systems change, keeping it simple

Health and Wellness for all Arizonans

Systems Change,Keeping It Simple

Virginia WarrenOffice Chief, Cancer Control Programs

Arizona Department of Health Services

Systems Change=Improving Patient OutcomesJune 27, 2014


Systems Change

• The process for sustainable change in policy, program and resource allocation

• The process of improving the capacity of the public health system to work with many sectors to improve the health status of all people within a community.


Your Community• Community is defined as your geographic area

with a strong focus on those using services from your providers


Why Participate in Systems Change?

• Proactively serve your patients• Prepare for environmental changes • Affordable Care Act• CMS reimbursement changes


Systems Change Participation (cont.)

• Position yourself in a competitive market• Maintain/increase revenue• Prepare for the Baby Boomer Tsunami


Getting Started• Success will not be achieved doing this by

yourself, Gather Your Champions• Who is Involved:• Leadership, absolutely• Operations staff, yes• IT support, yes


The Starting Point

Start Small and Start Smart• Decide on the area of focus• Prioritize the focal point

through clinic policy• This is a process, it takes

time, thought, planningPace Yourself


Policy is Set

• Example – “Increase breast cancer screening rates.”

• Determine baseline screening rates for your clinics


Policy Example

• How do you do that?• How many women 40 and older have received a

mammogram in the past two years? • Do you have the capacity to determine this

electronically? Or is a chart audit needed?• If you have an electronic system, do you have staff

to build the query?


Determining Baseline• How many women 40 and older use your

clinic?• At what age are you going to cap the review?

65? 70? • Are you going to look at biennial or annual

mammograms?


Don’t Be Surprised

• There will be room for improvement

4%

81.1%


Review and Discuss Baseline

• Baseline results will not be what you expect• Example: HealthCheck Program baseline data

compared to Healthy People 2020 Goals


Provider Reactions• Providers in a large practice may believe their

results will differ from others• Determine baseline rates separately: A

Provider may emerge as a champion of the project


Discussion and Disagreement Lead to Discovery

• The results will lead to a realization that:• Screening rate leaves room for

improvement• Evidence based strategies are necessary• Many insured women are not being

screened• Many insured women are not even

having annual visits – this is a missed opportunity


Baseline Determined• Preserve Process – be careful, thoughtful• Share Results• Schedule the same process for the subsequent

year• Assign responsibility for next steps• Who is driving?


Evidence Based Strategies

• Research Evidence Based Strategies• Community Guide To Preventive Services• Client Oriented or Provider Oriented

• Decide on EB strategies providing best fit• Use them wisely

http://www.thecommunityguide.org/index.html


Selection: Patient Reminders• How many do you send out?• What is the follow up process?• Send a letter and forget? Or follow up?


Patient Reminders (cont.)

• When they schedule appointment, is follow up complete?

• Where are screening results recorded?

• How can you improve process for the next group?


Division of Responsibilities

• Who does the audit? Or EHR report?• Who defines the audit/report guidelines?• Who decides on the strategy to increase

screening rates?


Assignment of Roles

• Who tracks the women referred to mammography and navigates or “stalks” them? (Patient Navigator?)

• Who is driving the bus? If you don’t have a driver you won’t get far.


Critical Elements

• Set the policy• Assign responsibilities• Allow discussion and debate over results• Monitor process and tweak to improve• Allow flexibility for improvements• Celebrate success!• Expand to the next topic –

Colorectal Cancer Screening


Will Patient Outcomes be Improved?• Regular screening• Monitoring timeliness of services provided• Receiving credit for the work that is done• Application to other measures?


Breast and Cervical Cancer Treatment Program Expansion


www.wellwomanhealthcheck.org

http://azdhs.gov/hsd/healthcheck/wellwoman/index.htm


My Usual Photo


Daytona - 2013


Hurricane Lillies - Japan


Thank You

Virginia [email protected]

Emily [email protected]

systems change, keeping it simple

Documents

goals health

clinics health

health status

project health

providers health

public health system

baby boomer tsunami

baseline screening rates