Project Option 1.1.2: Expand existing primary care capacity:EXPAND PRIMARY CARE ACCESS

Unique Project ID: 196829901.1.1

Performing Provider Name/TPI: Providence Memorial Hospital / TPI: 196829901

Project Description:

This project will expand hours of coverage, locations, and staffing of Urgent Care Centers to ensure the Medicaid and uninsured patient population has access to the appropriate venue for care.

This project will expand hours of coverage, locations, and staffing of Urgent Care Centers to ensure the Medicaid and uninsured patient population has access to the appropriate venue for care. Increased access to primary care will help address a substantial need in the community for increased access to primary care. Additionally, seeing patients in an ambulatory setting will promote the appropriate level of care in the appropriate setting and reduces unnecessary ED admissions for conditions better served in a clinic setting.

Target Zip Codes: 79912, 79924

Goals and Relationship to Regional Goals:

Project Goals: A primary goal of this project is increasing access to primary care for the population served, promoting the appropriate level of care in the appropriate setting and reducing unnecessary ED admissions for conditions better served in a clinic setting, thus containing costs and healthcare infrastructure. The project will also promote the appropriate redirection of patients to Urgent Care locations, resulting in promoting better health outcomes, improvement of patient experience and reduced cost of services provided. The project will also involve education of the public specific to understanding “emergent versus urgent” conditions.

This project meets the following regional goals: Expanding hours of coverage, locations, and staffing of Urgent Care Centers to ensure the Medicaid and uninsured patient population has access to the appropriate venue for care, aligns to the goals of the Region, by increasing access to primary care. Additionally, seeing patients in an ambulatory setting will promote the appropriate level of care in the appropriate setting which aligns itself to a Regional goal as well. This project also allows us, during the redirection of patients from the ED, to provide patient education to ensure the population is accessing the right care in the right setting and promotes a better patient experience through delivery of high-quality, effective healthcare services, which aligns to the goals of our Region.

Challenges:

A major challenge facing the project is the high volume of uninsured and unfunded patients utilizing the Emergency Room.

5-Year Expected Outcome for Provider and Patients:

Research shows that a strong primary care system can improve health outcomes and reduce health care costs. Primary care can also reduce costs by increasing access to preventive care. PMH believes the severe shortfall of available primary care physicians and facilities available to support primary care for prevention and chronic care management in the El Paso region, could affect why the El Paso region does not have health outcomes that correspond to our overall investment in healthcare. Thus, PMH believes that strengthening and growing our primary care workforce is critical to reforming the regions’ health care system. PMH believes that increasing access to primary care physicians and nurses can help prevent disease and illness and ensure our El Paso Region have access to high quality care.

Starting Point/Baseline:

Analysis of Emergency Department visits, classified as non-urgent and urgent, will provide the target population and medical conditions to develop protocols and education to redirect patients to the appropriate setting. Patient populations with multiple visits to the emergency department for urgent and non-urgent conditions will be evaluated to determine deterrents to primary care access.

Rationale:

It is well known the national supply of primary care does not meet the demand for primary care services. Moreover, it is a key goal of health care improvement to provide more preventative and primary care in order to keep individuals and families healthy and therefore avoid more costly ER and inpatient care. Over 30% of Emergency Room visits are visits that could be seen in an Urgent Care setting. At present, many of the ED visits present in late afternoon and evening hours, when primary care offices are closing. Expansion of Urgent Care clinic hours will make it possible for those patients to be redirected to a more efficient and effective site of care, rather than giving them no choice but to present at an ED for costlier treatment with which patients may be less satisfied. Expansion of Urgent Care clinic staffing will make it possible to expand the clinics’ hours. Expansion of Urgent Care clinic locations will make it more convenient for patients to choose primary care over emergent care, thereby making it more likely that they will do so, increasing patient satisfaction, and improving the quality of the patient experience while reducing the overall cost of care.

Project Components:

This project will accomplish the following project components:

a)Expand primary care clinic space.

