Transcript Slide 1

Camillus Health Concern, Inc.
Performance Review Presentation
Presented To:
Florida Association of Community Health Centers
July 28, 2008
Presented By:
Hirut Kassaye, MPH
Camillus
House
Camillus
Health
Concern
WHO WE ARE
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Healthcare Center for the Homeless
20 + years
FQHC
Federally Funded- HHS: HRSA/BPHC
5 sites
Catholic Entity- BGS
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WHO WE SERVE
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Homeless Population of Miami Dade County
4503 individuals in 2007
24,246 visits in 2007
91 % Adults, 9 % Children
85 % Black and/or Hispanic
93 % Uninsured
92 % below the Federal Poverty Guideline
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OBSTACLES TO HEALTH CARE
Homeless HC Provider
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Poor Compliance with Follow Up ( continuity )
Poor Compliance with Treatment Plan
(outcomes)
Limited Access to Specialty Care
Limited Access to Medications
Co-Morbidity
Substance Abuse ( patient ! )
Behavioral Health Disorders ( patient !! )
Complexity of Health Care System
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OBSTACLES TO HEALTH CARE
Homeless Patient
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Unstable Living Situations
No Health Insurance
Limited Resources, Little Access
Poor Education
Poor Nutrition
Substance Abuse
Behavioral Health Disorders
Complexity of Health Care System
Inadequate Social Skills
Low Priority ( Perception )
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PERFORMANCE REVIEW PROCESS
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Pre-site Visit Preparation
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On-site Performance Review
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Post-site Visit Activities
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Pre-site Visit Preparation
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Call from Review Team Leader to schedule on-site visit. (11/05/07)
Visit scheduled for 2/19/08 – 2/21/08.
Introductory phone conference with key staff and review team.
Discussion of Performance Review Process. (11/29/07)
Preparatory work by review team including review of our BPHC grant
applications, audits, UDS reports and consultation with our Project Officer
to identify a specific pool of potential measures.
Phone conference with key staff and review team to discuss the pool of
potential measures presented, and select which ones to focus on for the
review.
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PERFORMANCE MEASURES SELECTED
1. Access - Number of Users/Patients
Data available from UDS Reports 20042006.
(compulsory measure)
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PERFORMANCE MEASURES SELECTED
2. Financial – Current Ratio
Data available from Audit Reports
2004-2006.
(compulsory measure)
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PERFORMANCE MEASURES SELECTED
3. Clinical – Percent of adults with
type 1 or type 2 diabetes whose
last HbA1c is < 7.5.
Data will be provided from results of QI
chart reviews for 2005 – 2006 and
through information collected by HCN
for 2007.
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PERFORMANCE MEASURES SELECTED
4. Financial – Gross service charges
to expense.
Data available from Audit Reports
2004-2006.
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PERFORMANCE MEASURES SELECTED
5. Clinical – Percent of adults
diagnosed with hypertension
whose blood pressure is under
control.
Data will be provided based on a
random sample through a manual chart
audit for the period Jan – Dec 2007.
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(developmental discussion) Camillus
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PERFORMANCE MEASURES SELECTED
6. Clinical – Establishing depression
severity scoring for patients with
major depression.
Data not currently available.
(developmental discussion)
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Pre-Site Visit Preparation Cont’d
Completion of field force analysis prepared by Review Team by
commenting on:
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Key Factors behind performance on the selected review measures.
How internal systems and processes contribute to or restrict performance
on each measure.
External issues, including HRSA Policies, influencing performance.
Successes and challenges in forming and sustaining partnerships that
support performance on each measure.
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ON-SITE VISIT
Day 1
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Day 2
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Day 3
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Tour of the Facility
Introductory Meeting
a) Performance Review Process
b) Organizational Review
Tour of Camillus House Shelter.
Performance Analysis of Measures 1 & 2.
Performance Analysis of Measures 3 & 4.
Performance Discussion on Developmental Measures.
Preparation of Draft Report.
Action Plan discussion with key staff, review team and Project
Officer.
Exit debriefing with staff and Board Members.
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POST-SITE VISIT
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Received draft Performance Report,
with request for feedback and a draft
Action Plan to be developed from list of
Performance Improvement Options
identified during the site visit. (due
04/23/08)
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Performance Improvement Options
Performance Measure 1
Access to Health Care for the Homeless Services
Performance Improvement Options
a. Recruitment - CHC should conduct a compensation study
and consider benefits package updates to assist in
competitively recruiting and retaining providers.
b. Needs Assessment - CHC should conduct a needs
assessment to evaluate the support staff needs of CHC
providers.
c. Model of Care - CHC should adapt the standard care
model to meet the needs of the homeless and increase
access to care. CHC should determine how to further
incorporate case management and outreach into the care
Camillus
model.
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Performance Improvement Options
Performance Measure 2
Current Ratio
Performance Improvement Options
a.
Review Fund Development Activities - CHC should develop a
fund development plan for health care needs in collaboration with
Camillus House. The focus of the plan is to appeal to the Miami area
health care community.
b. Evaluate Case Management Services – CHC should evaluate the
feasibility of increasing case management and eligibility services with
the goal of increasing the number of insured patients
c. Review Employee Responsibilities – CHC should review work duties
assigned to personnel in comparison to job title and descriptions to
ensure that staff are not overextended.
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Performance Improvement Options
Performance Measure 3
Percentage of adult patients of Camillus Health Concern with Type 1 or Type 2 Diabetes
Mellitus whose last HbA1c was less that 7.5 or with a 20% reduction in HbA1c level.
Performance Improvement Options
a.
