bridge plan summary year 2 report - october 2019 - final plan final report... · 25.01.2019 · 3...

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BridgePlanJune2017–September2019

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LowellCommunityHealthCenter(LowellCHC)hasbeenprovidinghighquality,affordablehealthcareservicessince1970.Withafocusonculturallyappropriatecare,LowellCHChascontinuedtopositionitselftomeettheevolvinghealthcareneedsofthelocalcommunity,alwayslookingtoprovideserviceswhichempowerpatientstomaximizetheiroverallwell-being.

FollowingtheopeningofthenewfacilityinDecember2012,LowellCHCembarkedonasix-monthstrategicplanningprocesswhichengagedpatients,staff,andthebroadercommunity,culminatinginthe2014-2017StrategicPlan:MakingOurHouseaHome.Thisplansupportedthehealthcenterasitnavigatednumerousinternalandexternalchallenges,allowingforthefollowingkeyachievements,amongothers:

• AchievedLevelIIIPatientCenteredMedicalHomerecognition• Expandedaccessforprimarycare,accommodating20,000newpatientsandincreasingvisitsby21%• Launcheda340Bpharmacy,providingaccessibleandfinanciallysolventservices• Securedfundingforandintegratedbehavioralhealth(BH)servicesintobothpediatricandadultmedicine,

increasingBHvisitsby29%• EstablishedtheInterpreterServicesDepartmentprovidingsupporttoourpatientswhosepreferredlanguageis

otherthanEnglishandthosewhocommunicateusingAmericanSignLanguage• ObtainedfundingandexpandedservicesforHIVcare,office-basedopioidaddictiontreatment,asthma

educationandprevention,andcivicengagement• Launchedonsitemammography,radiology,expandedlabandultrasoundservicesinpartnershipwithLowell

GeneralHospital• Restructuredleadership,focusingonorganizationalrolesandresponsibilities• Designedcareerladdersforkeyroles(nurses,medicalassistants,andcommunityhealthworkers),and

developedandimplementedatwo-partleadershipdevelopmentprogram• Beganexpansionofspecialtyservices,culminatinginbusinessplansforserviceexpansionin101JacksonStreetAdditionally,theplanprovidedcriticalfocusduringthetransitionofthepreviousChiefExecutiveOfficer,DorcasGrigg-Saito,whoservedthecommunityofLowellforover20years.SusanWestLevinejoinedtheorganizationasthenewChiefExecutiveOfficerinJulyof2016.

Wealsoneededtofocusonserviceexpansionandgovernmentpaymentrestructuring.Withthatinmind,LowellCHCcommittedtoanexpandedfacilityat101JacksonStreet,allowingforadditionalprimarycare,specialty,dental,andvisionservices.Atthesametime,MassHealthnegotiatedapaymentreformprocesswiththeCentersforMedicareandMedicaidServices,launchinganaccountablecarepaymentsystem,requiringtheorganizationtoacceptrisk-basedreimbursementwithqualityincentives.Are-engineeringofclinicalandadministrativesystemsbecamenecessaryforsuccessfulpatientmanagementasofearly2018.

Theseweremajororganizationalchallenges,requiringfocus,resources,andleadershipdirection.ThenewFederaladministrationhasraisedtheprospectof“repealandreplace”fortheAffordableCareAct,alongwithotherpotentialhealthcarepolicyandfinancingchanges.Thespecificsandimplicationsofthesechangesarestillforthcomingbutaddedadegreeoffinancialuncertaintyforthecommunityhealthcaresystem.

Theleadershiptransition,operationalexpansion,andre-engineering,andtheuncertainpolicyclimateledustoadoptaninterimBridgePlan,atwo-yearstrategicplanfocusedonkeyprioritiesthroughFY19.Oncetheplanwascomplete,anewStrategicPlanningprocessranconcurrentlywiththeimplementationoftheworkdefinedintheBridgePlan.Thissequenceisillustratedbelow.

