john w. kennedy md amga cmo & president amga foundation ... · amga foundation enables medical...
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Geisinger Impact on Type 2 Diabetes Patient OutcomesJohn W. Kennedy MDAMGA CMO & President AMGA FoundationNovember 2019
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Disclosure• Notice of Requirements for Successful Completion:
For successful completion, participants are required to be in attendance in the full activity, complete and submit the program evaluation at the conclusion of the educational event.
• Presenter Conflicts Of Interest and Financial Relationships Disclosures: NONE
• Disclosure of Relevant Financial Relationships and Mechanism to Identify and Resolve Conflicts of Interest: No conflicts of Interest
• Non-Endorsement Of Products: Accredited status does not imply endorsement by AADE, ANCC, or ACPE of any commercial products displayed in conjunction with this educational activity.
• Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than that for which it was approved by the Food and Drug Administration.
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Objectives
• 1. Describe the national scope of the Together2Goal Campaign and the core measures that comprise the bundle of diabetes outcome measures
• 2. Recognize the relationship between Type 2 Diabetes and Cardiovascular Disease and assess the performance of the Innovator Track participants in improving patient health
• 3. Compare the use of retinal screening cameras embedded in primary care clinics to traditional specialty referral workflows and evaluate the impact on population health for patients with Type 2 Diabetes and diabetic retinopathy
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Indispensable Resource
Population Health Innovation Across Systems
AMGA Trade Association
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AMGA Members
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440+175,000
120million
1 in 3
Medical group and health
system members
Physicians practicing at
AMGA member groups
Americans receiving care
from our members
Americans visiting AMGA-
affiliated providers
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AMGA: By the Numbers
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MissionAMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health care.
VisionThe AMGA Foundation serves as a catalyst, connector and collaborator for translating the evidence of what works best in improving health and health care in everyday practice.
AMGA Foundation
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Acclaim AwardBest Practices
Learning Collaboratives
National Campaigns
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Foundation Programs
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Campaign Goal:Improve care for 1 million people with Type 2 diabetes by 2021
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Together 2 Goal® Reach• 150 groups in 36 states• 61,000 FTE physicians• 2.0 million patients
with Type 2 diabetes
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Campaign Participants
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Together 2 Goal® Non-Profit Partners & Supporting Organizations
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Presenting Corporate Collaborator
Innovator Track Corporate Collaborator
Founding Corporate Collaborator Distinguished Data and Analytics
Corporate Collaborator
Together 2 Goal® Extension Corporate Collaborators
Contributing Corporate Collaborator
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Data Reporting Tracks
BasicCore:
Bundle
HbA1C control < 8 percent ✓ ✓
BP control < 140/90 mmHg ✓
Lipid management ✓
Medical attention for nephropathy ✓
Bundle Measure ✓
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Continuous Quality Improvement: Lesson #1
• Improving outcomes for patients
• Improving more than other high performing health systems in benchmark
• Medical Attention to Nephropathy https://www.facebook.com/StarsAlignCHI/
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790,000 patients with type 2 diabetes, across 65 AMGA member organizations
Nephropathy – 2016 Q1 (Baseline)
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930,000 patients with type 2 diabetes, across 65 AMGA member organizations
Nephropathy – 2019 Q1 (Year 3)
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Continuous Quality Improvement: Lesson#2
• Improving Patient Outcomes
• Improvement is outpaced by other high performing health systems
• Lipid Management
https://www.insidehr.com.au/hr-not-keeping-up-with-the-pace-of-change-in-business/
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790,000 patients with type 2 diabetes, across 65 AMGA member organizations
Lipid Management – 2016 Q1 (Baseline)
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930,000 patients with type 2 diabetes, across 65 AMGA member organizations
Lipid Management – 2019 Q1 (Year 3)
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Continuous Quality Improvement: Lesson#3
• Shifting Sands result in reduction in quality metric performance
• Peer group of high performing health systems improve
• HgbA1c%https://jia.sipa.columbia.edu/shifting-sands-global-order
