Delivery System Reform Incentive Payments Dr. Michael J. Romano, Associate Dean for Clinical Affairs Mr. Oscar A. Perez, Project Manager, DSRIP-Texas Tech

EXPANDING NEUROLOGY CARE Salvador Cruz-Flores MD MPH Founding Chair, Neurology Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive June 28, 2013 @ 1:00pm

To improve the general health of the population in El Paso by increasing access to quality neurological health care services locally MILESTONES Recruitment of providers (physicians and non physicians) To expand services to include satellite ambulatory sites for outpatient visits and inpatient consult service. To establish an ACGME accredited residency Program in Neurology

Background Nearly half of the Department’s ambulatory encounters are Medicaid and/or No Insurance Population is aging and the burden of neurological disease like stroke, Alzheimer’s, and Parkinson’s disease is increasing Increase in workforce related to Neurology is a better predictor of mortality related to strokes (leading cause of death and disability in USA) -----Desai A, Bekelis K, Zhao W, Ball PA, Erkmen K: Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population. Clinical Article. Journal of Neurosurgery, published ahead of print November 30, 2012; DOI: 10.3171/2012.10.JNS12518

Background Currently there is a limited number of neurologists in El Paso (about 10 in El Paso excluding those who serve the military) Ideally 6.76 neurologists per 100,000 population (Kurtzke, Bennett, et al 1986) or 54 Neurologists for a city this size of 800,000 Time to appointment is a good surrogate of service need (in the community currently is 4-6months for new appointment)

Benefits for the region Increased access to general neurological care in the ambulatory and inpatient settings Increased access to subspecialty care in neurology such as epilepsy, stroke, movement disorders (i.e. Parkinson’s disease) Form basis for creation of a Comprehensive Stroke Center Facilitate the training of physicians in neurology that may choose to stay in El Paso

Progress Hired 2 FTE neurologists in Year 02 of DSRIP Future plans to include current increase from 4.2 FTE Faculty (2013) to 10-12 FTE within next 4 years (2017) Increased outpatient volume by adding additional clinic sessions and adjusting clinic grids Improvement of telephone access and referrals Began servicing more inpatient consults at UMC and Neuro intervention In the process of creating Stroke Program; Neuro ICU Plans have started to create residency program Residency Coordinator to complement in 2013-14 3 PGY 1 residents in 2015

Progress Risk areas: Attracting and recruitment of physicians to El Paso Mitigation strategies: within the constrains of academic medicine try to offer competitive compensation and a professional life that candidates may value Anticipated outcomes: Increased number of neurologists Creation of residency program in neurology as planned Increase number of new and established outpatient and inpatient encounters Connection with other initiatives (DSRIP or otherwise): Could be connected to the Family Medicine initiative by creating a neurology satellite clinic in one or more of the family medicine sites

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ENHANCING & EXPANDING COMPREHENSIVE BREAST CARE SERVICES Rene Vallejo Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive June 28, 2013 1:00pm

Description of the Project Synopsis Expand and enhance access to specialty care for women with breast disease. Develop a Fellowship Program and provide increased access to surgeons with special expertise in breast surgery. Establish a Survivor’s Program at UBCC with an emphasis on objective measures of quality of life and strategies to improve this matric. Department Involved: Department of Surgery- University Breast Care Center (UBCC) Major Milestones DY2: Baseline Report Time-to-3rd Appointment Survivor Program-(40 enrolled) Program starting to see enrolled patients Hire Breast Surgeon NAPBC Program Accreditation 2 RHP Seminars

Benefits to the Community Established in 1994, primary focus was to help the indigent. UBCC treats 1/3 of all breast cancer in El Paso. 4,500 patients seen annually @130 are diagnosed with breast cancer. UBCC has Multi-disciplinary team approach from diagnosis to end of treatment (5 yrs). UBCC is NAPBC- National Accreditation Program for Breast Centers. DSRIP Project will create more access to UBCC services and improving quality of life to those patients. UBCC patients are 45% Medicaid or uninsured

Progress Milestones: Risk Areas: Anticipated outcomes: Connection: Baseline Report Time-to-3rd Appointment Complete 100% Survivor Program In-progress 40% Hire Surgeon- Hired Search firm In-progress 30% NAPBC Program Accreditation Complete 100% 2 RHP Seminars In-Progress 50% Risk Areas: Hire Breast Surgeon- Hired Search firm Anticipated outcomes: Meet all other milestones Connection: Working with Texas Tech Internal Medicine Oncology Department

Innovations Developed an implemented a new schedule Matrix to track Survivor patients in Centricity Business. Completed contract services for Survivor Program. Kick off Survivor Program is July 1, 2013 at UBCC. UTEP Health fair July 11, 2013.

