Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie

Transcription

1 1 Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie August 13-15, 2014 HealthCare Partners Optimizing Value of RA Care

2 2 Medical Group Profile Established in 1993 as a partnership between 2 local medical groups in LA sites in Southern California also in NV, NM, AZ, FL, PA. Greater LA area including parts of Orange and Ventura Counties 1000 employed MDs, IPA affiliates, 7 rheumatologist (FTEs) Most specialties have at least one employed physician; affiliated network includes all specialties and several tertiary centers 600,000 patients in CA; 100,000+ seniors Group physicians use Allscripts Merger with DaVita in 2012 HealthCare Partners Institute is a non-profit entity for the purposes of applied research and educational activities

3 3 Team Composition Jeremy Rich, Director of HCP Institute Christine Castano, MD Medical Director, Utilization Management Wesley Mizutani, MD Clinical Lead Rheumatology Janelle Howe, RN; Senior Director Disease Management Mark Shinmoto, PharmD, Director of Pharmacy Steve Kawahara, Pharm D, Clinical Pharmacy Specialist Frederick Gonzales, Data Analyst Patient representative, TBD

4 4 RA Goals & Objectives Using data presented directly to practicing physicians: Implement an RA protocol using preferred meds Maximize DMARD use and optimize biologic use Achieve equal or better Disease Activity scores with lower cost Develop population management tools consensus among our employed rheumatologists cost savings Develop processes to implement and capture/trend CDAI Build registry & disease management programs

5 5 RA Intervention & Population Baseline Population: Group enrollees seeing group rheumatologists Not yet built-- Registry and Population data such as: Age, Gender, Health Plans, PCP, Rheumatologist, Race, Zip Code, Comorbidities, DME use, Joint Replacements ETG data Claims data regrouped into episodes Data shown (unblinded) to employed rheumatologists

6 6 Improvement Interventions First meeting: use preferred agents for new starts Second meeting: we are using biologics too quickly

7 7 Measures Used What national clinical standards, if any, did you use as your guideposts and why? STAR ACR guidelines Describe data sources and data collection processes, measures, and results. ETG: claims STAR: claims, and pharmacy data (challenging) Proportion of patients on biologics Referral data

8 8 Challenges or Obstacles Integrating CDAI with the EHR Logistics for PCP education Time and effort to develop internal metrics Logistics for Rheumatology meetings: frequency and location

9 9 Outcomes and Successes What are the key elements that contributed to the success of your initiative? Buy in from all physicians in a group meeting Showing variation data Transparency What are the results? CME on appropriate arthritis referrals provided to PCPs Cost savings on biologics

10 10 Future Steps What are your next steps? What do you hope to achieve? Meeting Triple Aims around RA care Extending capacity of specialists through extenders and patient interactions outside of and supplementing visits Exploring group visits as vehicle for pushing information out to patients Work on implementing effective disease activity measure

11 11 Lessons Learned Top down is less effective than organic group-derived solutions Differences in practice patterns even in one company Value of getting the right people in one room Transparency of data: clinicians want to talk about clinical practice! Does the patient really have RA? Operational challenges: adding an ops person to the group Day to day efficiencies a good idea can hang up on how do you actually get it done with the patient

12 12 Questions How to carry over the successes in the group model over to the IPA? Incorporation of patients what is best way? Implementation roadmaps? Any experiences with group appts with RA? Teaching components that are successful? Who is in room? Experiences using exercise groups targeted to RA? Any technology that is successful for patient assessments? Tailored metrics