
0
99 00 01 02 03 04 05 06 07
Da
199
200
200
200
200
200
200
200
200
Total Inpt Discharges per 1000 Member MonthsTotal Inpt Discharges per 1000 Member Months
10
1000
5.72 5.98
5
arge
s pe
r
02008 2009
Dis
ch
SCF 2008 HEDIS 10th Percentile (5.26)
Qrtly Hosp. Admissions Per 1000 Customers(Historical)
19.0320
per 1
000
75% Decrease Since 1999
4.72
10
mis
sion
s p 75% Decrease Since 1999
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
Adm
Customer Satisfaction (Top Box %)
71.268.2100
0
50%
02008 2009
SCF **Mayo 69% **Clev. 66% **JH 75%y
Customer Satisfaction (Top Box %)
70 74 73 73 83 9166
100 70 74 73 7353 56 66 66
50%
008 09 08 09 08 09 08 09 08 09
Clinics Dental Home Hlth Emerg. Outpt BHgServ.
p
SCF
BSC Customer Satisfaction (Positive Response)91.788.5100
50%
02008 2009
SCF BSC 2009 Target (85%)SCF BSC 2009 Target (85%)
Ability to Give "Input" (Top Box %)
100
65.3 65.0
50%
008 0908 09
SCF CAHPS (Top Box) 2009 (53.5%)
FY Operating MarginFY Operating Margin
12.5 11.0 11.18.6 8.8 8.410 0
15.0
2.4 2.3
0.0
5.0
10.0%
-5.0
2002
2003
2004
2005
2006
2007
2008
2009
SCF SATO MGMA 90th %tile 2009 (1.3)
FY Total Revenue ($Millions)
174.6200
102.5 120.2 128.5 143.2 146.3 149.0174.6
150.3
100
200
0 2002
2003
2004
2005
2006
2007
2008
20092 3 4 5 6 7 8 9
SCF SATO MGMA 90th %tile 2009 (77.4)
SCF Customer Growth (# Empanelled)
80,00059,992
40 000
60,000
#
18,21620,000
40,000#
0FY 1999 FY 2009
Cumulative Per Capita ExpendituresRelative % Change with 2004 as BaselineRelative % Change with 2004 as Baseline
262726
25
30ba
selin
e
15
10
15
20
nge
from
b
5
0
5
10
tive
% c
han
-10
-5 2004 2005 2006 2007 2008Rel
at
SCF Cumulative Primary CareSCF Cumulative Hospital ServicesNational Health SpendingNational Hospital Care ExpendituresNational Physician and Clinic Services Expenditures
Workforce Commitment Indicator
3 83 3 91 3 92 4 0753.83 3.91 3.92 4.07
23
4S
core
01
2S
2003 2005 2007 2009
SCF Morehead Nat HC Ave 2009 (4.10)
Development Center Courses per 100 FTE
8 5910FTE
8.59
3.945
10s
per 1
00 F
0SCF Local HospitalC
ours
es
2010
% of Workforce Promoted
8 70
13.5011.80 12.60
20
8.70
0
10%
02005 2006 2007 2008
SCF 2008 Saratoga 90%tile (11.50)SCF 2008 Saratoga 90%tile (11.50)
% of AN/AI Workforce Promoted
20
9.5 9.2 9.5
14.1
10
20
%
0
10%
02006 2007 2008 2009
SCF 2008 Saratoga 90%tile (11.50)
"I understand mission & core values"
4 435 4.31 4.323.87
4.43
3
45
ore
01
2Sco
02003 2005 2007 2009
SCF Morehead Nat HC Ave 2009 (4.34)
90 Day Turnover Rate
20
5 9 7.110% 5.93.4
02007 2008 2009
SCF 2008 Saratoga 90%tile (7.30)
"This org. cares about employee safety"
3 88 4.05 4.17 4.3053.88
23
4
Sco
re
01
2003 2005 2007 2009
S
2003 2005 2007 2009
SCF Morehead Nat HC Ave 2009 (4.16)
Benefit Satisfaction & Organizational Support
3 69 3 66 3.89 3 67 3 73 3.87 3 68 3.93 4.0245
3.69 3.66 3.67 3.73 3.68
1234
Sco
re
01
05 07 09 05 07 09 05 07 09
I am Satisfied w/ Benefits
Org Support Work vs Pers.
Org Interested in Health\Wellness
SCF 2009 Morehead Natl HC Ave (Sat 3 66 Sup 3 82)SCF 2009 Morehead Natl HC Ave (Sat 3.66 Sup 3.82)
% Appointments Available at 0800for Whole Day (FMC/PEDS/VAL)
10047 48 58 62 55 59
41 42 43 35
0
50%
0
Ove
rall
Ove
rall
Ove
rall
Ove
rall
Ove
rall
Ove
rall
Ove
rall
FMC
PE
DS
VA
L
03 04 05 06 07 08 09 09
SCF SCF Innovative Target (50%)
Behavioral Health Urgent Response Capacityg p p y
2915
3984 3867
3000
4000
333
1176 1114
2005
1000
2000#
3330
2003 2004 2005 2006 2007 2008 2009
SCF
Continuity of Care with Primary Provider
83 76100
35
73 67647183 76
50% 35
0
50%
099 00 01 02 03 04 05 06 07 08 * 09
PEDS FMC VAL MHS (44.85%)