Health System Redesign Implementation Plan by Quarter

February 2008 through March 2009

By February, 2008

March – June 2008

July – September 2008

Oct – December 2008

Jan – March 2009

Overall Redesign Initiative

1.

Create Health System Redesign Initiative Steering Team

x

2.

Secure 07-08, 08-09 Budget and Staff, consulting resources

x

x

3.

Select priorities of focus and develop workplans

x

4.

Develop initiative implementation plan for BOS approval

x

5.

Initiate cross system workgroups

x

x

6.

Initiate and oversee local evaluation of Redesign, CI

X

x

x

x

7.

Monitor progress on workplans, overall effort

x

x

x

x

8.

Six-Month update to BOS

x

9.

Year-One update to BOS and key stakeholders

x

Eligibility and Administration

1.

Appoint cross-system (SMMC, HPSM, HD, HSA) workgroup with accountability to HPSM Executive Director and HSA Director.

x

2.

Identify gaps and problems with current eligibility, enrollment and retention (EER) processes from a client- and systems- point of view.

x

3.

Recommend an organizational structure for optimizing EER and minimizing administrative costs with clear accountability for: a) operational leadership and day-to-day decision-making; b) defined roles for each County entity; c) effective liaison to non-County entities (e.g., Social Security Administration, Private vendors, other); d) policy oversight and decision-making.

x

4.

Initiate and complete at least two initiatives for increased enrollment and retention of public insurance/coverage programs, first year emphasis on Medi-Cal.

x

x

x

5.

Develop proposal and obtain needed agreement by governance/ policy boards to transfer administration of indigent care programs to HPSM in order to implement a seamless and coordinated coverage program.

x

x

6.

Develop proposal and obtain needed agreement by governance/policy boards regarding optimal placement of client/patient billing and collections functions for clients accessing healthcare at SMMC.

x

x

7.

Monitor progress against targeted goals and develop new initiatives for EER improvement.

x

x

x

x

Chronic Disease Management and Care Coordination

1.

Initiate cross-system chronic disease and care management “champions” who will work with the SMMC Chief Medical Officer and HPSM Medical Director to guide dissemination and improvement of chronic disease management approach.

x

2.

Complete detailed workplan and then launch and disseminate a “Radically Redesigned” model of clinical care that embodies key principles of chronic disease management as well as critical access for patients who would otherwise not be able to utilize care appropriately.

x

x

3.

Analyze patient/ member statistics and identify target clients to improve assignment of clinical and other resources aimed at improving care and cost management.

x

4.

Initiate mechanisms for continuous/ ongoing monitoring of care statistics to flag areas of focus and resource direction.

x

x

5.

Develop and implement plan for improving care management of highest cost clients served within SMMC or who “float” between SMMC, HD, HPSM systems to address system issues across continuum of care.

x

x

x

6.

Analyze options and develop plans for expanding pilot care coordination initiatives to additional provider setting and/or client populations.

x

x

7.

Develop plan and implementation schedule for pediatric and geriatric expansions designed around learnings in promoting prevention and care coordination.

x

x

Integration Across Levels of Care

1.

Initiate cross-system workgroup accountable to Health Director and SMMC CEO.

x

2.

Increase sub-acute psychiatric capacity to enable prompt discharge and/or reduced admissions of non-acute psychiatric patients.

x

3.

Develop and implement a plan for increased specialized sub-acute capacity for priority “hard-to-place” patients whose needs are not able to be served by existing acute or sub-acute options that shares risks and responsibilities across systems.

x

x

x

4.

Improve assessment of need and diversion of patients presenting at the Emergency Room (ER) and Psychiatric Emergency Services (PES) who are not in need of acute medical care.

x

x

5.

Develop revised acute admission criteria that better reflect goals and opportunities identified by this workgroup.

x

x

6.

Analyze current gaps and develop plan to increase Burlingame Long-Term Care (BLTC) capacity to serve clients with behavior challenges. Monitor implementation of plan at the end of six months.

x

x

7.

Analyze opportunities and develop plan to maximize reimbursement for allowable acute days. Monitor implementation of plan at the end of six months.

x

x

8.

Standardize philosophy, education and training across systems to achieve increased uniformity and reduced barriers to achieving optimal placement for clients who do not need to be served in an acute care setting.

x

x

9.

Complete and submit to the State business and operational plan for the Long-Term Supportive Services Project (LTSSP) to facilitate increased local control and accountability for Medi-Cal long-term care resources.

x

x

10.

