Welcome! 15 th Community Health Checkup. Diane Solov. Director, Communications and Foundation Relations Better Health Partnership

Transcription

1 Welcome! 15 th Community Health Checkup Diane Solov Director, Communications and Foundation Relations Better Health Partnership 15 th Community Health Checkup betterhealthpartnership.org June 17, 2015

2 a healthier place to live Improving Population Health Focus on the Safety Net Randall D. Cebul, MD President and CEO Better Health Partnership 15 th Community Health Checkup betterhealthpartnership.org June 17, 2015

3 Measuring Ohio s Health How are we doing?

4 We re # 40

5 How about Cuyahoga County? How is it doing?

6 2015 County Health Rankings Cuyahoga ranks 65 th of 88 Ohio counties. (and remember, Ohio is 40 th of 50 states) How could this be?

7 The Triple Aim: An incomplete view of health Better health requires more than just better care Better Care Better Health Lower Costs

8 Determinants of Health and Premature Death Poverty Income Inequality Violent Crimes Smoking, Physical Inactivity, STDs, Teen Births Schroeder SA. Shattuck Lecture. N Engl J Med. 2007; 357:

9 Social determinants are linked to where you live: Place Matters

10 Why Cuyahoga County is 65 th of 88 Some measures we can address, together Measures Health Outcomes Length of Life Quality of Life Health Factors Health Behaviors Clinical Care Social, Economic Cuyahoga 51 st 72 nd 36 th 6 th 78 th Selected Examples Unhealthy eating, Physical inactivity, STDs, Smoking Lack of insurance, preventable hospitalizations, tests and vaccines Poverty, income inequality, violent crimes

11 Taking Action Together: Linking Clinical Care and Public Health

12 HIP-C and REACH HIP-C Kickoff June 11, 2015 Heidi Gullett CCBH, Erika Trapl CWRU PRC, Greg Brown Policy Bridge, Rita Horwitz BHP, Terry Allan CCBH moderator Kay Colby Health Improvement Plan Cuyahoga (HIP-C) SIXTY (60) partners for better health Better Health anchors chronic disease management priority Clinical leadership in CDC REACH

13 REACH - Neighborhoods for Better Care and Access to Better Foods and Exercise Facilities

14 Taking Action Together: A Federal waiver that anticipated Medicaid Expansion

15 Medicaid Expansion in 2013 When Ohio approved Medicaid expansion in 2013, Cuyahoga County already was in the midst of an expansion enabled by a federal waiver, to: Enroll up to 30,000 poor uninsured Employ closed panel care At risk of loss if an expenditure cap was exceeded Participation of closed panel partners in Better Health enabled: Comparison of MetroHealth Care Plus (MHCP) enrollees to patients who remained uninsured Application of Best Practices identified in Better Health s data

16 A Prepared Safety Net Challenges the Conventional Wisdom Conventional Wisdom: Medicaid expansion will not improve health or lower ED use MHCP = MetroHealth, Neighborhood Family Practice, Care Alliance All meaningfully use EHRs, health information exchange 16 of 18 practices nationally recognized as patient-centered medical homes All participants in Better Health Partnership Enrollment in MHCP was rapid: 28,295 patients February 5 December 31, MHCP enrollees with HBP or diabetes compared to 1150 patients who remained uninsured in 2013.

17 Results after 9 months enrollment: better care, better outcomes, savings Cost: 28.7% ($ per member-month) below federal expenditure cap, or $41M across all enrollees.

18 Conclusions from MHCP 1. Medicaid expansion can help address the Triple Aim If it is linked to a prepared delivery system that is committed to care for its poor residents and is willing to accept risk. 2. Better results may be observed over longer periods of time and with positive incentives for better outcomes, not just penalties

19 Taking Action Together: Finding and disseminating Best Practices

20 Our Secret Sauce for Improvement Who are those guys? How did they do that?

21 A Sauce, not a Silver Bullet Ingredients and Steps 1. Find the bright spots in our data ( those guys ) Examine the data to determine whether the observed improvement was likely to be due to something other than what they did 2. Interview key informants and write up what they did 3. Disseminate the process in a safe space 4. Re-measure all others to see if they improved too 5. If all have improved, we have another (Replicable) Best Practice!

22 Find Bright Spots (1), Interview, Write-up & Disseminate (2-3) Step 1: 2007 Who are those guys? How d they do this? Steps 2-3: How they did this

23 Voila! The region improves! 2007 Who are those guys? How did they do this?

24 Updates and Discoveries in 2014 Thomas E. Love, PhD Data Director Better Health Partnership 15 th Community Health Checkup betterhealthpartnership.org June 17, 2015