Background

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Jan2014-Dec2016

Jan-June2017

July2017

June2018

Sept2019

Oct2019-Sept2024

CalendarYear2014-2017StrategicPlan

BridgePlanDeveloped

BridgePlanImplemented

FiscalYear2020-2024

StrategicPlanDeveloped

BridgePlanand

StrategicPlanAlignment

FiscalYear

2020-2024

StrategicPlanImplemented

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TheplanningprocessbeganwiththeformationofaStrategicPlanningcommitteeandtheengagementoftheJerichoRoadProjecttofacilitatetheprocess.CommitteememberswerechosenfromtheBoardandStaffandincludedthefollowingwithchangesduetostafftransitionsinFY19:BoardMembers SueBeaton SherylBourbeauBruceRobinson,BoardChair

StaffJeremyDiaz,FY18RobertEbersole,FY18LindaChanFlynnClareGuntherElizabethHaleSusanWestLevine

MelaniePriestly,FY19RobinLicata,FY19DonaldMillerHenryOchSheilaOchOlgaVillanova

ThecommitteemetregularlyfromMarch-June2017andworkedunderthisdefinedStrategicAim:TodevelopaplanningtooltoprioritizeandaddressLowellCHCtransformationeffortsthroughFY18asweundertakearobust,stakeholder-engagedstrategicplanningprocess.TheBridgePlanalignedtheannualoperatingplanwithtransformationalprioritieswhilemaintainingeffortsfocusedonkeyelementsofsuccess:excellentqualityofcareandpatientexperience,staffengagement,andongoingcommunication.InFY18,weestablishedfourkeyprioritiesfortheBridgePlan,threeofwhichacknowledgedthemajorinitiativessitedearlier:expansioninto101JacksonStreet(101Jackson);developmentandimplementationoftheaccountablecareorganization(ACO);andtheneedforadvocacyaswenavigatetheexpectedchangesinhealthpolicy(Advocacy&Policy).Thefourthpriority,FinancialHealth,emergedinrecognitionofthecomplexityoftheseissuesandasakeyrequirementforcontinuedeffortsnotsurewhatthismeans,especiallygiventhethreeyearstheorganizationhasoperatedwithoutarateincreasefromMassHealth.Thisprioritywasinstrumentaltotheotherprioritiesandongoingworkoftheorganizationtosecurethefinancialresourcesnecessaryforservicedeliveryandreinvestment.InFY19,afterreviewofouraccomplishmentsinFY18,werevisitedourpriorityareasfortheBridgePlantoassessaccomplishmentsthusfaranddeterminenextsteps.Twoprioritiesslightedevolvedtohelpsupporttothepriorwork:101JacksonandACO.Thesuccessfulcompletionofa$25.6millionexpansionprojectof101JacksonSt.nowprovidedtheopportunitytoevaluateourservicesandensuresuccessfulimplementationofournewservices.ThisgroupevolvedintotheServiceExpansionandTransformationCommittee,chargedwithdevelopingaprocesstoreviewallprogramandservicesproposalsassuretheysupportourmissionandourpatients,meetourregulatoryrequirements,anddemonstratefinancialsustainability.Inaddition,theACOprioritychangedtoModelofCare(MOC).ThelaunchofourAccountableCareOrganizationandBehavioralHealthCommunityPartnerinitiativesshiftedthefocustoreviewingournewModelofCareandensureproperalignmentwithourpracticeandservicedelivery.

ProcessandPriorities

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Thefollowinggoalswereestablishedforeachpriorityarea:FY18Goals: 101JacksonIncreaseaccesstoneededhealthcareservicesbycreatingsustainablesystemstosupportgrowthandinnovationwhileofferingquality,culturallycompetentcarethroughanintegratedservicedeliverymodel.

ACODesignanddevelopACOthatisresponsivetotheneedsofLowellCHCpatientsandfamiliesthatassurespositiveclinicalandfinancialoutcomes,andaddressesthesocialdeterminantsofhealth.Successwillbedeterminedbypatientexperience.

FinancialHealthCreateaframeworkforasustainedbusinessmodeltoaccomplishourmission.

