Improving Colorectal Cancer Screening

Transcription

1 Improving Colorectal Cancer Screening HIMSS Davies Presentation DAREN WU, MD, CHIEF MEDICAL OFFICER

2 Open Door was founded as a free clinic in 1972 to address health inequities in Ossining Open Door Sleepy Hollow 1994 Open Door Foundation 1995 Open Door Port Chester 2003 School-Based Health Centers 2006 Open Door Mt. Kisco 2007 eclinicalworks implementation 2010 Hudson Information Technology for Community Health (HITCH) 2011 Family Medicine Residency Program 2013 Open Door Brewster 2015 Mobile Dental Unit (K 12) 2016 Relevant adoption 2017 Open Door Mamaroneck 2018 Brand new Open Door Sleepy Hollow Dental Residency Program History of Open Door

3 Care Delivery Sites

4 2017 Highlights

5

6 Patients by Age and Sex, , ,000 12,000 10,000 8, ,000 4,000 2, Infants Children Adults Older Adults Seniors Male Female Patients by Age and Sex

7 Insurance Coverage of Our Patients Open Door s Uninsured population is 260 % higher than the percentage of uninsured patients in New York State FQHCs* CHIP, 5.2% Uninsured, 44.4% Medicaid, 30.4% CHIP Medicaid Medicare Private Uninsured Source: HRSA UDS National Health Center Data Medicare, 4.2% Private, 15.8% Insurance Coverage

8 Scope of Services

9 Source: American Cancer Society, 3 rd most common cancer in both men and women. 3 rd leading cause of cancer deaths. Mortality rates have declined in the past two decades. Why Screen for Colorectal Cancer?

10 Who to screen? Why? Who does the recommendation? Who does the screening? And Where? How do we get that report? Will we ever get that report? It is ugly stuff, but we have to start somewhere. Start by measuring the data Cancer Screening is HARD!

11 A variety of factors make successful screening for colorectal cancer seemingly an obvious need that clinicians would want to work on unusually difficult and frustrating. Both Internal factors within the discipline of primary care and within individual organizations, and External factors related to screening partners, make it harder than one would expect. The Complexity of Screening

12 Adults between the ages of who: Have had a colonoscopy completed and with the results in our records in the past 10 years. or Have had a FIT kit completed and the results in our records in the past 1 year. Colorectal Cancer Screening

13 Colorectal Cancer Screening Compliance Open Door vs NYS FQHCs 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% New York State FQHCs Open Door Family Medical Centers Source: HRSA UDS National Health Center Data Screening Compliance

14 Open Door has been working on improving cancer screening metrics for years, and through a variety of interventions we have made progress in breast, cervical, and colorectal cancer screening rates. Making Progress

15 Management Through Measurement Infrastructure Joined HIMSS Built infrastructure to support electronic health record Purchased BridgeIT for extraction and reporting Implementation Implemented eclinicalworks Developed Clinical Report Cards Improved coding, reporting and disease monitoring Recognition Meaningful Use NCQA Diabetes program Pay for performance introduced Reevaluation Information Management evaluation Visualization Created actionable, visual dashboards that are accessible to all care team members and clinicians Built standardized data warehouse Information Management Timeline

16 We are still chasing after the Healthy People 2020 goal, as well as the 80% by 2018 Pledge. Still a Distance to Go

17 Colorectal Cancer Screening 90% 80% 70% 60% 1 PCG Visit 2 PCG Visits 50% 3 PCG Visits 40% HP 2020 Goal 80% by % 20% Visit Planning Relevant Dashboards 10% Pay For Performance

18 Visit Planning

19 Reviewed before morning and afternoon sessions by care team Alerts team to gaps in care Initiated by care team to review patient needs Support team is empowered through standing orders Support team can care for patient before clinician enters the room Relevant: Visit Planning Report

20 eclinicalworks Template

21 eclinicalworks Order Set

22 Proactive Outreach

23 Population Health

24 Pay For Perfomance

25 Clinicians must TRUST the data! Number of eligible patients on one s panel % of eligible patients with the screening satisfied o o Count only those tied to the PCP Count only those seen by the PCP at least twice in the past 12 months Getting from Buy-In to Ownership

26 Patient-level data

27 Colorectal Cancer Screening Call Flow Chart Patient calls after receiving CRCS message (voice/sms) Ask patient if they have had a Colonoscopy in the last 10 years OR a FIT kit in the last 12 months Yes, Colonoscopy Yes, FIT No Check in DI section for Colonoscopy (received, reviewed, attached) and patient documents Check in laboratory section for Fit kit (received, reviewed) Patient desires Colonoscopy? Patient desires FIT kit? Patient declines both methods of screening 1.Create TE that includes: a. Doctor who did colonoscopy. b. Where was it done. c. Date. 2. Send TE to PSR/PCT of PCP 1. Remind PT that this test is important and encourage to complete and bring in the specimen. 2. Create TE to PCT to follow up with patient TE to PCP to make a referral TE to PCP to order FIT and advise PT to come in to pick up FIT KIT and instructions at the lab or call Nurse/PCT to discuss TE to PCP noting patient declined all methods of colorectal cancer screening ecw Optimization

28 2016: Value-Based Payment Contract with MVP $25,000 Improved compliance from 58% to 63% 2016 & 2017: HRSA Quality Improvement Awards $33,000 Top Quartile in Colorectal Cancer Screening Compliance Quality Payments

29 Completed an additional 3,600 Medical visits for Adults years of age from Increased patient revenue by $466,000 Quality Payments + Patient Revenue = $524,000 ROI Improved Provider Efficiency

30 Communicate (explain, listen, reinforce) Accept Feedback and Criticism Track, Report, and Use Data for QI Incentivize (striving for quality) Team Effort Build, train, and support teams Form Partnerships Share Best Practices In Summary

31 90% 80% 70% 60% 50% 40% 1 PCG Visit 2 PCG Visits 3 PCG Visits HP 2020 Goal 80% by % 20% 10% Marching Toward Goals

32 Thank You Daren Wu, MD Chief Medical Officer Open Door Family Medical Centers Website: opendoormedical.org