maine health data organization board of directors retreat barbara sorondo, md mba director emmc...

Maine Health Data OrganizationBoard of Directors Retreat

Barbara Sorondo, MD MBA

Director EMMC Clinical Research Center

June 5, 2014

Together We’re Stronger

Outline

1. Purpose1. Describe recent projects that utilized multiple data sources

2. Describe some limitations of the access of the data

2. Examples1. Bangor Beacon Community

2. High Value Healthcare Collaborative


Bangor Beacon Community –ONC Grant

1. Objectives: Triple Aim

2. Data sources: EHR, HIN, Patient Reported

3. Limitations: Lack of time sensitive claims data,

Lack of patient crosswalk

Inability to identify the financial impact of the Interventions

4. Solutions Prospective Cohort

Using HIN to identify the utilization

5. Results Improve Quality,

Reduce Utilization,

Improve Patient Experience


Bangor Beacon Community

1. Evaluation of the Care Management Model on High Risk High Cost Chronic Condition Patients

2. Evaluation of a Multi-institutional Regional Collaboration for Quality Improvement for Patients with Chronic Conditions

Bangor Community

Bangor Beacon Chronic Conditio

n Patients

Bangor Beacon

High Risk/High

Cost Patients

2

1


Healthcare Goals

• Quality: Better Care

• Cost: Affordable Care

• Experience: Improved

Experience of Care

5

• Clinical and Preventive Measures (EHR)

• Healthcare Utilization (HIN)

• Patient Reported Measures

Outcomes

1. Evaluation of the Care Management Model on High Risk High Cost Chronic

Condition Patients



Visit 1

(Enrollment day)

Visit 2

(six months

after enrollment)

Visit 3

(12 months after

enrollment)

Visit 4

(18 months after

enrollment)

Informed consent form X Patient Demographics X Past Medical History X Vital Signs X X X XDisease-Specific Tests or Management (HbA1C, LDL, as applicable)

X X X X

Health care utilization/cost related outcomes --past 30 and 180 days(Visit 1); past 180 days (Visit 2, 3, 4)

X X X X

Immunization compliance X X X X

PHQ-2 Depression question X XMedication adherence (Modified Morisky Scale (MMS)) X X X X

Chronic Disease Self-efficacy Scale (CDSES) 6 item X X X X

EQ-5D Quality of Life Survey X X X XPatient satisfaction and perception of care (adapted CAHPS survey with addition of a chronic care module (Visit 1 and 4) and a care manager module (Visit 4)

X X

Intervention GroupPatients from BBC primary care practices

Control GroupPatients from:

Non BBC primary care practicesSpecialty care practicesNo PCP

5



Results -- Healthcare Utilization _ ED visits


2. Evaluation of a Multi-institutional Regional Collaboration for Quality Improvement for Patients with Chronic Conditions

• Consensus on metrics and target goals

• Centralization of data abstraction and reporting

• Transparently sharing information and best practices

• Practice of Plan, Do, Study, Act (PDSA) approach.

8


9

Performance Improvement Intervention Process

Bangor

Beacon

Community

Healthcare

Systems

Primary Care Practi

ces

Primary Care Provid

ers

Care Manag

ers

Bangor Beacon Community Measures Progress Meets BBC Criteria

Does not meet any criteria

NCQA BBC

Num Den Pct Num Den Pct Num Den Pct Num Den Pct Num Den Pct Num Den Pct GOALS GOALS

HbA1C <7 2682 5406 50% 2285 4527 50% 2217 4460 50% 2197 4227 52% 2551 4821 53% 2627 5044 52% >40% >55%HbA1C <8

3955 5406 73% 3289 4527 73% 3221 4460 72% 3163 4227 75% 3610 4821 75% 3761 5044 75%>60%

≥65%*>70%

HbA1C >9 829 5406 15% 784 4527 17% 733 4460 16% 573 4200 14% 802 4821 17% 884 5044 18% <15% <10%*(new) HbA1C >9 who had an A1C tested within 365

484 4821 10% 519 5044 10% <10%

LDL ≥1301280 5406 24% 1174 4283 27% 972 4460 22% 1043 4227 25% 1293 4821 27% 1276 5044 25%

<37%≤35%*

<25%

LDL <1003028 5406 56% 2738 4527 60% 2634 4460 59% 2624 4227 62% 2931 4821 61% 2940 5044 58%

>36%≥50%*

>55%

BP ≥140/90 1046 5406 19% 891 4527 20% 809 4460 18% 737 4227 17% 1147 4821 24% 1210 5044 24% <35% <15%BP <130/80 2651 5406 49% 2671 4527 59% 2644 4460 59% 3035 4227 72% 2170 4821 45% 2275 5044 45% >25% >50%

