NCHS and Quality

1. 2017 NCHS Clinical Quality ReviewReport to NCHS Board of DirectorsPatrick Tellez, MD, MPH, MSHAFebruary 13, 2018

2. NCHS and Quality Mission • “To improve the health status of our diverse communities by providing quality health care that is comprehensive, affordable, and culturally sensitive.” • Core Values • Excellence • Integrity • Teamwork • Qualityof Care and Services • Innovation • Stewardship

8. Scope of NCHS Quality Programming • Clinical Quality • Uniform Data System (“UDS”) • Healthcare Effectiveness Data & Information Set (“HEDIS”) • Patient Centered Medical Home (“PCMH”) • Access to care • Peer Review (Peer Review Committee and Peer-to-Peer Review) • Clinical Guidelines • Malpractice risk management • Clinical Innovation • Information technology • Clinical workflows & outcomes • Patient Experience/Service • Risk Management • Employee & Patient Safety • Facility security • Hazardous materials • Workers comp risk management • Biohazard exposures • Accidental injuries • Emergency preparedness • Communicable Diseases, Tracking • Flu, zika virus, measles, diphtheria, TB • Immunizations/screenings

9. 2017 Clinical Performance Highlights Quality • Tracking over 300 individual clinical performance measures • Advancements in 12 of 16 UDS Clinical Quality Measures reported to HRSA for 2017 • Meaningful Use incentives achieved in both 2016 and 2017 Success • Secured PCMH Level 3 Recognition for Perris • Clinical Care Advancements • Clinical Pharmacy Consulting • Clinical Quality Improvement Programing in every clinical department Access to Care • Expanded licensed clinical staffing by 25 providers • Exceeded 2016 Visit volume • Opened new Crouch Specialty Clinic site, Oceanside Patient Experience • Sustained high ratings - exceeding national benchmarks

10. Measures We Are Tracking - 2017

11. Clinical Performance: Final UDS 2017 Scores

12. Integrated Health Partners QualityMeasures(2-6-2018)

13. Hypertension (HTN) - Blood Pressure Control18 – 85 years

14. Diabetics (DM) Hemoglobin A1C Poor Control18 – 75 years >> Lower is better

15. Population Management ALL Heart – Diabetics 50 & Older (lower is better)

16. Peer to Peer Medical Record Review by Specialty

17. Patient experienceQ4 – 2017 (6058 surveys in 2017) • Loyalty Likely to return 99 % • Referral Likely to refer 99% • Overall Satisfaction 98%

18. Medical Dental Behavioral Health 2017 Patient Experience

19. Occurrences, Complaints, GrievancesTotal Number of Visits & Staff (+48%)

20. Clinical Innovations in Practice • Clinical Pharmacist Medication Therapy Consulting: • Transitions in care, multiple meds, blood thinners, diabetes care • Behavioral Health: • Increased clinical staffing > Improved access to care • Development of integrated medical-mental health • Screening: depression, alcohol and drug abuse and referral to treatment, adverse childhood experience • NCHS Dentistry Practice • Awarding of NCHS Dentistry of participation in the National Oral Health Initiative and in the CMS sponsored Transforming Clinical Practice Initiative implementing at NCHS Perris care site in Riverside

21. Clinical Innovations: Technology & Telehealth TelePsychiatry • NCHS procured a new grant which is key to extending TelePsychiatry capability to all NCHS care sites throughout 2018 Remote Home Monitoring • Clinical Pharm-D monitoring of blood pressure is continuing under clinical policies and protocols that describe collaboration between primary care providers and our clinical Pharm-D staff. E-consulting • Advanced access to specialty care by NCHS providers, on behalf of NCHS patients, to more than 20 specialties through “e-consulting” services thereby enabling over 2000 patients to access specialty guided care in the primary care setting. Clinical Informatics • Advanced Clinical Dashboard Reporting to provider and teams

22. Strategic Partnerships Integrated Health Partners RadyChildrens • Childrens Physician Medical Group (CPMG) Network • CHOC/RadySouthwest Pediatric Practice Transformation Network (TCPI) • Childrens Primary Care Medical Group (CPCMG) Palomar Health • Clinically Integrated Network • Palomar Prime • Transitions in Care Kaiser Permanente, San Diego • NCHS Family Practice Residency Training Site UCSD Medicine-Pediatrics • NCHS IM-Peds Residency Training

23. Clinical Strategy: “Managing our future” Population Trends we should reasonably expect: • Uncertainty in funding • Form of future federal funding of Medicaid? • Decrease in pay-for-performance incentives from payers? • Increases in number of uninsured • Increased self-rationing of care

24. “Take Home” Points • “Quality” is expressed in NCHS’ Mission and Core Values • Industry evidence shows that high quality correlates with strong financial performance • High quality performance is a “team sport” • NCHS’ quality reporting is demonstrating improvement and is a factor in our success • The key to future growth and mission effectiveness lies in promoting the core patient values at a systems level

25. Securing Future Success… Our Values and the Test of Time

26. U.S. National Quality Strategy IMPROVE POPULATION HEALTH

27. U.S. National Quality Strategy Lower Cost of Care

28. U.S. National Quality Strategy Improve the Patient Experience

29. Ethics of Medicine “First, do no harm...”- Hippocrates

30. Beneficence

31. AUTONOMY

32. JUSTICE

33. Integrate Ethics into Systems that Care…” Beneficence AUTONOMY AUTONOMY JUSTICE