A Report from the AllianceClinical Practice Improvement

NetworkJanuary 30, 2013

Today

Briefly review highlights from the Alliance’s 2012 Community Checkup

Share results from the Alliance’s 2012 Medical Group Survey

Presenting: • Susie Dade, Puget Sound Health Alliance

Commentary: • Peter McGough, MD, Chief Medical Officer,

UW Neighborhood Clinics• Scott Kronlund, MD Chief Medical Officer,

Northwest Physicians Network2

Community Checkup 2012: Ambulatory Highlights Sixth Community Checkup Includes results for:

• 81 medical groups with 4 or more clinicians in more than 300 locations

• Claims covering 2 million lives• Measurement year: July 2010 - June 2011

30+ performance measures New: Generics reporting @ individual provider

level New: Generic anti-hypertensives measure Medicaid data back in! Comparison of results over time

www.WAcommunitycheckup.org 3

Data Suppliers Aetna The Boeing Company Carpenters’ Trust CIGNA City of Seattle Community Health Plan of

Washington First Choice Group Health King County Molina Healthcare of

Washington Premera Blue Cross

Recreational Equipment Inc. (REI)

Regence Blue Shield Sound Health and Wellness

Trust Snohomish County UnitedHealthcare Washington State Health Care

Authority – Public Employees Washington State Health Care

Authority – Medicaid Washington Teamsters

Welfare Trust

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Alliance’s data repository includes approximately 2 million covered lives!

Alliance Vision

Physicians, other providers and hospitals will achieve top 10% performance in the

nation in the delivery of equitable, high quality,

evidence-based care and in the reduction of unwarranted variation, resulting in a significant reduction in the rate of medical cost trend.

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Progress in Achieving Top 10% PerformanceAt or Above NCQA 90th Percentile, CommercialScreening for Colon Cancer** (but still only at 61%)Screening for Cervical CancerAntidepressant Medication Adherence (12 weeks)Diabetes – HbA1c TestingDiabetes – Kidney Disease ScreeningAvoidance of Antibiotics for the Common ColdAvoidance of Imaging for Low Back PainUse of Spirometry – COPD

**Measures the newly eligible

2012 Community Checkup Results

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Progress in Achieving Top 10% PerformanceBelow NCQA 90th Percentile, CommercialAntidepressant Medication Adherence (6 months)Diabetes – Cholesterol TestingHeart Disease – Cholesterol TestingHeart Disease – Use of Beta BlockersAvoidance of Antibiotics for BronchitisAppropriate Use of Medication – Asthma

Way Below NCQA 90th Percentile, CommercialAdolescent Well Child VisitsScreening for Chlamydia

2012 Community Checkup Results

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Prevention

2012 Community Checkup Results

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Opportunity!

Appropriate Use of Care

2012 Community Checkup Results

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Opportunity

!

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There is still a lot of variation among medical

groups.

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Generics Prescribing: StatinsTremendous variation within medical groups

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Bottom Line . . .

Significant variation persists in our region Some medical groups perform among the best in the

nation on some measures; others have significant room for improvement

No one medical group excels at everything, so opportunities for all to learn

While Medicaid results are generally lower, some clinics do as well as high performing clinics in commercial population

Low rates translate into thousands of people not getting the right care or having a good experience

“…the gap between what we know works and what is actually done is substantial enough to warrant

attention. These deficits, which pose serious threats to the health and well-being of the U.S. public, persist despite initiatives …” Elizabeth

McGlynn, NEJM, 200312

To see detailed Community Checkup results, go to:

www.WAcommunitycheckup.org

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Comments from Drs. McGough and Kronlund

Adoption of Processes and Tools to Advance Effective Patient Care

 Medical Group Survey ResultsOctober 2012

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Background and Purpose of the Survey Collect and share information that describes

whether or not activities and tools are being implemented in the practice setting

• Survey developed with physician guidance• Focuses on activities and tools that have been

shown to positively impact performance and support the delivery of evidence-based care

