2011–2012 Report to the Community

Quality. Value. Results.

We all have questions that keep us up at night. Here are a few of the ones over which I regularly toss and turn:

• How can we maximize value while preserving quality of care? • What are all the ways we can put technology to use to improve health and healthcare?• With healthcare evolving, how do we stay ahead of the curve? These questions have been around for a while and aren’t going to be going away any time soon. But yesterday’s answers may not be sufficient to meet tomorrow’s needs. Qualis Health is at the forefront of improving healthcare delivery by partnering with our clients and stakeholders to improve care for millions of Americans every day.

I am lucky. I get to work with a team of experts who care deeply about the health and welfare of our clients and their patients. No matter how quickly healthcare evolves, my colleagues at Qualis Health have the expertise and experience to improve care delivery and patient outcomes on behalf of public and private sector clients across the nation. This team brings a transformative approach to their work. And it pays off by producing results.

Qualis Health MissionThe mission of Qualis Health is to generate, apply and disseminate knowledge to improve the quality of healthcare delivery and health outcomes.

Qualis Health VisionQualis Health’s vision is to be recognized for leadership, innovation and excellence in improving the health of individuals and populations.

In this report, we profile some of our recent initiatives in four areas of our work: • Health information technology consulting• Care management• Healthcare quality improvement consulting• Patient-centered medical home consulting Advancing healthcare, improving health and producing results. That’s what Qualis Health is all about.

Thanks for being a part of it.

Jonathan Sugarman, MD, MPHPresident & CEO

Qualis Health works to optimize organizational performance in the public and private healthcare sector through achievable and proven health information technology (IT) and business transformation solutions. We offer: • In-depth understanding of meaningful use• A robust group of health IT consultants with clinical and system experience• Leadership with a direct connection to the latest thinking at the Centers for Medicare & Medicaid

Services and the Office of the National Coordinator for Health Information Technology • The right information at the right time

Bringing Thousands of Providers to Meaningful Use of Electronic Health RecordsAt Qualis Health, the Washington & Idaho Regional Extension Center (WIREC) provides consulting services to more than 4,000 healthcare professionals across Idaho and Washington State. WIREC’s work is part of a broader effort to improve patient continuity and outcomes by getting providers’ electronic health records up and running. It’s also about teaching them how to meet federal standards for meaningful use, thereby earning associated incentives. As a result, over 20 million incentive dollars had already flowed into the region by the end of 2012.

95%of WIREC enrollees responded that WIREC helped them attain meaningful use more quickly.

Working with Alaska to Secure Federal Systems CertificationQualis Health provides quality assurance, independent verification and validation, and other technical assistance to the state of Alaska in monitoring and evaluating the design, development and implementation of its new Medicaid Management Information System. This ensures that the new system will meet federal certification requirements and thereby qualify for full Federal Financial Participation funding.

Harnessing the Power of Health IT

Qualis Health has helped us on the road to meaningful use by providing a comprehensive evaluation of where we need to adjust our processes to reach the criteria for meaningful use. Having an objective third party come in and discuss our software and workflow is extremely helpful.

—Kathryn Houck, Kittitas Valley Healthcare NextGen Projects Manager and WIREC client Photo by Joe Whiteside/Daily Record

Helping Washington Develop a Medicaid Health Information Technology VisionQualis Health helped Washington State develop its State Medicaid Health Information Technology Plan to guide implementation of its Medicaid electronic health record provider incentive program. Our work included assessing the state’s current health IT landscape, facilitating visioning related to the state’s desired future health IT landscape, developing a health IT road map to bridge the gaps between the current and desired states, and creating documentation to request federal funding to implement the final plan.

Providing Health Information Technology Consulting Nationwide We assist public and private sector healthcare organizations across the nation to improve and align their operational processes, information and technology. Our Outlook Associates consulting division provides clients with services such as health IT assessments, tactical and strategic plans, procurement support, implementation oversight and support, system optimization, and best practice training and tools. Every aspect of this work supports providers to improve their financial, operational and overall performance.

Ensuring the Right Care, Right Place, Right Time

Qualis Health is one of the nation’s leading care management organizations. In partnership with our clients, we improve care for millions of Americans every day. We provide utilization management, case management, care coordination and behavioral health management for public and private payers across the country.

We deliver award-winning care management services that ensure value through: • Administrative simplification• Support for evidence-based interventions • Stewardship of limited resources • Best-in-class solutions

In an era of limited healthcare resources, every dollar counts. That’s why it matters that in 2011 and 2012, we averted over 61,000 unnecessary days in the hospital, and our interventions saved clients over 164 million dollars (over 100 million dollars for Medicaid agencies), resulting in a return on investment of six dollars for every dollar spent on care management services.

