“THE URBAN HEALTH PLAN EXPERIENCE: A SUSTAINABLE

SAFETY NET PROVIDER”

PALOMA IZQUIERDO-HERNANDEZNATIONAL HISPANIC MEDICAL ASSOCIATION

March 19, 2011

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

Community Profile – South BronxSource: NYCDOHMH Community Health Profiles 2005

* per 100,000

MORBIDITY/MORTALITY HUNTS POINT/

MOTT HAVENBRONX NYC

Diabetes – (% of Adults) 17% 12% 9%

Obesity – (% of Adults) 25% 25% 20%

Asthma - (5 of Adults) 9% 7% 5%

Child Asthma Hospitalization*

12% 10% 7%

Heart Disease Hospitalization*

2,773 2,201 1,856

Death Rate Due to HIV* 61 39 18

People Living w/ HIV/AIDS* 3,149 2,017 1419

Hospitalization Mental Illness*

1051 949 831

Teenage Mothers, 15-19 Year*

155 120 45

URBAN HEALTH PLAN’S

PERFORMANCE

Percent of Patients Ages 18+ with Smoking History DocumentedSource: NYCDOHMH PCIP

Percent of Patients Ages 18+ with Smoking History Documented

93.6%98.2% 98.9% 99.1%

41.0%

0%

20%

40%

60%

80%

100%

2006 2007 2008 2009 NYC DOH

Percent of Patients ages 18+ screened for Alcohol Use

Source: NYCDOHMH PCIP

Percent of Patients Ages 18+ Screened for Alcohol Use

89.3%97.9% 98.9% 99.5%

33.0%

0%

20%

40%

60%

80%

100%

2006 2007 2008 2009 NYC DOH

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

Percent of Patients Ages 18+ with a Documented BMI within the past 24mos

97.7% 98.6% 98.9% 99.0%

76.0%

0%

20%

40%

60%

80%

100%

2006 2007 2008 2009 NYC DOH

CHILDHOOD OBESITY

Source: NYCDOHMH

 

New York City

South Bronx

Dr. Ally 3 to 4 y/o

Underweight 5% 5% 4%

Healthy Weight 53% 49% 64%

Overweight 15% 16% 6%

Obese 27% 31% 26%

Total percentage Overweight/Obese 42% 47% 32%

Percent of Patients Ages 50+ with an Influenza Vaccine

Percent of Patients Ages 50+ with an Influenza Vaccine

21.7%24.1%

19.5%

31.5%

15.0%

0%

10%

20%

30%

40%

2006 2007 2008 2009 NYC DOH

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

Percent of Patients Ages 18+ Screened for Depression

7.3%

14.1%

20.5%

28.5%

18.0%

0%

5%

10%

15%

20%

25%

30%

2006 2007 2008 2009 NYC DOH

UHP Asthma Registry Size

Number of Asthma Patients in the Registry

6745

0

2000

4000

6000

8000

number

of pts

Total

Average Symptom Free Days (out of last 14)

Average Symptom-Free Days (out of last 14)

11.2

0.02.04.06.08.0

10.012.014.0

days

Total

Hunts Point-Mott Haven NYCComparison of Asthma Emergency Room Visits

2003 to 2008Source: NYCDOHMH PCIP

48.60

21.90

05

1015202530354045505560

Rat

e p

er 1

,000

Po

pu

latio

n

2003 2008

55% Decrease

Business CaseAffinity 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%

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

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

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

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

ORGANIZATIONAL DASH BOARD JUL 2008

73.86%

72.89%

104.08%

102.04%

94.18%

130.00%

31.37%

75.88%68.38%

90.14%90.65%

48.74%

77.92%

80.72%106.00%

76.33%

94.94%

73.86%

57.56%15.00%

88.11%

78.63%

73.50% 65.89%

81.60%

87.50%

130.00%

95.16%

55.55%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

140.00%1 Current Ratio

2 Days In Account Receivable

3 Days In Account Payable

4 Days cash on hand

5 Actual Visits

6 Rate of Change

7 Staff Turn Over Rate

8 New Patient Satisfaction

9 Existing Patient Satisfaction

10 Pt Cnts: Patient Contacted w/ in 48hrs

11 Patient Complaints per 1000

12 Provider Changes: Unacceptable

13 Third Available Appointment Initial

14 Third Available Appointment F/ U

15 Show Rate16 Medical Team Productivity

17 % of Reschedule Appointments due to Vacation

18 Average Cycle Time

19 Primary Provider Panel Size

20 Asthma Avg Symptoms Free Days

21 Depression 50% Reduction In PHQ

22 Diabetes- Average A1C

23 Cancer Screening: 42+ With A Mammogram Done In The Past 2 Yrs

24 Cancer Screening: 21+ With A Pap Smear Done In The Past 2 Yrs

25 Cancer Screening: M/ F 51+ With An FOBT Done In The Past 2 Yrs

26 Prenatal Care: Entry into Prenatal Care: 1st Trimester

27 Prenatal Care: Post Partum Visits Rate

28 Adolescent Care: % of Behavioral Risk Assessments

29 Pediatrics: Immunizations Rates

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

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

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

THE JOURNEY BEGINS …

WITH QUALITY…..

TO PATIENT CENTERED MEDICAL HOME…..

TO MEANINGFUL USE

TO PAYMENT REFORM through ACCOUNTABLE CARE

ORGANIZATIONS

CONTACT INFORMATION

Paloma Hernandez

Urban Health Plan

1065 Southern Boulevard

Bronx, New York 10459

(718) 991-4833paloma.hernandez@urbanhealthplan.org