Advocacy&PolicyCreateacultureofadvocacywhichcementsthisfocusasapartofallelementsofthehealthcenterandwhichsupportsthedeterminationofpolicyandadvocacyprioritiesthatengageourcommunityandarenimbleenoughtoadapttounforeseenchanges

FY19Goals: ServiceExpansionToreviewallprogramandserviceproposals(neworchanges)anddetermineiftheprogramorservice:• Supportsourmission

andourpatients• Meetsourregulatory

requirements• Demonstrates

financialsustainability

ModelofCare(MOC)DevelopenhancementstothecurrentmodelofcareattheLowellCHC,withanemphasisonintegratedcare,standardizationofcare,andfulfillingpopulationhealthgoals.

FinancialHealthCreateaframeworkforasustainedbusinessmodeltoaccomplishourmissionthatincludesimprovedfinancialliteracy,reportingandmanagement.

Advocacy&PolicyGoalremainedthesameasFY18.

Weestablishedclearobjectivesforeachofthesegoals.ThecommitteealsoreviewedandadjustedtheAnnualOperatingPlantoensurealignmentwithandfocusontheseefforts.Thisstandsasaseparatedocument.

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PlanDetails

FollowingisagraphicalrepresentationofourBridgePlan,depictingourjourneyfromonestrategicplantothenextwithourfocusonthefourpriorityareas.Importantly,thisgraphicalsohighlightsthoseelementswhicharefoundationaltoouroverallsuccess:communication,qualityofcare,patientexperience,andstaffdevelopmentandengagement.Everybridgemustbebuiltonastrongfoundation,andthatiscertainlytrueonourjourney.Ourservicesmustremainofthehighestqualityandwiththebestpatientexperiencepossibleaswemovetheseprioritiesforward.Likewise,wemustcontinueourinvestmentsinourstaff,developingandengagingtheminthisworktoensureourongoingachievements.Finally,ourworkrequiresclearandconsistentcommunicationwithallstakeholders:ourpatients,ourstaffandourentirecommunity.

TheBridgePlanjourneyallowedusthespaceandtimetobothachievecriticaltransformationprioritiesandimplementastrategicplanningprocesswhichfullyengagedourpatients,staff,communitymembers,andotherkeystakeholdersoverthenextfiveyears.

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AccomplishmentsbyPriorityArea

FY18:101JacksonStreetReadinessGoal:Increaseaccesstoneededhealthcareservicesbycreatingsustainablesystemstosupportgrowthandinnovationwhileofferingquality,culturallycompetentcarethroughanintegratedservicedeliverymodel.FY18Accomplishments:1) Completed$25.6millionexpansionprojectof101JacksonSt.includingEyeCareCenter,DentalServices,

CallCenterexpansion,Adult/Cariñoexpansion,andwelcomingNortheastRehabilitationasatenantof101JacksonSt.’s4thfloor

2) CompletedrenovationsandrelocationofAdult/Cariño,BHS,HealthPromotion,CallCenter,andMettaHealthCenter

3) LaunchedtheEyeCareCenterandDentalServicesdepartmentsFY19:ServiceExpansion(previously101JacksonStreetReadiness)Goal:Thecommitteewillreviewallprogramorserviceproposalstodetermineiftheprogramorservicesupportsourmissionandourpatients,meetsourregulatoryrequirements,anddemonstratesfinancialsustainabilityFY19Accomplishments:1) Completedanassessmentfocusedonthefollowing:

a. StudyingandoutliningcurrentservicelinesatLowellCHCb. Workingwithourelectronichealthrecordsystem(eCW)toimprovecustomizedreportsgeneratedon

monthlybasisforanalysisofservices/projectsthatcurrentlyexistatLowellCHCc. Developingprocedureandchecklistspertainingtochangeofscopeormodifying/creatingservicelinesd. Assessingcurrentneedoforganization,futurechangesinhealthindustryandGreaterLowell

communityrequestsregardingservicesofferedatLowellCHC2) Developedarequesttemplateforanypersonwantingtochangeserviceline/expandservices3) Createdafinancialmodeltoreporttheimpactofchangestoservicelineorscope

