Small Physician Groups Aim High

Small Physician Groups Aim High

Arch Health Partners A medical foundation in San Diego formed by Palomar Health and PIMG, a 20 year old multispecialty medical group formerly known as Centre for Health Care. Currently, Arch Health Partners has over 60 providers, including 24 PCPs and multiple specialties in 7 locations. Approx. 16,500 managed care lives 40-60 split HMO - FFS

Competitive Market Sharp Scripps UCSD Kaiser

Arch Health Partners Locations

AHP Vision Arch Health Partners will bring together the best physicians, hospitals, and employees to provide care of the highest clinical quality. Our focus will be to provide an exceptional patient experience where healing begins and health is restored.

Balanced Scorecard for Providers Clinical Quality Patient Experience Appropriate Resource Use Professional Development

AHP Quality Improvement Our goal is to be a Top Performing medical group in terms of quality, patient experience and appropriate resource use.

High Value Organization Q V = ---- C

In the Beginning, there was The P4P Program Our initial clinical scores did not represent the type of care we felt we were delivering, nor what our patients deserved.

Clinical Quality Program Validate the data Engagement Strategies: Patient, Physician and Staff, including Balanced Scorecard Reporting Care Management Team Services

Primum non nocere (First, Validate the Data) Initial results based on health plan data We developed our own Clinical Registries for the P4P metrics to validate health plan data using Intelligent Health Care 2009 supplemented by EMR Discovered better to self report in California as health plans in California may not receive all the clinical data with claims (improving).

Patient, Physician and Staff Engagement Personalized phone outreach by primary care offices for evidence-based care and screenings based on clinical data registries which identify gaps in care Education of Providers and staff Balanced Scorecard reporting for MDs Incentive Program for Staff and Providers

Care Management Services Team composition RN Performance Improvement Director RN Case Managers (one vacant position) RN Disease Manager Registered Dietician New: SNF Nurse Practitioner New: Shared Palomar Health Pharmacist

Safe Transitions Hospitalist program, including Palliative Care Board Certified Physician Inpatient Case Management liaison with inpatient, ambulatory, and disease management teams supplements hospital case management program. SNF Nurse Practitioner Post-discharge continuity of care program to ensure follow up post ER, SNF and inpatient stay.

Complex Case Management Identify high risk patients Assessment and close coordination of care Tracked and reported monthly

Arch Health Partners: Final 2011 Clinical P4P Results Target: Exceed 75th %ile Statewide 18 out of 24 exceeded 75th %ile (vs 15/24 in 2010) 14 out of 24 exceeded 90th %ile (vs 10/24 in 2010) 16/24 or 67% showed improvement (vs. 13/18 or 72% in 2010) Measure AHP 2010 Score: % Compliant 2011 Score: % Compliant 50th %ile Cutpoint 75th %ile Cutpoint 90th %ile Cutpoint CARDIOVASCULAR CARE Cholesterol Management for Patients w ith Cardiovascular Conditions: LDL-C Screening 92.68 97.44 89.47 94.45 95.76 Cholesterol Management for Patients w ith Cardiovascular Conditions: LDL-C Control <100 mg/dl 87.8 82.1 65.69 73.71 76.69 Annual Monitoring for Patients on Persistent Medications: Overall 78.09 79.85 80.52 83.55 87.87 DIABETES CLINICAL MEASURES: Diabetes Care: HbA1c Screening 95.06 94.82 87.24 91.3 93.23 Diabetes Care: HbA1c Poor Control > 9.0% 16.36 18.13 29.59 21.42 18.43 Diabetes Care: HbA1c Control < 8.0% 74.03 72.5 61.31 67.34 71.06 Diabetes Care: HbA1c Control < 7.0% 51.02 54.4 40.17 45.73 51.91 Diabetes Care: LDL-C Screening 94.03 92.49 84.19 88.9 92.22 Diabetes Care: LDL-C Control <100 mg/dl 65.19 65.54 46.33 55.79 64.27 Diabetes Care: Nephropathy Monitoring 94.29 95.34 81.9 88.77 93.02 Diabetes Care: Blood Pressure Control <140/90 mm Hg 68.57 67.1 23.95 64.9 79.01 Optimal Diabetes Care Combination Rate 1: A1c < 8%, LDL-c <100mg/dL and Nephropathy monitoring 50.65 50.77 28.13 41.64 46.92 Optimal Diabetes Care Combination Rate 2: All Combo 1 and BP Control <140/90 mm/hg 38.7 39.12 7.69 27.87 39.41 RESPIRATORY AND MUSCULOSKELETAL CARE Asthma Medication Ratio 74.07 83.78 68.42 73.53 77.44 Appropriate Testing for Children w ith Pharyngitis 97.14 85.19 65.9 86.59 93.54 Appropriate Treatment for Children w ith Upper Respiratory Infection 97.78 100 93.75 97.61 98.47 Avoidance of Antibiotic Treatment for Adults w ith Acute Bronchitis 65.63 54.1 37.48 50.9 61.87 Use of Imaging Studies for Low Back Pain 80.65 82.55 79.86 84.85 88.24 PREVENTIVE CARE: Childhood Immunization Status: All Antigens (by Age 2) 79.37 88.88 71.19 82.16 88.02 Immunizations for Adolescents: All Antigens (by Age 13) 53.07 72.37 41.35 54.51 62.7 Chlamydia Screening: Age 16-24 42.51 51.6 53.29 62.86 69.27 Evidence-Based Cervical Cancer Screening - Appropriately Screened 28.63 32.72 35.05 43.58 72.91 Breast Cancer Screening: Ages 52-69 73.82 79.56 73.36 80.44 83.71 Colorectal Cancer Screening: Ages 51-75 62.77 69.99 55.87 69.42 72.94