Health Education Specialist – CHC should explore the feasibility
of creating a health education specialist position. CHC should consider
providing educational certification opportunities for an existing employee
to become a health education specialist.
b. Collaborate With Local Colleges – CHC should collaborate with local
colleges to incorporate a nutrition and/or dietician program with students
rotating through the health center.
c. Case Management Expansion – CHC should plan for the expansion of
case management services to meet disease-specific and socio- economic
needs including eligibility entitlements
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Performance Improvement Options
Performance Review Measure 4
Gross Charges to Expenses
Performance Improvement Options
a. Fee Schedule – CHC should review their fee schedule for
ancillary services and compare to other fee schedules in
the area.
b. Mental Health Billing – CHC should study the feasibility
and cost benefit of contracting additional hours with a
Psychiatrist to oversee the mental health program and
potentially allow for billing encounters by MFT once she
obtains licensure.
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ACTION PLAN
Part 1
Action Item: Performance Measure 1 (Access to Health Care for Homeless Services)
A. Recruitment Target
Completion Date: 06/30/08
Expected Outcome: Increase Provider Retention
Key Steps
1. Increase recruitment efforts by broadening the
scope of website listings in the not for profit
segment to include websites such as 3RNet.
Timeframe
4/30/08
Party
Responsible
Status
Bureau
Cathy Lang
2. Review and update Compensation Study for
Providers.
5/31/08
Cathy Lang
3. Review present employee benefits and make
recommendation(s) to enhance benefit package
for Providers.
5/31/08
Cathy Lang
4. Present findings to the Board, make
recommendations and seek approval.
6/30/08
Hirut Kassaye/
Cathy Lang
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ACTION PLAN
Part I
Action Item: Performance Measure 2 (Current Ratio)
A. Review Fund Development Activities
Target Completion Date: 06/30/2008
Expected Outcome: Increase donations to CHC from Miami area health care community
Key Steps
Timeframe
Party Responsible
1. In conjunction with the Camillus House (CH) /
Camillus Health Concern (CHC) Institutional
Advancement Committee of the CH Board,
establish a health care funding study group.
2. Formulate draft Health Care Fund Development
Plan targeting Miami area health care community,
including professionals, suppliers, and educational
institutions.
5/31/08
Kate Callahan/CHC
Board
7/31/08
Fund Development
Committee
3. Present draft Health Care Fund Development
Plan to the CH/CHC Boards for approval.
8/31/08
Paul Ahr/Kate
Callahan
4. In conjunction with the CH/CHC Institutional
Advancement Committee, implement the Health
Care Fund Development Plan
.
5. Track donations consistent with the Health Care
Fund Development Plan.
10/31/08
Gloria Barbier/
CH Department of
Institutional
Advancement
11/1/07 –
10/31/09
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Status
Bureau
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ACTION PLAN
Part I
Action Item: Performance Measure 2 (Current Ratio)
B. Increase case management & benefits eligibility
Target Completion Date: 8/31/08
Expected Outcome: Increase the number of insured patients
Key Steps
Timeframe
Party
Responsible
1. Secure Board approval to request funding from
Camillus House to add additional Case Manager
line to the 2008-2009 budget
2. Hire new Case Manager (CM)
5/31/08
Hirut Kassaye
7/1/08
Cathy Lang
3. Have existing CM and new CM attend training
under local SOAR (SSI/SSDI Outreach, Access
and Recovery) Initiative
4. Schedule refresher course for providers on
completion of SSI/SSDI medical forms
8/31/08
Hirut Kassaye
8/31/08
Hirut Kassaye/Dr.
Collazo
5. Track ratio for # of approved SSI/ SSDI
applications to # of submitted SSI/SSDI
applications
6. Track number of insured patients before and
after participation in SOAR Initiative
8/31/08
(ongoing)
Case Managers
8/31/08
(ongoing)
Tom Goldring
Camillus
House
Status
Bureau
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ACTION PLAN
Part 1
Action Item: Performance Measure 4 (Gross Charges to Expenses)
A. Fee schedule-CHC should review fee schedule to capture the true
cost of providing services
Target Completion Date: 12/31/08
Expected Outcome: Increase Gross Charges to Expenses
Key Steps
Timeframe
Party
Responsible
1. Develop CHC ancillary fee schedule for
laboratory costs such that gross charges for
laboratory services are captured.
2. Forward to the Health Choice Network Central
Billing Office (CBO) for review.
5/31/08
Goldring/Dr.
Collazo
6/15/08
Tom Goldring
3. CBO to input schedule into the practice
management system.
4. Develop the encounter form to capture
laboratory services.
5. Implement the new ancillary services schedule.
7/01/08
CBO
7/01/08
Dr. Collazo
8/1/08
Dr. Collazo
6. Track ratio of gross service charges to expenses
and compare to ratio prior to implementation of
the ancillary services schedule
12/31/08
Tom Goldring
Camillus
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Status
Bureau
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ACTION PLAN /TECHNICAL ASSISTANCE REQUEST
Part II
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Summary of TA Request
(2-4 sentences fully describing the request)
At the current time, Camillus Health Concern, Inc. (CHC) is not part of
the Depression Collaborative. However, CHC would like to start
implementing the measures as set forth in the Collaborative. To this
end, CHC is requesting technical assistance with organizing and getting
this initiative started.
Expected Outcome: (2-3 sentences describing what you hope to
accomplish in the way of improved performance following the TA)
1. To develop a detailed, systematic plan for implementing
depression scoring.
2. To have the ability to track and objectively quantify depression
scores over time, in order to assess for potential improvement,
based on clinical interventions.
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OVERALL IMPRESSION
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Excellent Process
Data Driven
Well Prepared and Informed Reviewers
Respectful of Staff Experience and Expertise
Truly Collaborative Effort
Designed to address specific issues that are
important to both the Grantee and HRSA,
allowing for comprehensive analysis and
implementation.
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QUESTIONS
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