Qualis Health strikes the right balance between our clients’ obligation to be stewards of limited resources and the needs of providers to decrease administrative burden so that patients get quality care as efficiently as possible.

Our interventions saved clients over 164 million dollars.

$164 million

Making a Difference in Imaging ReviewsTwo years ago, the state of Washington asked Qualis Health to create a program to evaluate imaging service requests for medical necessity. It needed to be efficient, low in provider administrative burden and able to deliver financial results.

Quails Health provided an imaging review solution that maximized web-based technology while allowing for oversight and evaluation of imaging service requests. We launched the program with intensive provider training and comprehensive support. Now, our Washington imaging review program consistently delivers a high return on investment and ensures that limited resources are allocated to those most in need.

Qualis Health has been a premier utilization management organization for the Department of Labor & Industries. Their focus on quality and flexibility has allowed them to innovate above any kind of national standard. Qualis [Health] has been crucial in a number of leading edge innovations….

—Gary Franklin, MD, MPH, Medical Director, Washington State Department of Labor & Industries

My case manager gave hope and light in the midst of some dark times. Thank you.—Patient Perspective

I have always received nothing but quality service from Qualis Health. The reviewers have always been top notch.—Provider Perspective

Without my case manager’s help and guidance through the maze of healthcare, I would not have made it successfully.—Patient Perspective

I have enjoyed working with Qualis Health to provide the best possible care to our patients. Thank you.—Provider Perspective

Improving Systems to Improve Care

Improving the U.S. healthcare system calls for the simultaneous pursuit of three aims: better patient care, better population health and lower costs. Qualis Health’s expert consulting teams are striving to achieve breakthrough performance aligned with these aims.

Improving Care Transitions, Reducing RehospitalizationsQualis Health is reducing healthcare costs and patient risk by providing care transitions consulting services to help hospitals, health systems, community partners and patients prevent unnecessary hospital stays that cost the American healthcare system billions each year.

A Journal of the American Medical Association (JAMA) report shows that Qualis Health’s Stepping Stones project in Whatcom County, Washington, reduced hospitalization rates by nearly 6% and readmission rates by nearly 7%. Starting in 2011, Qualis Health reached beyond Whatcom County to support healthcare providers and community partners across all of Idaho and Washington State. Early results suggest hospitalization reductions similar to those reported in JAMA.

Improving Healthcare Quality and Value for the Medicare ProgramQualis Health is the Medicare Quality Improvement Organization for Idaho and Washington. Our team of consultants and clinical leaders work hard for over 1,000 healthcare providers and partners to improve patient safety in hospitals and nursing homes; refine care transitions to reduce unnecessary rehospitalization; redesign primary care to improve cardiac population health; protect Medicare beneficiaries by investigating individuals’ concerns about their care; and preserve the Medicare Trust Fund.

Sharing Innovative Tools That Help Hospitals Face Payment ReformStaying up-to-date with the Medicare value-based purchasing (VBP) program can be a challenge. That’s why Qualis Health developed interactive Model VBP Worksheets for hospital leaders, providers and frontline staff to set improvement goals, monitor progress and sustain gains. Initially developed as resources for hospitals in Idaho and Washington, the tools have now been deployed by Medicare quality improvement organizations in many other states across the country.

Increasing the Capacity for Healthcare InnovationOut of 900 applicants, Qualis Health’s Tina Schwien, MN, MPH, was one of 73 selected to be part of the Innovation Advisors Program (IAP). Inaugurated by the Centers for Medicare & Medicaid Services in 2011, the IAP fosters a network of experts who test new models of care delivery and form local partnerships. Its intent is to drive delivery system change so that communities will have better health and better care at a lower cost.

Qualis Health got us in touch with community providers in a way we couldn’t have done ourselves.—Kimberly Tilley RRT, BS, Clinical Patient Safety Specialist, St. Luke’s Treasure Valley, Boise, ID

Partnering with IHI to Activate Hospitals and Nursing Homes Starting in 2009, the Institute for Healthcare Improvement (IHI) leads the State Action on Avoidable Rehospitalizations (STAAR) Initiative to reduce rehospitalizations by engaging payers, stakeholders, patients and caregivers at multiple care sites and clinics. Washington was one of the three states where the STAAR Initiative was first implemented, and Qualis Health was part of if by assisting hospitals and providing a structured program for nursing homes associated with the project.

Qualis Health is a recognized pioneer and leader in patient-centered medical home (PCMH) practice redesign. We have helped more than 1,000 practices across the country redesign their clinical and administrative processes to improve quality, patient experience, provider and staff satisfaction, and operational efficiency. With those goals in mind, we’ve helped over 100 sites achieve NCQA PCMH™ Recognition.

