Advancing Quality in Health Centers: An overview of BPHC’s Quality Strategy

Advancing Quality in Health Centers:

An overview of BPHC’s Quality Strategy

MSCG Consultant Training SeriesMay 1, 2012

Overview

• Introduction• BPHC Quality Strategy• Alignment of Program Resources to

Advance Quality• Quality Priorities & Goals• Quality Oversight & Accountability • Resources

2

Primary Health Care Mission

Improve the health of the Nation’s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services

3

BPHC Quality Strategy

Ability of patients to be seen in atimely, affordable and culturallycompetent manner

Provision of full scope of primary health services, including dental, behavioral health, and enabling services

Coordination and Integration services within a Health Home

Coordination & integration of patient information and services among HCs and other community-based providers of services

ACCESS

COMPREHENSIVE SERVICES

INTEGRATED SERVICES

INTEGRATED HEALTH SYSTEM

Better Care Healthy People & Communities Affordable ⃘ ⃘Care

4


1. Implementation of QA/QI SystemsAll Health Centers fully implement their QA/QI plans

2. Adoption and Meaningful Use of EHRs

All Health Centers implement EHRs across all sites & providers

3. Patient Centered Medical Home Recognition

All Health Centers receive PCMH recognition

4. Improving Clinical OutcomesAll Health Centers meet/exceed HP2020 goals on at least one UDS clinical measure

5. Workforce/Team-Based CareAll Health Centers are employers/providers of choice and support team-based care

Priorities & Goals

ACCESS


INTEGRATED SERVICES



1. Programs/Policies

2. Funding

3. Technical Assistance

4. Data/Information

5. Partnerships/Collaboration

Strategy Implementation

5


1.Programs/Policies2.Funding3.Technical Assistance4.Data/Information5.Partnerships/Collaboration

Strategy Implementation

ACCESS


INTEGRATED SERVICES



6

Quality Strategy Implementation:Programs/Policies

ACCESS


INTEGRATED SERVICES


PCMHHI,CMS Demo

Public HealthIntegration

ACO

Collaboration PIN

Expanded Services

Beacon, HCCN

ProgramRequirements


7

Quality Strategy Implementation:Funding

ACCESS


INTEGRATED SERVICES



• $150M for Health Center New Access Points (~220 to 230 awards)

• $15M for Expanded Services, including Expanded HIV Services and Support for Health Center Recruitment and Retention Strategies, including the Health Center Veterans Hiring Challenge

• $20M for Health Center Controlled Networks (~25 to 30 awards)

• Capital Development: o $630M for Building Capacity o $100M for Immediate Facility Improvementso $75M for School-Based Health Center Capital

program (~150 awards) 8

Quality Strategy Implementation:Technical Assistance

ACCESS


INTEGRATED SERVICES



• National Cooperative Agreementso Homeless, Farmworkers, Public Housing,

AAPI, LGBT

• Primary Care Associations• Health Center Controlled Networks• HRSA Resourceso Quality Improvement, HIT, Oral and

Behavioral Health

• SAMHSA/HRSA Center for Integrated Health Solutions (CIHS)

9

Quality Strategy Implementation:Partnerships/Collaboration

ACCESS


INTEGRATED SERVICES



• National Partnerso Federal: White House, HHS, Other Federal

agencieso Non-Governmental Partners

• State Partnerso Primary Care Associationso Primary Care Officeso Medicaid

• Local Partnerso HCCNso Other Safety Net Providerso Hospitalso CBOs

10



2. Adoption and Meaningful Use of EHRsAll Health Centers implement EHRs across all sites & providers

3. Patient Centered Medical Home RecognitionAll Health Centers receive PCMH recognition


5. Workforce/Team-Based Care All Health Centers are employers/providers of choice and support team-based care

Priorities & Goals

ACCESS


INTEGRATED SERVICES



11







Priorities & Goals

ACCESS


INTEGRATED SERVICES



12

Quality Priority:Implementation of QA/QI

Systems• OIG study of quality assurance and care

provided at health centers recommendations:– Provide additional guidance on:

• Elements of QA/QI program• Information required in patient records• Required primary health services

– Establish procedures to independently assess patients’ receipt of services and patient records

• Draft QI PIN • Site Visits

13

FTCA Program Updates

• FTCA Deeming Application enhancements

• Focus is on implementation of risk management and quality improvement systems

• FTCA site visits• Training and Technical Assistance

Available - https://www.ecri.org/clinical_rm_program

• FTCA Claims Management14

https://www.ecri.org/clinical_rm_program







Priorities & Goals

ACCESS


INTEGRATED SERVICES



15

Source: Uniform Data System, 2010 data as of 5/10/11.

