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Southcentral Foundation Triple Aim

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Karen Kaizuka

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Transcript of Southcentral Foundation Triple Aim

thank you
BIBLIOGRAPHY
Southcentral Foundation
A Triple Aim Strategy
Linda Cole Karen Kaizuka Robert Klem Stephanie Schulz Dan Worcester
Team Cowlitz
HSMGMT 505
PROFESSOR WELTON
Winter 2014
THE COMMUNITY OF SOUTHCENTRAL FOUNDATION
CULTURE
Unique Population (e.g., distinct culture and language and cultural trauma)
High At-Risk Population
Substantial Challenges (e.g., cultural and language barriers, geographically disperse, and remote locations)
Concerted Efforts to Educate and Implement Solutions

ALASKA NATIVE HISTORY
First Contact: conquest, seizure of resources, compulsory relocation, and genocide
US policies: resettlement, attempted assimilation, and forced reservation relocation
Latter half of 20th century: in many AN communities, greater self-determination and cultural rights
225 federally recognized AN entities
11 cultures divided into 5 culture groups:
Aleut Athabascan (Interior Indians)
Tlingit and Haida (Coastal Indians)
Inuit (Northern Eskimos)
Yupik (Southern Eskimos)
11 AN languages/ 22 dialects

ALASKA NATIVE DEMOGRAPHICS
Much larger proportion of the AN population is under 20 vs U.S. as a whole
>22% of AN youth live below the poverty level (almost double that of AK non natives)
AN household income: $15,000 vs $55,000 for AK non natives
AN are the most impoverished ethnic minority group in the U.S.
Almost 1/10 of AN receive an
associate’s or higher degree
vs. nearly 40% of AK non natives

CULTURAL TRAUMA
The loss of traditional values has caused intergenerational conflict
AN not as connected to their history or culture
General lack of activity because no longer a purely subsistence culture: boredom, depression, substance abuse
Call for restoration of traditional environments
AN to be in charge of their own lives and destinies
Strong role models within AN culture
Value AN lifestyle
ALASKA NATIVE HEALTHCARE
Treating AN is particularly difficult
Lack of medical resources
Cultural-communication difficulties
Disperse population in remote locations
Limited physical, telephonic, and internet accessibility
Weather

PHYSICAL CHALLENGES
Communication – sometimes misinterpreted behavior (pauses, avoidance of eye contact, different standard of self care)
Communication – English is not the primary language spoken at home
Close-knit social structures (communal and extended family, adoption by relatives is common)
Culturally sensitive treatment:
Better integration of traditional
healing and spiritual practices
Involvement of extended family
in treatment

ALASKA NATIVE HEALTHCARE SYSTEM
Non-profit (est. 1977) provides services to AN
Approximately 150 beds
Comprised of ANMC (hospital) and the Southcentral Foundation Primary Care Center in Anchorage
Jointly owned and managed by Alaska Native Health Consortium (ANTHC) and Southcentral Foundation
Provides Specialty services and tertiary care to the entire state’s AN population
Provides Primary care services to AN living in the Anchorage Services Unit (ASU): Anchorage, Palmer, Wasilla, and ASU villages

