WAFCC Standards of Excellence – baseline survey results Staci Young, PhD Associate Professor, Department of Family & Community Medicine June 1, 2018

Objectives Describe preliminary findings for WAFCC clinics that completed a baseline assessment of Standards of Excellence Obtain feedback on the survey findings and elicit recommendations

Background WAFCC Standards Committee finalized the Standards of Excellence in summer 2017 Survey was submitted to MCW for IRB approval Online survey link distributed to all WAFCC clinics in December 2017 Once opened, up to 2 weeks to complete

Survey overview Five sections Part 1: Clinic and patient characteristics Part 2: Clinic governance, administration and management Part 3: Optimizing the patient care experience Part 4: Fostering community relationships Part 5: Perceptions of the Standards of Excellence Time period: January 1, 2016 – December 31, 2016

Preliminary findings 20 clinics completed the survey as of April 30, 2018 Average time to complete: 2 hours

Part 1: Clinic characteristics

Other clinic characteristics Year opened: 1977 – 2016 60% free-standing clinics 90% open at least 2 days/week Cash operating budgets ranged from $4,200 - $1.3M Unduplicated: range from 35 - 12,185 (mean=1,248) New patients served: range from 4 – 3,781

Patient characteristics GENDER: 51% male; 49% female RACE: 26% Hispanic or Latino; 42% white; 20% African American; 3% Asian AGE: 8% children ages 0-17 85% adults 18-64 6% adults 65+

Clinic services provided 90% provide medical care 20% provide dental 70% provide medications 45% provide behavioral health services 60% of clinics have a geographic residency requirement

Part 2: Clinic governance, administration and management

GAM 1: Governance and administration The purpose of the Governance, Administration, and Management (GAM) section is to provide a framework of tools by which a Clinic’s Governing Body ensures accountability, fairness, and transparency of the organization. The Standards describe mechanisms which promote a Clinic’s duty to enhance living its mission, monitoring meaningful impact on current and future health care gaps, and ensuring viability of the organization. Additionally, these Standards describe the criteria for directors and managers to efficiently administer a Clinic’s operations. MISSION LEGAL DOCUMENTS GOVERNANCE STANDARDS FINANCIAL STANDARDS

GAM 2: Operational competency The purpose of the Operational Competency Standards is to identify those organizational functions, which contribute to an efficiently run clinic, meet required legal statutes for employees and show effective volunteer engagement. EMPLOYEE & VOLUNTEER MANAGEMENT POLICY AND PROCEDURE MANUAL

GAM 3: Risk management The goal of the Risk Management Standards is to reduce risks to the clinic and ensure individual safety by identifying high risks and defining methods to avoid risk. Sources of risks to organization and individuals include but are not limited to financial viability, liability, organizational practices, and patient sources. All members of the Clinic are responsible to provide safe care and ensure safety processes. MEDICATION MANAGEMENT ENVIRONMENTAL SAFETY TRANSMISSION OF BLOODBORNE PATHOGENS AND COMMUNICABLE DISEASE LIABILITY PATIENT INFORMATION SAFETY

GAM 4: Performance measurement The purpose of the Performance Management Standards is to help clinics identify elements of a performance improvement program, which utilizes best practice guidelines to enhance the quality of care delivered to the free or charitable clinic population. QUALITY IMPROVEMENT

Part 3: Optimizing the patient experience

OPC 1: Optimal access to care Meeting the Optimal Access to Care Standards will help FCCs show how their organizations define, provide, and evaluate access to health care services for their target populations. Fulfilling the Optimal Access to Care Standards will facilitate the clinic’s role to bridge a gap in the healthcare system for a population that would otherwise lack access to healthcare. UNDERSTANDING THE POPULATION FILLING THE GAP EXPANDING ACCESS THROUGH COMMUNITY PARTNERSHIPS AND REFERRAL NETWORKS TRANSITIONING TO PERMANENT HEALTH CARE HOME

OPC 2: Care management and support The purpose of the Care Management and Support Standard is to help clinics systematically identify and address vulnerability or high risk for poor health outcomes in the population they serve. These Standards define measures to provide care coordination using a team-based approach. FORMING THE PATIENT-CENTERED CARE TEAM SUPPORTING SELF CARE AND SHARED DECISION MAKING IDENTIFYING VULNERABLE AND HIGH RISK PATIENTS FORMULATING THE CARE PLAN

Part 4: Fostering community relationships A close link between a clinic and its larger community can significantly enhance community responsivity to Clinic needs. The Fostering Community Relationships Standards describe means to strengthen a clinic’s connections within the community, and to promote a Clinic’s unique role and responsibility in building a healthier community.

FCR 1: Effective collaboration with health systems & community partners

FCR 2: Building trusting relationships with the community A close link between a clinic and its larger community can significantly enhance community responsivity to Clinic needs. The Fostering Community Relationships Standards describe means to strengthen a clinic’s connections within the community, and to promote a Clinic’s unique role and responsibility in building a healthier community.

FCR 3: Reducing the cost of health care By providing healthcare services to the uninsured, underserved, economically and socially disadvantaged, marginalized, or vulnerable populations the clinic reduces the financial burden on local healthcare organizations and the government. The purpose of the Reducing the Cost of Healthcare standards is to identify best practices of the Clinic that demonstrate cost effective care and to track the impact a Clinic has on reducing healthcare spending in a community. PROMOTING APPROPRIATE USE OF HEALTHCARE RESOURCES

Part 5: Perceptions of the Standards of Excellence

% “STRONGLY AGREE” OR “AGREE” STATEMENT % “STRONGLY AGREE” OR “AGREE” Confident we will achieve all SOEs at Required level in 1-5 years 84% SOEs offer measurable guidance suitable to the WI FCC environment 89% SOEs allow sufficient flexibility in “Required” and “Optimal” evidence 88% Achieving the SOE seal will improve the reputation of our FCC Achieving the SOE seal will help our FCC attract funding 74% Adopting the SOEs will help our FCC improve the quality of patient care Our FCC organization has sufficient resources to achieve the SOEs 63% Our FCC has access to the information and knowledge to implement the SOEs WAFCC communicates openly with our FCC organization WAFCC resources help our FCC stay abreast of health care changes and challenges RR is unknown…how many clinics received the survey? Would help to know why clinics chose NOT to complete (e.g. time, not generally meeting evidence, standards not a priority, etc.) Potential for selection bias…i.e. those clinics that generally met the required evidence more likely to complete

QUESTIONS