Tobacco free 3959 5406 73% 3462 4527 76% 3457 4460 78% 3086 4227 73% 3741 4821 78% 3946 5044 78% >80%DM Bundle (BBC Modified) 678 5406 13% 891 4527 20% 885 4460 20% 575 4821 12% 591 5044 12% >20%

HbA1C tested within 12 months

5127 5406 95% 4172 4527 92% 4186 4460 94% 3931 4227 93% 4503 4821 93% 4679 5044 93% >95%

BP recorded prev 365 days 5339 5406 99% 4472 4527 99% 4450 4460 100% 4197 4227 99% 4799 4821 100% 5025 5044 100% >98%Foot examination

3999 5406 74% 3406 4527 75% 3501 4460 78% 3150 3969 79% 3316 4180 79% 3891 5044 77%>80%

≥85%*>80%

Retinal eye exam 3161 5406 58% 2892 4527 64% 2861 4460 64% 2894 4227 68% 3373 4821 70% 3466 5044 69% >60% >60%Smoking status documented

4711 5406 87% 4441 4527 98% 4450 4460 100% 4219 4227 100% 3763 3847 98% 4052 4107 99% >80% >99%

Tobacco free OR smoking cessation advice given

4220 4527 93% 4223 4460 95% 3713 4227 88% 4539 4821 94% 4791 5044 95% >95%

BMI Assessed 4770 5406 88% 4142 4527 91% 4178 4460 94% 3942 4227 93% 4641 4821 96% 4895 5044 97% >80% >85%Depression screening (PHQ-2) within last 365 days 3193 5406 59% 2779 4527 61% 2908 4460 65% 2573 3634 71% 2434 3201 76% 2570 3352 77% >20% >80%

Influenza vaccine (> 18 yo) within the previous 365 days 2897 5485 53% 2797 4527 62% 2928 4460 66% 3137 4821 65% 3267 5044 65% >80%

2011-2012 Influenza (8/16/2011-8/15/2012)

3110 4821 65% 3259 5044 65% >80%

2012-2013 Influenza (8/16/2012-8/15/2013)

>80%

Pneumovax (> 18 yo) 3617 4527 80% 3667 4460 82% 3542 4227 84% 4143 4821 86% 4340 5044 86% >80%

DM BUNDLEHbA1C tested within 12 months HbA1C <8 LDL <100 BP recorded prev 365 days BP <130/80Tobacco s tatus documented Tobacco free OR smoking cessation advice given Pneumovax Infl uenza vaccine 11/2/2012

Meets NCQA Criteria. Where no NCQA criteria exists, interim goal is 10% below BBC Goal

February 2011Q1

May 2011Q2DM Metrics

BaselineSeptember 2010

July 2011Q3

February 2012Q1

April 2012Q2

Provider’s Comparison by Healthcare Organization

11

Provid

er 1 (1

)

Provid

er 2 (2

)

Provid

er 3 (9

)

Provid

er 4 (5

2)

Provid

er 5 (7

)

Steele

(9)

Provid

er 7 (6

5)

Raczek

(4)

Provid

er 8 (4

1)

Provid

er 9 (9

)

Provid

er 10 (9

)

Provid

er 11 (1

45)

Provid

er 12 (7

6)

Provid

er 13 (4

3)

Provid

er 14 (5

3)

Provid

er 15 (1

14)

Provid

er 16 (3

0)

Provid

er 17 (2

1)

Provid

er 18 (7

5)

Provid

er 19 (3

8)

Provid

er 20 (2

8)

Provid

er 21 (6

2)

Provid

er 22 (1

13)

Provid

er 23 (6

0)

Provid

er 24 (5

2)

Provid

er 25 (4

6)

Provid

er 26 (1

4)

Provid

er 27 (7

)

Provid

er 28 (3

7)

Provid

er 29 (8

6)

Provid

er 30 (2

4)

Provid

er 31 (1

69)

Provid

er 32 (1

65)

Provid

er 33 (3

1)

Provid

er 34 (5

6)

Provid

er 35 (6

1)

Provid

er 36 (2

5)

Provid

er 37 (1

16)

Provid

er 38 (4

4)

Provid

er 39 (7

5)

Provid

er 40 (9

2)

Provid

er 41 (7

)

