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	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
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Governance Board - SETMA’s Mission, Vision and Goals: Patient Safety and Quality Care

LD.02.01.01 The mission, vision, and goals of the organization support the safety and quality of care, treatment or services
LD.02.0301: Leaders regularly communicate with each other on issues of safety and quality.

Mission

The mission of SETMA was formalized into SETMA’s Mission Statement inn 1997. It states:

To build a multi-specialty clinic in Southeast Texas which is worthy of the trust of every patient who seeks our help with their health, and to promote excellence in healthcare delivery by example.

A framed copy of this statement is displayed in all public places within SETMA’s clinics. The statement is supported by SETMA’s:

Public Motto: Healthcare Where Your health is the only care

Private Motto: We want to do good while we do well

Vision

SETMA’s vision is to participate in the transformation of healthcare in the United States. This means that we understand that “transformation” comes from an internal, generative passion which drives us beyond the requirements of “reform” which is based upon regulations, rules and requirements. SETMA’s vision is defined by our wiliness to face our current reality and our wiliness to honestly and straightforwardly face the gap between our reality and our vision.

Peter Senge addresses “creative tension” as that which is created by the difference between our reality and vision. Our ability to hold that creative tension between our reality and our vision is the force which will drive us to the successful achievement of our mission, the reaching of our goals and the fulfillment of our vision.

In reality because of transformation and generative passion which is internalized our vision will continually expand and change. Our vision is a society in which all have access to excellent healthcare, in which healthcare is seen as a human right. It includes our collaboration with our patients as team members on their healthcare team where the patient is activated, engaged and participating in shared-decision making. It is a healthcare delivery system which is coordinated and integrated, and which is sustainable financially.

Goal

SETMA’s goal is to fulfill both the Triple Aim as defined by the Institute for Healthcae Improvement (IHI) and the Moral Test of Healthcare delivery as defined by Vice-President Hubert Humprhey in September, 1977.

In October, 2007, the IHI launched the Triple Aim Initiative which includes the “simultaneous
pursuit of three aims”:

Improving the experience of care
Improving the health of populations
Reducing per capita costs of health care”

IHI defined a set of components of a system that would fulfill the Triple Aim. Five of the components are:

Focus on individuals and families
Redesign of primary care services and structures
Population health management
Cost control platform
System integration and execution”

(http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/Approach.aspx)

The scope of the Triple Aim was defined by Senator Hubert Humphrey; he said:

“The moral test of government is how it treats those who are In the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.” (November 4, 1977, Senator Humphrey, Inscribed on the entrance of the Hubert Humphrey building, HHS Headquarters)

Dr. Don Berwick stated that success in the Triple Aim required:

“Preconditions for this include: enrollment of identified population, a commitment to universality for its members, and the existence of an organization (an “integrator”) that accepts responsibility for all three aims for that population.” (Donald M. Berwick, Thomas W. Nolan and John Whittington Health Affairs May 2008 vol. 27 no. 3 759-769)

SETMA’s goal is to be an integrator of healthcare. Key to SETMA as an “integrator” of the Triple Aim is the Patient Centered €“ Medical Home (PC-MH) and key to SETMA’s PC-MH is SETMA’s Model of Care. The second of IHI’s five components of The Triple Aim is the Redesign of “Primary Care” Services and Structures is that “Basic health care services are provided by a variety of professions: doctors, nurses, mental health clinicians,’ nutritionists, pharmacists, and others.” The steps to this redesign are:

“Have a team for basic services that can deliver at least 70% of the necessary medical and health-related social services to the population.
“Deliberately build an access platform for maximum flexibility to provide customized health care for the needs of patients, families, and providers.
Cooperate and coordinate with other specialties, hospitals, and community services related to health.” (IHI)

SETMA’s efforts are directed toward this mission, this vision and this goal.

Communications Between the leaders and colleagues of SETMA guide us to these goals and require us to continually review our pursuit of healthcare quality and patient safety. To that end SETMA:

Closes our office once a month for a halt a day. During that time the Governance Board meets with healthcare providers to discuss quality and safety. We review audits of provider performance and discussion ways to fulfill our mission, vision and goal. We have done this for four years.
Prepares a weekly healthcare newspaper column, in which we discuss, public, our mission, vision, goals and successes. We have done this for fourteen years.
Maintain a public website in which we transparently report on over 300 quality metrics by provider name. We have done this for five years.
Rather than static huddles which require everyone to be geographically in one place at time, SETMA participates in continuous electronic huddles thorough out the day and night.

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