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The Pacific Innovation Collaborative: Using local data to advance knowledge and improve health / health care practices December 3, 2011 Jeffrey Caballero, MPH Association of Asian Pacific Community Health Organizations

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The Pacific Innovation Collaborative:!Using local data to advance knowledge and improve health / health care practices!!December 3, 2011!

Jeffrey Caballero, MPH!

Association of Asian Pacific Community Health Organizations!

ASSOCIATION OF ASIAN PACIFIC COMMUNITY HEALTH ORGANIZATIONS

• Est. 1987 non-profit national membership organization !• 29 community health organizations in 9 states - 21 FQHCs in 70 clinic sites!

• Mission is to improve access to care and health status ofmedically underserved AA&NHPIs!

• Over 450,000 patients annually!• 75% - 100%FPL; 90% - 200%FPL!• 38% Uninsured; 35% Medicaid!• 78% AA & NHPI!• 62% LEP!

Association of Asian Pacific Community Health Organizations | 1!

EMERGING HEALTHCARE ENVIRONMENT

•  Began 2006!•  Health safety net threatened!•  Must prove our value:!

• Improve patient care and safety!• Reduce the cost of healthcare!• Improve population health – aligns with Mission, Goals, & Values!

•  Develop an electronic infrastructure to exchange information & track performance data!

•  Build on prior collaborative learning experiences!•  Learn how to share data and use information!

Association of Asian Pacific Community Health Organizations | 2!

PIC PROJECT MEMBERS •  Federally  Qualified  Health  Centers  

§  Country  Doctor  Community  Health  Center  §  HealthPoint  §  Family  Health  Centers  (FHC)  §  Interna;onal  Community  Health  Services  (ICHS)  §  Kalihi-­‐Palama  Health  Center  (KPHC)  §  NeighborCare  Health  §  Waianae  Coast  Comprehensive  Health  Center  (WCCHC)  §  Waimanalo  Health  Center  (WHC)  

•  Health  Plans  §  AlohaCare  §  Community  Health  Plan  of  Washington  (CHPW)  

•  Regional  Aggrega;on  Sites  §  Hawaii  Pa;ent  Accoun;ng  Services  (HPAS)  §  PTSO  of  Washington  

Association of Asian Pacific Community Health Organizations | 3!

PIC DATA AGGREGATION FLOW

Neighborcare  

Association of Asian Pacific Community Health Organizations | 4!

PIC PERFORMANCE INDICATORS Measures   Impact  of  Innova;on  

1.  %  by  age  2  years,  with  4  DTaP,  3  OPV/IPV,  1XMMR,  3XHepB,  3XHib  (and  Varicella)  

EffecEveness  &  Safety,  Risk  Management,  &  Quality  

2a.  %  of  paEents  with  either  Type  1  or  Type  2  Diabetes  whose  HBA1c  is  >  9   EffecEveness  &  Efficiency  

2b.  %  of  diabeEc  paEents  with  a  behavioral  health  (mental  health  or  substance)  diagnosis  whose  HBA1c  is  >  9  

EffecEveness  

3a.  %  of  pts  <  7yo  who  had  a  primary  care  visit  within  the  last  12  months   EffecEveness  &  Timeliness  

3b.  %  of  pts  >  6  yo  who  had  a  primary  care  visit  within  the  last  24  months   EffecEveness  &  Timeliness  

3c.  Third  next  available  appt   EffecEveness  &  Timeliness  4a.  %  of  paEents  seen  in  ER  with  low  complexity  problems   EffecEveness  

4b.  %  of  paEents  seen  in  ER  who  f/u  with  primary  care.   EffecEveness  

5.  %  of  pts  with  well  child  visits:  a)  In  first  15  months;  b)  At  3-­‐6  years;  c)  At  12-­‐21  years  

EffecEveness  

6.  %  of  paEents  on  whom  early  noEficaEon  of  pregnancy  was  made  to  the  Health  Plan.  

Timeliness  &  Efficiency  

Association of Asian Pacific Community Health Organizations | 5!

