The document provides an overview of Arroyo Fresco Community Health Center's operations, including its mission, vision, values, patient and clinical data, employee satisfaction, and financial performance. It finds that while some metrics have improved, there are still opportunities to enhance patient satisfaction and retention, employee satisfaction and retention, clinical excellence, and the organization's financial position. Recommendations include increasing screening rates, appointment availability, and consistency of care; improving employee benefits and recognition programs; and pursuing more grant funding, partnerships, and investment opportunities.

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Arroyo-Fresco
Organizational Strategy

2. Arroyo Fresco
Community Health Center:
Enhancing the FOCUS model
Study Group B members:
Beatrice Toyin Babalola
Ibrahima Diallo
Shalini Gund
Shereese Maynard
CJ Spann

3. Arroyo Fresco
Mission
To serve all patients; regardless of their ability to pay;
against tight fiscal environments at federal, state, and local
level, including:
- an increasing percentage of uninsured patients (one of the highest in the
United States),
- no growth in federal grant payments for uninsured patients, and
- cutbacks in Medicaid eligibility at the state level
Vision
Through our leadership in health care design and delivery, education and
training, and community involvement, the people of western Arizona will
become the healthiest in the state.
Values
◦ Respect
◦ Trust
◦ Relationship
◦ Performance
◦ Accountability

4. FOCUS model
Financial performance
Serve all patients regardless of their ability to pay
Organizational learning
Address workforce gaps
Clinical Excellence
◦ Low incidence of prevention & screening
◦ Higher incidence of communicable disease
Utilization
Mechanisms to provide specialty care and unmet service
needs
Satisfaction
◦ Staff recruitment & retention challenges
◦ Maintain/enhance relationships with patients,
community, & external partners

5. Arroyo Current Patient Data
Fewer patients are
reporting they could
not get an appointment
when wanted,
however, La Paz &
Yuma are still at
almost 10% each.
Unfortunately, wait
times increased from
the previous year,
showing little
improvement over the
past 4 years

6. Arroyo Current Patient Data
Fewer patients are
reporting their
medications were not
explained so they could
understand them,
however, all counties
have room for
improvement.
A large percentage
(30% on average) of
patients feel as
though their
questions are not
answered.

7. Arroyo Current Employee
Satisfaction
 Daily huddles to determine staffing
needs
 Workforce mirrors community
demographics
 Staff members meet with supervisors
twice annually
 STAR and Superstar recognition
 Teamwork culture
 Succession plans evaluated annually
 Employee training and development
 Decreased staff turnover

8. Arroyo Current Clinical Data
•Results for community confidence show
improving results over the last three years
among users and nonusers in all counties,
with overall, pediatric, and senior care
performance that is the best in the state for
2005.
•These results demonstrate AF’s progress
toward the key customer and stakeholder
requirement that AF have a reputation as a
high-quality health center.

9. Arroyo Current Clinical Data
 In 2005, performance results for communicable diseases—
influenza and pneumococcus immunizations met Arizona’s
Healthy People 2010 goals in all three counties.
 These results link to AF’s efforts to provide preventive
services and address challenges related to low incidences in
prevention and screening and high incidences of chronic
and communicable disease.

10. Arroyo Current Clinical Data
Figure 7.5-3 shows
all counties’
performance is
meeting the goal and
equal to the state
best CHC
performance levels
for office visit cycle
time.

11. Arroyo Current Clinical Data
These measures of clinical outcomes show favorable trends for
the past four to five years, with levels that approach, equal, or
surpass the state and/or national comparisons.

12. Arroyo Current Clinical Trends
Challenges
 Low incidence of prevention and screening
 High incidence of chronic and communicable diseases
Areas of Improvement
 While results from various patient and other customer surveys
relative to satisfaction are described, results related to patient-
and other customer-perceived value, such as patient
dissatisfaction and retention, are absent.
 Also lacking are results stemming from the service experience
survey or complaints from patients and other stakeholders.
Without this information, it may be difficult for AF to determine
the effectiveness of its patient complaint and relationship-
building processes.
Objectives
 Increase the overall ratio of patient visits to staff
 Increase the number of new patients served by developing
internal and external resources to address unmet health care
needs in the area.

13. Arroyo Fresco Financial Data

14. Current Financial Performance
 37% increase net income (2001 – 2005)
 Significant Increases across several metrics including:
◦ Amounts collected from Accounts Receivable
◦ Development funding and Donation values
◦ Capital Appreciation
◦ Grant rates
◦ Market Share
 Annual Cost Saving
◦ Purchasing Consortium
◦ Expansion of Clinical microsystems
◦ Training staff to perform the tasks that reduce the costs of audits and inspections
 ROA = Relative Value Units (RVU’s)/ 1000 net asset value
◦ 15% - 19%, from 2001 to 2004
◦ 16.5% 2004 ROA; Under benchmarks of 18%-20%
 Assuring Adequate Resources/ Fiscal Responsibility
◦ Zero based budgeting process linked to the five year capital and funding plans
developed during the Strategic Planning Process
◦ Consideration for productivity standards, external benchmarks and desired
technological implementations
◦ Risk Reduction: by conservatively projecting revenues, managing the timing of
revenue realization and expenses, paying careful attention to cash management,
and requiring a continuous and detailed budget-monitoring process
◦ Reduce expenditures of non-mission-critical expenses if needed

