to Strengthen Primary Care

Transcription

1 Aligning and Linking Opportunities to Strengthen Primary Care Center for Health lthcare Strategiest November 3,

2 Beacon Communities Funded by U.S. Department of Health and Human Services Administered by the Office of the National Coordinator for Health Information Technology The Beacon Program will support these communities to improve care coordination, increase the quality of care, and slow the growth of health care spending Beacon Communities will focus on specific and measurable improvement goals in the three vital areas for health systems improvement: quality, cost efficiency, and population health. &cached=true 2

3 17 Beacon Communities 3

4 Beacon In The News 4

5 Southeast Michigan Beacon Community Collaborative (SEMBC) Vulnerable Population Detroit, Highland Park, Hamtramck, Dearborn, Dearborn Heights Population Flight Physician Flight Considerations Unemployed Uninsured Limited access to healthcare 5

6 Beacon in Southeast Michigan Focus on Diabetes Provider interventions HIT enabled clinical and operational interventions Patient and community outreach interventions 6

7 SEMBC Domains Information Technology and Security Evaluation & Measurement Clinical Transformation Sustainability Stakeholder Engagement & Participation 7

8 Example Linkage Opportunity for Alignment Local Level: Physician Participation and Leadership State Level: MDCH Participation and Leadership PCPisgoverning boardco chairchair PCPs active across teams Medicaid represented on governing board HIT Coordinator represented on governing board Frequent State sponsored collaborative meetings for all ARRA and HIT/HIE related initiatives Regular reports to HIT Commission and others Introduction to RDPS practice participants Dr. Herbert Smitherman, Executive Board Co Chair, seeing a patient at one of his FQHC clinics. i 8

9 SEMBC Interventions Physician data reporting and performance feedback Establish a network of physicians who are committed to process change and data exchange. Care Coordination Ambulatory Utilization of patient navigators to help patients adhere to treatment plans. Clinical Decision Support Targeted alerts, reminders, and decision support information. Care Coordination Hospital Emergency Departments Partnerships with ED that helps identify, treat, and coordinate care of diabetic patients. Patient Engagement Partnerships with community and faith-based organizations that extend the reach of SEMBC. Telehealth Use mobile and other messaging options to identify diabetes within the SEMBC. 9

10 Beacon, HIEs, meaningful use, regional extension center, EHR incentives, PCMH (local and national definition), health homes, competing and misaligned private payer initiatives, Medicaid health plan requirements, AF4Q, EHR vendors, pharm reps, ACOs PO reps, OSCs, health system reps, PCP bump, measurement and evaluation, claims versus clinical data, university research projects, CMS demo 10

11 Example Linkage Opportunity for Alignment Use of Practice Coordinators Contracted to leverage existing experience and relationships within physician community Knowledge of federal, state and private payer initiatives and incentives Assist practices with leveraging practice work to meet multiple obligations Linkage with Regional Extension Center Linkage with EHR Incentive Program 11

12 Example Linkage Opportunity for Alignment Other Benefits Assistance with revenue cycle management and other business management issues CME Credits 12

13 Clinical Transformation: SEMBC Target Goals and Measures 1. A health 5% increase in the proportion of diabetic patients who receive standard recommended testing and examinations A 5% reduction in the proportion of non-urgent Emergency Department utilization among diabetic patients. A 5% reduction in the proportion of diabetic patients having disparity ratios for quality of care and population health measure disparities related to gender, insurer, or race. 13