  • Providence will expand its primary care locations.

b)Expand primary care clinic hours.

  • Providence will expand its primary care hours of coverage.

c)Expand primary care clinic staffing.

  • Providence will expand its primary care clinic staffing.

Unique community need identification numbers the project addresses:

  • CN-1: Primary Care

How the project represents a new initiative or significantly enhances an existing delivery system reform initiative:

Expanding hours of coverage, locations, and staffing of Urgent Care Centers to ensure the Medicaid and uninsured patient population has access to the appropriate venue for care will be an ENHANCED initiative for PMH. The redirection of low acuity patients from the Emergency Room to promote the right care in the right setting will be a new initiative for PMH.

Related Category 3 Outcome Measures:

OD-6 Patient Satisfaction

IT-6.1: Percent improvement over baseline of patient satisfaction scores

130601104.3.1

Reasons/rationale for selecting the outcome measures:

As this project is implemented and Urgent Care Centers are made more available and accessible to the patient population, Providence believes that patients will have better access to primary care, which will result in an improvement in patient satisfaction scores for the target population of the project. Specifically, Providence expects that the successful implementation of this project will be evidenced by an improvement in patients’ ratings of access to care in the target population.

Relationship to Other Projects:This project is part of Tenet’s larger plans to expand and develop primary care and specialty care services in the El Paso community, while improving access to care and containing the costs of care. Specifically, this project will complement Tenet’s Enhance Interpretation Services and Culturally Competent Care project (130601104.1.2) and Implement/Expand Care Transitions project (130601104.2.1); each of these projects is intended to improve the patient experience by providing care in more effective and efficient ways. Furthermore, this project will complement Tenet’s Expand Specialty Care Capacity project (130601104.1.3) in developing and expanding a robust community-wide network of primary care and specialty care services in El Paso.

Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative:

This project is congruent with an Expand Primary Care Access project to be performed in RHP Region 15 by Sierra Providence East Medical Center (196829901.1.1).

Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.

Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also recognize the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare delivery system for the low-income and indigent population.

Project Valuation

$8,396,338. In determining the value of this project, Tenet considered the extent to which increased access to primary care through expanding its primary care clinics will address the community’s needs, the population which this project will serve, the resources and cost necessary to implement the project, and the project’s ability to meet the goals of the Waiver (including supporting the development of a coordinated care delivery system, improving outcomes while containing costs, and improving the healthcare infrastructure). Specifically, Tenet considered the significant cost savings that will result from the successful implementation of this project when patients are navigated away from high-cost treatment sites such as Emergency Rooms, as well as the significant investment that will be necessary to implement the project.

Tenet plans to implement a similar Category 1 project at its Sierra Providence East Medical Center location, serving a different geographic area of the city. The disparity in valuation between this Providence project and the similar Sierra East project is due to the fact that Providence is a much larger facility than Sierra East (with 508 beds, compared to 110 at Sierra East) and accounts for 270% more Medicaid and uninsured days than Sierra East.

