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“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) [email protected]