Brenda Kennedy, DHA, BSN, RN Quality Director “If you’re not measuring it, you’re not improving it!” Greg Wolverton, FHIMSS Chief Information Officer “You can’t afford NOT to transform”

“It’s not good enough to report data. We improve by searching data for missed improvement opportunities.”

A 13-year Quality Journey Team leaders for Transformation journey since 2003 Finance Redesign Collaborative IT/EHR adoption Use data & info to assist ARcare in achieving:  Mission  Vision  Values  Process Outcomes  Population Health Outcomes Leaders of Change Management Team  Evaluate internal & external data needs  Design & standardize workflows & processes

Stewards for 90,000 Patients 2015 Federally Qualified Health Center 42 Clinical Sites, 4 pharmacies Primary and specialty care services  Pediatrics  HIV/AIDS  Longevity  Diabetes  Behavioral Health  Wellness  Cancer Care 90,000 patients under care 63 clinicians (21 MDs, 42 APRNs & PAs)

Total Organizational Performance Initial 9 Defining Population Based Measures

Clinical condition = measure + standard = patient “at goal” Population = number of patients under care with condition Target = % of population at goal aligned with HEDIS Percent population at goal Months Actual Target Ideal Performance… Definition 6

Clinical condition = Diabetes Measure = HbA1C control <7 Controlled diabetes = Low Risk 7 – 9 = Moderate Risk >9 High Risk Standardized Workflow + Best Practice Standing orders Alerts/Reminders Templates CDSS PERFORMANCE … An example 7

8 Clinical Process Measures 1.Asthma - Rx therapy 2.CAD – Lipid therapy 3.Colorectal Cancer Screen 4.Adult Weight Assessment & Follow-up 5.Tobacco Use Assessment & Intervention 6.Depression Screening 7.Child Weight Assessment & Counseling Clinical Outcome Measures 8.HTN BP control 9.DM HbA1c control 10 % 15 % 31.1 % 54 % 82.6 % 46 % 26 % 10.2 % Total Organizational Performance: Nine performance metrics 8 Scope of Performance % Affected Patient Population

Clinical Process Measures 1.Asthma - Rx therapy 2.CAD – Lipid therapy 3.Colorectal Cancer Screen 4.Adult Weight Assessment & Follow-up 5.Tobacco Use Assessment & Intervention 6.Depression Screening 7.Child Weight Assessment & Counseling Clinical Outcome Measures 8.HTN BP control 9.DM HbA1c control % % % % 95.6 % % 8.21 % % % Total Organizational Performance: Bold Targets 9 Targets - % of population at goal

Current Status on 9 Defining Measures 10 6 Measures Meet or Exceed Target Asthma - Rx therapy CAD – Lipid therapy Colorectal Cancer Screen Adult Weight Assessment & Follow- up Tobacco Use Assessment & Intervention Depression Screening 3 Measures Improving Trend To Target  Child Weight Assessment & Counseling  HTN BP control  DM HbA1c control No Measures Not at Target, Not Improving  (None)

Measurement: Our foundation for managing performance “If you’re not measuring it, you’re not improving it.” Decide what data is most meaningful! Levels of aggregation needed: Organization Region Facility Provider Population

Performance Results Ongoing transparent sharing of results and actions = IMPROVEMENT

Controlling Chronic Diseases TOPS Report Results (Organizational)

Reducing Risks TOPS Report Results (Organizational)

Sustained Improvement

Meaningful Management Transparent Timely Clearly defined expectations Creates competition, sharing, and improvement

Monthly Facility Comparisons Population Measures

Performance Management Data Analysis Communication and Action Performance Reports

Data Analysis Trends Outliers “OFI’s” Problem Solving Change Management Team

Performance Reports Organizational Facility Department Provider Snap Shot Trends

Communication and Action TOPS Report Action Plans Clinic Meetings Activity Reports Change Management Team Process Mapping

Performance Management Quality Champions Share P & P changes* Post/discuss facility results Discuss organizational scores Gather input from staff* Submit reports of activities* Report OFIs* Complete Action Plans* * For ALL facilities, including administrative TOPS Report

Current Communication CMTYammer Support Desk Policy & Procedures KMS Education ARcare Staff

Current Care Delivery Maximizing Care Multidisciplinary Teams Standard Work Leveraging Technology

25 Opportunities for Improvement: how to move to an ideal Population not at target Target is consistently met or exceeded Drill down to patient level data. Look at performance variation among facilities, providers. Drill down on high outliers. Advanced analytics continuously improves & moves targets. Surface, seize Opportunities for Improvement.

Transforming Care Delivery Embracing Principles Leadership Support Knowledge Migration and Shared Learning Clinical Champions Identify & Close Gaps Attitudinal Orientation Team Approach Develop Action Plans

Transforming Care Delivery Mission, vision, and values Total quality improvement – no “sacred cows” “What’s in it for me?” Consistent communication and follow-up Transparency Performance expectations Incentives Creating Motivation

Getting Started

Remember the Purpose Every single organization on the planet, even our own careers, function on three levels: 1. What we do 2. How we do it, and 3. Why we do it. When those three pieces are aligned, it gives us a filter through which to make decisions. It provides a foundation for innovation and for building trust. When all three pieces are in balance, others will say, with absolute clarity and certainty, “We know who you are,” “We know what you stand for.” Simon Sinek “The greatest of all mistakes is to think you can only do a little.” Zig Ziglar

The project described was supported by Funding Opportunity Number# 1L1CMS from the U.S. Department of Health & Human Services, Center for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.