community care physicians quality of care initiatives 2006 bridges to excellence bridges to...
TRANSCRIPT
Community Care Physicians Community Care Physicians Quality of Care Initiatives Quality of Care Initiatives
20062006
Bridges to ExcellenceBridges to Excellence Performance Improvement ProjectsPerformance Improvement Projects EMR ImplementationEMR Implementation
Bridges to Excellence Status Bridges to Excellence Status ReportReport
17 Practices representing 84 Physicians achieved recognition17 Practices representing 84 Physicians achieved recognition Improved patient outcome and responseImproved patient outcome and response Quality brandingQuality branding Significant monetary reward: >$470,000 and counting from Significant monetary reward: >$470,000 and counting from
the collaborativethe collaborative An additional $188,000 anticipated by year’s endAn additional $188,000 anticipated by year’s end ~ $500,000 received in related incentives (Healthplans)~ $500,000 received in related incentives (Healthplans) Corporate Application in progress with EMR implementationCorporate Application in progress with EMR implementation
BTE Related ActivitiesBTE Related Activities
Diabetes Care InitiativeDiabetes Care Initiative
Diabetes Case Management ProgramDiabetes Case Management Program
Diabetes Self Management Education ProgramDiabetes Self Management Education Program
ProCareProCare
EMREMR
DCIDCIDiabetes Care InitiativeDiabetes Care Initiative
Diabetes Performance Measurement and ImprovementDiabetes Performance Measurement and Improvement
- Develop Diabetic registry - Develop Diabetic registry - Conduct process audit - Conduct process audit - Provide benchmarking data- Provide benchmarking data- Develop interventions and implement- Develop interventions and implement- Re-measure- Re-measure
Phase 1 conducted at 5 Practices involving 40 Practitioners Phase 1 conducted at 5 Practices involving 40 Practitioners and 3000 patientsand 3000 patients
Phase 2 expanded to total of 10 Practices, 60 PractitionersPhase 2 expanded to total of 10 Practices, 60 Practitioners4500 patients4500 patients
Areas of Opportunity and InterventionsAreas of Opportunity and Interventions
Tobacco screeningTobacco screening- Staff education on Diabetic patient prep and Tobacco screening- Staff education on Diabetic patient prep and Tobacco screening
Scheduling of follow-up visitsScheduling of follow-up visits- Process changes in the way we schedule patients - Process changes in the way we schedule patients
Comprehensive foot careComprehensive foot care- Diabetes Tool Kits filled with tools for the provider and the patient – to - Diabetes Tool Kits filled with tools for the provider and the patient – to facilitate foot examsfacilitate foot exams
Annual dilated retinal examAnnual dilated retinal exam- Documentation Tools: flow sheets, standing order sets etc. - Documentation Tools: flow sheets, standing order sets etc.
Nephropathy testingNephropathy testing- Educational information on nephropathy testing - Educational information on nephropathy testing
Self Management EducationSelf Management EducationADA Certified Diabetes Self Management Education ProgramADA Certified Diabetes Self Management Education Program
Relationship of # of Visits per Year to A1C LevelsSelected CCP Practices (2004)
6
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
7
1 1.5 2 2.5 3 3.5 4 4.5
Number of Visits/Year
A1C
Lev
els
Practice Experience
Linear (Practice Experience)
Practice 1
Practice 2 Practice 3
Practice 4
Practice 5
Note: Demographics of each practice - including age, sex, geographic location
and insurance all very similar.
Diabetes Case Management ProjectDiabetes Case Management Project
CDPHP Health Plan CDPHP Health Plan and and
Community Care Physicians Community Care Physicians Diabetes Case ManagementDiabetes Case Management
2004 - 20052004 - 2005
The Collaborative ProjectThe Collaborative Project
Patients were included in the project if their Patients were included in the project if their HbA1c was >9.0% (Case Management Trigger)HbA1c was >9.0% (Case Management Trigger)
CDPHP Case Managers worked with patients on CDPHP Case Managers worked with patients on lifestyle modifications, medication and diabetes lifestyle modifications, medication and diabetes management and provided general diabetes management and provided general diabetes disease education.disease education.
The Case Manager sent a follow-up report to the The Case Manager sent a follow-up report to the patient’s physician documenting the intervention.patient’s physician documenting the intervention.
The Provider incorporated the intervention into The Provider incorporated the intervention into the plan of care thereby reinforcing the message.the plan of care thereby reinforcing the message.
Average A1c - Case Management
10.138
8.676
7.5
8
8.5
9
9.5
10
10.5
# of Lab Draws
A1c
Val
ue
Last Draw
First Draw
Average A1c Without Case Management - 2005
9.459.96
0
2
4
6
8
10
12
Average A1c for the First Draw Average A1c for the Second Draw
Case Management Results Case Management Results
YearAverage A1c Pre-Case
ManagementAverage A1c Post-Case
Management N Change
2004 10 8.2 98 1.8
2005 10.1 8.6 76 1.5
Combined 2004 2005 10.05 8.4 174 1.65
Diabetes Self Management Education Diabetes Self Management Education ProgramProgram
ADA certified ADA certified Multiple sites, times, group and individual classes - Multiple sites, times, group and individual classes -
accessaccess
Improve patient outcome by providing a previously Improve patient outcome by providing a previously un-reimbursable form of patient intervention. un-reimbursable form of patient intervention.
