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Health 3.0 Leadership Conference: HealthFirst Primary Care Redesign with Russell Lee


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In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.

We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:

- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.

Enjoy this Bright Spot presentation from Judy Li, Vice President, Health System Innovation and Community Benefit, Sutter West Bay Region, and Russell Lee of St. Luke's Health Care Center, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.

To learn more about this event, please visit:

Learn more about CALPACT:

Learn more about the CHL:

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Health 3.0 Leadership Conference: HealthFirst Primary Care Redesign with Russell Lee

  1. 1. St. Luke’s Primary Care Redesign:HealthFirst Project PlanExcerpts (5/31/2013)
  2. 2. St. Luke’s Neighborhood Clinic:Primary Care Redesign In ActionPre-HealthFirst HealthFirst Current Implementation New Integrated Clinic1996 - 2006 2007 - 2011 2011 - 2015Five decentralized solo-physician primarycare practices, which eventually mergedto create a two-physician practiceTwo separate locations: physicianprimary care practice on 5thfloor andHealthFirst on 6thfloor of MOBIntegrate HealthFirst and physicianpractice; Increase physician practicefrom two to four physiciansMD treated patients one at a time Chronic disease management pilot ofselected patients with community healthworkers worker extending licensedprofessionalsInterdisciplinary team of physicians,nurse practitioners, chronic diseaseeducators and community health workerstreats a population of patients; PanelmanagementPrimary focus on symptoms Patient self-management Focus on disease prevention & patientself-management of chronic illnessesPaper medical records Paper medical records Electronic Health RecordSF Health ExchangeMostly Medi-Cal and Medicare-coveredpatientsMostly Medi-Cal and Medicare-coveredpatientsIncrease commercial and Medicare-covered patientsSignificant financial losses Improved efficiencies to increasethroughput; Reduced operating lossesApply "Guided Care" model; Apply LEAN;Increase throughput; Reduce operatinglosses through realization of economiesof scale1
  3. 3. Clinical Outcomes:HealthFirst produced notable improvements in asthmamanagement4.481.891.0800.511.522.533.544.55Baseline Follow-Up 1 Follow Up 216%46%0%5%10%15%20%25%30%35%40%45%50%HealthFirst EnrolledPatientsNon-HealthFirstEnrolled PatientsMean # of Nights Awakened in the Previous Month % of ED Patients Seen in the ED for an Asthma EventSource: Regina Otero-Sabogal, PhD. “Final Evaluation Executive Report 2007-2010: HealthFirst Pilot Program”, 11/05/10
  4. 4. Clinical Outcomes:HealthFirst produced notable improvements in diabetesmanagement10.558.72024681012Baseline Follow Up100.3889.920.0020.0040.0060.0080.00100.00Baseline Follow-UpAverage HbA1c Mean Glucose Level Mean LDL Cholesterol LevelsSource: Regina Otero-Sabogal, PhD. “Final Evaluation Executive Report 2007-2010: HealthFirst Pilot Program”, 11/05/10
  5. 5. Phase II Redesigned Clinic Team RolesClinic Team Role DescriptionPhysician l  Lead teaml  Assess new ,unstable, and complex patientsl  Provide initial diagnosis and treatmentl  Supervise team careNurse Practitioner l  Serve as physician extendersl  Manage stable chronically illl  Provide uncomplicated urgent careCertified Diabetic /Asthma Educatorl  Serve as physician extendersl  Adapt treatment plan to individual patientsl  Teach patient self-managementClinic Manager l  Coordinate case-managementl  Oversee information system & panel managementSocial Worker l  Assist patients with accessing outside resources (e.g.,immigration, insurance, housing, etc.)Community Health Worker l  Serve as educator extendersl  Provide patient navigationl  Address cultural and language barriers with patientsl  Reinforce and monitor self-management4