2015 QUALITY PLAN WORK PLAN GHC Quality Work Plan

Transcription

1 2015 GHC Quality Work Plan 1

2 Achieve 2015 Quality Goals: Improve population health, the quality, safety and satisfaction of the customer experience while improving affordability by committing to the integration of reliability as an organizing principle that results in care processes that are performed as intended consistently over time. Rationale and Hypothesis for Improvement Activity: The Patient Protection and Affordable Care Act has reduced payment for Medicare Advantage plans such as Group Health Medicare, which accounts for about 98% of our Medicare patients. At the same time, a bonus payment system linked to quality of care has been implemented, potentially minimizing the impact of the payment reduction. In addition, an increasing number of purchasers and employee groups have introduced various payment incentives related to clinical and service quality performance. Group Health fully supports the shift in health care payments from quantity (number of procedures) to quality (a fully immunized population) resulting in high quality outcomes at lower costs. The quality bonus payments will be based on Medicare "Star Rating" system to rate health plans on a one-to-five scale, with five stars representing the highest quality. Group Health current rating is 5 stars, one of 11 Health Plans in the country to achieve this rating in Group Health is well positioned to maintain 5 stars and its NCQA performance in order to appreciate bonus payments or avoid monetary penalties from purchasers for its high clinical and service quality ratings, but we will need to maintain or improve that performance as other plans improve Quality Hypothesis to Achieve Goals The execution of a focused Action Plan with critical tactics will achieve the 2015 quality goals. This will result in a more highly reliable organization with demonstrated improvement in the patient experience of care, including safety, service and clinical quality and will contribute towards reducing the per capital cost of health care. The hypothesis for achieving the 2015 goals includes: Committing to the integration of reliability as an organizing principle will result in more fully engaged leaders, providers and staff to achieve and sustain a patient safety; service and quality culture to optimize the patient experience. Closing the gap from current performance to the 90 th percentile for cancer screening, immunizations, diabetes, heart disease, asthma and depression by increasing patient and provider activation, opportunistically addressing the care gaps during each touch and giving timely feedback to the engaged provider and care team will result in improved clinical performance. If we reliably execute the use of consistent workflow and use of tools across operational areas, assure reliable checking and monitoring with leadership rounding and use of tiered metrics, then we will return to a consistent trend of improvement. Extending patient activation strategies and tactics across the Enterprise including our ability to evaluate effectiveness of impact to broaden use of tools and technologies to reach patients more often and in new ways will result in increased patient activation and improved outcomes. 2

3 STRATEGY: IMPROVE RELIABILITY CULTURE TO ELIMINATE SERIOUS SAFETY EVENTS TACTICS INCLUDE: Continue to improve the accountability and culture for high reliability (in collaboration with HPI) by: Implementing the Leadership Method (use of behaviors) for leading a values-based high reliability organization Implementing the safety absolutes with establishment and implementation of Red Rules Train all staff on tools and tones for meeting patient expectations for safety, quality and service WHOM Mazzawy, Hert with GPDLT (COMPLETE, G OR R) Build reliability practice habits with: Establishment of transformation teams Establishment of goals, metrics and a feedback loop to operational leaders regarding performance of reliability behaviors Integration of work into performance and development plans Mazzawy, Hert Q1-2 Improve measurement systems to maximize learning from patient safety events by: Improving the detection and reporting of events Optimizing cause analysis (root cause analysis, apparent cause analysis, common cause analysis) Establishment of a transparent lessons learned process Mazzawy, Hert Support patients, families staff and practitioners who are involved in safety events including: Enhancement of disclosure support Implementation of a peer support program Mazzawy, Hert With GPDLT 3

4 STRATEGY: IMPROVE POPULATION HEALTH AND CLINICAL OUTCOMES TO ASSURE MEDICARE 5 STAR, WASHINGTON HEALTH ALLIANCE AND NCQA PERFORMANCE. TACTICS INCLUDE: Improve Quality Tools and Measurement Systems By WHOM Improve and/or re-design the available Epic and Reporting tools that support patient centered strategies as well as improvements in documentation and coding to address chronic conditions by: Cascade reporting with targeted subscale, display and analysis for Group Practice and Health Plan leaders. McDonald Handley Brodsky Continue improvements and alignment in the Epic dashboard, PCER, MCER and other clinical reporting and tools to achieve clarity and consistency of focus for clinical teams. Re-clarify standard use, purpose, users and associated standard work for use of clinical and reporting tools across both Delivery Systems. Establish a regular cadence for dissemination and visibility of performance data specific to purchaser performance guarantees and incentives (e.g., Molina, specific purchaser groups) Improve the reliability of key processes that support clinical quality in the Group Practice by: Pre-visit and outreach standard work in clinical teams: Strengthen the standard work processes within each Region for pre-visit workflow and clinical team outreach. WHOM Szalwinski Tarnoff and GPDLT Leadership rounding: Establish routine cadence and structure for leadership rounding Ancillary Services: Pharmacy, Lab, Radiology, Eye Care and others as appropriate: Assure that care teams integrate population outreach or opportunistic reminders for targeted populations including but not limited to: 4