Service Excellence Initiatives 2010 patient experience results were disappointing AHP Executive Leadership expressed a strong commitment to achieve long-term success in this domain and use it as a competitive differentiator Improvement efforts targeting both physicians and practice operations staff were initiated

Service Excellence Initiatives Staff and Physician customer service training Physician shadowing/coaching Ongoing feedback and monitoring via Press Ganey Staff and physician incentives Leadership rounding Service Excellence Committee

Service Excellence Committee Activities Prepare For Your Visit Agenda Setting Tool Service recovery protocols Cleanliness Survey/competition and reception area distractions S.M.I.L.E mnemonic from service excellence training posted in each exam room Commitment Form demonstrating our expectations signed by all staff and leadership team

Promise of Commitment As a member of the staff at Arch Health Partners, I am committed to patient satisfaction. I will treat patients in a manner that is friendly, courteous and compassionate, and will be attentive and responsive to patients needs. I will encourage patients to be actively involved in their healthcare. At all times, I will maintain patient confidentiality and dignity. I am committed to communicating both honestly and openly. I will share information and knowledge in a clear and supportive manner. I will support our policies both internally and externally. When I disagree, I will do so in a professional and respectful manner. I am committed to an active role in our organization. I will participate in continuous improvement of our processes. I will take responsibility for problem solving. As a member of a healthcare team, I am responsible for providing well-coordinated services. I will keep myself informed about policies and procedures. I will continually strive to improve. I am committed to personal achievement from my co-workers and myself. I will treat all staff with respect, friendliness, courtesy and compassion. I will take responsibility for my actions. I will maintain my appearance and conduct myself in a manner that well represents Arch Health Partners. These commitments will be in effect upon arrival at all Arch Health Partners locations each day. Committed Employee Signature Printed Name Date

Medical Practice Press Ganey %ile Ranking Trends 2009 2010 2011 2012 Standard Overall 30 th 37 th 42 nd 60 th Standard Care Provider 35 th 46 th 51 st 50 th Likelihood of Recommending Care Provider 32 nd 40 th 41 st 44 th Likelihood of Recommending Practice 34 th 35 th 30 th 66 th

Arch Health Partners CCHRI PAS 2012 P4P Summary Results (Measurement Year 2011) The following table displays the Provider Organization's 2012 Patient Assessment Survey (PAS) results for the Integrated Healthcare Association's Pay-for-Performance (P4P) measures. The display shows the group's score on each of the P4P measures, the absolute and relative change in scores from 2011, and the statewide scores of all groups at various percentile rankings. The results are mean scores, case-mix adjusted to account for patient population differences across groups. 2012 Group Scores 2011-2012 Trending^ 2012 Statewide Percentiles Variable Question Number of Responses Group Score 2011 Score Absolute Change Relative Change 10th 25th 50th 75th 90th Overall Ratings of Care Overall rating of all health care (0 to 10 scale) PCP Q. 32 Specialist Q. 32 310 88.0 85.5 2.4 16.8% 82.0 84.0 86.0 87.6 88.4 Patient recommends doctor PCP Q. 24 Specialist Q. 24 311 87.9 85.8 2.1 15.0% 82.3 84.7 87.3 89.0 90.2 Patient-Doctor Interactions Composite Score Patient Access to Care Composite Score Coordination of Care Composite Score Office Staff Composite Score PCP Q. 10, 11, 12, 14, 15, 16 Specialist Q. 9, 10, 12, 13, 14, 15 PCP Questions 4, 5, 6, 7, 8 Specialist Questions 4, 5, 6, 7 PCP Questions 20, 22 Specialist Questions 19, 21 PCP Questions 30, 31 Specialist Questions 30, 31 311 89.2 86.5 2.6 19.7% 85.4 87.1 88.9 90.5 91.5 295 79.0 73.1 5.9 21.8% 71.3 73.9 76.7 79.3 81.3 295 78.2 72.5 5.7 20.6% 69.5 72.2 74.9 78.2 80.7 311 87.5 86.7 0.8 6.1% 81.6 83.6 85.7 87.6 89.0

Outcomes IHA: Bangasser Award 2009 Top Performer 2010, 2011 Top Performer and Bangasser Award 2012 DMHC RCI: Gold Performance Award 2011 CAPG: SOE Exemplary status 2009, 2010 SOE Elite 2011

http://www.opa.ca.gov/report_card/topmedicalgroup.aspx

Balanced Scorecard for Providers Clinical Quality Patient Experience Appropriate Resource Use Professional Development

Where do we go from here ARU Challenges: Good consolidated data Engaging all the players Working across continuum of care

Meeting the New Challenge Continue PCMH journey Working the continuum of care Continue our successes: SNF NP, hospitalists, Care Management Team Addition of Pharmacist to help with med reconciliation, optimal prescribing Coordination of referrals across multiple or non-existent IT platforms Working across all payers All very highly IT-enabled

Meeting the Challenge: Resources Became a Foundation in partnership with Palomar Health Learning collaboration with AMGA Right Care Initiative

Questions? scott.flinn@archhealth.org 858 675-3188 maryellen.leahy@archhealth.org 858-675-3176 http://www.archhealth.org