14 OMG Detroit specific Measures National Programs Notes and Reference Codes SEMBCC SEMBCC BCBSM NQF SEMBCC SEMBCC MiPCT BCBSM Ref No. Ref No. PGIP Meaningful Use PCMH Ref NCQA Measure (Beacon (Beacon Clinical PGIP CMS Adult Meaningful Use PCMH Data Source Notes Baseline) Impact) Ref No. No. Ref No. No. NCQA (Beacon (Beacon Program CHIPRA Ref Measure Name (alpha order) Number GDAHC Baseline) Impact) Metrics Program CHIPRA Core 130 Day Readmission Rate x x For specific conditions 2ACE/ARB Continuation and persistence for Congestive Heart Failure (CHF) 0551 x Congestive Heart Failure (CHF) 14 3ACE/ARB for Congestive Heart Failure (CHF) x Congestive Heart Failure (CHF) 13 4ACE/ARB Use with comorbid Congestive Heart Failure (CHF) 0081; 0137 x x x Diabetes 27 5ACE/ARB Use with comorbid Hypertension x Diabetes 29 6ACE/ARB Use with comorbid Nephropathy x Diabetes 28 7Adolescents (12 19 yrs) having accessed primary care services x x Administrative Data HEDIS AWC 14 8Adolescents having had recommended immunizations / Adolescent x x x x Administrative Data HEDIS AIS/IMA; Child/Adolescent 7 6 2C, #1 9 Adult BMI / Adult Weight Screening and Follow up 0421 x x x Adult Chronic Care Obesity 8 (Core, 2B, #6 Adult females (24 64 yrs) had cervical cancer screening / Cervical cancer HEDIS CCS; Adult Preventive Care 10 screening 0032 x x x x x Administrative Data Screening; Adult Prevention 2 2C, #1 Adults with cardiovascular condition had cholesterol lscreening (LDL C) / HEDIS CMC; Congestive Heart LDL C screening for Congestive Heart Failure / LDL C screening for Failure (CHF) RETIRED (2011 PY); 11 Coronary Artery Disease (CAD) 0075 x x x Administrative Data Coronary Artery Disease (CAD) 12; 16 2C, #1 12 Antibiotics within one hour before surgery (Outpatients) 0125; 0527 x x x MCC Hospital Report 13 Antidepressant medication management 0105 x x Medication Management 31 Assessment of patient tobacco use / Percent current smokers / Record Health system EMR data (6 Adult Preventive Care Tobacco 14 smoking status for patients 13 years old or older x x x x x participants); Payer claims / (age 13 and older); Pediatric Care (Core) 2B, #8 15 Asthma Appropriate medication use 0036 x x Retired (H PY) 5 Atrial Fibrillation/Atrial Flutter: Chronic Anticoagulation Therapy for Coronary Artery Disease (CAD) 16 Coronary Artery Disease (CAD) 0241 x x (new for 2011 PY) Attitude Toward HIT Improvement Rate x Provider Interview/Survey Barrier resolution rate x Provider Interview/Survey Barriers to HIT adoption/use Identified (#) x Provider Interview/Survey Blood pressure <130/80 x Health system EMR data ( Blood pressure <140/80 x Health system EMR data ( Blood pressure <140/90 / BP control <140/ x x x x Health system EMR data (6 Adult Chronic Care Diabetes, BMI documentation < 18.5 x x x Health system EMR data ( (Core, 2B, #6 24 BMI documentation < 30.0 x x x Health system EMR data ( (Core, 2B, #6 25 BMI documentation x x x Health system EMR data ( (Core, 2B, #6 26 BMI documentation x x x Health system EMR data ( (Core, 2B, #6 27 Breast cancer screening 0031 x x x x x Administrative Data Adult Preventive Care 1 2C, #1 28 Child BMI x x x x Pediatric Care Obesity 7 8 (Core, 2B, #7 Children (15 mos) had all 6 recommended well child visits; Well child HEDIS W15; Peditric Care 29 visits in first 15 months of life x x x x Administrative Data Preventive; Child/Adolescent 9 10 Children (3 6 yrs) had at least 1 well child visit per year / Well child visits HEDIS W34; Peditric Care 30 in the third, fourth, fifth and sixth years of life x x x x Administrative Data Preventive; Child/Adolescent Children (7 11 yrs) having accessed primary care services x x x Administrative Data HEDIS CAP; Peditric Care 14 Children and adolescents (2 18 yrs) appropriate testing for throat 32 infections prior to antibiotic use 0002 x x x Administrative Data HEDIS CWP 15 Children and adolescents (3 mons 18 yrs) appropriate p use of antibiotics for upper respiratory infection (URI) / Appropriate treatment for children 33 with URI 0069 x x x Administrative Data HEDIS URI; Antibiotic Use 3 Children and adolescents (5 17 yrs) having had appropriate medication HEDIS ASM; Measure 0036 doesn't 34 use for Asthma 0036 x x Administrative Data specify age 35 Chlamydia Screening (ages 16 24) 0033 x x x x Adult Preventive Care Screening 9 2C, #1 36 Colorectal Cancer Screening 0034 x x x x Administrative Data Adult Preventive Care Screening 2C, #1 37 Controlled Blood pressure 140/90 / BP control <140/ x x x Adult Chronic Care Hypertension 5 Diabetes Combo (Percent of patients meeting three diabetic care 38 measures: HbA1c Testing, HbA1c<9.0%, and Lipid Screen) x x Administrative Data Developed by GDAHC 2C, #1 39 Disparity ratios (gender, insurer and race) for quality and population x x x Payer claims / encounter data or 16 7 (Core; 1F, #1; 2A, 40 E prescribe x x x 4 (Core) 3E 41 ED Rate: Previously Diagnosed Asthma x x Adult Chronic Care Asthma ED visits (adults) x 43 ED visits (children) x x ED visits that likely PCP treatable (adults) x x x Medicaid, Medicare Cost Utilization ED visits that likely PCP treatable (children) x 46 Eye examination within 12 months 0055 x x x Payer claims or encounter data; Follow up care for children prescribed ADHD medication 0108 x x x Medication Management Foot exam within 12 months 0056 x x x Payer claims or encounter data; FSP: Back Surgery Rate of back surgery per 1,000 member years x Administrative Data 50 HbA1c level < x x x JVHL Adult Chronic Care Diabetes 2 51 HbA1c level > x x x x JVHL Adult Chronic Care Diabetes 3 52 HbA1c tested within 12 months x Payer claims or encounter data; 1 53 HbA1c Testing