Provid

er 42 (6

)0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%100%

75%

67%

50%

43%

33%28%

25%24% 22%21% 21% 21%20%19%19%18% 18%17% 15% 14%14% 13%13%11%11%10% 9% 8% 8% 7% 7% 7% 5%0% 0%

BB Diabetes HGBA1C greater than 9 (Target <=10%)

Reports

Interventions

12

Indicator

Jan-Mar

Q1FEB

Apr-Jun

Q2MAY

Jul-Sep

Q3JULY

Oct-Dec

Q4OCT

Interim Goal

(NCQA)BBC Goal

% 9% 16% 15% 17% 12% <=15% <10% Q1

N 231 305 278 315 231 Q2

OFM - 1)review patient list. How many have been in the practice over one year. Give Providers a list of patient s over 12months to review for plan.2) consider Nurse care management consult.HFM - Attempt to have every patient w ith A1C>9 to be enrolled w ith nurse care manager Kathleen Bates RN for regular contact and relaying of recorded glucose levels, for medication adjustment. See patients every 1-3 months. Refer for

D 2,529 1,910 1,905 1,846 1,855 Q3

CFM - This remains our priority improvement target for Diabetes. We w ill continue to review these patients and encourage care management involvement. Providers receive monthly reports on their patients w ith diabetes. OFM - 1) Review list to identify patients w ho have not been in in over 4 months. 2) Process change to have MAs w ork w ith providersFMB - new pts, case mgt, education and Lab done in off ice if non compliantHFM - Continue to have nurse care manager give focused

Q4

OFM - Check patients w ho haven't been seen in 3 months, call patients and set up f/u apps w /providers then get labs to check level. Go from there once you know the result

Sept-Oct 2010

Baseline 90 day Action PlansHbA1C greater than 9


Performance Improvement InterventionSuccessful Interventions

• Work flow: MA driven protocols including:– depression screening,– preparation of patients for foot

examination, – LDL audits

• EHR: New and revised forms, clinical protocols, alert systems and decision support tools

• Data auditing• Point of care testing

– Hb A1c

13


Performance Improvement Intervention

Results: Improvement in Quality

14

From September 2010 to January 2013

1. Metrics reaching interim or BBC goals:

68% 82%

2. Metrics improved:

DM metrics: 13/19 (68%)

CVD metrics: 10/12 (83%)

COPD metrics: 6/7 (86%)

Asthma metrics: 6/6 (100%)

Limitation: No cost or savings associated to the interventions, lack of patient crosswalk


“Engaging Patients to Meet the Triple Aim”. CMMI, 2012


“Triple Aim +” by John Wennberg , MD

1. Improve Quality

2. Reduce Cost

3. Improve Patient Experience

4. Improve Providers Experience


High Value Healthcare Collaborative

Patient level

Clinic level

Hospital level

HVHC

Claims Data

Clinical Data

Patient Reported Measures

Patient Crosswalk1. Benchmarking toidentify best practices

2. Address clinical project team questions

3. Measure impact ofInterventions

4. Inform Patient Care


HVHC Project Overview - Goals Sepsis Heart Failure Hip & Knee

Improve Care

1. Improve adherence to sepsis bundled care by 5%

1. >50% eligible patients referred to Shared Decision Making (SDM) and 2. >50% of referred patients/families participate in SDM interventions3. Improve Patient Experience

Improve Health

1. Reduce the burden of chronic morbidity from sepsis-associated chronic organ dysfunction

Reduce emergency department rates and hospitalizations by 10%

Improve health status measures (function, pain) for >50% of patients considering hip and knee surgery at one year.

Metrics used will include: Hip disability and Osteoarthritis Outcome Score (HOOS) , Knee injury and Osteoarthritis Outcome Score (KOOS); Harris Hip Score (HHS) and Knee Society Score (KSS)

Reduce Cost Achieve a 5% (relative rate) reduction over three years in the number of patients with sepsis requiring long term acute care or sub-acute nursing care after an incident episode of severe sepsis.

Reduce cost of annual episodes by 2% for complex patients with CHF

Reduce rates of surgeries (hip, knee) and episode utilization resulting in 5% total cost reduction.


High Value Healthcare Collaborative

• Objectives: Triple Aim

• Data Sources: EHR, patient reported measures,

claims data

• Limitations: Data Standardization

• Preliminary results: Improvement in patient experience, Improvement in quality, reduction of

Medicare payment


Barbara Sorondo, MD [email protected]

maine health data organization board of directors retreat barbara sorondo, md mba director emmc...

Documents

care management model

chronic care module

perception of care

better care cost

affordable care experience

improved experience

care manager module

applicable xxxxhealth