ALASKA NATIVE MEDICAL CENTER (ANMC)
TRIPLE AIM READINESS
The defined population has clear identified targets to improve care of the entire community
The commitment of an organization for long term success that is dependent upon attaining better health, better care experience, and lowering per capita cost for the population being served and the strategy explicitly states this
Reliable metrics around all three dimensions
The ability to show, using solid data that per capita costs have been reduced while improving health and care experience
A portfolio of improvement projects that will move the population as a whole towards all three dimensions of the IHI Triple Aim
Solid leadership that can effectively incorporate the Vision, Mission, and Values of the organization on all levels
http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx
http://www.ihi.org/engage/initiatives/TripleAim/Documents/BeasleyTripleAim_ACHEJan09.pdf
http://www.ihi.org/Engage/Initiatives/TripleAim/Documents/ConceptDesign.pdf
http://futurehealth.ucsf.edu/Content/11660/2011_09_Southcentral_Foundation-Nuka_Model_of_Care_Provides_Career_Growth_for_Frontline_Staff.pdf
http://www.circumpolarhealthjournal.net/index.php/ijch/article/viewFile/21118/pdf_1
http://stakeholderhealth.org/nuka-system-care/
https://www.southcentralfoundation.com/files/2012_30-yearReport_web.pdf
http://archive.constantcontact.com/fs092/1011270028002/archive/1101868645165.html
http://www.arcticparl.org/files/080812KatherineGottlieb1.pdf
http://annfammed.org/content/11/Suppl_1/S41.full
http://www.nytimes.com/2012/07/22/opinion/sunday/a-formula-for-cutting-health-costs.html?pagewanted=all&_r=0
http://www.northstarbehavioral.com/Alaska_Native_Mental_Health_Dukoff_--_6-5-12.pdf
http://anthctoday.org/index.html
http://www.anthctoday.org/epicenter/index.html
http://www.baldrige.nist.gov/PDF_files/2011_Southcentral_Foundation_Award_Application_Summary.pdf
http://www.ihs.gov/alaska/documents/hf/asu.pdf
https://www.southcentralfoundation.com/index.cfm
http://www.hipscc.org/uploads/PDFs/Our_Work/Triple%20Aim/Whittington%20TA%20Visit%20Report%2004-10.pdf
http://www.ihi.org/engage/Initiatives/TripleAim/Pages/TripleAimReady.aspx

Alaskan Native Health Statistics

All-causes death rate
Suicide
Quadruple non natives
Leading cause of death under age 19
Alcoholism
Drinking during pregnancy
FASD
Sexual abuse
Diabetes
Obesity
Sexually Transmitted Infections

Alaskan Native Health Statistics

SUICIDE RATES
INFECTIOUS DIESASE
SMOKING
POPULATION AREA
Approximately 55,000 Alaska Natives from Anchorage, the Matanuska-Susitna Valley and the McGrath region.

Also provide regional support to residents of 55 rural villages in the Anchorage Service Unit

A geographical area stretching 107,400 square miles across Southcentral Alaska – extending from the Canadian border on the east to the Aleutian Chain and Pribilof Islands on the west.

Individuals and Families
Definition of Primary Care
Health Care
Public Health
Social Services

THE 8 FAMILY WELLNESS POINTS
1. Reduce the rate of Domestic
Violence, Child Abuse, and Neglect
2. Reduce the rate and improve the
management of cancer
3. Reduce the incidence of suicide
4. Reduce the rate of obesity
5. Reduce the rate of substance abuse
6. Reduce the rate and improve the
management of diabetes
7. Improve oral health
8. Reduce the rate of and improve the
management of cardiovascular
disease
INCLUDING THE COMMUNITY
Annual ‘Gathering’ - healthcare fair with booths for education
Interaction with employees
Feedback for SCF - return information for each piece of feedback
SCF Health Education Department’s Annual Fiddle My Heart Fiddle Dance for Elders
Potluck event that featured live music and a performance by the Yurapik Dance Group
Focuses on exercise and heart disease prevention

REACHING THE COMMUNITY
Dance to Beat Cervical Cancer
Health Education and Wellness Programs
Exercise Education and Individual Counseling Services
Group Exercise - Wellness Center Calendar of Group Exercise Classes
Lose to Win Weight Loss Program
Quit Tobacco Program
Diabetes Prevention and Diabetes Education
Chronic Disease Self-Management Education
Cardiovascular Disease Education - Heart Healthy Guide
Elders Nutrition and Exercise Program
75210 "Small Steps to Wellness" Education
Injury Prevention Education
Parenting Classes
Childbirth Classes
Classes open to SCF employees, family members, and ‘customer-owners’

Suicide
2nd highest rate of suicide per state
24/7 access to prevention services
Local pre-crisis counseling
Activity based peer support programs
26% of customer owners knew someone
who used the suicide prevention services
Substance Abuse
Access to Recovery (started in 2004) – Provide people seeking drug and alcohol treatment with vouchers allowing them a greater range of choice in selecting the services most appropriate for their needs
Cultural enrichment activities, life skills instruction, vocational skills training, exercise and wellness activities, educational enrichment opportunities (music lessons, etc)
3 year target – 125,000 but exceeded by treating 170,000
Obesity
26% in 2010 is national average, but 40% in American Indian/Alaskan Native
75210 program
Lose to Win Program