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FY18:ImplementationofAccountableCareOrganization(ACO)Goal:DesignanddevelopACOthatisresponsivetotheneedsofLowellCHCpatientsandfamilies,assurespositiveclinicalandfinancialoutcomes,andaddressesthesocialdeterminantsofhealth.Successwillbedeterminedbypatientexperience.FY18Accomplishments:1) LaunchedandimplementedourAccountableCareOrganization–WellforceCarePlan2) LaunchedandimplementedBehavioralHealthCommunityPartnersincollaborationwithLowellHouseInc.3) Hired37employeestosupportACOandBHCPimplementationFY19:ModelofCare(previouslyACO)Goal:DevelopenhancementstothecurrentmodelofcareattheLowellCHC,withanemphasisonintegratedcare,standardizationofcare,andfulfillingpopulationhealthgoals.FY19Accomplishments–TheMOCestablishedmultiplesubcommitteestosupportefforts.Subcommitteereportstheaccomplishmentsbelow.1) TeamBasedCare:

• DevelopedroomingchecklistforMedicalAssistants(MAs)• TrainedMAsandprovidersonnewprocess,implementationcompleteincludingallrequired

componentsofprevisitplanningandidentifiedqualityKeyPerformanceIndicators(KPIs)• ImplementedTeamSteppstrainingforChargeNurses,MAs,andnursingstaff

2) UtilizationReview:• DevelopedUtilizationReviewcommitteescopeandworkplan• Developedproviderscorecard/dashboardincludingutilizationdata(emergencyroomvisits,MedicalIP,

andBehavioralHealthinpatient)andqualityKPIs• Pilotedoutreachtohighemergencyroom(ED)utilizerstodeterminereasonsforEDutilizationand

opportunitiestoredirecttoprimarycareprovider(PCP)office• DesignedPatientWalk-InCenter(PWC)patienteducationbrochure

3) BehavioralHealth(BH)Strategy:• DevelopedgoalsandstrategyforBHincludingintegration,access,andtransitioninleadership• Implementednewmodelforutilizationmanagement

4) Panel/ScheduleOptimization:• Paneledover4,000patients(over2,000Wellforcepatients)toincluderegistrationandoutreach• Completeddataanalysisofpatientnoshowvolumetosupportrecommendationsfornoshowpolicy.• ImplementedPCPassignmentactivitiesinCallCenterandPSC• CentralizedscheduletemplatesforAdult,Family,Pediatrics,Cariño,OBAT,PASSandPWC

• RevisedtemplatesinAdultandPediatricstomeetbudgetedvolumesforvisits• Reviewedandrevisedbookingguidelinesforprimarycaredepartments• Decreasedscheduleblocksandvisitholdstomaximizeaccess,begantemplatereviewinFamily

MedicineandMettaHealthCenter

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FinancialHealthGoal:Createaframeworkforasustainedbusinessmodeltoaccomplishourmissionthatincludesimprovedfinancialliteracy,reportingandmanagement.FY18Accomplishments:1) Establishedweeklygrouptoreviewoperatingbudgetandformulatebudgetaryrecommendations2) HiredscheduleadministratortosupportpanelmanagementFY19Accomplishments:1) Establishedweeklygrouptoreviewoperatingbudgetandformulatebudgetaryrecommendations2) Hiredscheduleadministratortosupportpanelmanagement3) TheFinanceTeammetwitheachdepartmenttodiscuss

• financialperformanceversusbudget• ongoingtrainingonhowtousetheirmonthlyincomeandexpensereportstoaidinmanagingfinancial

performance4) Reviewedweeklybudgetperformance,revenueopportunitiesandrisks,andcostmanagement5) Implementedconservativehiringtoassistinmanagingfinancialperformance6) BuiltarealisticFY2020budgetwithattainablerevenuegoalsandconservativeexpenserequestsaswe

continueourtransitionfromavolumetovaluebasedcaredeliveryandreimbursementsystem

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AdvocacyandAddressingHealthPolicyChangesGoal:EnhanceourpositionasatrustedsourceofhealthinformationandleaderinhealthpolicyandadvocacyintheGreaterLowellcommunityandbeyondFY18Accomplishments:1) Conductedenvironmentalscanofcurrentissues2) EstablishedLowellCHCCommunityHealthPrioritiesgroup3) HostedCongresswomanTsongasasguestspeakeratLowellCHCBreakfast4) Createdandimplementedadvocacycampaignthatengagedcommunitypartnersandstaffforrallyand

advocacyonaddressingtheFederalfundingcliffFY19Accomplishments:1) Completedaninternalenvironmentalscanofadvocacyandpolicyefforts2) Implementedquarterlyactivitiestoengageelectedofficialsincluding:

• Sendingwelcomenotestoentiredelegationwelcomingthemtotheirposts(01/19)• Coordinatingandworkingwithlocal,stateandfederaldelegationonon-goingpolicies• HostingStateRepresentative’sChiefsofStaffMeetingatLowellCHC(01/25/19)• HostingCongresswomanTrahanVisittoLowellCHC(03/11/19)• AttendingNACHCPolicyandIssuesForuminWashingtonDC/MeetingwithCongresswomanTrahan• HostingStateSenatorEdKennedyVisittoLowellCHC(06/07/19)

3) DevelopedLowellCHCPolicyonTakingPublicPolicyStands,andProcedureonEndorsementswhichisunderreviewbytheComplianceDepartment

4) Additionalpolicyandactivitiescompletedincluded:• StanceonBallotQuestion1(10/2019)• GenderIdentityAnti-DiscriminationInclusivityMessageDeveloped(11/2019)• SubmissionofwrittencommentsonPublicChargeRuleChange(12/10/219)• Advocatingforstate’sCommunityHealthTransformationFund(01/25/2019)• MassLeagueofCHC’sStateHouseDay&MeetingStateDelegation(05/02/19)• LaunchofAdvocacy101Training(05/03/19)

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AccomplishmentsbyFoundationalElement

CommunicationsGoal:Createa12-month,internalcommunicationsplantoassurethebestmethodsofcommunicatingwithstaffanddisseminatinginformationaboutthehealthcenteranditsinitiativesandserveasambassadorstoaccuratelyconveyinformation.FY18Accomplishments:1) AdvocatedforFY19budgetincludeDirectorofCommunications2) DevelopedstoryboardsforTellingOurLowellCHCStoryCampaign–completedforCHEC,Health

Promotion,OBAT,PediatricBehavioralHealthIntegrationandTeenBLOCKFY19Accomplishments:1) ImplementedweeklyStaffAnnouncements(expandedtoaddnewhires),viaemailandpostedwithin

departments2) UpdatedintranetroutinelywithinformationfromStaffAnnouncementsandotherresources3) ImplementedweeklyOperationsHuddlesbytheCOOandmadeslidesavailabletoProgramManagersto

utilizewithintheirdepartments4) Re-designedMonthlyLeadershipMeetingtoincorporateroutineagendaitems(newleader

announcement,reviewofrecentapprovedpolices,acknowledgementofimpactawardees,etc.)sixtimesperyear,fourallmanagerleadershiptrainings,andtwosocial/teambuildingsessions.

5) InformationfromProgramManagersmeetingisconveyedutilizingaPowerPointformatallowingdepartmentmanagerstosharetheinformationwiththeirstaff

6) CreatedLowellCHCEventsCalendar:complete–“HowTo”and“StepbyStep”processcreated,posted&leftontheIntranettoguidestaffonhowtoaccesscalendarandaddittotheirOutlook

7) HiredDirectorofCommunicationstoleadCommunicationsDepartmentandeffortswithastrongfocusoninternalcommunications

8) Developed“TellingOurStory”CampaignBoardsinclusiveof:EyeCareCenter,FamilyPlanning,SchoolBasedHealthCenterandCariño

9) DevelopedanddisseminatedPatientWalk-InCenterBrochure10) ReviewedCommunicationspolicies

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PatientExperienceGoal:Todevelop,implement,andmonitorsustainableactionstoimprovethepatientexperienceandcommunicateresults.Overseecontinualimprovementsinthepatientexperiencebyassuringthattheconceptsofpatientandfamilycentered,culturallycompetentcareareintegratedintotheorganizationalcultureutilizingevidence-basedsolutions.FY18Accomplishments:1) Projectdevelopedtopilotself-check-inkioskusingiPads2) Launchedprojecttoinstallnewpatientqueuingsystem