Qualis Health, in partnership with the MacColl Center for Health Care Innovation at the Group Health Research Institute, and with the support of The Commonwealth Fund, has developed a framework for medical home transformation. This framework, called the Change Concepts for Practice Transformation, has been extensively tested and is supported by a comprehensive library of training materials that have been accessed tens of thousands of times.

Safety Net Medical Home InitiativeThe Safety Net Medical Home Initiative (SNMHI) demonstrates a replicable and sustainable model for transforming primary care safety net practices into patient-centered medical homes with benchmark performance in quality, efficiency and patient experience. Operating in five regions (Colorado, Idaho, Massachusetts, Oregon and Pittsburgh) representing 65 safety net practices across the U.S., the initiative has achieved remarkable results. As such, the SNMHI is one of only four case studies of leading primary care practice facilitation programs featured by the Agency for Healthcare Research and Quality.

L.A. Health Plan PCMH Pilot ProjectIn late 2010, Qualis Health began helping transform practices in L.A. Care Health Plan, the nation’s largest public Medicaid managed care plan, into high-functioning patient-centered medical homes. In nine months, measures in access, population management, team-based care and care coordination all improved by almost 30%.

Redesigning Primary Care

REACH Medical Home InitiativeThe REACH Healthcare Foundation contracted with Qualis Health to launch a bi-state medical home initiative in the Kansas City region. Using the NCQA PCMH Recognition standards as a framework, Qualis Health provides participating safety net practices with onsite consultation and workshops on PCMH topics.

Advanced Primary Care Practice Demonstration ProjectQualis Health serves as a technical assistance partner for the CMS Federally Qualified Healthcare Center APCP Demonstration Project. With its partners, Qualis Health implemented a support program to help the 500 participating FQHCs achieve Level 3 NCQA PCMH Recognition and trained State Primary Care Association coaches and facilitators engaged in this project.

Harvard Medical School Center for Primary CareQualis Health is facilitating primary care redesign in academic medical settings by supporting the Harvard Medical School Center for Primary Care’s Academic Innovation Collaborative. In partnership with the Center and the Institute for Healthcare Improvement, Qualis Health is helping Harvard Medical School-affiliated teaching practices incorporate PCMH principles into primary care delivery and medical education.

ClientsOur clients include organizations such as:

Alabama Medicaid Agency

Alaska Department of Health and Human Services

American Institutes for Research

Association for Utah Community Health

Centers for Medicare & Medicaid Services

Greater New York Hospital Association

Guam Department of Public Health and Social Services

Harvard Medical School Center for Primary Care

Idaho Department of Health and Welfare

Kansas Association for the Medically Underserved

L.A. Care Health Plan

Nebraska Department of Health and Human Services

Office of the National Coordinator for Health Information Technology

REACH Healthcare Foundation

The Commonwealth Fund

Washington State Department of Labor & Industries

Washington State Department of Social and Health Services

…and many more

Our Impact

Guam

Hawaii

Alaska

Financials

Revenue by Business Product

Care Management

Quality Improvement

Health Information Technology

2011–2012

Revenue by Market Segment

Medicaid Commercial

Public Payers

Medicare

Foundation/Nonprofit

53%

27%

20%

35%

2010

$32.7

2009

$30.0

2008

$29.1

2011

$34.6

2012

$33.9

40M

35M

30M

25M

20M

15M

10M

5M

0

Consolidated Revenue

2011–2012

28.5%

20%

9%

7.5%

Where Qualis Health worked, 2011–2012

Leadership Jonathan Sugarman, MD, MPH President & CEO

Marci Weis, RN, MPH, CCM Chief Operating Officer

Margaret M. Griffiths, CPA Chief Financial Officer

David Chamberlain Chief Information Officer

Foster C. “Bud” Beall Jr., MA Vice President, Consulting Services Outlook Associates

Michael B. Garrett, MS, CCM Vice President, Business Development

Sharon Gorman, SPHR Vice President, Human Resources

Cara Robinson, RN, BSN, CCM Vice President, Care Management

Julie Sylvester, MPA Vice President, Quality and Safety Initiatives

Eric M. Wall, MD, MPH Senior Medical Director

Board of Directors Timothy Frazier, MS Chair

Hugh Straley, MD Vice Chair

Karl B. Kurtz Secretary/Treasurer

Steven Burgon, JD

Andrew D. D. Craigie

Mabel Ezeonwu, PhD, RN, BSN

Ernest H. Kimball IV, MPH

Margaret T. Stanley, MHA

Lori Whittaker, PhD, MD, MPH, FAAFP

List current as of December 2012

Qualis Health

Corporate Headquarters

PO Box 33400

Seattle, Washington 98133-0400

(206) 364-9700 or (800) 949-7536

Fax (206) 368-2419

www.qualishealth.org