deleting culturally competent care (Ex1) and replacing “enable to seek information” with “access mechanisms” (Ex7). Split first sentence into two based on comment by Ex3. The applicant identifies current customer groups and market segments and anticipates future changes during the SPP a cross-site analysis that considers projections of health care needs based on population growth and current trends. The evaluation focuses the applicant on gaps in services and health care disparities to determine which new market segments and opportunities to pursue. Determinations are based on the accomplishment of the applicant’s VMV and support the vision of the people of western Arizona the healthiest in the state. Changes made after R2 feedback include rewording of the first sentence based on comments by Ex3 and Ex4 and the strengthening of the rationale suggested by Ex7. a(3) The applicant systematically builds engagement through the four phases of the Relationship- Building Methods (Figure 3.2-2), which begin with new patients establishing a Personal Health Profile that supports the delivery of culturally sensitive care customized to patient requirements. Patient interactions with Primary Care Teams, volunteers, and partners use Personal Health Profile (PHP) information to support patient satisfaction and engagement. Engagement is evidenced by patient involvement on teams and councils, which may help the applicant retain patients. Comment 3.2b1 Comment supported by aspects of comments by Ex8, Ex1, Ex4, Ex7, Ex2, Ex5. There also is an OFI on the effectiveness of the approach. Reviewed the two comments during b(1)
Changed the nugget on Ex5 feedback, incorporated language from Ex3 comment. I went with the double because I believe this is a key blind spot for the applicant and a major factor in the score for this probably also 2.1 and 2.2. It is not clear how the applicant deploys improvement priorities to partners and collaborators. For example, the use of the Innovation Council (P.1b[2]) is not evident, and it is not clear how the service provider for dialysis is included in the deployment of opportunities for innovation and improvement in the care of the diabetic/obese population. Deploying such priorities to partners and collaborators may help the applicant achieve its vision for the people of western Arizona. Lack of clear deployment / engagement of suppliers, partners, collaborators. The “innovation council” is mentioned in the profile (without a description) and never referenced again. c(2) How the applicant assesses its performance against that of local competitors is not evident. For example, it is not clear how the state CHC benchmarking consortium or other comparative data resources inform the applicant about local competitors’ performance; nor is it clear how the applicant uses publicly reported data or social media reviews of local, private providers of similar health care services. Understanding its performance relative to local competitors may help the applicant maintain or increase market share and be successful in its tight fiscal environment. Issues surrounding use of competitive data. Competitive performance is addressed in 4.1b, so I used that for the item reference. b It is not clear how the applicant selects comparative data and information—such as comparative data from non-CHC providers in The applicant lists the comparative a(2)
Opportunities for Improvement -- Opportunity for Improvement Rationale Item Ref. X The applicant does not report comparisons to or regional competitors for many patient and other customer satisfaction results (e.g., aggregate patient satisfaction, satisfaction with medical services, dental services, school services, mobile van services, and support services and key requirements; Figures 7.2-1 through Comparing these results with those of competitors may enable the applicant to identify areas in which it might more effectively compete for patients. Comment on local comparisons based on comment by Ex5 and supported by Ex8 and Ex2. Ex4 suggested bold in her backup feedback. If needed, will discuss at consensus. a(1) Results are missing for the success of the patient Comment on SCs based on comment by Ex7 and a(2)
acquisition and retention mechanisms presented in Figure 3.2-2. Given the challenges associated with the recent and anticipated changes in the Affordable Care Act and Medicaid expansion enabling CHC patients to obtain care elsewhere, specifically measuring and monitoring such results may help the applicant enhance utilization. supported by Ex3. Ex4 suggested a double during her backup feedback. We can discuss this at consensus if there is not agreement. Revised comment based on feedback by Ex3 in R2 feedback. Patient/family satisfaction with services such as pharmacy, laboratory, and behavioral health, as well as satisfaction with partners, are not segmented by product offerings, customer groups, or market segments. Analysis by Comment on segmentation on comment by Ex1 and Ex8. a(1)
