1 new york ckd coalition enhancing ckd system changes through collaboration in new york state...
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NEW YORK CKD COALITION
Enhancing CKD System Changes through Collaboration in New York State
November 2008
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IPRO
Medicare Quality Improvement Organization for New York State (NYS).
End Stage Renal Disease Network for NYS (ESRD Network 2).
One of the 10 states awarded the CMS 9th SoW Chronic Kidney Disease (CKD) Project – Theme 7.3.
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Background
9th leading cause of death
in the U.S.
For each patient who does not progress to
dialysis, Medicare saves $250,000.
New York ranks 4th in the
incidence of CKD
Screening rates for patients with
known risk factors for CKD are as low as
20%. Currently 42% in NYS.
Nearly 26 million American have CKD, with 1.2 million
in NYS estimated additional 20 million undiagnosed
CKD beneficiaries are living with CKD and don’t know it.
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Background
Screening rates for patients with known risk factors for CKD are as low as 20%. NYS currently at 42%.
Hypertensive diabetics, treated with ACEs, the progression of CKD can be slowed.
The fistula rate for NYS is 55.3%. The Fistula First Breakthrough Initiative (FFBI) goals are to increase the rate to 55% (already achieved) by 3/31/09 and 66% by 6/30/09.
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Mission Statement
Encourage the early identification and treatment of CKD and minimize and/or
prevent the onset of ESRD in
New York State.
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CMS CKD Quality Improvement Goals
Early detection and decrease the progression of CKD. Improve statewide rate timely testing for diabetes – annual micro
albumin testing.
Improve statewide rate of prescribing ACE/ARBs – slowing progression – hypertensive individuals with diabetes.
PQRI companion measure.
Key collaboration with NYS-CKD Task Force for system changes at state and local level.Improvement of Fistula placement rate at onset of hemodialysis.
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Why Support IPRO’s CMS NYS Collaborative???
NYS CKD Quality Improvement Opportunity
Medicare Cost - CKD
Medicare Savings - CKD
NYS-CKD IMPACT
Increasing incidence
affecting elderly and disparity populations
with high correlation to
DM & HTN conditions with escalating cost.
Improve Quality of Care for Medicare
Beneficiaries through CKD
Project for New York State
Cost to Medicare of
managing CKD is high.
Medicare beneficiaries
with CKD account for
16.5% costs in the year the disease is identified
Savings to Medicare for each patient
who does not progress to dialysis is
estimated at $250,000
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New York State Impact 1.2 Million (est.) New Yorkers affected by CKD.
CDC reports a 116% increase in CKD in NYS over the past decade.
NYS 4th highest state at $2.9 billion.
13.1% of NYSCKD patients are 65 or older.
43% of hospitalized CKD patients are diabetics.
Diabetic CKD prevalence rate increasing from 6.2% to 7.6% (2000-2006) in NYS.
African-American and Hispanic-Americans have higher rates of CKD.
African Americans represent 17.4% of NYS population, yet were 40.3% of prevalent CKD cases in 2006.
7,300 New Yorkers will advance to ESRD annually.
Primary Causes of ESRD
Diabetes 40.5%
Hypertension 24%
23,000 New Yorkers suffer from ESRD with almost 5,000 deaths annually.
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Challenges
PCP Support- Time Allocation, Recruitment and Education
Perceived high rate of prescribing of ACE/ARBs for Medicare Beneficiaries
Graft Surgery is better reimbursed than AVF
Physicians creating more AVF get lower income due to lower intervention needs
Uninsured ESRD Patient waits for 3 months to qualify for Medicare
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Strategy
Prescription review with PCP recommendations.
Continuum of care model for improved communication among PCPs, specialists and patients.Adoption of processes that target CKD patients for community outreach to implement a chronic care model.
Support CKD Screening.CKD Education outreach.
Support renal community communication of CKD.
Pharmacy Model
Increased public awareness and professional education of CKD management.Advocate and promote policy and system level changes affecting CKD.
Community Outreach/ Community Health Centers
CKD CoalitionIdentification of priorities at the system level and development of recommendations that can be implemented in all settings.
Prescription of ACE/ARBs for diabetic patients.Annual micro-albumin testing.
