“THE URBAN HEALTH PLAN
EXPERIENCE: A SUSTAINABLE
SAFETY NET PROVIDER”
PALOMA IZQUIERDO-HERNANDEZ
NATIONAL HISPANIC MEDICAL ASSOCIATION
March 19, 2011
Overview - Urban Health Plan
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Founded in 1974 by Dr. Richard Izquierdo
Became Federally Qualified Health Center in 1999
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4 practice sites in the South Bronx and Corona, Queens in New York City
5 School Sites 4 Off Sites
3 Administrative Sites
Expansion Plans
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Fully implemented EHR System since 2006
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Largest Employer in our Zip Code: 488
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2007 National Exemplary Award, US EPA
2009 Selected as one of the top performing Health Centers in the US by HRSA
2009 Nicholas E. Davies Award by HIMSS
2009 NCQA PCMH Level 3 Certification
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2010
Actual Visits:
Projected Users:
230,000
43,000
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2011
Visit Projections:
Projected Users:
250,000
50,000
Community Profile – South Bronx
Source: NYCDOHMH Community Health Profiles 2005
* per 100,000
HUNTS POINT/
MOTT HAVEN
BRONX
NYC
Diabetes – (% of Adults)
17%
12%
9%
Obesity – (% of Adults)
25%
25%
20%
Asthma - (5 of Adults)
9%
7%
5%
Child Asthma
Hospitalization*
12%
10%
7%
Heart Disease
Hospitalization*
2,773
2,201
1,856
61
39
18
People Living w/ HIV/AIDS*
3,149
2,017
1419
Hospitalization Mental
Illness*
1051
949
831
Teenage Mothers, 15-19
Year*
155
120
45
MORBIDITY/MORTALITY
Death Rate Due to HIV*
URBAN HEALTH PLAN’S
PERFORMANCE
Percent of Patients Ages 18+ with Smoking History
Documented
Source: NYCDOHMH PCIP
Percent of Patients Ages 18+ with Smoking History Documented
100%
93.6%
98.2%
98.9%
99.1%
80%
60%
41.0%
40%
20%
0%
2006
2007
2008
2009
NYC DOH
Percent of Patients ages 18+ screened for
Alcohol Use
Source: NYCDOHMH PCIP
Percent of Patients Ages 18+ Screened for Alcohol Use
100%
97.9%
98.9%
99.5%
89.3%
80%
60%
40%
33.0%
20%
0%
2006
2007
2008
2009
NYC DOH
Percent of Patients Ages 18+ with a
Documented BMI within the past 24 months
Percent of Patients Ages 18+ with a Documented BMI within the past 24mos
100%
97.7%
98.6%
98.9%
99.0%
76.0%
80%
60%
40%
20%
0%
2006
2007
2008
2009
NYC DOH
CHILDHOOD OBESITY
Source: NYCDOHMH
New York
City
South
Bronx
Dr. Ally 3
to 4 y/o
Underweight
5%
5%
4%
Healthy Weight
53%
49%
64%
Overweight
15%
16%
6%
Obese
27%
31%
26%
Total percentage
Overweight/Obese
42%
47%
32%
Percent of Patients Ages 50+ with an
Influenza Vaccine
Percent of Patients Ages 50+ with an Influenza Vaccine
40%
31.5%
30%
21.7%
24.1%
19.5%
20%
15.0%
10%
0%
2006
2007
2008
2009
NYC DOH
Percent of Patients Ages 18+ Screened for
Depression
Source: NYCDOHMH PCIP
Percent of Patients Ages 18+ Screened for Depression
28.5%
30%
25%
20.5%
20%
18.0%
14.1%
15%
10%
7.3%
5%
0%
2006
2007
2008
2009
NYC DOH
UHP Asthma Registry Size
Average Symptom Free Days (out of last 14)
Hunts Point-Mott Haven NYC
Comparison of Asthma Emergency Room Visits
2003 to 2008
Rate per 1,000 Population
Source: NYCDOHMH PCIP
60
55
50
45
40
35
30
25
20
15
10
5
0
48.60
55%
Decrease
21.90
2003
2008
Business Case
Affinity Health Plan PMPM Comparative Data
of UHP v. All Affinity Network
2006-2007
Non-UHP
Providers
Pediatrics
Adults
UHP
% Difference
Network
$81.11
$49.18
-39%
$280.62
$219.96
-22%
URBAN HEALTH PLAN’S
JOURNEY
• Stable business operation
• Embraced a Culture of Performance