of adults with diabetes / HbA1c Testing 0057 x x Administrative Data HEDIS CDC; Diabetes High tech radiology services (adults and children) x 55 High tech radiology standard cost PMPM (adults and children) x 56 HIT Misconception resolution rate x Provider Interview/Survey 27 Home Management Plan of Care document to children/caregivers while x 57 hospitalized 0338 x (Asthma x x MCC Hospital Report 8 (Menu) 3C, #3 58 Hospitalization Rate (Ambulatory Care Sensitive Conditions ACSC) x x 59 Hospitalization Rate: Previously Diagnosed Asthma x Adult Chronic Care Asthma 60 Improved HIT use rate x Provider Interview/Survey 29 Inappropriate antibiotic for adults with acute bronchitis / Avoidance of 61 antibiotic treatment in adults with acute bronchitis 0058 x x Administrative Data Antibiotic Use 4 62 INR Monthly testing for patients on Warfarin Coronary Artery Disease x Coronary Artery Disease (CAD) LDL C level of control < x x x JVHL Part of measure pair; Adult 5 64 LDL C level of control < x JVHL Part of measure pair 6 65 LDL C Screening of adults with diabetes / LDL C Screening test 0063 x x x Administrative Data HEDIS CDC; Diabetes 23 2C, #1 66 LDL C tested within 12 months x x Payer claims or encounter data; Lead Screening (Medicaid Only) x x 2C, #1 68 Lipid lowering drug rate for Coronary Artery Disease (CAD) 0074 x x Coronary Artery Disease (CAD) Lipid lowering drug rate for Diabetes x Diabetes 25 Low Back Pain: Adults (18 50 years old) having had appropriate use of 70 imaging studies for low back pain 0315 x x Administrative Data 71 Low Back Pain: Use of Imaging Studies 0052 x x x Administrative Data Low Back Pain Low tech radiology services (adults and children) x 73 Low tech radiology standard cost PMPM (adults and children) x 74 Median Time to Fibronolysis 0287 x MCC Hospital Report Medication management: Annual monitoring for patient on persistent 2B, #9; 2D, 75 medications x x x Medication Management 32 5 (Core) #4; 3D 76 Nephropathy assessment within 12 months x x Payer claims or encounter data; Nephropathy monitoring / Monitor for nephropathy 0062 x x Administrative Data HEDIS CDC; Diabetes Number of new HIT initiatives implemented x Provider Interview/Survey Outpatient physician visit prior to 30 day all cause readmission x Payer claims or encounter data Outpatient physician visit prior to 30 day readmission x Payer claims / encounter data or Outpatient physician visit within 14 days of acute care hospitalization x x Payer claims or encounter data; Outpatient physician visit within 3 days of acute care hospitalization x x Payer claims or encounter data; Outpatient physician visit within 30 days of acute care hospitalization x x Payer claims or encounter data; Outpatient physician visit within 6 months of acute care hospitalization x x Payer claims or encounter data; Outpatient physician visit within 7 days of acute care hospitalization x x Payer claims or encounter data; Outpatient standard cost PMPM (adults and children) x Participation in cardiac rehabilitation following a qualifying cardiac event Coronary Artery Disease (CAD) 87 Coronary Artery Disease (CAD) x (new for 2011 PY) Patient knowledge regarding improved self management x Navigator interview Patient experience x Navigator interview Patient knowledge regarding disease process x Navigator interview Patient no show rate x Provider reporting Perceived HIT utility improvement rate x Provider Interview/Survey Perceived norm improvement rate x Provider Interview/Survey Percent of adults having had appropriate medication use for Asthma 0036 x x Administrative Data HEDIS ASM; Measure 0036 doesn't Percent of children (2 yrs) having received all recommended childhood HEDIS CIS; Pediatric Care 95 immunizations / Childhood immunization status 0038 x x x x x x Administrative Data Preventive; Child/Adolescent 8 5 2C, #1 Percent of use of generic (non brand) medications / Generic dispense rate 96 (adults and children) x x Administrative Data 97 Persistence of beta blocker treatment after a heart attack 0071 x x Administrative Data HEDIS; Coronary Artery Disease Proportion of tobacco users advised to quit or receiving cessation therapy 0028ab; x x x x Health system EMR data ( Provider experience x Provider interview Rate of influenza vaccination in the past 12 months 0043 x x x x Payer claims or encounter data; C, #1 101 Reduce e prescribing errors x Pharmacy fill file 31 Registry with Decision Support & Performance Reporting / Implement one 102 clinical decision support rule relevant to specialty or high x x 11 (Core) 103 Risk Adjusted Acute Care Hospitalization Mean Length of Stay x Care/caid claims data Data source may change to Risk Adjusted Mean Annual costs Across Treatment Episode x n/a Measure dropped, unable to Risk Adjusted non urgent/avoidable Emergency Department Utilization x Care/caid claims data MEASURE DROPPED, replaced 27 Statin Therapy for Persons with Cardiovascular Conditions having filled a Developed by MQIC; Coronary 106 statin prescription for cholesterol management / Statin Use x x Administrative Data Artery Disease (CAD) Retired 18 Statin Therapy for Persons with Diabetes: Percent of adults with diabetes (50 75 yrs) having filled a statin perscription for cholesterol management / Developed by MQIC; Diabetes, 107 Statin Use x x Administrative Data Retired (2101 PY) Successful HIT use implementation rate x Provider Interview/Survey Technical assistance success rate x Program monitoring data Urinary catheter removed 1st or 2nd day post surgery 0453 x x x MCC Hospital Report 111 Use of spirometry testing in the assessment and diagnosis of COPD x Chronic Obstructive Pulmonary 11 14