SOUTHCENTRAL FOUNDATION AND TRIPLE AIM
Design of a Triple Aim Enterprise
BETTER HEALTH
FOR THE POPULATION
BETTER CARE
FOR INDIVIDUALS
LOWER COST
THROUGH IMPROVEMENT
FETAL ALCOHOL SYNDROME
ALASKA NATIVE HEALTHCARE
SOCIAL CHALLENGES
ALASKA NATIVE HEALTHCARE SYSTEM
AN-owned, nonprofit healthcare organization
Serves nearly 64,000 AN/AI living in ASU
Owns/manages ANMC Primary Care Center
Traditional Healing Clinic
Traditional AN approaches to healthcare,
involving tribal doctors, in an outpatient setting
Healing Hands
Culturally-sensitive supportive counseling
Healing Touch
Talking Circles
Prayer, Songs, Dances
Consultations with tribal elders

SOUTHCENTRAL FOUNDATION (SCF)
SYSTEM LEVEL METRICS
SCF: DEFINITION OF PRIMARY CARE
PARADIGM SHIFT
OPERATING PRINCIPLES FOR PRIMARY CARE
PRIMARY CARE TRANSFORMATION
SCF PRIMARY CARE MEDICAL HOME

System rebuilt upon what the customer/owners want and the professionals must adapt to that.
It is the HCO’s job is to adapt to them, to support them on their terms, in their places, on their models, not ours.
Health Care is a service industry, not a product industry.
Relationships are the primary product.










Value relationships with emphasis of the well being of the whole person.
System design around customer owners and how they access care.
Access to care: simple, ease to use, based upon quality measures.

Per Capita Cost Reduction
INDIVIDUALS AND FAMILIES
Integration
Prevention and Health Promotion
Serves 64,000 customer owners
$227 million annual budget
45% Indian Health Service
45% Medicare/Medicaid, Private Insurance
10% Philanthropy
SCF per capita cost $3600
US per capita cost $8233
THE NUKA SYSTEM OF CARE:
PATIENT-CENTERED MEDICAL HOME
NUKA PCMH
IMPLEMENTATION
PER CAPITA COST REDUCTION: NUKA PCMH
ADMISSION RATES
53% decrease in hospital admissions
50% decrease in ER visits
Fewer visits to specialists
Fewer primary care visits
WHAT PATIENT COSTS WERE REDUCED?
PATIENT OUTCOMES IMPROVED:
More children immunized
Diabetic adults with blood sugar under control in top 10% of national benchmark
Customer Satisfaction >90%

HOW DID THEY DO IT?
PER CAPITA COST REDUCTION: NUKA PCMH
Patient care coordinated by teams
Patient/caregiver team trusting relationships = increase in compliance to treatment regimen
Teams are located in the same space
Physician, nurse, medical and behavioral specialists
Staff work at the top of their license

Operational efficiencies
Staff retention
Upfront financing for training and data processing
PER CAPITA COST REDUCTION: NUKA PCMH
HOW DID THEY DO IT?
Teams have access to data:
SCF Data Mall
All patient care teams have access to data to monitor and manage their efficiency and effectiveness.
Improved access to primary care
Customer-Owners same day access (reduced ER visits)
Visits are “Max-Packed”
Use of telehealth and electronic communication
COMMUNITY OUTREACH AND PREVENTION
BETTER HEALTH
FOR THE POPULATION
BETTER CARE
FOR INDIVIDUALS
LOWER COST THROUGH IMPROVEMENT
As per IHI’s Report through “The Quality Chasm” the patient’s (Customer-Owner for SCF) experience must improve while quality is advanced:

For medically and socially complex patients, establish partnerships among
Individuals
Families
Caregivers
Identify a family member/friend who will be supported to coordinate services among multiple providers.
Jointly plan and customize care at the level of the individual.
Actively learn from the patient and family to inform work for the population.
Enable individuals and families to better manage their own health.

At Southcentral Foundation,
this is defined by the Nuka System of Care.

