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innovation for people a core value we strive to innovate by re-strategizing and re-working solutions to meet the needs of various departments within CCHP and patients in our community. we understand that with innovation comes the risk of failure; however we accept these failures as learning opportunities that continuously inform our work. we understand that to be successful in our work requires changing systems from the office practice to state and national policies where are we headed early auto workshop non-standard product high cost poor quality early assembly line standardized work lower cost higher quality modern assembly line team-based work automation delegation standardized inputs multiple models varied complexity but patient are not cars! a core value we strive to innovate by re-strategizing and re-working solutions to meet the needs of various departments within CCHP and patients in our community. we understand that with innovation comes the risk of failure; however we accept these failures as learning opportunities that continuously inform our work. we understand that to be successful in our work requires changing systems from the office practice to state and national policies successful innovation three things are required from all of us to be successful innovators look innovation begins and ends with people and requires keen and caring observation understand innovation is not a lightbulb moment of genius, it emerges from deep understanding, rigorous discernment and thoughtful analysis make putting great ideas into action calls for a commitment to successive improvement, frequent iteration, resourcefulness and an ability to embrace change as the norm THE URBAN HEALTH INSTITUTE Healthcare Delivery Innovation August 15, 2014 Improved Outpatient Care at Lower Cost • Large outpatient multispecialty practice dedicated to the underserved: • 23 specialties across Medicine, Orthopedics, Surgery & Neurosciences • Only accepting “underserved”, defined as self-pay & Medicaid, and Medicare from 5 Camden zip codes. • 22 office staff FTEs, 10 grant-funded business and clinical innovation staff, 100+ physicians, 120+ undergraduate and graduate trainees • Group Visits: 6 disease states • Care Management/Care Transition projects • Data driven operational stabilization and clinical redesign 5/25/2017 12 Year 2 Areas of Focus Year 1 Top Accomplishments • Segmented the market • Renovated the suites • Grew from 19 to 23 specialties • Redesigned our clinical operations – to make our 22 office staff flexible across roles • Reduced overhead cost/visit from ~$200/visit to ~$150/visit • Grant renewed for additional 2 years Year 2 Areas of Focus • Meeting grant financial step-down goals • “The Year of Actually Fixing Things” • • • • • 13 Extensive continuous improvement for operational processes Clinical redesign and protocolization Improving the patient experience Predictive modeling (next generation of SmartBooking) Staffing stabilization and workforce development Care Transitions Patient Engagement “Brief needs assessment Facilitation Accompaniment Warm hand-off Responsive to needs “Your doctor knows you’re beyond PCP hospital in the hospital” follow-up Rapport-building Patient as expert Motivational interviewing Cardiothoracic Surgery General Surgery Trauma Podiatry Orthopaedics Vascular Urology Complexity Involved in Building Surgical Care Management Service A Focused Factory Approach: Group Visits Cooper Call Centers ED/Hospital Referrals Group Visit Program UHI Physicians 16 Staff Education Year 2: Focus on High Volume Group Visits Diabetes Diabetic Foot Hand Knee Pain Headache Sleep Apnea 17 Clinical Redesign: Hypertension Protocol Ongoing Primary Care Provider identifies patient as appropriate for LPN HTN Protocol •LPN discusses case with PCP at each visit •LPN schedules follow-up visit for patient at completion of visit Continued followup with PCP and LPN at provider’s discretion and case discussion with LPN Patient is scheduled for LPN visit the following week •LPN contacts patients started on new medications •LPN contacts patients who do not come to follow-up appointments LPN Visit #2: BP measurement and Pocket Card completed, video and handout on low-salt diet 18 LPN Visit #1: BP measurement, video and handout on HTN, BP Pocket Card completed Custom-Designed “SmartBooking” to Optimize Physician Utilization 19 Operational Improvement Metrics & Initiatives Non-Patient Visit Needs: Throughput: • • • • • • • • • • • Outbound referrals Inbound referrals Prescription refills Medical Questions Paperwork Arrival to Roomed and Ready Roomed and Ready <30 minutes (%) Median MA Time Median Rooming Time Scheduled vs. Actual Appt. Duration After Visit Summary (AVS) Printed 20 Operational Excellence: The Everyday 10 • Customer Service – – Champion – Julia Suite champions – Albert & Maria • Batching & handling of co-pays – – Champion – Evan Suite champion – Sofia • Chart Checklist/Provider communication tool – – Champion – Amanda Suite champions – Donna & Yvonne • Referrals: Log for data collection – – – – Champion – Liz Suite champions – Sylvia & Norma • Provider Variance Log – – • Protected Health Information Champion – Julia Suite champions – Sofia, Karen, Stacey • Attendance & Punctuality – Champions – Evan & Sofia • Teamwork: Team Huddles every session at 9:00 & 12:55 – Champions – Evan & Liz • Daily calls & in-basket status – – Champion – Liz Suite champion – Aleshia • Compliance and Inspection Readiness – Champion – Evan Suite champion – Sylvia & Marisol 21 Champions – Julia & Liz Workforce Development • Staffing instability/weakness is the biggest obstacle to success • Additional hours are required to onboard new staff (a 6-8 week process to fully train CPAs on both front desk and clinical functions). • Per diem feeder pool has dried up – candidates want full time positions • Designing a workforce development plan – German-style apprenticeship supported by Cooper and in collaboration with a local college 22 a core value