requirements increased from 89% to the 98% benchmark (Figure 7.4-2). Results for perceptions of ethical behavior and community Staff, Volunteer, and Community Response to Ethics-Related Questions (Figure 7.4-7), Support of Key Communities: Staff Members’ Volunteer Hours (Figure 7.4-8), and Applicant’s Community Support of Key (Figure beneficial trends since 2012. These results show adherence to the core values of trust, relationship, and accountability. This is a combined strength derived from 5 strengths identified by 3 examiners (Ex2, Ex5, Ex8). Ex2 and Ex8 provided the strengths for 7.4a(4) and 7.4b, while Ex5 provided it for 7.4a(5). The relevance statement is based on the MVV elements that the nugget and examples are most aligned. Decided to combine these strengths into one comment because splitting the strength into two would have resulted in more strengths than OFIs, which would not be consistent with the assigned score for the item (45%). Revision for R2: Removed references to 7.4b, strategy implementation, and Figure a(4, 5)
to the relevance statement the alignment with the organizational culture of providing health care for underserved populations. Revision at Consensus (R4): Amend the nugget sentence by changing “Results for ethical behavior” to “Results for perceptions of ethical behavior.” Notes Opportunities for Improvement -- Opportunity for Improvement Rationale Item Ref. X Results are missing for several identified leadership and governance approaches. Examples are results for the effectiveness of approaches to ensure responsible governance (Figure 1.2-1) Two examiners (Ex3, Ex5) labeled this OFI as a. In the construction of the draft consensus comment, Ex5 provided the nugget; Ex1, Ex2, Ex3, and Ex7 provided examples, but the Item Lead retained 2 examples for the sake of brevity; Ex2, Ex3, and Ex5 provided the relevance statement. Backup Feedback at R1: Separate this OFI into OFIs—a(1,2,4), a(5), and consolidate “a(5)” and “b” contents of other proposed OFIs into the new “a(5)” and “b” OFIs. a(1, 2,5)
2016: in Y county, from 21% to 23%; in M county, from 11% to 12%; and in LP county, from 19% to 22%. These results support the applicant’s mission to provide access to health care services to the populations of its tricounty service area regardless of residents’ ability to pay. (Ex7) noted a(2) results as a double. Notes Opportunities for Improvement -- Opportunity for Improvement Rationale Item Ref. X Results are missing or limited for operating margin, fundraising revenues, cost control, and ACA impact. Such financial and market performance measures may help leaders address changes in the financial Missing results for measures and indicators of financial and marketplace performance, including meaningful comparisons. One examiner (Ex8) indicated a double for lack of financial and marketplace a
environment, including the strategic challenge of balancing the mission to all patients regardless of ability to pay against a tight fiscal environment. results. Using one examiner’s (Ex5) comment as the stem, I refined the comment to reflect details of other examiners’ IR inputs. I did not double the comment, pending CR inputs. TEAM FEEDBACK: In response to one examiner (Ex4), I doubled this OFI and deleted the sentence about comparisons: Comparisons are not presented for market share by county or by service line, and for budget performance to projections. X Results for market share by service (Figure 7.5-6) show low market share for dental services (15%) and chronic disease (10%) from 2012 to 2016. Such results may indicate a missed opportunity to establish and manage mechanisms to provide specialty care and meet One examiner (Ex7) noted a double a(2) OFI for levels of market share by service (Figure 7.5-6). I included this double OFI for CR consideration. TEAM FEEDBACK: In response to two examiners (Ex1, Ex7), I a(2)
6.2 Operational Effectiveness 40 55% 22 Category Totals 85 47 SUBTOTAL Cat. 1-6 550 300 4 (261-320 pts) Category 7—Results 7.1 Health Care and Process Results 120 50% 60 7.2 Customer Results 80 55% 44 7.3 Workforce Results 80 50% 40 7.4 Leadership and Governance Results 80 40% 32 7.5 Financial and Market Results 90 35% 32 SUBTOTAL Cat. 7 450 208 3 (171-210 pts) GRAND TOTAL 1000 TOTAL SCORE 508