chronic disease work group meeting may 29th, 2018 · 2018-06-06 · chronic disease work group...

CHRONIC DISEASE WORK GROUP MEETING

MAY 29TH, 2018

1

Introduce yourself: Name, organization, and county

Welcome and Introductions

2

WELCOME

Review Proposed Agenda Items Program Updates

Assessment Data

Summary of Toolkit and Project Area

Discussion

Next steps and closing

3

Program Updates

• First provider participatory payments were released on 5/18/2018

• RFP

• Implementation Plan completed in October

4

State Capacity Assessment

5

By County By Project

1719 20 20

14

29

7

6

32

39

2926

2023

7

9

2

8

0

1

2

3

4

5

6

7

8

9

10

Yes, EHR Yes Separate Software No

Does your practice maintain a chronic disease registry or registries? [3402]

8

1

18

20

5

10

15

20

Offers Onsite Does Not Offer Referred Offsite

Stanford Chronic Disease Self-Management Program (CDSMP): Please select the response option that best describes

your practice. [3403]

4

13

20

5

10

15

Offered Onsite Does not offer or refer Refers offsite

National Diabetes Prevention Program (NDPP): Please select the response option that best describes your practice. [3404]

9

Asthmaeducation(on-site)

Referrals toasthma

education(off-site /

community-based)

Home visitsfor asthma

services

COPD -Chronic

ObstructivePulmonary

Diseaseeducation(on site)

Referrals toCOPD -Chronic

ObstructivePulmonaryDisease -education(off-site /

community-based)

Home visitsfor COPD -

ChronicObstructivePulmonaryDisease -services

Hypertension

education(on-site)

Referrals tohypertensi

oneducation(off-site /

community-based)

Home visitsfor

hypertension

Support forhome-basedblood

pressuremonitoring

Diabeteseducation(on-site)

Referrals todiabetes

education(off-site /

community-based)

Series1 13 6 0 9 6 0 12 5 1 6 12 12

13

6

0

9

6

0

12

5

1

6

12 12

0

2

4

6

8

10

12

14 Our practice currently offers the following:

10

6

15

19

6

3

0

2

4

6

8

10

12

14

16

18

20

Mammograms Immunizations Annual checkups No Other

Do providers ask about any of the following routine preventative care? (Please check all that apply.) [2149]

Evidence Based Approaches: Chronic Care Model

Regions are encouraged to focus on more than one chronic condition under the Chronic Care Model• The Community Guide

• Million Hearts Campaign

• Stanford Chronic Disease Self-Management Program

• CDC-recognized National Diabetes Prevention Program (NDPP

• Community Paramedicine Models

11

12

Specific Change Strategies in MTP Toolkit for Chronic

Care Model

MTP: Timeline

13

Plan

2018

Implement

2019

Scale

2020

Next Steps and ClosingRequest for Proposals (RFP) will be released May 30th and close July16th, 2018

•CPAA is hosting a virtual town hall meeting on Friday, June 8, to answer any RFP related questions.

Submit any requested work group topics or collaboration meetings to

toneya@crhn.org

14

15

Thank You!