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850,000 patients with type 2 diabetes, across 70 AMGA member organizations
HbA1c < 8.0 – 2016 Q1 (Baseline)
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1,010,000 patients with type 2 diabetes, across 70 AMGA member organizations
HbA1c < 8.0 – 2019 Q1 (Year 3)
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Geisinger denominator growth primarily due to new diagnosisThe population growth for
these groups is primarily due to acquisitions
T2DM T2G cohort over time• For most groups the T2G cohort (measure denominator) is fairly stead with slight growth over time
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Understanding Overall Improvement
• Diabetes Bundle• % patients with 4 out of 4
measures in control– A1c– BP– HTN– Nephropathy
https://www.lynda.com/Creativity-tutorials/Synthesis/433738/462428-4.html
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790,000 patients with type 2 diabetes, across 65 AMGA member organizations
T2G Bundle – 2016 Q1 (Baseline)
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930,000 patients with type 2 diabetes, across 65 AMGA member organizations
T2G Bundle – 2019 Q1 (Year 3)
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Geisinger T2G
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Geisinger T2G
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Tactics to improve HgbA1c & Bundle Control• Point of Care HgbA1c% testing• Diabetes Education• MTM Pharmacist Diabetes Medication Carepath• Case Management • Best Practice Alert acknowledgement• Pre-visit planning--Diabetes Huddles• Endocrinology Consultation
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Together 2 Goal® Year 2 Impact
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New Project: Innovator Track
Cardiovascular Disease Cohort Eye Care Cohort
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New Project: T2G Diabetes Bundle Best Practices Learning Collaborative
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Geographic Distribution of Cohort
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T2G 2018 Q2 (BL): Prevalence of type 2 diabetes among active patient population(Innovator Track Eye Cohort)
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T2G T2DM patients with documented screening for diabetic retinal disease
4.7% relative improvement+ 1,262 patients
12% increase in T2DM patients(~ 4,500 newly diagnosed)
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T2G T2DM patients with documented screening for diabetic retinal disease
22.6% relative improvement+ 775 patients
21.3% relative improvement+ 3,148 patients
15.3% relative improvement+ 462 patients
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• Denominator: Grew from 151,200 to 159,500 T2DM patients
• 5.4% absolute improvement
• 11.6% relative improvement
• 8 of 10 groups saw improvement
3 with relative improvement ~ 5%
5 with relative improvements of 15% – 45%
4 groups with > 1,000 additional patients
• 8,600 additional patients with a documented screening!
T2G T2DM patients with documented screening for diabetic retinal disease
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New Project: Innovator Track
Cardiovascular Disease Cohort Eye Care Cohort
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Participant Interventions
21%
21%
19%
16%
13%
10%Provider Education
EHR Enhancements
Care Redesign/Workflow Improvements
Patient Outreach and Education
Data/Documentation Improvements
Elevate Emphasis within Leadership
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Intervention Hot List – Top 5
• #5: Leveraging EHR to better identify or treat risk
Best Practice Alerts
Smart Phrases
Diabetes Order Sets
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Intervention Hot List – Top 5
• #4: Integrating pharmacy team into DM/CVD efforts
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Intervention Hot List – Top 5
• #3: Leverage data reports to identify patient gaps
List of High-Intensity Statin Candidates
Registry of DM Patients at Risk for CVD
Unblinded Provider Data re: Prescribing Statins, Evidence-
Based CVOT Meds
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Intervention Hot List – Top 5
• #2: Educate providers on relevant topics
Link between Diabetes and CVD
CVD Risk Reduction Guidelines
Statins Aspirin
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Intervention Hot List – Top 5
• #1: EHR integration of ASCVD risk calculator
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Campaign Extension into 2021
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New ResearchPublications & Presentations from AMGA Analytics
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New Offering: Revamped Website
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New Offering: Toolkit Supplement
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New Offering: Plank Mentors
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Campaign Planks
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Together 2 Goal® Welcomes Plank Mentors!
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2019Q2 Data Summary Report : August 29, 2019