San Francisco Department of Public Health Integrated Delivery System Planning Project Update

1. San Francisco Department of Public Health Integrated Delivery System Planning Project Update Finance & Planning Committee of the San Francisco Health Commission August 2, 2011

2. Overview of Integrated Delivery System (IDS) Planning Project • Planning process designed to strengthen and further promote integration of the Department’s health care delivery system Integrated health care delivery systems (IDS) • IDS definition for the Department: The San Francisco Department of Public Health’s integrated delivery system (IDS) is a comprehensive system of care that is clinically and financially accountable to provide coordinated health services to the diverse and vulnerable individuals it serves and to improve the health of their communities.

3. IDS Goals • Provide medical homes responsible for coordinating preventative, primary, and specialty care • Reduce misuse, overuse and underuse of services • Enhance information technology to improve quality of care and decision making • Manage resources responsibly for the maximum benefit of clients • Ensure service excellence • Increase the number of insured patients served

4. IDS Key Points of Integration • Care Coordination/Case Management • Clinical Leadership • Disease Prevention and Health Promotion • Information Technology & Informatics • Innovations in Health • Quality and Utilization Management

5. Planning Structure

6. Progress to Date – Planning Group and Workgroup Meetings • IDS Planning Group • Held first meeting June 2011 • Meets every other month • Integration Steering Committee IDS Sessions • Monthly IDS sessions • Outlined general work plan and timeline • IDS Planning Workgroups • All planning workgroups have met and developed regular meeting schedule with the exception of Innovations in Health Workgroup (scheduled for August 10th) • Some workgroups have formed subgroups or are considering • Case Management • Disease Prevention and Health Promotion • Informatics and Information Technology • Quality and Utilization Management • Workgroups have refined (added or deleted) membership

7. Progress to Date – Case Management Workgroup • Modification(s) in Deliverables • No significant modifications • Preliminary Plan or General Approach • The workgroup has developed a vision and four subgroups to complete its work: (1) case management services, (2) acuity index, (3) utilization management and outcomes and (4) operations • Internal survey of DPH programs and analysis of DPH case management contracts • Review of best practices (e..g, scope of services, staffing, outcomes, training, etc.) • Potential Dependencies • Some subgroup activities are interdependent due to sequential nature of project • Both Case Management Workgroup and Quality and Utilization Workgroup are examining utilization management -- requires coordination and communication on activities • Potential Challenges • Obtaining a comprehensive view of case management services provided both directly by DPH staff and by contractors

8. Progress to Date – Clinical Leadership Workgroup • Modification(s) in Deliverables • Develop recommendations to improve current policies and procedures for transitions in care for all patients, possibly focusing on one or more “high-pressure” transition points • Will define training and service excellence standards for the transition(s) • Model a process that can then be applied to other transitions and clinical practice issues • Preliminary Plan or General Approach • Research best practices • Inventory and prioritize transitions (consider criteria such as cost, efficiency, communications, teamwork) • Develop recommendations for priority transition(s) by examining how transitions are working now and how they could work better • Define training and service excellence standards for priority transition(s) • Potential Dependencies • None at this time • Potential Challenges • Too early to determine

9. Progress to Date – Disease Prevention/ Health Promotion Workgroup • Modification(s) in Deliverables • Develop recommendations that will outline how the three key sectors (clinical settings, community-based organizations, broader community) will work to support health and wellness prevention efforts. This will include: • Reviewing best practices/models related to clinical and community preventive services • Identifying opportunities to build a broad-based prevention system • Recommending a model that identifies how sectors can maximize coordination while considering the strengths and limitations of each sector • Adapt strategies and approaches identified in the National Prevention Strategy and the National Quality Strategy • Agreed on principles that will inform their work moving forward: a focus on primary prevention efforts, transparency, efficiency, innovation, and working to improve the existing system by prioritizing gaps • Preliminary Plan or General Approach • May form two subgroups to complete the work based on modifications in deliverables • Potential Dependencies • Too early to determine • Potential Challenges • Creating a realistic scope of work • Identifying and accessing relevant data to make accurate assessments to direct disease prevention efforts

10. Progress to Date – Informatics and IT Workgroup • Modification in Deliverables • None at this time • Preliminary Plan or General Approach • Established specific work teams for the implementation of new information systems at San Francisco General Hospital and Community Oriented Primary Care, as well as, Ad Hoc Task Forces for analysis activities such as the Clinical Database Inventory • Potential Dependencies • Will depend upon the findings and input of the other five workgroups in order to determine the impact and potential Information Technology needs identified as a result of the overall analysis process • Potential Challenges • Very short timelines for implementation of key information systems • Insufficient technical and programmatic staff resources • Change management for the impact of new technologies or clinical and support workflows

11. Progress to Date – Innovations in Health Workgroup • Workgroup has not had its first meeting yet • Scheduled for August 10, 2011 • Workgroup co-chairs are in the midst of reviewing charge/deliverables and making modifications for workgroup review • The following will be provided in November quarterly update: • Modification in Deliverables • Preliminary Plan or General Approach • Potential Dependencies • Potential Challenges

12. Progress to Date – Quality and Utilization Management Workgroup • Modification in Deliverables • None at this time • Preliminary Plan or General Approach • Gather information on how Q/UM is currently structured and implemented in each DPH division (including current IT systems, training/education, and staffing) • Current practice will be compared to best practice models and requirements under Health Care Reform • Develop recommendations related to guiding principles for Q/UM, coordinating and streamlining Q/UM processes, developing necessary IT infrastructure, and proposing appropriate staffing • Taskforces have been formed to address the following issues: Current Quality & UM Practices; Best Practices; IT Systems and Needs; Educational/Knowledge Assessment • Potential Dependencies • Timing of recommendations to IT Workgroup • There is some overlap and risk of duplicating efforts with the Care Coordination/Case Management workgroup, in that both workgroups are looking at Quality and Case Management -- need to ensure communication about efforts to gather information • Potential Challenges • Too early to determine

13. Progress to Date – Internal Communications • Instituted monthly one-page updates for staff – distributed via Director of Health’s Fast Facts • Established intranet sites for staff to obtain meeting materials and minutes from the IDS Planning Group and minutes from the Workgroups: • SFHG site http://insidechnsf.chnsf.org/ • COPCnet site http://10.80.12.146/copc/default.asp • LagunaNET: http://in-sfghweb01/LHH/ • Made IDS presentation to stakeholder (that included staff and community members) as part of a Health Reform forum (July 22, 2011) • Will identify other opportunities to do similar staff presentations/town halls

14. Progress to Date – External Communications • All Health Commission updates will be placed on Department internet site • Department made IDS presentation to stakeholder (that included staff and community members) as part of a Health Reform forum (July 22, 2011) • Will identify other potential opportunities to do similar presentations • Planning group and workgroups will identify external stakeholders whose input would strength planning effort • Town hall meetings • Surveys • Focus groups

15. QUESTIONS