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INCREASING ACCESS TO SURGICAL SERVICES Rene Vallejo Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive June 28, 2013 1:00pm

Description of the Project Synopsis: This project will increase the number of surgical providers serving the region. Surgery will expand the number of sites at which the performing provider offers outpatient general surgery clinic services and implement an electronic referral system. Department Involved: Texas Tech Department of Surgery Major Milestones: Increase clinic volume Increase Specialty locations Hire Provider Needs Assessment E-Referral 2 RHP Seminars

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Benefits to the Community Each new surgical provider, when established, will provide services to a minimum of 250 unique patients each year. Benefit to Medicaid / Indigent Patients: Given that 60% of our enterprise ambulatory encounters are to patients with Medicaid or no insurance, this project will be a direct benefit to that population.

Progress Milestones: Risk Areas: Anticipated outcomes: None Increase clinic volume In-Progress 90% Increase Specialty locations In-Progress 40% Hire Provider In-Progress 40% Needs Assessment In-Progress 80% E-Referral In-Progress 40% 2 RHP Seminars In-Progress 50% Risk Areas: None Anticipated outcomes: Meet all Milestones

MINIMALLY INVASIVE GYNECOLOGY SURGERY FELLOWSHIP J. Salvador Saldivar, MD, MPH Assistant Professor Gynecology Oncology Department of OB/GYN Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive June 28, 2013 1:00pm

Description of the Project AAGL approved Fellowship in MIGS 2 year program with 1 Fellow per year Faculty preceptors from Texas Tech and the community Supported internally by the Dept of OB/GYN Milestones Increase the number of residents choosing MIGS specialties (shortage). Design workforce enhancement initiatives to support access to MIGS providers in El Paso region (underserved) Expand MIGS training.

Benefits to the Community Provide gynecologic services to patients at Texas Tech, UMC and the community Production of an independent provider for the greater El Paso community Increasing the pool of outside applicants to our Program and in turn, retention to the El Paso area Benefits of minimally invasive surgery

Progress Milestones Risk Areas / Mitigation strategies Quarterly evaluation for Fellow advancement Risk Areas / Mitigation strategies Faculty preceptors role as supervisors Anticipated outcomes Successful completion of an independent MIGS Connection with other initiatives (DSRIP or otherwise)

Innovations Innovative ideas implemented Improvements to processes Advanced minimally invasive endoscopic instruments Robotic technologies Improvements to processes Ability to apply MIS technology to patient care where the availability was scarce or non-existence

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INCREASING ACCESS TO OCULAR CARE Rene Vallejo Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive June 28, 2013 1:00pm

Description of the Project Synopsis Improve utilization rates of clinical preventive services (testing, preventive services, treatment) in target population with identified disparity Departments Involved: Texas Tech Surgery- Ophthalmology Milestones DY2: Baseline data- Performance indicators-established and implemented Patient Questionnaire E Referral- IT team working with EMR to create referral 4 Hire Ocular Providers currently Recruiting 2 RHP Seminars

Benefits to the Community El Paso community consist of large Hispanic population with many having Type II diabetes and a significant number are indigent or have Medicaid. The importance of this exam is underscored by it being a core HEDIS marker. In addition, the lack of access to primary care creates more barriers to receiving this screening exam.

Progress Milestones: Risk Areas: Anticipated outcomes: Baseline data- Performance indicators established and implemented Patient questionnaires In-Progress 80% E Referral- IT team working with EMR to create referral In-Progress 40% 4 Hire Ocular Providers currently Recruiting In-Progress 20% 2 RHP Seminars In-Progress 50% Risk Areas: Hiring of Providers prior to deadline- added more resources to recruiting. Anticipated outcomes: Milestones will be met

Innovations Improvements to processes: Educated team on CQI/Rapid Cycle Improvement Formulated Action Plan

Results of Survey 1st Quarter Survey OPHTHALMOLOGY PATIENT SATISFACTION SCORES Poor Fair Good Very Good Excellent   How long you waited to get an appointment 7 33 31 21 42.3% Convenience of the location of the office 1 14 45 27 36 51.2% Getting through to the office by phone 4 13 40 35 53.7% Length of time waiting at the office 12 30 20 28 39.0% Time spent with the physician you saw 3 11 32 29 48 62.6% Explanation of what was done for you 6 24 63 74.8% Technical skills of the physician you saw 17 66 82.1% The professional manner of the person you saw 18 25 75 81.3% The visit overall 5 56

Quarterly Process Improvement Meeting June 21, 2013 Project Leader: Ceci Sambrano/ Michael Maldonado Clinic: Ophthalmology Contact Phone: 545-6999 Team Members: Rene Vallejo-Facilitator, Esther Estrada-Scribe, Sandra Alderete, Sandra Villagran, Belinda Sanchez Purpose: Review Quarterly Patient Satisfaction Scores and develop an Action Plan to improve scores. Opportunity Statement: Decrease Length of time waiting at Office Root Causes: (Analyze with Brainstorming-Select 1-2 Root Causes) 1. EMR Implementation 2. Registration Process 3. Schedule Matrix Action Steps Person Responsible Est. Completion Date Date Completed Follow Up (results, outcomes, observation, trend data) Changed Schedule Matrix Esther Estrada July 5, 2013   Registration Process Improvement, Preloading and Flagging Charts Ceci Sambrano/ Aug 31, 2013 EMR Proficiency All Staff

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