130601104.1.1 / 1.1.2 / 1.1.2.X / Expand Primary Care Access
Providence Memorial Hospital / 130601104
Related Category 3 Outcome Measure(s): / 130601104.3.1 / IT-6.1 / Percent improvement over baseline of patient satisfaction scores
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016)
Milestone 1:Establish baseline for metrics P-1.1, P-4.4, P-5.1, I-11.1, I-11.2, I-11.3, and I-13.1.
Metric 1: Establish baseline for future years.
Milestone 1 Estimated Incentive Payment: $2,053,447 / Milestone 2 [P-1]: Establish additional/expand existing/relocate primary care clinics.
Metric 1 [P-1.1]: Number of additional clinics or expanded hours or space.
Baseline/Goal: 1 primary clinic.
Data Source: New primary care schedule or other Performing Provider document or other plans as designated by Performing Provider.
Milestone 2 Estimated Incentive Payment: $746,734
Milestone 3 [P-4]: Expand the hours of a primary care clinic, including evening and/or weekend hours.
Metric 1 [P-4.1]: Increased number of hours at primary care clinic over baseline.
Baseline/Goal: Increase hours to include after hours.
Data Source: Clinic documentation.
Milestone 3 Estimated Incentive Payment: $746,733
Milestone 4 [P-5]: Train/hire additional primary care providers and staff and/or increase the number of primary care clinics for existing providers.
Metric 1 [P-5.1]: Documentation of increased number of providers and staff and/or clinic sites.
Baseline/Goal: Addition of 2 primary care clinics/providers.
Data Source: Documentation of completion of all items described by the RHP plan for this measure; hospital or other Performing Provider report, policy, contract, or other documentation.
Milestone 4 Estimated Incentive Payment: $746,733 / Milestone 5 [I-11]: Patient satisfaction with primary care services.
Metric 1 [I-11.1]: Patient satisfaction scores: Average reported patient satisfaction scores, specific ranges and items to be determined by assessment tool scores. Demonstrate improvement over prior reporting period.
Baseline/Goal: Improvement 2%.
Data Source: CG-CAHPS or other developed evidence-based satisfaction assessment tool, available in formats and language to meet patient population.
Metric 2 [I-11.2]: Percentage of patients receiving survey. Specifically, the percentage of patients that are provided the opportunity to respond to the survey. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: Performing provider documentation of survey distribution; EHR.
Metric 3 [I-11.3]: Survey response rate. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: CG-CAHPS or other developed evidence-based satisfaction assessment tool; Performing Provider documentation of survey distribution; EHR.
Milestone 5 Estimated Incentive Payment: $1,123,356
Milestone 6 [I-13]: Enhanced capacity to provide urgent care services in the primary care setting.
Metric 1 [I-13.1]: Percent patients receiving urgent care appointment in the primary care clinic (instead of having to go to the ED or an urgent care clinic) within 2 calendar days of request. Demonstrate improvement over baseline rates.
Baseline/Goal: Redirection of 5% of identified population.
Data Source: Registry, EHR claims, or other Performing Provider scheduling source.
Milestone 6 Estimated Incentive Payment: $1,123,356 / Milestone 7 [I-11]: Patient satisfaction with primary care services.
Metric 1 [I-11.1]: Patient satisfaction scores: Average reported patient satisfaction scores, specific rangers and items to be determined by assessment tool scores. Demonstrate improvement over prior reporting period.
Baseline/Goal: 2% improvement.
Data Source: CG-CAHPS or other developed evidence-based satisfaction assessment tool, available in formats and language to meet patient population.
Metric 2 [I-11.2]: Percentage of patients receiving survey. Specifically, the percentage of patients that are provided the opportunity to respond to the survey. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: Performing provider documentation of survey distribution; EHR.
Metric 3 [I-11.3]: Survey response rate. Demonstrate improvement over prior reporting period.
Baseline/Goal: 5% improvement.
Data Source: CG-CAHPS or other developed evidence-based satisfaction assessment tool; Performing Provider documentation of survey distribution; EHR.
Milestone 7 Estimated Incentive Payment: $927,990
Milestone 8 [I-13]: Enhanced capacity to provide urgent care services in the primary care setting.
Metric 1 [I-13.1]: Percent patients receiving urgent care appointment in the primary care clinic (instead of having to go to the ED or an urgent care clinic) within 2 calendar days of request. Demonstrate improvement over baseline rates.
Baseline/Goal: Redirection of 5% of identified population.
Data Source: Registry, EHR claims, or other Performing Provider scheduling source.
Milestone 8 Estimated Incentive Payment: $927,990
Year 2 Estimated Milestone Bundle Amount: $2,053,447 / Year 3 Estimated Milestone Bundle Amount: $2,240,200 / Year 4 Estimated Milestone Bundle Amount: $2,246,712 / Year 5 Estimated Milestone Bundle Amount: $1,855,980
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD:$8,396,338

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