THE SCF NUKA MODEL
SYSTEM LEVEL METRICS - FINANCIAL

Total revenue has consistently increased from $120.2 million in 2003 to $201.3 million in 2010 (90th% MGMA)
Third-party payer revenue increased from $7.4 million to $17.9 million in the same time period (90th% MGMA)

Between 2004 and 2009, Southcentral’s annual per-capita spending on hospital services grew by 7%, but still well below the 40% increase posted in a national index issued by the Medical Group Management Association

SYSTEM LEVEL METRICS - HEALTH
Same-day access to care: 70 - 80%
of appointment slots are open at the
start of each day
Children receiving high-quality care for asthma has soared from 35% to 85%
Infants receiving needed immunizations by age 2 has risen above 90%
Diabetes Care (4th leading cause of death among AN-twice the national average)
Since 2009, performance levels for diabetes care exceed the 90th percentile of (HEDIS)
SYSTEM LEVEL METRICS - SATISFACTION
In a 2010 survey SCF received overall customer satisfaction of 91%
Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys ask consumers to report on and evaluate their experiences with health care
Overall staff turnover has decreased from 37 percent in 2008 to 17 percent in 2011.
Alaska Native and American Indian staff turnover (who make up 53 percent of the SCF workforce) for the same period decreased from 29 percent to 15 percent

Morehead Associates' Workforce Commitment Survey Results
based on a 5 point scale

From 2005 to 2009, SCF improved its satisfaction scores for…
Benefits (from 3.69 to 3.89)
Balancing work and personal life (from 3.67 to 3.87)
Interest in employee health and wellness (from 3.58 to 4.02)
Management's concern with employee safety (from 3.88 to 4.30)
SINCE THE IMPLEMENTATION OF NUKA CARE...
CUSTOMER SATISFACTION
EMPLOYEE SATISFACTION

Provides strong measurement and analysis data
Compares benchmark to 75 specific criteria
Transparent access for every employee to view SCF company-wide balanced scorecards, and individual dashboards which provide information specific to their jobs
Goals, action items, coaching, and mentoring are tied to every job and every employee to create an environment to support improvement
Clinical professionals utilize the data on their patients to better their outcomes

Defining the purpose. Building a relationship over time
Understanding evidence based principles
Moving from product to service as the fundamental base of entire system
Optimized primary care with redefined entire system on that 'new' backbone/platform
Customer driven design. Reallocation of power and control at every level
Optimizing messy human relationships

quyana
qagaasakung
igamsiqanaghhalek
tautugniaqmigikpin
quyanaq
quyanaa
háw’aa
way dankoo
gunalchéesh
’awa’ahdah
dogedinh
mahsi
baasee’
maasee’
chin’an
tsin’e e

1998
SCF assumed Primary Care responsibility from the Indian Health Services

1999
Implementation of Nuka began

2010
SCF received PCMH accreditation from the National Committee on Quality Assurance
OVERALL ER USE
PER CAPITA COST REDUCTION: NUKA PCMH
-LISTENING TO COMMUNITY NEEDS
-CREATING WELLNESS PROGRAMS TAILORED
TO SPECIFIC CULTURE AND HEALTHCARE NEEDS
-ADDRESSING SIGNIFICANT ACCESS ISSUES TO BRING HEALTHCARE TO THE COMMUNITY
-DEVELOPING LONG LASTING RELATIONSHIOPS WITH THE COMMUNITY AS WELL AS TRIBAL GOVERNANCES
-CREATING STRATEGIC GOALS WITH ASSOCIATED SHORT TERM AND LONG TERM GOALS
-UTILIZING DATAMALL CRITERIA TO IMPROVE OPERATIONS EFFICIENCIES AND UTILIZING MENTORING AND COACHING
-COST SAVINGS IN ER VISITS, HOSPITAL READMISSIONS, PRIMARY CARE VISITS
-INVESTING IN THEIR EMPLOYEES, THEIR EDUCATION, AND THEIR ADVANCEMENT
-NUKA SYSTEM OF CARE
-EMPOWERING INDIVIDUALS TO GET INVOLVED IN THEIR OWN HEALTHCARE
-GIVING THEIR CUSTOMER-OWNERS THE TOOLS TO ADVOCATE FOR THEIR OWN HEALTHCARE
-FOCUS ON FAMILY WELLNESS

DATAMALL
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