5 pharmacy medication adherence, retinal eye exams, breast cancer screening, etc. Chronic Disease Management: Test, revise and spread the tools for management of chronic disease, specifically diabetes within primary care and pharmacy. Improve provider engagement across the Enterprise for the Contracted Network by: Practice engagement: Refine and further standardize the Network practice engagement model with tools, cadence, feedback and data analysis, adoption of best practices across providers groups. WHOM Mora, Anderson, Delostrinos Q1-2 Complete,G,R QI population efforts: Target specific populations for local improvement efforts with contracted provider groups (e.g., DRE outreach project, use of care coordinator in provider practices for focused phone outreach). Incentives: Evaluate and spread the use of incentives and shared savings for quality performance including more sophisticated method for member activation through Network practices. Data capture: Continue to improve processes to improve HEDIS data capture in contracted provider practices such as fax back programs. Assure reliable performance management system in both GPDLT and HPDLT for meeting quality metrics: Conduct monthly review of performance by Divisional leadership, GPDLT and HPDLT to check performance, identify gaps, adjust countermeasures. WHOM Szalwinski Mora Q1-2 Complete,G,R Use Delivery System forums (e.g., GPD SQS, HPD Provider Engagement team) to review work, share and disseminate best practices, check performance and adjust tactics. Trehearne Handley Sherman Mora 5

6 Optimize Enterprise wide patient activation and outreach WHOM Continue patient activation and outreach capabilities across the Enterprise by increasing and/or improving patient touches for those with care gaps through letters, IVR, my group health. Incorporate analysis of impact to adjust targeted populations. McDonald/ Bradford Complete G,R Integrate population based strategies into care management interventions across the Enterprise Care Management population based interventions: Enhance efforts of the Care Management Design Team (CMDT) to design and implement population based strategies for members with complex health needs including: Those appropriate for medication adherence programs Members with chronic kidney disease Complex care/others to be determined WHOM Grossman/ Trehearne/ Complete, G,R STRATEGY: DESIGN AND IMPLEMENT TACTICS TO IMPROVE THE CUSTOMER EXPERIENCE Tactics include: WHOM Improve the Care Experience in the Group Practice WHOM Improve the patient experience in the Group Practice as measured by Press Ganey Overall Satisfaction mean and rank scores. Tactics include: Support the ongoing development and implementation of the Group Practice reliability culture transformation, its tools and tones for top leaders, and all people managers and staff with specific emphasis on the tools that influence service behaviors. Implement 100% transparency of the Press Ganey scores and comments and develop and implement a feedback and service recognition program. Fleming/ Desimone Complete G,R COUNTEMEASURE 6

7 Coordinate the GPD implementation and management of an enterprisewide Service Recovery and Complaint Management program and develop recommendations and work plans for next phases of service recovery program for leadership approval and resourcing. Maximize the use and competency of users in the Press Ganey Improvement Portal. Partner with Innovation Director, Web Services, CDIT and Customer Experience partner to develop a strategy and business requirements for the next generation of patient access and navigation tools and technology. Develop Road for Improvements in Care Experience Across the Enterprise WHOM Care Experience Improvements Across the Enterprise Using data, assess care experience across the Enterprise and define a customer experience roadmap for improvement by: Using existing data (from pilot of Press Ganey Health Plan CAHPS survey linked to care giver data) to prioritize customer experience design work Assess our current ability to understand customer satisfaction and needs across all touch points, review best practices, develop a future-state way to systematically and continuously listen to the customer, share actionable information, and implement in response to that information. Gelazis Sustain and Improve the Tactics that facilitate Part D (Health Plan processes) for Medicare 5 Star population Medicare 5 Star Part D Metrics: Sustain and continue to improve the implementation efforts to support the Medicare 5 Star Part D metrics for: Member complaints and appeals Customer Service and member experience with the drug plan Pharmacy medication safety and adherence efforts WHOM Lewis- Smith/Jordan 7

8 Reducing Unwarranted Clinical Variation Rationale and Hypothesis for Improvement Activity: With the philosophical underpinning of the Dartmouth Atlas framework, clinicians (with support from quality and data experts) will provide better clinical care to our members and reduce medical costs while improving their satisfaction with their care. Critical elements in this strategy include clinicians leading the design and implementation of care processes incorporating evidence-based care, shared decision making, and identified best practices that reduce clinical variation. Scope of Improvement: All areas where clinical decisions are made with focus on individual specialties, the group practice, and the contracted network. STRATEGY: REDUCE UNWARRANTED CLINICAL VARIATION THAT REULTS IN IMPROVED QUALITY AND AFFORDABILITY TACTICS: Improve the use and adoption of Shared Decision Making throughout the Delivery System: Promote shared decision making communication skills as a core competency for all clinical staff. Ensure that SDM processes and outcomes are addressed in leader rounding Implement provider- and facility-level defect reporting Increase primary care use of SDM in areas where specialty care is provided by external providers. Incorporate new decision aids into maternity care WHOM McCulloch/ Wicklund (COMPLET E, G OR R) COUNTER MEASURE Resource Stewardship: Expand the effort to include an enterprise view to identify and intervene in areas where significant variation and/or low value care is identified. Continue to evolve efforts within the Group Practice to share provider level data on utilization and create a learning community to match the performance of the best. As capacity allows, expand efforts in transparency into key specialty service lines. Handley/ McCulloch 8

9 Monitoring and Evaluating the QI workplan Rationale and Hypothesis for Improvement Activity: Continuous monitoring and evaluation is an important component of the QI program, as described in the Quality Program Description. Monitoring and evaluation of our QI program is part of the check adjust process to inform future actions. Monitor and evaluate QI workplan and program (Quarterly per available QOT meeting dates) TARGET INITIATIVES WHOM QOT (COMPLET E, G OR R) COUNTER MEASURE Please refer to the Group Health 2015 Quality Dashboard for explanation of metrics to support the Quality Plan and Workplan. 9