The Case for Quality in 2006

CCNV 2nd Annual Client ConferenceOctober 17, 2006

Colleen Lynch, RN, MSN, CPHQCommunity Care Network of Virginia

Problem Statement More than 90 million Americans

live with chronic illnesses Chronic diseases account for 70%

of all deaths in the United States The medical care of people with

chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care costs

Burden of Chronic Disease

The United States cannot effectively address escalating healthcare costs without addressing the problem of chronic diseases.

National Center for Chronic Disease Prevention and Health Promotion

Why Pursue Quality in the Office Setting?

Heart disease, diabetes and hypertension are significant public health problems in the United States

The majority of chronic disease care is managed in the physician office

Chronic conditions account for significant costs to the healthcare system

Chronic Disease in the Office Setting:

In 2002 Individuals with heart disease

accounted for 20.8 million office visits Individuals with diabetes accounted

for 24.9 million office visits Individuals with hypertension

accounted for 17.2 million office visits

Centers for Disease Control and Prevention Fast Stats

Chronic Disease in the Office Setting:

The direct and indirect costs attributed to coronary heart disease and congestive heart failure are projected to be $170 billion in 2005

The total direct healthcare cost attributed to diabetes in 2002 was $92 billion with an additional $40 billion in indirect costs (disability, work loss and premature death)

The total direct and indirect costs of hypertension in 2005 were $59.7 billion

Quality as a National Focus

Crossing the Quality Chasm: A New Health System for the 21st Century

“Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.”

Institute of Medicine, 2001

Key Institute of Medicine Recommendations All health care organizations

should adopt as their explicit purpose: to continually reduce the burden of

illness, injury and disability to improve the health and functioning

of the people of the United States.

Crossing the Quality Chasm, 2001

Key Institute of Medicine Recommendations All health care organizations

should pursue six major aims: health care should be safe, effective, patient-centered, timely, efficient and equitable

Crossing the Quality Chasm, 2001

Key Institute of Medicine Recommendations

Congress should continue to authorize and appropriate funds for the establishment of, monitoring and tracking processes for use in evaluating the progress of the health system

The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of care provided to the American people.

Crossing the Quality Chasm, 2001

National Healthcare Quality Report

First national comprehensive effort to measure the quality of healthcare in America

Report includes a broad set of performance measures to measure quality in cancer, diabetes, end-stage renal disease, heart disease, HIV and AIDS, metal health and respiratory disease

Key Findings of National Healthcare Quality Report

High Quality Healthcare is not universal

Opportunities for preventive care are frequently missed

Management of chronic diseases presents unique quality challenges

There is more to learn Greater improvement is possible

HRSA Goals: Improve access to Health Care Improve Health Outcomes Improve the Quality of Health Care Eliminate Health Disparities Improve the Public Health and Health Care

Systems Enhance the Ability of the Health Care

System to Respond to Public Health Emergencies

Achieve Excellence in Management Practices

Mission of the Bureau of Primary Health Care:

To increase access to comprehensive primary and preventive healthcare

To improve the health status of underserved and vulnerable populations

Quality: What is it?“The degree to which health services

for individuals and populations increase the likelihood of desired

health outcomes and are current and consistent with

current professional knowledge”

- Institute of Medicine

Quality: What is it?

A proactive task of management aimed at the continual monitoring of processes/outcomes within a business/organization

Using information to develop ways to enhance the future performance of these processes

Improved Quality comes from Improvement in

Work Processes

Quality = Process Focused

“Each system is designed perfectly to get the results that it gets.”

-W. Edwards Deming

Eliminate blame Redesign system

An Important Concept…

From a Toyota Senior Executive:

“We get brilliant results from average people managing brilliant processes”

Why Pursue Quality? Demonstrating improvement to

regulatory and accreditation entities JCAHO, OPR Reviews

Contracting leverage – payor quality incentive programs, P4P

Marketing purposes Seeking additional funding

opportunities

Why Pursue Quality? Payor Quality Programs

CMS DOQ-IT project and Physician Voluntary Reporting Project

Medicare Care Management Performance Demonstration Project

Anthem Performance Extra Program Asthma, Diabetes

United Healthcare Ambulatory Quality Alliance measures

Why Pursue Quality?

The overarching goal is to: Continually reduce the burden of

illness, injury and disability Improve the health and functioning

of the people in our communities

Where to begin…? Opportunities for preventive

care are often missed Management of chronic

diseases presents unique challenges

The majority of chronic disease care is provided in the physician office

Can we impact these rates? Adults receiving recommended

screening and preventive care – 49% Adults with diabetes under control –

74% Adults with hypertension under

control – 29%

“US Health System Performance: A National Scorecard” Health Affairs, September 2006

Can we impact these rates? Needed mental health care and

received treatment Adults – 47% Children – 59%

Adults with chronic conditions given self-management plan – 58%

“US Health System Performance: A National Scorecard” Health Affairs, September 2006

Key Questions to Ponder: How is your center managing the

challenge of chronic illness? How is the health in your

communities improving as a result of your work?

Is quality a core business strategy of your operations?

The Vision: To continually reduce the

burden of illness, injury and disability

To improve the health and functioning of the people in our Virginia communities

How CCNV is helping you meet the challenge:

Medical Management Program Medical Management Committee

Randall Bashore, MD – Central Virginia Bickley Craven, MD – Stone Mountain Parker Dooley, MD – Eastern Shore Roger Chinery, MD – Alexandria Hellen Streicher, PhD – Central Virginia Meghan Sullivan, FNP – Southwest Virginia

How CCNV is helping you meet the challenge:

Medical Management Program Updating CCNV Clinical Practice

Guidelines for incorporation into EMR Diabetes Cholesterol Hypertension Obesity

How CCNV is helping you meet the challenge:

Medical Management Program Defining “core set of measures”

that can be tracked across the network

Developing and testing reporting functionality to ensure meaningful and valid data capture

Setting “network goals” for care

How CCNV is helping you meet the challenge:

Medical Management Program

Monitoring payor quality programs and Pay for Performance efforts to position the network appropriately for future activities

Role of EMR in Quality Plan and deliver evidence-based

care to individuals and groups of patients

Improve timeliness of patient tracking and follow-up

Identify and track patients with chronic disease

Compare practice performance with other benchmarks

But don’t forget…

“If you always do what you’ve always done…

You’ll always get what you’ve always gotten”…

Don’t forget about processes! High quality care is only possible in

systems that have fully integrated good practices into the care process.

Poorly designed systems are prone to errors and inefficiency.

Redesigning workflow is essential to increasing efficiency and ensuring quality care.

What we know now…

“The current care systems can not do the job. Trying harder will not work. Changing systems of care will…”

Crossing the Quality Chasm, 2001

How CCNV is helping you meet the challenge:

Quality Improvement Program “Revitalized” network Quality

Improvement Committee in May 2006

Core group: 14 individuals from 12 centers

Network “Knowledge-Sharing” Sharing successes and challenges

How CCNV is helping you meet the challenge:

Quality Improvement Program Workflow analysis presentations:

“How to Map Your Office Processes”

July 2006 WebEx “How to Examine Value and

Waste in Your Office Processes” August 2006 WebEx

The Challenge before us:“Better health is an individual

responsibility, and it is an important national goal. We’re making great progress in preventing and detecting and treating many chronic diseases, and that’s good for America…We’re living longer than any generation in history. Yet we can still improve. And we can do more.”

President George Bush, June 2002

We can still improve!

And we can do more!