Physicians
Support EHR where appropriate.
Pharmacy school clinical education extension process.
Referral of patients to nephrologists for fistula counseling where appropriate.Support PCP CKD education.
University Model
Support EHR where appropriate.
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Goal: System-level Change
Considered a change in:
● Practice
● Policy, or
● Procedure
Results in sustained improvement
Influenced by activities
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High Functioning Coalition
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Goals for IPRO’s NYS-CKD CoalitionAssist in increasing adoption of evidence-based practice standards.
Promote community awareness through education.
Support and promote IPRO’s efforts to effect system level improvement.
Collaboration of Membership for NYS CKD
● Task force to drive public awareness of CKD
● Promote evidence based Chronic Care Model
● Collaboration with other interested entities in the care and treatment of renal disease
● Promote community screening, e.g. NKF KEEP Program
● Support efforts of the ESRD Network, e.g. Fistula First
● PCP education
● Participation in CKD workgroups to affect system level changes
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Mission of NYS CKD Coalition
To combine the efforts and resources of members and encourage prevention, early detection and appropriate ongoing treatment of CKD;
To communicate Kidney Disease Outcomes Quality Initiative (K/DOQI) standards of care to health care providers, annual micro-albumin test, prescribing ACEs or ARBs, referring patients to nephrologists, and encouraging AV fistula placement and maturation.
Communication and support of American Diabetes Association Standards of Medical Care in Diabetes –2008.
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Blueprint for Action
A shared vision.
A set of common principles, strategies, and actions for achieving goals.
A broad, collaborative and transparent process led by and involving diverse stakeholders.
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Blueprint for Action
Key focus areas Outreach and education Care delivery System-level changes Resources
The Blueprint is not the end, but the beginning.
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NYS CKD Coalition – Action Steps
Promote and support early screening for CKD through existing programs, e.g. NKF KEEP. Communicate and educate care community- ADA Standards of Medical Care in Diabetes –2008 .Promote and support chronic care model for CKD. Promote and support continuum of care communication (University Model) where applicable. Promote and support PCP model. Promote and support pharmacy model of ACE/ARB improvement.Promote and support EHR where appropriate.
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NYS CKD Action StepsTo encourage and facilitate dialogue to: increase understanding and action of community health
priorities (specifically CKD & ESRD)
facilitate removal of barriers to improving the health status of the community;
To disseminate provider and patient educational materials for achieving the CKD coalition objectives.
Support existing activities in the CKD community, e.g. NKF KEEP, North Shore University CKD Program.
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NYS CKD Action Steps
To share knowledge and best practices with other organizations to better serve their populations.
Ultimately, the coalition’s combined disciplines, strengths and resources will educate, motivate,
and improve outcomes for Medicare beneficiaries and other healthcare consumers.
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NYS CKD Coalition MembershipBroad-based membership with representation from providers, patients, regulators, educators, community health care organizations and the renal communities.
Leadership & Coordination
NYS CKD Task Force
IPRO-CKD Coalition
Meetings
Regular teleconferences monthly
Face-to-face twice per year
Regular workgroup interaction
No fees or membership dues
Voluntary, not mandatory
Shared incentives and commitment to a working consensus model
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Proposed IPRO-CKD Proposed IPRO-CKD Coalition MembersCoalition Members
Albany College of Pharmacy & Health Sciences
Albany County DOH
Albany Dialysis Center
Albany Medical College
Albany Memorial Hospital- Laboratory Director
American Access Care
American College of Clinical Pharmacy – NY Chapter
American Diabetes Association-the Diabetes Resource Coalition
American Nephrology Nurses Association- NY Chapter
Blue Cross/Blue Shield of NY
Catholic Charities-Terrance Cardinal Cooke Center
Columbia University College of Physicians & Surgeons-Internal Medicine Residency Program
Columbia University Nephrology Division
Counsel of Renal Social Workers
ESRD Network 2
ESRD Network 2 Fistula First Steering Committee
Feed the Soul Nutrition
Greater Brooklyn Health Coalition & CAMBA
Glen Falls Hospital dialysis Unit
IPRO C. Bradley, MD
IPRO Consumer Health Collaborative
Dr. Kessel, Montifore Medical Center
Lani Jones, Albany EDU
National Association of Nephrology Technicians
National Kidney Foundation- Dr. Joseph Vassalotti
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Proposed IPRO-CKD Coalition Members (continued)
National Kidney Foundation Kidney Early Evolution Program
National Kidney Foundation NY Chapters
National Kidney Foundation of NE NY
National Kidney Foundation of Central NY
Nephrology Associates of Syracuse
NY Chapter of the American Society of Consultant Pharmacists
The New York State Council of Health-system Pharmacists
New York Diabetes Coalition
North Shore LIJ Health System - Janet & John Raggio Nephrology Institute
NYS CKD Task Force
NYS DOH Diabetes Prevention and control Program.