Commission an actuarial study for inclusion of skilled nursing facility (SNF) and adult day health (ADH) funding in HPSM’s capitation rates.

x

11.

Achieve state agreement on rates and plan for inclusion of MC SNF and ADH funding within HPSM’s capitation rates.

x

x

12.

Meet with relevant stakeholders to inform and finalize a start-up and operational plan for LTSSP operations. Initiate actions for target LTSSP start-up date of July 2009, pending successful State negotiations.

x

x

x

13.

Assess County’s long-term care needs (e.g., SNF, Assisted Living, housing with on-site supports, other home- and community-based services) in anticipation of LTSSP and local demographic trends.

x

x

Physician Leadership, Relationships and Accountability

1.

Create job description and appoint a Chief Medical Officer, with delineated responsibility for physician leadership and accountability distinct from other medical leadership functions in SMMC (e.g., VP of Quality, Department Chairs, other Medical Staff) and HPSM (Medical Director).

x

2.

Develop updated inventory of all employed and contracted physicians to enable analysis and prioritization of opportunities for improved standardization and cost-effectiveness.

x

3.

Determine benchmarks for specialty care access to set employment and contracting standards, expectations and decisions, as well as strategies pursued in developing the Community Health Network for the Underserved.

x

4.

Develop referral standards and guidelines for specialty care services against which access and referrals will be monitored. Develop process for regular monitoring.

x

x

5.

Develop specific guidelines or models for improving alignment of specialty physicians around chronic disease management. Identify and develop pilot specialties that will serve as models for others.

x

x

6.

Initiate regular meetings of Chief Medical Officer and key medical and administrative leaders to ensure alignment of clinical philosophy with operational opportunities and constraints, as well as joint identification of areas for priority focus.

x

x

Community Health Network for the Underserved

1.

Build on provider capacity analysis completed for the BRTF to create an outline, by service area, of provider capacity needed to address the needs of the underserved.

x

x

2.

Identify, from the deepened provider capacity analysis, targeted roles for each major provider organization that capitalizes on their specific strengths and complements the roles of others to achieve a sustainable distribution of delivery responsibilities across a public/private network.

x

3.

Develop an initial proposal for expanded partnership that targets OB/Pediatrics and achieve agreement from at least three private sector partners.

x

4.

After completing a successful OB/Pediatrics partnership, develop proposals for expanded partnership for each major provider partner and pursue and achieve agreement from each partner.

x

x

5.

Align scope of services provided by SMMC to complement partnerships achieved with other providers.

x

x

6.

Analyze and determine most effective use of unique clinical resources shared across SMMC and the Health Department (Edison Clinic, Mobile Clinics) to best leverage these assets.

x

x

7.

Consider development of a local “scorecard” that monitors, tracks and publicizes providers’ roles in meeting the needs of the underserved.

x

8.

Communicate private providers’ roles as partners in a new Community Health Network for the Underserved (CHNU) through a County-led media and communications strategy.

x

x

x

x

Long-Term Care

1.

Assess BLTC to inform County decisions regarding physical plant renovations and/or replacement.

x

x

x

2.

Determine point-person for leadership of long-term care business development opportunities within leadership of SMMC, HD, HPSM.

x

3.

Host forum with HMA expert on long-term care business development to discuss potential opportunities and strategies to explore in San Mateo County.

x

4.

Analyze number of skilled nursing facility (SNF) beds that could be guaranteed and paid for by private healthcare providers if capacity were available at SMMC or affiliated sites.

x

x

5.

Develop several operational and financial models for the operation of SNF services, with guaranteed patients from private healthcare providers.

x

x

x

6.

Explore potential management structures/ arrangements to assure efficiency and quality of SNF services.

x

x

7.

Develop recommendations and obtain agreement on business development targets from appropriate governing boards and private healthcare provider partners.

x

x

x

Finance and Revenue Enhancement

1.

Populate SMMC financial decision support system with data and assumptions necessary to develop and refine strategic financial analyses.

x

x

2.

Identify appropriate financial performance benchmarks and analyze current productivity to select priorities for operational changes.

x

3.

Develop monthly cost and revenue reporting at the service-line, site, specialty, and payer levels.

x

x

4.

Develop plan for increased Medi-Cal Inter-Governmental Transfer (IGT) to the County (via HPSM) to support SMMC operations. Complete negotiations with the State.

x

x

5.

Develop and implement plan to improve billing and collections functions.

x

x

6.

Analyze opportunities to restructure current debt service.

x

x