Camillus Health Concern, Inc.

Performance Review Presentation

Presented To:Florida Association of Community Health

CentersJuly 28, 2008

Presented By:Hirut Kassaye, MPH

CamillusHouse

CamillusHealthConcern

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CamillusHealthConcern

Healthcare Center for the Homeless 20 + years FQHC Federally Funded- HHS: HRSA/BPHC 5 sites Catholic Entity- BGS

WHO WE ARE

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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

WHO WE SERVE

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OBSTACLES TO HEALTH CARE

Homeless HC Provider

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

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

Pre-site Visit Preparation

On-site Performance Review

Post-site Visit Activities

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Pre-site Visit Preparation

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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1. Access - Number of Users/Patients

Data available from UDS Reports

2004-2006. (compulsory measure)

PERFORMANCE MEASURES SELECTED

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2. Financial – Current Ratio

Data available from Audit Reports 2004-2006.

(compulsory measure)

PERFORMANCE MEASURES SELECTED

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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.

PERFORMANCE MEASURES SELECTED

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4. Financial – Gross service charges to expense.

Data available from Audit Reports 2004-2006.

PERFORMANCE MEASURES SELECTED

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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.

(developmental discussion)

PERFORMANCE MEASURES SELECTED

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6. Clinical – Establishing depression severity scoring for patients with major depression.

Data not currently available. (developmental discussion)

PERFORMANCE MEASURES SELECTED

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Pre-Site Visit Preparation Cont’d

Completion of field force analysis prepared by Review Team by commenting on:

• 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 Tour of the Facility Introductory Meeting

a) Performance Review Process b) Organizational Review

Tour of Camillus House Shelter. Performance Analysis of Measures 1 & 2.

Day 2 Performance Analysis of Measures 3 & 4. Performance Discussion on Developmental Measures.

Day 3 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

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 Measure 1Access 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 model.

Performance Improvement Options

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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.

Performance Improvement Options

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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

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 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.

Performance Review Measure 4 Gross Charges to Expenses

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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 Timefram

eParty

ResponsibleStatu

sBurea

u

1. Increase recruitment efforts by broadening the scope of website listings in the not for profit segment to include websites such as 3RNet.

4/30/08

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

ACTION PLAN

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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

Status

Bureau

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

7/31/08

Kate Callahan/CHC Board

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

11/1/07 – 10/31/09

Gloria Barbier/CH Department of Institutional Advancement

ACTION PLAN

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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

Status

Bureau

1. Secure Board approval to request funding from Camillus House to add additional Case Manager line to the 2008-2009 budget2. Hire new Case Manager (CM)

5/31/08

7/1/08

Hirut Kassaye

Cathy Lang

3. Have existing CM and new CM attend training under local SOAR (SSI/SSDI Outreach, Access and Recovery) Initiative4. Schedule refresher course for providers on completion of SSI/SSDI medical forms

8/31/08

8/31/08

Hirut Kassaye

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)

8/31/08 (ongoing)

Case Managers

Tom Goldring

ACTION PLAN

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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 ExpensesKey Steps Timeframe Party

ResponsibleStatus Bureau

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

6/15/08

Goldring/Dr. Collazo

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

7/01/08

8/1/08

CBO

Dr. Collazo

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

ACTION PLAN

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ACTION PLAN /TECHNICAL ASSISTANCE REQUEST

Part II

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

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