1. “THE URBAN HEALTH PLAN EXPERIENCE: A SUSTAINABLE SAFETY NET PROVIDER” PALOMA IZQUIERDO-HERNANDEZ NATIONAL HISPANIC MEDICAL ASSOCIATION March 19, 2011

2. Overview - Urban Health Plan Founded in 1974 by Dr. Richard Izquierdo Became Federally Qualified Health Center in 1999 4 practice sites in the South Bronx and Corona, Queens in New York City 5 School Sites 4 Off Sites 3 Administrative Sites Expansion Plans Fully implemented EHR System since 2006 Largest Employer in our Zip Code: 488 2007 National Exemplary Award, US EPA 2009 Selected as one of the top performing Health Centers in the US by HRSA 2009 Nicholas E. Davies Award by HIMSS 2009 NCQA PCMH Level 3 Certification 2010 Actual Visits: 230,000 Projected Users: 43,000 2011 Visit Projections:250,000 Projected Users: 50,000

3. Community Profile – South Bronx Source: NYCDOHMH Community Health Profiles 2005 * per 100,000 MORBIDITY/MORTALITY HUNTS POINT/ MOTT HAVEN BRONXNYC Diabetes – (% of Adults)17% 12%9% Obesity – (% of Adults)25% 20% Asthma - (5 of Adults) 9%7%5% Child Asthma Hospitalization* 12%10%7% Heart Disease Hospitalization* 2,7732,2011,856 Death Rate Due to HIV*613918 People Living w/ HIV/AIDS*3,1492,0171419 Hospitalization Mental Illness* 1051949831 Teenage Mothers, 15-19 Year* 15512045

4. URBAN HEALTH PLAN’S PERFORMANCE

5. Percent of Patients Ages 18+ with Smoking History Documented Source: NYCDOHMH PCIP

6. Percent of Patients ages 18+ screened for Alcohol Use Source: NYCDOHMH PCIP

7. Percent of Patients Ages 18+ with a Documented BMI within the past 24 months

8. CHILDHOOD OBESITY Source: NYCDOHMH New York City South Bronx Dr. Ally 3 to 4 y/o Underweight5% 4% Healthy Weight53%49%64% Overweight15%16%6% Obese27%31%26% Total percentage Overweight/Obese42%47%32%

9. Percent of Patients Ages 50+ with an Influenza Vaccine

10. Percent of Patients Ages 18+ Screened for Depression Source: NYCDOHMH PCIP

11. UHP Asthma Registry Size

12. Average Symptom Free Days (out of last 14)

13. Hunts Point-Mott Haven NYC Comparison of Asthma Emergency Room Visits 2003 to 2008 Source: NYCDOHMH PCIP 20032008 55% Decrease

14. Business Case Affinity Health Plan PMPM Comparative Data of UHP v. All Affinity Network 2006-2007 Non-UHP Providers UHP Network % Difference Pediatrics $81.11$49.18-39% Adults $280.62$219.96-22%

15. URBAN HEALTH PLAN’S JOURNEY Stable business operation Embraced a Culture of Performance Improvement Embraced the Use and Sharing of Data Adopted Health Information Technology – SUPPORTS A P4P PROGRAM Transformed Health Care Delivery System

16. STABLE BUSINESS OPERATIONS Sufficient infrastructure to support innovation Good financial position Motivated to invest resources in making change Senior leadership buy in to make improvements

17. PERFORMANCE IMPROVEMENT Became biggest proponent for PI work Embraced Performance Improvement throughout the organization Developed infrastructure to support PI Critical Mass of Staff involved in PI activities Multiple Internal PI teams Standard methodology

18. USE AND SHARING OF DATA Each PI team shares data with each other and the organization Storyboards are everywhere Bad data is good Dash Boards are used organization wide

20. HEALTH INFORMATION TECHNOLOGY ADOPTION Early Adopters Second EHR system Full implementation of second system in 6 months Productivity increased as we implemented “Never go back” mentality has developed Ability to collect data has been facilitated Decision Support tools are invaluable Provider incentive program

21. TRANSFORMATION OF UHP HEALTH CARE DELIVERY SYSTEM Through re-engineering Through performance improvement Through data sharing Through improved knowledge Through HI adoption We have transformed our health care delivery system Not in an additive way but through true transformation

22. WHERE WE ARE NOW…. 2009 HIMSS Nicholas E. Davies Award for Adoption of Health Information Technology 2009 Recognition as a Level 3 Patient Centered Medical Home Ready for Meaningful Use Incentives Ready for Research Initiatives Ready for Accountable Care Organizations

23. THE JOURNEY BEGINS … WITH QUALITY….. TO PATIENT CENTERED MEDICAL HOME….. TO MEANINGFUL USE TO PAYMENT REFORM through ACCOUNTABLE CARE ORGANIZATIONS

24. CONTACT INFORMATION Paloma Hernandez Urban Health Plan 1065 Southern Boulevard Bronx, New York 10459 (718) 991-4833 paloma.hernandez@urbanhealthplan.org