15. External Contributing Factors
◦ Medicaid
◦ Arizona’s Budget Deficit
◦ 1115 Medicaid Waiver, Brewers Healthcare
Reform Plan
◦ PPACA - threats of repeal
◦ Depleting 303 Funding
◦ Immigration
◦ Discontinuation of Medicare Part B

16. External Contributing Factors

17. Impact
 Hemorrhaging Revenue
◦ Transient Populations – Lack of accounting
 Loss of Market Power
◦ Yuma County (36%) of AF annual budget
◦ La Paz County – Rural Health loss of ability to
care for Native American pop.
◦ Loss of Medicare payors – 6% of revenue
 Utilization and purchasing behaviors
◦ Loss of coverage
 Loss of major revenue source
 Decrease quality of care
◦ Increase in demand from competitor patients
◦ Increase market share
◦ Reduction in Access, Affordability

18. Recommendations
Patient Satisfaction & Retention:
Extended appointment availability
Increase throughput/decrease wait times
Improve explanation of medications
Improve consistency of answering patient’s
questions
Improve consistency of including patient’s
preferences in care decisions
Consider implementing patient advocates, case
managers, translators, and/or social work to
help address these concerns and bridge the
gaps.

19. Recommendations
Employee Satisfaction & Retention:
◦ Re-organization to ensure consistency
◦ Convert volunteers to employees and extend
offers of employment, even if part-time,
rather than volunteer positions to potential
candidates
◦ Modification to Rising Star program to
minimize embarrassment of new employees
◦ Expand promotional checklist program
◦ Expand health benefits and decrease
employee’s cost for said benefits

20. Recommendations
Clinical Excellence:
In order to increase the screening process to prevent against the
communicable and chronic diseases we need to take the measures
below.
 PEDIATRICS
Increase immunization rates for children and adolescents.
 FEMALES
Increase screening rates for domestic abuse, depression,
cervical cancer, and colon cancer.
Increase in mammography services
 MALES
Increase screening rates for depression
Increase screening rates for colon cancer.
 OTHERS
Increase screening and support in clinical preventive areas such
as smoking cessation and obesity.
Increase immunization rates and promote influenza vaccines
Increase diabetic screening

21. Recommendations
Financial:
◦ Increase Grant Funding
◦ Developing Political Capital
◦ Mergers: Take Advantage of Economies
of Scale
◦ Partnership: CRIT Gaming Industry
◦ Lucrative Investment Practices
 Endowment Portfolios/ Diversification
 Investment in Securities Market
 Accounts Receivable and Sweep
Accounts

22. Recommendations for
Organization
Learning
•Reduce variance in processes through
improved work flow standardization,
leadership and staff training across county
lines.
•Strengthen grants and process for work-to-
learn programs across the board to develop
work skills and competencies across county
lines
•Ensure knowledge integration into work to
increase efficiency and effectiveness
•Ensure robust processes for scheduling
appointments, responding to employees,
communicating with patients and recording of
medical incidents and errors

23. Utilization
Services offered by AF include ambulatory
medical, family and pediatric care, and dental
services. AF also offers laboratory services, x-
rays, vision and hearing screenings,
behavioral health, drug screening, and
pharmacy services. The center ensures
access to services by its patients by
managing mobile operations six days a week,
making stops at churches, schools, and
community centers. Population Growth now
makes it necessary to expand access to
surrounding counties.

24. Service Population
Current Expansion
 Mohave Three New Mobile
 LaPaz Sites
 Yuma Lake Havasu
City
Population Saunders
 Native American Tucson
 Retirees

25. Internet & Expanded
Mobile Access Access &
Engagement
 Standardization of
Patient
Demographic data
 Tele-radiology
 SATScan
Technology
integration

26. Tackling Disparities through
engagement & partnerships
 Al-Anon & Alateen
Community
partnerships to  American Diabetes
address and Association
overcome  American Heart
disparities Association
 Planned
Parenthood

27. Social Strategy &
Benefits
AF
Media Facebook page:
Argument  Facebook will allow
 51% of Arroyo to reach
Americans young, female
access health population and
info. On-line promote health
partnership
 Women are
more likely to programs. Services
would be highlighted
contact health to include OBGYN
providers on-line services, trainings,
than men and healthy eating
 Americans
 LinkedIn will be
preferring useful for attracting
emailing talented staff
physician↑3.6%

28. Security
Current Standard New Standard
 Password protection  Expanded duties for
 HIPAA compliance the CIO to include
training for staff disciplinary action
protocols & oversight
 EHR limited access
of compliance program
 System upgrades to
increase protection of
PHI: EHR
interoperability
 Annual Risk Analysis
to detect breach
vulnerabilities
 Adoption of a
Notification policy

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