Expanding Pediatric Diabetes and Endocrinology Care Brad Fuhrman

Expanding Pediatric Diabetes and Endocrinology Care Brad Fuhrman, MD Region 15 RHP Meeting El Paso First Healthplan, 1145 Westmoreland Drive July 30, 2014 1: 00 pm

Description of the Project Ø The Department of Pediatrics is the primary provider of Diabetes and Endocrinology care to infants and children in El Paso. Ø We have, for many years, had a single Endocrinologist to service the entire region. Ø Appointment wait times range from 6 to 12 months. Ø Large numbers of children leave the region to find care.

Description of the Project The primary goal of this project is to expand the availability of endocrine care by hiring additional pediatric endocrinologists, dieticians, diabetes educators and diabetes nurses to work as a team to improve access to care.

Description of the Project ØDY 3 Milestones: ØImplement E-Referral Technology ØHire 2 FTE Pediatric Endocrinologists ØBi-Weekly Meetings ØIncrease Number of Clinic Visits by 500 ØIncrease Number of Medicaid and Uninsured Visits by 300

Description of the Project ØDY 4 Milestones: ØBi-Weekly Meetings ØIncrease Number of Pediatric Endocrinologists by 0. 5 FTE ØIncrease Number of Visits over Baseline by 750 ØIncrease Number of Medicaid and Uninsured Visits Over Baseline by 450

Description of the Project ØDY 5 Milestones: ØBi-Weekly Meetings ØIncrease Number of Visits Over Baseline by 1200 ØIncrease Number of Medicaid and Uninsured Visits Over Baseline by 720

Description of the Project ØAdditional Category 3 Outcomes: ØHb. A 1 c Testing Rate ØPediatric Quality of Life Assessment

Benefits to the Community Ø Greater Access to Pediatric Endocrine Care Ø Reduced Need to Travel for Pediatric Endocrine Care Ø Improved Quality of Care Ø Fewer Acute Hospitalizations Ø Better Quality of Life

Progress Ø Bi-Weekly Meetings held to review project status Ø Three Pediatric Endocrinologists Hired in DY 3 Ø DY 3 Visit Milestones Nearing Completion Ø DY 3 Medicaid Visits Milestone Nearing Completion Ø Quality of Life Survey Baseline Established Ø Hb. A 1 c Testing in Pediatric Endocrine Clinic Established

Data Pediatric Patient Encounters in Endocrinology Clinic -- Baseline DY 2 DSRIP GROUPING Oct Nov Dec Jan Feb Mar UNINSURED MEDICAID ALL OTHERS 1 55 46 2 52 39 1 11 16 5 32 48 4 32 53 2 20 40 Apr May 4 54 48 1 47 47 Jun Jul Aug Sep Total 1 54 47 2 28 28 5 55 61 1 53 31 29 493 504 Total Encounters 102 93 28 85 89 62 106 95 102 58 121 85 % Uninsured 1% 2% 4% 6% 4% 3% 4% 1% 1% 3% 4% 1% % Medicaid 54% 56% 39% 38% 36% 32% 51% 49% 53% 48% 45% 62% DY 3 DSRIP GROUPING Oct Nov Dec Jan Feb Mar UNINSURED MEDICAID ALL OTHERS 1 46 54 1 38 31 2 37 32 4 51 60 4 46 57 1 47 62 1 70 86 70 1% 54% 71 3% 52% 115 3% 44% 107 4% 43% 110 1% 43% 157 1% 45% Total Encounters 101 % Uninsured 1% % Medicaid 46% Apr May Jun Total 0 81 90 0 92 103 14 508 575 171 0% 47% 195 0% 47% 1097 1% 46% 1026 3% 48% 7% Increase Thus Far

Innovations ü I-Pad administration of Peds QOL Assessment ü In-house HBA 1 c’s

Quality Improvements ü Improvements to clinic processes through Value Stream Mapping and Rapid Cycle Improvements PDSA’s: