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Transformation Success - YVFWC Tracks Progress Toward PCMH!

Monday, December 16, 2013   (0 Comments)
Posted by: Joy Ingram
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by Juan Carlos Olivares, Chief Executive Officer, Yakima Valley Farm Workers Clinic

As the healthcare industry begins to shift to quality-based, shared savings payment models, and Medicaid continues to expand, the need to transform care delivery models into one that is population-based, scalable, proactive, and efficient becomes more critical than ever before. YVFWC is at the forefront of this industry-wide transformation, and is leading the charge in the community health center (CHC) space by implementing tools, methodologies, and frameworks that will align the organization with the new models of care delivery and reimbursement.

In September of 2012, the Yakima Valley Farmworkers Clinic (YVFWC) launched a 15-month transformation effort with the objective of transforming all 14 of its eligible sites to operate as Patient Centered Medical Homes (PCMHs) and gain level 3 PCMH recognition. Guided by practice coaches and PCMH experts from Arcadia Healthcare Solutions, YVFWC's ultimate objective stretched beyond PCMH recognition. The end goal was to implement sustainable change and the necessary workflows, staffing models, and day to day operations that would allow them to function as a PCMH and position the organization for success in the new era of healthcare.

This transformation engagement will not only accelerate YVFWCs path to PCMH recognition, but will strategically position the organization to thrive under new quality based, shared savings payment models, and enable it to quickly deploy quality improvement initiatives to ensure YVFWC is delivering the highest quality of care to its patients. New change processes will enable the organization to be more dynamic and quickly respond to the new initiatives and requirements in the rapidly evolving healthcare industry. YVFWC's strategic partnership with Arcadia provides the tools, resources, support, and expertise to execute this transformation quickly, effectively, and in a sustainable and scalable way.

To say the least, PCMH transformation across a large organization is difficult. Not only must the organization implement new technology, business functionality, and various processes that will allow it to function as a Health Home, leadership must fundamentally change the way the organization thinks about and implements change. In order to accomplish this, YVFWC has adopted a standardized change methodology that now serves as the vehicle for implementing change across the large organization. This methodology has been leveraged to implement a number of functionalities required for PCMH, as well as other various Quality Improvement initiatives in the organization. The new process and methodology ensure that change is timely, standardized, and scalable across all areas of the organization.

Despite its challenges and the level of complexity associated with a transformation effort of this magnitude, the organization is already beginning to show measureable signs of improvement. Thanks to the hard work and dedication of team members across all levels of YVFWC and dedicated support from Arcadia, measureable improvements are being seen throughout the entire organization.

Evidence of Change

An initial survey was administered across the organization at the start of the project to both qualitatively and quantitatively assess the state of the organizational culture and where sites were within the transformation process, and assess their general "readiness" for PCMH. Upon re-assessment of the clinics six-months into the transformation process, measureable improvements had taken place in regards to the readiness and current state within the PCMH transformation process, or the "cultural change" associated with PCMH transformation. The survey revealed measureable improvements across all 8 key drivers in the assessment, indicating that the organization was becoming more patient centered (shown below).

YVFWC Chart 1

Additionally, a drop in standard deviation across all drivers demonstrated a growing alignment in practice operations and improved communication across the organization (shown below).

YVFWC Chart 2

Improvements were observed beyond PCMH, in areas that were not focused on in the transformation. This was evidence that the improvement processes are taking hold in the organization and practice teams are taking initiative to drive change in other areas.

YVFWC has shown improvements across MU measures (shown below), indicating an improvement in EHR adoption as well as the ability to identify, target, and improve quality and patient care with the use of data.

YVFWC Chart3

Noticeable improvements that have been noted from practice coaches, care team members, leadership, and patients include:

  • Quality Outcomes: Improvements in the quality of care are beginning to surface, and the organization is beginning to leverage data to provide proactive care to its patient population.
  • PCMH Recognition: All sites currently have between 68 and 73 of the required 85 points for level 3 PCMH recognition.
  • Care teams creating a high quality and consistent patient centered experience
  • All staff members driving standardization in practice operations across the network
  • Increasing consistency, reliability and understanding of reporting across the organization

The most critical indicator that will measure the success of the transformation is the satisfaction and quality of care being delivered to YVFWC's patients. The following statement came to YVFWC unsolicited in regards to its improvements four months into the engagement:

"I don't know what you guys are doing differently there but it's so great! A year ago, no offense, your clinic was a mess. I couldn't get a call back for days, no one would contact me with results, I couldn't get an appointment and now everything is easy and organized. I can tell that you guys are working to make everything better and I wanted to let you know it's working."
- Unsolicited Patient Feedback to YVFWC

All of this is evidence that the transformation is taking hold, and the organization is heading in the right direction. A significant amount of work from YVFWC team members and Arcadia staff remains, but there is a great deal of momentum moving forward in the process. YVFWC is excited about the opportunity to drive a real difference in the community and is motivated to work to improve the quality of care and the overall health of their patient population.

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