NYS clinical Laboratory Association
NYS Senate Health Committee
NYSDOH Clinical Chemistry & Hematology Laboratory Wadsworth Ctr.
NYSDOH Heart Health Program
Olean General Hospital
Quentin Medical Labs
Renal Support Network
Counsel of Renal Nutrition – Long Island Chapter
State University of NY-Eli Friedman, MD
University of Buffalo Jefferson Family Medicine. Chester Fox, MD
University of Buffalo, School of Pharmacy
Wegman’s School of Pharmacy
Chain of Pharmacy Association of NYS
Touro College of Pharmacy
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NYS CKD Coalition Structure
N Y S R e g u la to rs & N Y S L e g is la t ive
N Y S D O H B u re a u o f C h ro n icD ise a se S e rv ices
N Y S D O H D iab e te s P re se na tio n &C o n tro l P ro g ram
NYS CKD Task Force
M a rke tin g & C o m m u n ica tio nsW o rkg ro up
S ys tem Le ve l C h an g esW o rkg ro up
C lin ica l P ra c tice W o rkg ro up C o m m u n ity E du c a tio n W o rkg ro up
S e c re ta ry
V ice C h a ir
Chair
O th er In te res te d P art ies
R e n a l C o m m u n ity
P h a rm a cy P ro g ram
U n ive rs ity P ro g ram
P C P P ro g ram
C lin ica l C h a m p io ns
IPRO CKD CQ I Project
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Workgroup Functions
Marketing & Communications Workgroup
System level changes Workgroup
Clinical Practice Workgroup
Community Education Workgroup
Develop/identify audience appropriate message
Identify change opportunities for coalition and their implementation
Promote adoption of K/DOQI clinical guidelines with PCP Practices
Create a listing of beneficiary education materials
Interact with other groups to define target audiences for out reach and distribution of coalition products and marketing packets
Options for achieving change Promote positive clinical treatment patterns and best practice through peer-to-peer contact, education and training
Evaluate materials using Clinical Champions
Develop directory of New York State nephrologists
Analyze options for change and there feasibility
Promote ADA care guidelines Develop / adopt core messages for patients
Coordinate speakers bureau and assist with other marketing activities
Outline implementation steps for recommended changes
Promotion of Continuum of Care-Chronic Care Model (University Model)
Develop dissemination plan for community education
PCP recruitment Develop statewide policy & regulatory improvement
Promotion of Pharmacy Model Develop dissemination plan for provider education
Develop data for CKD and its impact in NYS
Support CKD research
Distribute CMS-CQI results for NYS and national benchmarks
Support CKD patients needs and activities
Develop list of provider participants.
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Next StepsNext Steps
Organizational meeting ____________, 2008 – Teleconference Facilitated by IPRO
● IPRO’s role
● Coalition structure
● Volunteer workgroup established
● Meeting dates
● Blueprint for Action
● Next meeting
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For more information, contact
Corporate Headquarters: 1979 Marcus Avenue, Lake Success, NY 11042 ● www.ipro.org
William F. Brezsnyak, MHSAProject Director(516) 209-5356
Jessica Squeglia, BAPerformance Improvement Coordinator
(516) [email protected]
Chris Scalamandre, BS, RDPerformance Improvement Coordinator
(516) [email protected]
Clare Bradley, MDMedical Director
Alan Silver, MDClinical Director
Ti-Kuang Lee, ScMStatistician
Susan Ulmer, BAAdministrative [email protected]
Thomas Hartman, BAVice President