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1 Geisinger Impact on Type 2 Diabetes Patient Outcomes John W. Kennedy MD AMGA CMO & President AMGA Foundation November 2019

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Page 1: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

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Geisinger Impact on Type 2 Diabetes Patient OutcomesJohn W. Kennedy MDAMGA CMO & President AMGA FoundationNovember 2019

Page 2: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

2©2019 All Rights Reserved

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.

Page 3: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

3©2019 All Rights Reserved

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

Page 4: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

4©2019 All Rights Reserved

Indispensable Resource

Population Health Innovation Across Systems

AMGA Trade Association

Page 5: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

5©2019 All Rights Reserved

AMGA Members

Page 6: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

6©2019 All Rights Reserved

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

6

AMGA: By the Numbers

Page 7: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

7©2019 All Rights Reserved

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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

Page 8: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

8©2019 All Rights Reserved

Acclaim AwardBest Practices

Learning Collaboratives

National Campaigns

8

Foundation Programs

Page 9: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health
Page 10: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

10©2018 All rights reserved©2018 All rights reserved 10

Campaign Goal:Improve care for 1 million people with Type 2 diabetes by 2021

Page 11: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

11©2018 All rights reserved©2018 All rights reserved 11

Together 2 Goal® Reach• 150 groups in 36 states• 61,000 FTE physicians• 2.0 million patients

with Type 2 diabetes

Page 12: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

12©2018 All rights reserved©2018 All rights reserved 12

Campaign Participants

Page 13: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

13©2018 All rights reserved©2018 All rights reserved 13

Together 2 Goal® Non-Profit Partners & Supporting Organizations

Page 14: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

14©2018 All rights reserved©2018 All rights reserved 14

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

Page 15: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

15©2018 All rights reserved©2018 All rights reserved 15

Data Reporting Tracks

BasicCore:

Bundle

HbA1C control < 8 percent ✓ ✓

BP control < 140/90 mmHg ✓

Lipid management ✓

Medical attention for nephropathy ✓

Bundle Measure ✓

Page 16: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

16©2018 All rights reserved©2018 All rights reserved 16

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/

Page 17: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

17©2018 All rights reserved©2018 All rights reserved 17Copyright © 2019 AMGA. All rights reserved. 17

790,000 patients with type 2 diabetes, across 65 AMGA member organizations

Nephropathy – 2016 Q1 (Baseline)

Page 18: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

18©2018 All rights reserved©2018 All rights reserved 18Copyright © 2019 AMGA. All rights reserved. 18

930,000 patients with type 2 diabetes, across 65 AMGA member organizations

Nephropathy – 2019 Q1 (Year 3)

Page 19: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

19©2018 All rights reserved©2018 All rights reserved 19

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/

Page 20: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

20©2018 All rights reserved©2018 All rights reserved 20Copyright © 2019 AMGA. All rights reserved. 20

790,000 patients with type 2 diabetes, across 65 AMGA member organizations

Lipid Management – 2016 Q1 (Baseline)

Page 21: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

21©2018 All rights reserved©2018 All rights reserved 21Copyright © 2019 AMGA. All rights reserved. 21

930,000 patients with type 2 diabetes, across 65 AMGA member organizations

Lipid Management – 2019 Q1 (Year 3)

Page 22: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

22©2018 All rights reserved©2018 All rights reserved 22

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

Page 23: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

23©2018 All rights reserved©2018 All rights reserved 23Copyright © 2019 AMGA. All rights reserved. 23

850,000 patients with type 2 diabetes, across 70 AMGA member organizations

HbA1c < 8.0 – 2016 Q1 (Baseline)

Page 24: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

24©2018 All rights reserved©2018 All rights reserved 24Copyright © 2019 AMGA. All rights reserved. 24

1,010,000 patients with type 2 diabetes, across 70 AMGA member organizations

HbA1c < 8.0 – 2019 Q1 (Year 3)

Page 25: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

25©2019 AMGA Analytics, LLC and OptumInsights Inc. All rights reserved.