Promote continuum of carePromote continuum of care
DSME OutcomesDSME Outcomes
9.75%
6.93%
0%
2%
4%
6%
8%
10%
12%
Pre DSME Program HbA1c 6-month Post DSMEProgram HbA1c
*Mean difference between HbA1c pre and post DSME Program was -2.8% (95% CI -2.09 to -3.55)
* p≤.001
Post DMSE HbA1c DistributionPost DMSE HbA1c Distribution
18%
23%
41%
18%
>8.0%7.0-7.9%6.0-6.9%5.0-5.9%
*68.18% of patients who participated in the DMSE Program achieved a HbA1c≤7.0%
Disease Management Disease Management “Pro-Care”“Pro-Care”
Systematic method of identifying patients in need of care and Systematic method of identifying patients in need of care and contacting them for follow upcontacting them for follow up
Evidenced based management of chronic illnessEvidenced based management of chronic illness
Utilizes data mining of internal and external information Utilizes data mining of internal and external information sourcessources
Improves Provider payor profiles by “cleaning” claims dataImproves Provider payor profiles by “cleaning” claims data
ProCare ROI - 5 PracticesProCare ROI - 5 PracticesPilot Project 2Pilot Project 2ndnd half 2005 half 2005
Using “3 Most Prevalent ConditionsUsing “3 Most Prevalent Conditions””
# of Pts Identified ------------- # of Pts Identified ------------- 23512351
# of Visits scheduled ---------- # of Visits scheduled ---------- 677677
Success rate --------------------- Success rate --------------------- 28%28%
Total charges ------------------- Total charges ------------------- $151,367$151,367
Expenses ------------------------- Expenses ------------------------- $4,158$4,158
EMR ROI COST SAVINGSCOST SAVINGS
CHARTS – SUPPLIES, PAPER, FORMS, SUPERBILLS, FOLDERS, SCRIPT PADSCHARTS – SUPPLIES, PAPER, FORMS, SUPERBILLS, FOLDERS, SCRIPT PADS CHART AVAILABILITY – ALL THE TIME IN MULTIPLE PLACESCHART AVAILABILITY – ALL THE TIME IN MULTIPLE PLACES CHART PULLS – TIMECHART PULLS – TIME CHART PREP – TIMECHART PREP – TIME TRANSCRIPTION – COSTS (50 – 90%)TRANSCRIPTION – COSTS (50 – 90%) SCANNED EOBsSCANNED EOBs DIRECT CHARGE ENTRYDIRECT CHARGE ENTRY REDUCED CALL BACKSREDUCED CALL BACKS STREAMLINED ePRESCRIBINGSTREAMLINED ePRESCRIBING DECREASE OVERTIME DECREASE OVERTIME
REVENUE ENHANCEMENTSREVENUE ENHANCEMENTS PAY FOR PERFORMANCE – e.g. Bridges to ExcellencePAY FOR PERFORMANCE – e.g. Bridges to Excellence BETTER CODING – BETTER DOCUMENTATION (5 – 15 %)BETTER CODING – BETTER DOCUMENTATION (5 – 15 %) CLINICAL RESEARCH CAPABILITIESCLINICAL RESEARCH CAPABILITIES ENHANCED INCENTIVES FROM PAYERSENHANCED INCENTIVES FROM PAYERS
REDUCED MEDICAL ERRORREDUCED MEDICAL ERROR ENHANCED SPACE UTILIZATIONENHANCED SPACE UTILIZATION IMPROVED QUAILTY CAREIMPROVED QUAILTY CARE
LEGIBILITYLEGIBILITY DISEASE MANAGEMENTDISEASE MANAGEMENT REFERRAL TRACKINGREFERRAL TRACKING HIGH RISK TRACKINGHIGH RISK TRACKING PREVENTIVE MANAGEMENTPREVENTIVE MANAGEMENT DECISION SUPPORT TOOLSDECISION SUPPORT TOOLS
EMR Improvement on EMR Improvement on Documentation of CareDocumentation of Care
Network Comparison: November 2004 vs November 200598.1
1%
89.5
8%
70.7
7%
65.2
6%
51.2
7%
63.0
7%
43.2
6%
28.1
1%
52.9
1%
37.3
0%
36.0
5%
10.9
4%
0.0
0%
96.6
0%
87.4
8%
79.2
5%
74.2
4%
70.4
8%
62.7
9%
56.5
3%
50.6
3%
49.7
3%
42.7
5%
31.4
8%
12.8
8%
11.0
9%
99.8
1%
98.3
0%
94.7
0%
83.3
3%
79.3
6%
72.9
2%
72.9
2%
62.5
0%
69.7
0%
54.9
2%
36.5
5%
39.5
8%
18.1
8%
12.6
9%
99.6
6%
100.0
0%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Blo
od P
ressure
Med R
evie
w
Lip
id
Glu
cose
Tobacco S
cre
en
Die
t
Follo
w U
p V
isit
Exerc
ise
Foot E
xam
Mic
roalb
um
in
AS
A U
se
Eye E
xam
MN
T w
/RD
Sm
oker
Jan 04 thru Sept 04
November 2004
November 2005