25 86 primary care clinics are BHP members

26 68 clinics nationally recognized for PCMH

27 Reporting: 68 clinics, 726 providers

28 Growing the Better Health Partnership Report 1

29 Growing the Better Health Partnership Report 2

30 Growing the Better Health Partnership Report 3

31 Growing the Better Health Partnership Report 4 Heart Failure Added

32 Growing the Better Health Partnership Report 5 High Blood Pressure Added

33 Growing the Better Health Partnership Report 6

34 Growing the Better Health Partnership Report 7

35 Growing the Better Health Partnership Report 8

36 Growing the Better Health Partnership Report 9

37 Growing the Better Health Partnership Report 10

38 Growing the Better Health Partnership Report 11

39 Growing the Better Health Partnership Report 12

40 Growing the Better Health Partnership Report 13

41 Growing the Better Health Partnership Report 14

42 Growing the Better Health Partnership Report 15

43 Our 15 th report 169,745 patients, 726 providers, 68 practices Care Alliance, Cleveland Clinic, HealthSpan MetroHealth, Neighborhood Family Practice North Coast Health, Louis Stokes Cleveland VA St Vincent / Sisters of Charity and LakeHealth (14 sites first public report welcome) Scott Husak, Analyst

44 Diabetes: Care A1c screen Kidney mgmt. Eye exam Pneumovax Outcomes control of A1c control of BP LDL or statin weight not smoking

45 High Blood Pressure: Care Assessment of Blood Pressure Creatinine LDL cholesterol Control BP < 140/90 for most; < 150/90 for age 60+ without diabetes

46 HEDIS: Comparing BH (2014) to Nation (2013) DM Measures Medicare Comm. Medicaid Uninsured Overall BP < 140/80 52 BP < 140/90 72 Eye Exam 58 A1c testing 95 A1c < 7 47 A1c < 8 69 A1c > 9 19 LDL screening 84 LDL < Monitoring Neph. 89 HBP Measure Medicare Comm. Medicaid Uninsured Overall BP < 140/90 68

47 HEDIS: Comparing BH (2014) to Nation (2013) DM Measures Medicare Comm. Medicaid Uninsured Overall BP < 140/ BP < 140/ Eye Exam A1c testing A1c < A1c < A1c > LDL screening LDL < Monitoring Neph HBP Measure Medicare Comm. Medicaid Uninsured Overall BP < 140/ BH Above National Average BH Above 90 th Percentile BH Below National Average

48 We have virtually eliminated race/ethnicity disparities in care White African- American Hispanic

49 But disparities persist in outcomes

50 In 2014, we have grown from 42 (in 2007) to 86 primary care clinics and from 417 (in 2007) to 726 providers reporting their care to the public 9,430 more patients meeting Better Health s diabetes care standards than in ,078 more patients whose high blood pressure is under control than in 2009 virtually eliminated gaps in care of diabetes and high blood pressure by race and ethnicity

51 Potentially Replicable Best Practices

52 Potentially Replicable Best Practices at Sites A, B, C and D Care getting the process right appropriate, timely care A more than doubled % meeting standard in 2 years B more than tripled % meeting standard in 3 years Outcomes intermediate outcomes control of key measures C vastly improved rate of controlling cholesterol D vastly improved BP control (for DM and for HBP)

53 Are A, B, C, and D unusual in terms of race / insurance? A + B + C + D = 2,891 patients with Diabetes Others = 38,999 patients with Diabetes

54 Comparing A, B, C, and D to Others A + B + C + D = 2,891 patients with Diabetes Others = 38,999 patients with Diabetes

55 Improvement of other 47 sites Practice A has improved Diabetes Care by 30 percentage points from

56 Practice B has improved Diabetes Care from 15% to 47% in three years

57 Three System C practices improved LDL < 100 or Statin more than all others

58 Practice D has improved BP Control in Hypertension and Diabetes patients

59 Four New Bright Spots (Potentially) Replicable Best Practices Moving our Care Measures A has improved diabetes care enormously B has improved diabetes care, especially eye exams and pneumovax Moving our Outcomes C has improved cholesterol control (statins) D has improved blood pressure control

60 Improvement of other 47 sites Practice A has improved Diabetes Care enormously Who Are Those Guys?

61 Improvement of other 47 sites Care Alliance Downtown Clinic 1530 St. Clair

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63 Practice B has improved Diabetes Care from 15% to 47% in three years Who Are Those Guys?

64 Cleveland Clinic Stephanie Tubbs Jones Health Center

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66 Three System C practices improved LDL < 100 or Statin Who Are Those Guys?

67 Three System C practices improved LDL < 100 or Statin Neighborhood Family Practice

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69 Practice D has improved BP Control in Hypertension and Diabetes patients Who Are Those Guys?

70 MetroHealth West Park Health Center

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72 Raising the Gaze to Promote Health Across Boundaries 15 th Community Health Checkup betterhealthpartnership.org Kurt C. Stange, MD, PhD Family Physician, Neighborhood Family Practice Promoting Health Across Boundaries Editor, Annals of Family Medicine, American Cancer Society Clinical Research Professor Distinguished University Professor Gertrude Donnelly Hess, MD Professor of Oncology Research Professor of Family Medicine & Community Health, Epidemiology & Biostatistics, Sociology, and Oncology, CWRU June 17, 2015

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74 Presenting our Gold Star Honorees

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