15 Example Linkage Opportunity for Alignment Alignment of Measurement and Evaluation There s too much noise around measurement activities RWJF AF4Q GDAHC linkage with Beacon North Star Initiative NQF, GDAHC, Beacon June discovery meeting Longer term PCMH and other incentive programs through payers 15

16 A Reluctant Leader and an idea for the future I m coming off of the best two years I ve had (financially.) My office is more efficient and workload more manageable. And, I m providing better care to my patients. Primary Care Practitioner, Southeast Michigan 16

17 Challenges Ahead in Detroit The city has lost 67 percent of its primary care physicians since the mid 1990s. Close to ½ of Michigan s active physician work force will reach retirement age within the next 10 to 15 years Detroit s PCPs are generally older thanthethe Stateaverage average. From The Detroit News: healthcrisis Family doc shortage#ixzz1a1w5dp4c 17

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19 1 of the 3 SEMBC BHAGs A vibrant provider community (with an emphasis on PCPs): Physicians desire to practice here, given advancements in physician and patient care supports toward clinical integration. Support includes technology that exceeds expectations around ease of use, functionality and tools that support optimal patient care. Payment reform recognizes and supports this clinical integration and transformation. Employers want to re/locate in the region because of advancements in clinical care integration, optimal provision of healthcare, and the ability of the region to bend the cost curve. 19

20 Contact Information: Terrisca Des Jardins Southeast Michigan Beacon Community (313) website: 20