dr. robert gabbay: "improving care & success in diabetes" at the 2014 diabetesmine...

IMPROVING CARE AND ACCESS

Getting the Care You Want Wherever You

Are!

Robert A. Gabbay, MD, PhD, FACP

Chief Medical Officer & Senior Vice President

Joslin Diabetes Center

Harvard Medical School

HOW DO WE IMPROVE CARE

Current Model- Episodic- Acute Care

System

Primary Care evolving to Patient Centered

medical home

Center of Excellence-How to extend reach

The First Step to Improve Quality

HOW ARE WE DOING IN THE US?

Only 19% of diabetes patients in the US

are currently at goal for ABCs

It’s not because of bad care providers or

bad patients

IT IS THE SYSTEM

Acute Care vs. Chronic Care

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THIS IS NOT A NEW IDEA?

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Joslin Clinical Quality Measures

Outcome Quality MeasureADA

BenchmarkJoslin

% A1c <9.0% >79% 84%

% LDL <130 >63% 89%

% LDL <100 >45% 71%*

% BP <140/80 >50% 64%*

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* = HEDIS 90th

Percentile Goal

Achieved

NOTE: Not all ADA measures

have associated HEDIS measures.EYE CARE

Best Corrected VA, median (Q1, Q3)*

20/20 (20/16,20/25)

Change in BCVA, mean (SD)*† - 0.5 letters

20/20 or better (N) 72% (10,535)

20/40 or better (N) 92% (13,414)

20/200 or worse (N) 1% (153)

SOUNDS GREAT BUT I DON’T LIVE

IN

Exporting Our Care- A Joslin Tradition

Wandering Nurses

– Nurses that instructed the community to

instruct people with diabetes about the use of

insulin and management of the disease

Now known as Certified Diabetes

Educators

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Centers of Excellence Concept

Organize into integrated practice units (IPUs) or Centers Excellence

Measure outcomes and costs for every patient

Move to bundled payments for care cycles

Integrate care delivery across separate facilitates

Expand excellent services across geography

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The Strategy That Will Fix Healthcare, Michael Porter, Thomas Lee – Harvard Business Review 2013

Expanding Access to the Best Care

Replicate Centers of Excellence

Spread Exemplar Models of Care

Guiding local providers

Virtual visits

ACCELERATING DIFFUSION

SPREADING BEST PRACTICES

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Accelerating the Diffusion of High Value Care Delivery Innovation

Create diffusion innovation collaboratives

– Sharing between early and late adopters

Rapid evaluation systems with the

understanding of how to customize local

circumstances

Known care delivery innovations can lower

healthcare costs 20-35%

Learning Health Networks (IOM)

Berwick JAMA 2003

Joslin Affiliates as an

Innovation Collaborative and Learning

Health System Network

Continuously innovate

Share data to identify positive deviants

Disseminate best practices

Move towards transparency

The Patient-Centered Medical Home

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PCMH Without a Neighborhood

What does a Good Neighbor

Look Like?

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Redefining the Role of the Specialists

Leveraging Expertise

Itinerant Embedded Specialists

Project Echo- knowledge multiplier

Tele-screen (i.e. Retinal Camera)

Population management

eConsults

Teleconsult and Virtual Visits

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WHAT ARE WE DOING NOW

20 Affiliates Nationally

International Activities

Educating all types of providers

Expanding reach digitally

– virtual visits, apps

CAN WE ADVOCATE REFERRALS TO

CENTER OF EXCELLENCE

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What's the biggest impact change?

REIMBURSE FOR NON-FACE TO

FACE CARE