Provide community-wide scan of progress being made (compared results to 2010)

Share results to (1) provide broad view of overall clinic management and care coordination, and (2) identify opportunities for improvement

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Survey Overview Sent to 53 Medical groups • 5-county region, included in Community Checkup

42 respondents, up from 33 in 2010 (62% response rate to 79%)• 32 medical groups with multiple locations• 10 individual clinics• 7 medical groups declined to respond• 4 medical groups declined to participate

Survey assessed practice activity in several domains:• Understanding Healthcare Disparities• Access and Communication• Chronic Conditions Management• Care Coordination• Data Management• Improving Quality and Patient Experience

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Access and Communication

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Access and Communication

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High Level Results for the Region

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Management of Chronic Conditions

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BIG Opportunity !

Management of Chronic Conditions

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Management of Chronic Conditions

Use of Patient

Reminders

Point of Care Computer

Prompt Reminder

Send Postcards/ Letters by

Mail

Outbound Calls to Patients for

Specific Reminders

Secure Email Contact for

Specific Reminders

Yes, in All Clinics

62% 52% 62% 19%

Yes, in Some Clinics

19% 31% 29% 12%

Not Used 19% 17% 9% 69%

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Processes to Educate Patients

with Chronic Health Conditions

Schedule Longer Visits for

Counseling and Education

Proactively Call Patients to Check

and Counsel

Proactively Email or

Write to Patients

Yes, in All Clinics 48% 29% 17%Yes, in Some Clinics 31% 33% 36%

Not used 21% 38% 47%

Care Coordination

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Care Coordination

Patient Reminders

for Preventive

Services

Breast Cancer

Screening

Colorectal Cancer

Screening

Cervical Cancer

Screening

Flu Vaccine

Pneum.

Vaccination

Well Child Visit

Yes 90% 71% 79% 81% 67% 81%No 10% 29% 21% 19% 33% 19%

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Process to Ensure Medication Reconciliation

Response

Yes, at each visit, all clinics 74%Yes, at each visit, some clinics 9%No process in place 17%

Use of EHRs to Manage and Improve Care

Not surprisingly, EHR adoption is improving in the region and the number of capabilities being used is increasing compared to 2010 (55% to 69%)

Strengths:Patient appointment schedulingClinical documentation of each visitDocumentation of current medical listLab results reporting

Moderate Improvement:Complete, standardized problem listsRX ordering w/ability to highlight drug interactions/correct dosingLab/radiology order entryAlerts re: abnormal values

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Uses Lagging Behind:Point-of-care clinician alerts based on evidenceDecision support tools (easy access to clinical guidelines or protocols)EHR-linked patient registriesAccess to clinical documentation from ED and inpatient staysSecure patient portal

• On line appointment scheduling• Patient reminders for needed tests or follow-up care• Secure email• Access to clinical information

(e.g.,lab/radiology/biometric results, medication lists and ordering, visit summaries, immunization records)

Use of EHRs to Manage and Improve Care

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Community Progress – High Performers

Implemented majority of tools and resources:• Group Health Cooperative• The Everett Clinic• Virginia Mason

Implemented or in the process of implementing majority of tools and resources:• MultiCare Medical Associates• Pacific Medical Centers• Swedish Medical Group• UW Medicine Neighborhood Clinics

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What’s Ahead?

2013 Community Checkup

• Beginning statewide-expansion, starting at county level first

Fielding 2nd Ambulatory Patient Experience Survey Updated “Resource Use Report” on Common

Hospitalizations, to include utilization/service intensity, quality and pricing

Potentially Avoidable ED Visits by Hospital & Medical Group

30-day All Cause Readmissions without an MD Visit

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For more information:

Susie Dade

Deputy Director

Puget Sound Health Alliance

sdade@pugetsoundhealthalliance.org

Please visit our new website:

www.wacommunitycheckup.org

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Comments from Drs. McGough and Kronlund

Questions?