Quality Priority:Adoption and Meaningful Use

of EHRs

16

Adoption and Meaningful Use

of EHRs• 2012 UDS includes additional EHR

adoption questions• Participation in CMS Meaningful

Use Incentive Payment Program • Beacon Supplemental • FY12 HCCN Funding Opportunity• HRSA’s Network Guide - The guide,

currently including information on 46 networks, is available at http://www.hrsa.gov/healthit/networkguide/index.html 17

http://www.hrsa.gov/healthit/networkguide/index.html






5. Workforce/Team-Based Care All Health Centers are employers/providers of choice

and support team-based care

Priorities & Goals

ACCESS


INTEGRATED SERVICES



18

PCMH Recognition by Region

R1 R2 R3 R4 R5 R6 R7 R8 R9 R10National0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%% PCMH Recognized % PCMHHI Participants

2012 Goal: 13%

Health Centers

Recognized

as PCMH

2013 Goal: 25%

Health Centers

Recognized

as PCMH

PCMH Recognized Includes: NCQA, Joint Commission, and AAAHC 19







Priorities & Goals

ACCESS


INTEGRATED SERVICES



20

o Over 80% reported the overall quality of services received at the health center were “excellent” or “very good.”

o Over 80% reported that they were “very likely” to refer friends and relatives to the health center.

o Over 75% reported the main reason for “going to the health center for healthcare instead of someplace else” was because it was convenient (28%), affordable (25%), and provided quality healthcare (22%).

Health Center Performance2009 Health Center Patient

Survey

21

Health Center Performance

Health Disparities• Access to Primary Health Care

– No racial/ethnic differences in the proportion of HC patients who are satisfied with the overall care received (98% overall).

• Preventive Services Counseling– No racial/ethnic differences in the proportion of HC patients

who receive weight management counseling.• Diabetes

– Patients were more likely to be current with their A1c testing and see or talked with an eye doctor if they received diabetes management support from HC staff.

• Hypertension– Patients reporting unmet healthcare needs in past year

were more than twice as likely to have a hypertension-related ED visit or hospitalization.

• Cancer Screening– African American and Hispanic/Latino colorectal cancer

screening rates are higher than national average. 22

Quality Priority:Improving Clinical Outcomes

2012 Goal: 10% of Health Centers Meet or Exceed HP 2020 Goals

Source: 2010 UDS and Healthy People 2020 23

2012 UDS Reporting

Changes to CY 2012 UDS:

1. New staff tenure table; 2. Three new clinical measures;

– Coronary Artery Disease (CAD): Lipid Therapy– Ischemic Vascular Disease (IVD): Aspirin

Therapy– Colorectal Cancer Screening

3. Reporting on all (versus primary) diagnoses for selected conditions; and

4. Questions about electronic health record capabilities and national quality recognition

Refer to the UDS website for more information:http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

24

http://bphc.hrsa.gov/healthcenterdatastatistics/index.html








Priorities & Goals

ACCESS


INTEGRATED SERVICES



25

Quality Priority:Workforce/Team-Based Care

• Student/Resident Education &Training (Bureau of Health Professions)

o Teaching Health Centers

• Recruitment and Retention (Bureau of Clinician Recruitment and

Services)o NHSCo Loan Repayment

• Training and Developmento Guidelines & Best Practices

• Inter-Professional Team-Based Careo Integrated within Medical/Health Homeo Enabling Services Providers

26

Shared Accountability for Quality in Health Centers

27

Health Centers

NCAs PCAs HCCNs

Project Officers• Site Visits – integration and support of Quality Priorities

(with Consultants)• UDS Data and Performance Reports• Annual Progress Reviews• Discuss Quality Priorities and progress during quarterly

calls

Quality Improvement Resources

• National Quality Recognition– Accreditation:

http://bphc.hrsa.gov/policiesregulations/accreditation.html • AAAHC, TJC

– NCQA recognition: http://bphc.hrsa.gov/policiesregulations/policies/pal201101.html

– Comparison chart: http://bphc.hrsa.gov/policiesregulations/policies/qualrecogn.pdf

• ECRI Institute Resources– Available to all Health Centers and FQHC

LALs https://www.ecri.org/clinical_rm_program/Pages/default.aspx

28

http://bphc.hrsa.gov/policiesregulations/accreditation.html

http://bphc.hrsa.gov/policiesregulations/policies/pal201101.html

http://bphc.hrsa.gov/policiesregulations/policies/qualrecogn.pdf

https://www.ecri.org/clinical_rm_program/Pages/default.aspx



Quality Improvement Resources

• HRSA– FTCA Resources http://bphc.hrsa.gov/ftca/index.html – BPHC QI Plan Learning Series and Modules

http://bphc.hrsa.gov/policiesregulations/quality/index.html– BPHC Training and Technical Assistance

http://bphc.hrsa.gov/technicalassistance/tatopics/qualitymanagementimprovement/index.html

