THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENTS PROGRAM:

INCREASING ACCESS, ENHANCING QUALITY OF CARE

IN CONTRA COSTA COUNTY

Contra Costa Regional Medical Center and Health Centers (CCRMC & HC) has embarked on an ambitious plan to expand access to care and enhance quality through a robust effort called the Delivery System Reform Incentive Payments (DSRIP) program. The program was created by the Section 1115 Medicaid waiver, sometimes called the Bridge to Health Care Reform, a joint federal/state agreement with California s public hospital systems that waives certain Medicaid requirements in order to test improvements in health care. The Incentive Program will allow public hospitals to receive up to $3.3 billion statewide if they achieve multiple specified milestones. Hospitals will only receive funding for those milestones they meet. Below is a summary of the program s aims and specifically of CCRMC & HC s plan and commitments over the five-year period, which began on July 1, 2010 and runs through June 30, 2015. This critical work builds on the quality-improvement initiatives already achieved by CCRMC & HC as part of its dedication to the continuous improvement of care.

I.

What is the goal of the Incentive Program?

The program is a bold five-year plan designed to build on our current efforts to: Expand access to timely and appropriate care Enhance the quality of health care Improve the health of patients and communities Help us prepare for Health Care Reform in 2014

II.

How is this program different than those in previous waivers?

The program is much more far-reaching and innovative and is built on Pay for Performance: CCRMC & HC has committed to achieving multiple milestones simultaneously.

III. Why do we need the Incentive Program?

CCRMC & HC has worked for many years to expand access and improve quality with significant success, but a lack of resources has hampered our ability. In the past we have received funding to treat patients, not to develop systems or to manage care. Better infrastructure and resources are needed to make care more coordinated and integrated, so that we can build the foundation necessary to implement improvements, and turn successful pilots into systemwide efforts. In many cases this work requires us to first collect and analyze data, in order to identify problems or to establish baseline levels and benchmarks for improvements.

Contra Costa Regional Medical Center and Health Centers September 2011

IV. What will it mean for patients in Contra Costa County?

The Incentive Program will enable us to: See more patients in a timely manner and in the right place Reduce avoidable Emergency Department visits and hospital admissions Keep patients healthier and better able to manage their health Improve the quality of care Improve patient safety Identify and address health care disparities Enhance the patient experience Improve the community s health (e.g., obesity, diabetes, heart disease) Improve communication and coordination between the patient and provider Help ensure a sufficient number of primary care doctors for the future

V.

What s in the plan?

The plan crosses four categories that recognize the breadth of change we need: 3. Population-Focused Improvement What can we do to improve the health of our population as a whole? Reporting 21 patient experience and population health measures across the following domains: o The Patient s Experience o Effectiveness of Care Coordination (e.g., measured by hospitalization rates for heart failure patients) o Prevention (e.g., mammogram rates and childhood obesity) o Health Outcomes of At-Risk Populations (e.g., blood sugar and cholesterol levels in patients with diabetes) 4. Urgent Improvement in Care How can we improve quality to ensure our patients safety? o Improve sepsis detection and management o Prevent central line-associated bloodstream infections (CLABSI) o Prevent hospital-acquired pressure ulcers (HAPU) o Prevent and treat venous thromboembolism (VTE)

1. Infrastructure Development What investments must we make in people, places, processes, tools and technology? o Increase primary care capacity through new clinic space and training o Increase training of primary care workforce in low-income, diverse communities o Increase timely access to health care interpreter services o Collect race, ethnicity and language (REAL) data to identify and address health care disparities 2. Innovation and Redesign What changes in design or methods can we make to expand access and improve quality? o Expand medical homes o Improve the medication refill process o Enhance patient experience of care o Begin to integrate behavioral and physical health care

Contra Costa Regional Medical Center and Health Centers September 2011

VI. What have we achieved so far and where are we going?

So far under the Incentive Program we have: Increased the number of evening clinics by nine clinics, allowing us to provide more than 3000 additional patient visits per year [Richmond, Martinez, Concord, Antioch] Hired an additional Family Nurse Practitioner, which will result in 22 additional primary care hours per week and 2700 more outpatient visits per year Merged three call centers into one for all health care interpreters, increasing the number of calls handled by the same number of personnel Trained more than 100 registration staff on collecting Race, Ethnicity and Language (REAL) data Begun using a lactate blood-draw tool with all positive sepsis screens to achieve faster recognition time By the end of Year 2 (June 30, 2012), we expect to have: Expanded appointments by 600 additional clinic visits Begun construction on a 53,000 sq ft replacement health center, which will add as many as 15,000 patient visits per year [San Pablo] Expanded one clinic to include nine additional exam rooms, which will allow us to handle 16,600 more clinic visits annually [Concord] Collected baseline data for reducing appointment wait times Increased primary care training in community-based settings by 750 additional clinic visits (120 additional achieved in Year 1) Conducted a gap analysis to determine hardware and training needs for health care interpreter services Provided at least 3200 health care interpreter encounters per month Collected accurate REAL data for at least 40% of patients Assigned at least 85% of eligible patients to a Primary Care Provider (PCP) within a medical home Expanded use of patient surveys into ambulatory and ED settings Piloted integration of physical and behavioral health at one center Begun construction on the Concord Adult Mental Health-Integrated Primary Care Building Piloted a medication refill process in one ambulatory care health center Reported at least six months of data collection on implementing the Sepsis Resuscitation Bundle to establish a baseline and set benchmarks Implemented Central Line Insertion Practices (CLIP) and reported at least six months of data on CLABSI prevalence Reported HAPU prevalence to the State and established the benchmark for lowering the percentage the following year Reported at least six months of data on compliance with five VTE measures in order to establish a benchmark and increase the rate of prophylaxis and treatment in future years

Contra Costa Regional Medical Center and Health Centers September 2011

VII. Where do we expect to be in five years?

When we achieve all of our milestones under the Incentive Program, in five years we will have: Constructed two new buildings with more than 60,000 sq ft of clinic space and expanded one additional clinic [New: Martinez and San Pablo; Expansion: Concord] Significantly increased the number of clinic visits available for our patients Significantly reduced the wait time for clinic appointments Increased the total number of residents who receive primary care training in communitybased health centers and increased the number of clinic visits in these centers by almost 4000 visits Increased the number of qualified health care interpreter encounters to 3500 per month (from initial average of 3000/month) Identified and begun to address health care disparities through the collection and comparison of patient demographic data Piloted the integration of behavioral and physical health care Increased adherence to medication for at-risk populations through implementation of a new medication refill process Reduced sepsis mortality through improved compliance with validated interventions Reduced central line-associated bloodstream infections through improved compliance with validated protocols Reduced hospital-acquired pressure ulcers to 1.1% prevalence or below by implementing and adhering to standardized processes Improved the prevention and treatment of VTE through improved compliance with evidence-based protocols

For more information, please contact Shelly Whalon, CCRMC & HCs Chief Quality Officer, at shelly.whalon@hsd.cccounty.us.

Contra Costa Regional Medical Center and Health Centers September 2011