• Phaseone–soundchangefromvoicetochime(Fall2018)• Phasetwo–optiontoleavemobilenumberfortext

FY19Accomplishments:1) IncorporatedpatientcommentsatweeklyOperationsHuddleformanagerstodiscuss2) LaunchedPatientExperiencecommittee08/08/19andestablishedcommitteegoalsandobjectives3) Relaunchedpatientexperienceeffortwithclinicalleadership4) EnhancedthecapabilitiesoftheonlinePatientPortal5) Redesignedtheregistrationprocessresultingina48%reductioninwaittimes(from11:05to5:45-from

January2019–July2019):Draftplantodecentralizeregistration(underreview)• Enhancepre-verification• Redesigndepartmentalregistrationarea• Introducesoundmaskingtechnology• Streamlineexistingregistrationprocess• Introduceself-servicekiosks;kioskstobedeployed,Pediwillhaveone

6) IntroducedtheroleofPatientAdvocate,YokastaBrito,effective05/06/197) BeganworkingwitharchitectstocreateaframeworkforredesigningthePatientWelcomeCenterand

addingentrywayslidingdoors8) Establishedapatientexperiencecampaigntosupportanenhancedpatientexperience;workedwithFallon

andaBostonbasedconsultingfirmtodevelopapatient’sjourneymapandidentifyopportunityareassuchaswaittime,parking,transportation,andinterpretsupport

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FY18:QualityofCareFY18Accomplishments:1) PrioritizedbuildinginfrastructureforQualityandAnalyticsdepartment2) HiredMedicalDirectorofPopulationHealth3) HiredDirectorofQualityandAnalyticsFY19:QualityandPerformanceImprovement(previouslyQualityofCare)Goal:Developandimplementtargetedimprovementinitiativesforpriorityqualitymeasuresinanefforttoincreasequalityperformanceandearnings,closegapsincareforpatients,andimprovehealthoutcomes.FY19Accomplishments:1) CommitteeconvenedinJanuary2019tofinalizeworkplan2) Leadshavebeenassignedforeachoftheprioritymeasuresandworkhasbeguntodevelopoperational

anddocumentationworkflowsforeachmeasure.ThecommitteecollaborateswithassomeofthequalityworkoverlapswithworkthatisbeingdonewithModelofCare:TeamBasedCare,eCWOptimizationandtheSDOHStrategyworkgroup.

3) Elevenprioritymeasureshavesetoperationalandstandardizeddocumentationworkflowsthathavebeentrainedacrossthedepartments

4) WorkedwithriskcontractsforBCBCS,Tufts,HarvardMedicaid,Wellforce(on-going)5) ConductedtrainingonCDSSAlertsandalignedwithqualitymeasures6) ViatheClinicalQualityImprovementCommittee(CQI)focusedonworkflows,comparingperformance

formlastyeartopresentyearandcreatinganoversightcommitteethatCQIwillbereportingtotheQualityCouncil

7) BeganprocessofcreatingaQualityMeasuredashboard

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StaffEngagementGoal:Createanenvironmentinwhichstaffareexcitedtojoin,enthusiastictoworkfor,andhappytostayatLowellCHC.FY18Accomplishments:1) Developedandimplemented“WeloveourstaffWednesdays”onsocialmedia2) PlannedandlaunchedMeet,Eat,andAppreciateLowellCHCquarterlylunches(launchedFall2019)FY19Accomplishments:1) OrganizedthreeStaffMEALshighlightingfoodfromthecontinentofAfrica,AsiaandLatinAmerica.The

MEALShadhighstaffparticipationandsatisfaction.StaffMEALshavebeenscheduledforthenexttwoyearsandCHEC/StaffLoungehasbeenreserved.

2) StaffEngagementCommitteehasaddedninenewcommitteememberswhohavebeenhighlyengagedinimplementingStaffengagementactivities.

3) ImpactAwardpresentationsweredoneatalldepartmentalstaffmeetingsandprogrammanagermeeting.ImpactAward“kits”havebeenplacedinaccessiblelocationsonallfloorsandover75awardshavebeengivensincethelaunchinMay.

bridge plan summary year 2 report - october 2019 - final plan final report... · 25.01.2019 · 3...

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