Improvement
• Embraced the Use and Sharing of Data
• Adopted Health Information Technology –
SUPPORTS A P4P PROGRAM
• Transformed Health Care Delivery System
STABLE BUSINESS OPERATIONS
• Sufficient infrastructure to support
innovation
• Good financial position
• Motivated to invest resources in making
change
• Senior leadership buy in to make
improvements
PERFORMANCE IMPROVEMENT
• Became biggest proponent for PI work
• Embraced Performance Improvement
throughout the organization
• Developed infrastructure to support PI
• Critical Mass of Staff involved in PI activities
• Multiple Internal PI teams
• Standard methodology
USE AND SHARING OF DATA
• Each PI team shares data with each other
and the organization
• Storyboards are everywhere
• Bad data is good
• Dash Boards are used organization wide
ORGANIZATIONAL DASH BOARD JUL 2008
1 Cur r ent Rat i o
29 P edi at r i cs: I mmuni zat i ons Rat es
140.00%
2 Days I n A ccount Recei vabl e
28 A dol escent Car e: % of B ehavi or al Ri sk A ssessment s
3 Days I n A ccount P ayabl e
120.00%
27 P r enat al Car e: P ost P ar t um V i si t s Rat e
4 Days cash on hand
100.00%
26 P r enat al Car e: E nt r y i nt o P r enat al Car e: 1st T r i mest er
5 A ct ual V i si t s
81.60%
73.50%
78.63%
73.86%
95.16%
65.89%
80.00%
104.08%
72.89%
88.11%
25 Cancer Scr eeni ng: M / F 51+Wi t h A n FOB T Done I n T he P ast 2 Y r s
6 Rat e of Change
60.00%
130.00%
40.00%
24 Cancer Scr eeni ng: 21+Wi t h A P ap Smear Done I n T he P ast 2 Y r s
7 St af f T ur n Over Rat e
20.00%
57.56%
87.50%
15.00%
23 Cancer Scr eeni ng: 42+Wi t h A M ammogr am Done I n T he P ast 2 Y r s
8 New P at i ent Sat i sf act i on
102.04%
73.86%
0.00%
94.18%
94.94%
55.55%
22 Di abet es- A ver age A 1C
76.33%
9 E xi st i ng P at i ent Sat i sf act i on
31.37%
21 Depr essi on 50% Reduct i on I n P HQ
10 P t Cnt s: P at i ent Cont act ed w/ i n 48hr s
48.74%
106.00%
80.72%
20 A st hma A vg Sympt oms Fr ee Days
68.38%
77.92%
19 P r i mar y P r ovi der P anel Si ze
18 A ver age Cycl e T i me
17 % of Reschedul e A ppoi nt ment s due t o V acat i on
90.65%
75.88%
11 P at i ent Compl ai nt s per 1000
130.00%
12 P r ovi der Changes: Unaccept abl e
90.14%
13 T hi r d A vai l abl e A ppoi nt ment I ni t i al
14 T hi r d A vai l abl e A ppoi nt ment F/ U
HEALTH INFORMATION
TECHNOLOGY ADOPTION
• Early Adopters
• Second EHR system
• Full implementation of second system in 6
months
• Productivity increased as we implemented
• “Never go back” mentality has developed
• Ability to collect data has been facilitated
• Decision Support tools are invaluable
• Provider incentive program
TRANSFORMATION
OF
UHP HEALTH CARE DELIVERY SYSTEM
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Through re-engineering
Through performance improvement
Through data sharing
Through improved knowledge
Through HI adoption
We have transformed our health care delivery
system
• Not in an additive way but through true
transformation
WHERE WE ARE NOW….
• 2009 HIMSS Nicholas E. Davies Award for
Adoption of Health Information Technology
• 2009 Recognition as a Level 3 Patient
Centered Medical Home
• Ready for Meaningful Use Incentives
• Ready for Research Initiatives
• Ready for Accountable Care
Organizations
THE JOURNEY BEGINS …
WITH QUALITY…..
TO PATIENT CENTERED
MEDICAL HOME…..
TO MEANINGFUL USE
TO PAYMENT REFORM
through ACCOUNTABLE CARE
ORGANIZATIONS
CONTACT INFORMATION
Paloma Hernandez
Urban Health Plan
1065 Southern Boulevard
Bronx, New York 10459
(718) 991-4833
paloma.hernandez@urbanhealthplan.org