•  Availability  of  historic  data  from  2007  •  De-­‐iden;fied  data  at  central  report  site  •  Disaggregate  ethnicity  data  for  AA&NHPIs  •  Data  from  mul;ple  vendors  and  disparate  systems  

•  NextGen,  Centricity,  and  WCCHC’s  EPM  •  Availability  of  current  data  

•  Exchanged  daily  for  Hawaii  health  centers  and  weekly  for  Washington  •  Ability  to  compare  data  via  the  PIC  Compara;ve  Dashboard  •  Scheduled  /  automated  &  ad-­‐hoc  reports  •  Sharing  of  best  prac;ces  at  CHCs  and  health  plans  across  states  

•  Development  of  HIE  that  serves  as  a  founda;on  for  many  current  &  future  projects    (i.e.  P4P,  PIC  ES)  •  Trend  analysis  –  planned  for  future  development  •  Risk  stra;fica;on  –  planned  for  future  development  

•  HRSA  CHARN  Pa;ent-­‐Centered  Outcomes  Research    

PROJECT STRENGTHS & BENEFITS

Association of Asian Pacific Community Health Organizations | 6!

•  Improves  quality  of  care  data  exchange  between  health  centers  and  health  plan  

•  Ability  to  test  interven;ons  on  target  high-­‐risk  pa;ents  by  selected  performance  measures    •  Measure  impact  of  specific  clinical  or  non-­‐clinical  services,  cultural  

appropriate  services,  &  team  care  models  •  Measure  impact  on  specific  race,  ethnici;es,  age,  gender,  etc  

RWJ PAY-FOR-PERFORMANCE (P4P) STUDY

Association of Asian Pacific Community Health Organizations | 7!

•  Preliminary  Findings  •  A  Pay-­‐for-­‐Performance/Health  Informa;on  Technology  program  led  to  

decreased  ER  visits  •  Contribu;on  to  reduce/eliminate  Health  dispari;es  by  assessing  

effec;veness  of  P4P  incen;ves  

 

P4P/HIT IMPACT ON PATIENT OUTCOMES

Association of Asian Pacific Community Health Organizations | 8!

HRSA HIE DIABETES DECISION TOOL

•  Key  features  of  the  decision  support  tool  include:    •  A  decision  support  tree,  or  flow  chart  that  allows  staff  to  monitor  processes  and  steps  in  managing  a  pa;ent’s  diabetes  and  care  

•  Auto  alerts/reports  a  pa;ent  need  (e.g.  medica;on;  follow-­‐up  appointment  with  a  specialist,  etc.)    

•  Provider  feedback:  •  Easy  to  use  •  Enjoy  customized  work  flow  

•  The  tool  allows  CHCs  to  maximize  their  team  approach  to  care  in  order  to  improve  pa;ent  outcomes  

Association of Asian Pacific Community Health Organizations | 9!

Summary of Local Data Capacity Benefits:

Association of Asian Pacific Community Health Organizations | 10!

•  Builds  staff  and  organiza;onal  capacity  at  community  level  -­‐  Data  Usability  •  Current  not  old  data  •  Visual  analy;cal  dashboards  and  auto/scheduled  reports  •  Monitors/measures  performance  &  quality    •  Rapidly  iden;fy  &  correct  nega;ve  trends    -­‐  Supports  Evidence-­‐based  System  Change  •  Monitors  pa;ent/popula;on  health  status  •  Ability  to  evaluate/compare  interven;ons,  incen;ves,  and  services    •  Facilitate  sharing  of  best  prac;ces  between  providers,  orgs.,  etc.  •  Demonstrates  quality  improvement  •  Measures  health    &  health  care  disparity  reduc;on/elimina;on  efforts  

 •  Demonstrate  alignment  with  Mission,  goals,  and  values  •  Founda;on  for  future  research  and  capacity  development    

Government-­‐Community  Integra;on  •  Strengthen  support  for  data  collec;on  and  engagement  of  

community  of  color  by  state  level  en;;es.    (ie.  HIE,  Beacon  Communi;es,  and  Regional  Extension  Centers)  

Research  Dissemina;on  •  Na;onally  partner  to  facilitate  sharing  of  best  prac;ces,  tools,  

lessons  learned,  and  rapid  learning  techniques.  

Recommendations:

Association of Asian Pacific Community Health Organizations | 11!