– HRSA Office of HIT and Quality http://www.hrsa.gov/quality/toolsresources.html

– HIV/AIDS Bureau Quality Resources http://nationalqualitycenter.org/

• Safety Net Medical Home Initiative http://www.qhmedicalhome.org/safety-net/qistrategy.cfm 29

http://bphc.hrsa.gov/ftca/index.html

HIT Resources

• HRSA’s HIT Web Page (http://www.hrsa.gov/healthit/)– HIT Health IT Adoption Tool Boxes:

http://www.hrsa.gov/healthit/toolbox/– HIT Health IT and Quality Webinars:

http://www.hrsa.gov/healthit/toolbox/webinars/index.html– HRSA Network Guide, currently including information on 46

networks: http://www.hrsa.gov/healthit/networkguide/index.html

• The Office of the National Coordinator for Health Information Technology: http://healthit.hhs.gov– HIT Regional Extension Center program:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__rec_program/1495

– 2010 report on HIT in Underserved Communities: http://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf

• The AHRQ National Resource Center for HIT: http://healthit.ahrq.gov

30

http://www.hrsa.gov/healthit/

http://www.hrsa.gov/healthit/toolbox/

http://www.hrsa.gov/healthit/toolbox/webinars/index.html

http://www.hrsa.gov/healthit/networkguide/index.html

http://healthit.hhs.gov/



http://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf

http://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf

http://healthit.ahrq.gov/

Data Resources

• HRSA Data Warehouse: http://datawarehouse.hrsa.gov/

• Public site for UDS Data: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html

• UDS Performance Reports:⁻ Health Center Trend Report (National/State/Grantee)⁻ Health Center Summary Report

(National/State/Grantee) ⁻ Performance Profile (National/State) – Performance

on Key Indicators

• UDS Mapper: http://www.udsmapper.org/

31

http://datawarehouse.hrsa.gov/


http://www.udsmapper.org/

PCMH Resources

• PCMH Readiness Assessment Tools– Primary Care Development Corporation (PCDC):

http://www.pcdc.org/resources/patient-centered-medical-home/pcdc-pcmh/ncqa-2011-medical-home.html

– PCMH Assessment (PCMH-A) from the Safety Net Medical Home Initiative: http://www.safetynetmedicalhome.org/practice-transformation/assessment

– Medical Home Implementation Quotient Assessment (MHIQ) from TransforMED: http://www.transformed.com/userLogin.cfm

• PCMH Change Concepts: http://www.safetynetmedicalhome.org/change-concepts

• Patient-Centered Primary Care Collaborative (PCPCC): http://www.pcpcc.net/content/pcmh-outcome-evidence-quality

32



http://www.safetynetmedicalhome.org/practice-transformation/assessment

http://www.safetynetmedicalhome.org/practice-transformation/assessment

http://www.transformed.com/userLogin.cfm

http://www.safetynetmedicalhome.org/change-concepts



http://www.pcpcc.net/content/pcmh-outcome-evidence-quality

PCMH Resources

• Agency for Healthcare Research and Quality (AHRQ) PCMH Resource Center: http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483

⁻ Clinical Practice Guidelines: http://www.ahrq.gov/clinic/cpgsix.htm

⁻ US Preventive Services Task Force: http://www.uspreventiveservicestaskforce.org/tools.htm

⁻ Consumer Assessment of Healthcare Providers and Systems (CAHPS patient experience survey): https://www.cahps.ahrq.gov/default.asp

⁻ Innovations Exchange: http://www.innovations.ahrq.gov/

⁻ Patient Health Literacy Toolkit: http://www.ahrq.gov/qual/literacy/

33

http://www.pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483

http://www.ahrq.gov/clinic/cpgsix.htm

http://www.uspreventiveservicestaskforce.org/tools.htm

https://www.cahps.ahrq.gov/default.asp

http://www.innovations.ahrq.gov/

http://www.ahrq.gov/qual/literacy/

Behavioral Health Resources

• HRSA BH website: www.hrsa.gov/publichealth/clinical/BehavioralHealth/index.html

• Center for Integrated Health Solutions:– Motivational Interviewing for Better

Outcomes– Peer Support Wellness Respite Centers – Screening, Brief Intervention, and Referral

to Treatment (SBIRT) in Clinical Settings – Person-Centered Health Homes– Introduction to Effective Behavioral Health

in Primary Care http://www.thenationalcouncil.org/cs/center_for_integrated_health_solutions

• SAMHSA SBIRT page http://www.samhsa.gov/prevention/SBIRT/index.aspx 34

http://www.hrsa.gov/publichealth/clinical/BehavioralHealth/index.html

http://www.thenationalcouncil.org/cs/center_for_integrated_health_solutions

http://www.samhsa.gov/prevention/SBIRT/index.aspx

Contact Information

MSCG Point of Contact for additional information or questions:

Sheri Hughes [email protected]

301-577-3100

35

mailto:[email protected]

Evaluation

Here is the link to the online evaluation survey for the session below:

http://www.surveymonkey.com/s/B3DHFMF

36



Documents

Advancing Quality in Health Centers: An overview of BPHC’s Quality Strategy