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PHCPI framework: Presentation Crosswalk to Service Delivery Elements
C1. Facility Organization and Management
C1.a Team-based care organization
C1.b Facility management capability and leadership
C1.c Information systems
C1.d Performance measurement and management
C3. Access
C3.a Financial
C3.b Geographic
C3.c Timeliness
C4. Availability of Effective PHC Services
C4.a Provider availability
C4.b Provider competence
C4.c Provider motivation
C4.d Patient-provider respect and trust
C4.e Safety
C5. High Quality Primary Health Care
C5.a First Contact C5.b Coordinated C5.c Comprehensive C5.d Continuous C5.e Person-Centered
C2. Population Health Management
C2.a Local priority Setting
C2.b Community engagement
C2.c Empanelment
C2.d Proactive population outreach
C. Service Delivery
Community-Based Primary Care at the Southcentral Foundation Donna Galbreath, MD Southcentral Foundation
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Southcentral Foundation Overview
Alaska Native People Shaping Health Care
Donna Galbreath| Senior Medical Director of Quality Assurance
65,000 voices
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Evidenced-based generational change reducing family violence
36% drop in both ER visits and hospital admissions from 2000-2015
75-90%ile on many HEDIS outcomes
Benchmarked data nationally and internationally showing top in class performance in utilization, quality and satisfaction
Employee turnover rate decreased 15% from 2007-2015
96% customer satisfaction and 95% staff satisfaction
Baldrige Award 2011
Why listen to our story
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Southcentral Foundation Board of Directors
13 Years Service
34 Years Service
13 Years Service
12 Years Service
16 Years Service
7 Years Service
7 Years Service
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591,000 Square miles (951,000 Square km)
Alaska San Francisco
Charleston
Alaska is larger than Texas, California and Montana combined
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Incorporated in 1982 Employees
• 1985: 24 staff • 2016: 2,000 staff
Operating Budget • 1985: $3 million • FY 2016: $323 million
Serving 65,000 Customer-owners • 55,000 Anchorage and Valley • 10,000 in 55 villages
From 1985 to 2016… Operating Budget
1985 FY 2016
$323 M
$3 M
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Nuka Reach
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More than 80 different programs and services including:
SCF Programs and Services
Primary care, OB, Peds Behavioral health Dental
Complementary medicine Traditional healing
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Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness
Mission Working together with the Native Community to
achieve wellness through health and related services
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Goals S hared Responsibility C ommitment to Quality F amily Wellness
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Customer Ownership
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Operational Principles
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Ask the Community
Governing board Advisory committees Elders Council Annual Gatherings 24- hour hotline Personal interactions
Customer-owners Satisfaction surveys and comment
cards Employee survey and satisfaction
surveys Employee interactions (over 55% are
customer-owners)
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We Changed Everything
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Customer-owner changes We are active We are responsible We seek information We ask questions We seek advice and options We become a partner with the Provider
Key Improvement
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Providers and Customer Owners in Shared Responsibility
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No longer gives orders No longer just prescribes meds No longer our hero No longer controls
Gives customers options Provides customer with resources Provider becomes our partner
Health care provider changes
Key Improvement
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Same day access to Primary Care Provider Created Integrated Care Teams Monitoring for culturally appropriate care Improvements in waiting times
SCF Changed Everything
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SCF Links EVERYTHING TOGETHER!
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People said: Cleaner, better facilities, Direct input into health care redesign
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Feedback to the People
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CELEBRATE!!
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Leaderships Findings The Vision
• A vision created with the community and governance
• A vision that describes the end result
• A vision that is achievable • A vision you believe in
Alignment • Buy in of leadership • Customer-owner, employee and
governance
• Knowledge of achievement accomplished together
• Give the resources necessary • Create a safe environment for
change • Hedge them in
Selecting the right people • For key positions that drive change • Find champions for your cause
Do the right thing even if it costs • Change laws (Congress)
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Integrated Care Teams
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Information to Knowledge % SCF Central Pharmacy customer-owners requesting other
medications at dispensing
0%
10%
20%
30%
40%
50%
8/5/10 8/12/10 8/19/10 8/26/10 9/2/10 9/9/10 9/16/10 9/23/10 9/30/10
Percent
Average
Better
Source: Central Pharmacy-Pharmacy tic-sheet 9.27.10
Change Tested
Change Implemented
% Employees with Current Annual Disaster Tng
53
7494 98 100
0
50
100
2005 2006 2007 2008 2009
%
SCF Industry Best (100%)
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200
400
600
800
1000
1200
1400
160019
96
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Num
ber o
f Visi
ts
Day per 1000 Night per 1000
Better
Native ownership begins
Anchorage Area Customer-owner Visits to ER/Urgent Care Per 1000
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Excludes Newborns and Delivery Moms and Length of Stay must be more than 1 day
p
40
50
60
70
8019
96
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Num
ber o
f Adm
its
Admts per 1000
Better
Native ownership begins
Anchorage Area Customer-owner Admits per 1000
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Thank You! Qaĝaasakung
Aleut Quyanaq
Inupiaq
Háw'aa Haida
‘Awa'ahdah Eyak
Mahsi' Gwich’in Athabascan
Igamsiqanaghhalek Siberian Yupik
Tsin'aen Ahtna Athabascan
T’oyaxsm Tsimshian
Gunalchéesh Tlingit
Quyana Yup’ik
Chin’an Dena’ina Athabascan
Quyanaa Alutiiq