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

Page 26: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

26©2018 All rights reserved©2018 All rights reserved 26

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

Page 27: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

27©2018 All rights reserved©2018 All rights reserved 27Copyright © 2019 AMGA. All rights reserved. 27

790,000 patients with type 2 diabetes, across 65 AMGA member organizations

T2G Bundle – 2016 Q1 (Baseline)

Page 28: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

28©2018 All rights reserved©2018 All rights reserved 28Copyright © 2019 AMGA. All rights reserved. 28

930,000 patients with type 2 diabetes, across 65 AMGA member organizations

T2G Bundle – 2019 Q1 (Year 3)

Page 29: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

29©2018 All rights reserved©2018 All rights reserved 29

Geisinger T2G

Page 30: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

30©2018 All rights reserved©2018 All rights reserved 30

Geisinger T2G

Page 31: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

31©2018 All rights reserved©2018 All rights reserved 31

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

Page 32: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

32©2018 All rights reserved©2018 All rights reserved 32

Together 2 Goal® Year 2 Impact

Page 33: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

33©2018 All rights reserved©2018 All rights reserved 33

New Project: Innovator Track

Cardiovascular Disease Cohort Eye Care Cohort

Page 34: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

34©2018 All rights reserved©2018 All rights reserved 34

New Project: T2G Diabetes Bundle Best Practices Learning Collaborative

Page 35: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

35©2018 All rights reserved©2018 All rights reserved 35

Geographic Distribution of Cohort

Page 36: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

37©2018 All rights reserved©2018 All rights reserved 37

T2G 2018 Q2 (BL): Prevalence of type 2 diabetes among active patient population(Innovator Track Eye Cohort)

Page 37: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

38©2018 All rights reserved©2018 All rights reserved 38

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)

Page 38: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

39©2018 All rights reserved©2018 All rights reserved 39

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

Page 39: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

40©2018 All rights reserved©2018 All rights reserved 40

• 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

Page 40: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

41©2018 All rights reserved©2018 All rights reserved 41

Page 41: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

42©2018 All rights reserved©2018 All rights reserved 42

New Project: Innovator Track

Cardiovascular Disease Cohort Eye Care Cohort

Page 42: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

43©2018 All rights reserved©2018 All rights reserved 43

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

Page 43: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

44©2018 All rights reserved©2018 All rights reserved 44

Intervention Hot List – Top 5

• #5: Leveraging EHR to better identify or treat risk

Best Practice Alerts

Smart Phrases

Diabetes Order Sets

Page 44: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

45©2018 All rights reserved©2018 All rights reserved 45

Intervention Hot List – Top 5

• #4: Integrating pharmacy team into DM/CVD efforts

Page 45: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

46©2018 All rights reserved©2018 All rights reserved 46

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

Page 46: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

47©2018 All rights reserved©2018 All rights reserved 47

Intervention Hot List – Top 5

• #2: Educate providers on relevant topics

Link between Diabetes and CVD

CVD Risk Reduction Guidelines

Statins Aspirin

Page 47: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

48©2018 All rights reserved©2018 All rights reserved 48

Intervention Hot List – Top 5

• #1: EHR integration of ASCVD risk calculator

Page 48: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

49©2018 All rights reserved©2018 All rights reserved 49

Campaign Extension into 2021

Page 49: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

50©2018 All rights reserved©2018 All rights reserved 50

New ResearchPublications & Presentations from AMGA Analytics

Page 50: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

51©2018 All rights reserved©2018 All rights reserved 51

New Offering: Revamped Website

Page 51: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

52©2018 All rights reserved©2018 All rights reserved 52

New Offering: Toolkit Supplement

Page 52: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

53©2018 All rights reserved©2018 All rights reserved 53

New Offering: Plank Mentors

Page 53: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

54©2018 All rights reserved©2018 All rights reserved 54

Campaign Planks

Page 54: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

55©2018 All rights reserved©2019 All rights reserved 55

Together 2 Goal® Welcomes Plank Mentors!

Page 55: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

56©2019 All Rights Reserved

Page 56: John W. Kennedy MD AMGA CMO & President AMGA Foundation ... · AMGA Foundation enables medical groups and other organized systems of care to consistently improve health and health

2019Q2 Data Summary Report : August 29, 2019