Value-Driven Quality Improvement in Primary Care · Value-Driven Quality Improvement in Primary...

Value-DrivenQualityImprovementinPrimaryCareWilliamRollow,MD,MPH,PrimaryCareDevelopmentCorporationJanetDesGeorges,Hands&Voices,Inc.DennisKuo,MD,MHS,DepartmentofPediatrics-UAMSRichardSnow,DO,MPH,OhioHealth

VALUE-DRIVENQUALITYIMPROVEMENTINPRIMARYCARE

WilliamRollow,MD,MPH(moderator)JanetDesGeorges

DennisKuo,MD,MHSRichardSnow,DO,MPH

November12,2015

WhyValue?

• StudiesofPCMHtypicallyassessimpacton:– Clinicalqualitymeasures– Cost/utilization– Patientsatisfaction

WhatDoPatientsValue?

• Health– Dimensions:physical/somatic/physical,cognitive/emotional,social/functional,spiritual

• Cure– Uni-dimensionalresolution

• Healing– Integratedimprovementacrossdimensions

• Preconditionsofhealth– Housing,employment,income,safety

• Experience– Access,relationship,amenities

HowCanPrimaryCarePracticesCreateValueforPatients?

• Needed– Amodelthatprovidesaroadmapforpracticetransformationwitheffectivefacilitation/assistance

– Researchanddevelopmentoncomponentsofthemodel– Paymentthatcoversthecostsofprovidingcare

WhatWillWeDiscussInThisSession?

• Whatpatientsvalue• Howcanprimarycarepracticesprovidevalue

ParentsandPatientsasPartnersinQIWork—BeyondtheClichés

SessionJ:Value-DrivenQualityImprovementinPrimaryCare

Presentedby:JanetDesGeorges

∗ Credentials:M.O.M.(“mom,youwouldn'thaveajobifitwasn’tforme”);ourfamilystory

∗ Systemicinvolvementforover15years(medical,educational,community)

∗ ExecutiveDirectorandCo-Founder,Hands&Voices(over50chaptersintheU.S.andabroad)

∗ Authorofpeer-reviewedarticlesinMedicalJournals∗ CertificateofCompletionattheUniversityofNorthCarolina-ChapelHillMCHPublicHealthLeadershipInstitute

MyProfessionalBackground

ABriefhistoryofourfamily’sjourney…

•Sarawasbornin1991–priortouniversalnewbornhearingscreening;qualifiedforPartCServices–Hypotonia(at11months)•LateI.D.atagetwo–with2yearlanguagedelays(congenital,sensorineuralbilateralmoderate-profoundhearingloss);37professionalsinourlivesbyage7•Successful,youngdeafadult–bi/modalcommunicator;collegegrad;intheworkworld

Thiswasjustour‘world’ofdeafness….imagineformorecomplexconditions?Whatwereourvalues?Ourneeds,Ourgoalsforhealth/wellbeing?...

MedicalHome

∗ PDSACYCLE:∗ Colorado:∗ Prework:

∗ Plan:DetermineifPCPshaveresultsofhearingscreenincharts.Predicttheydo.

∗ Do:Chartreviewof10chartsfrom3PCPSthatagreedtoparticipate.∗ Study:1PCPhadall10results,2PCPShadnone.

∗ Surprisingresult∗ InpatientandOutpatientEMRsdonotcommunicate.

∗ Act:∗ DosmalltestsofchangeusingfurtherPDSAcycles:IdentifyPCPpriortohospitaldischarge;fax

resultstoPCP;provideresultstofamilyinwriting.∗ Promotestatewidedataintegrationeffortswithimmunizationregistry,developastrategic

planfordatamanagementandcasetracking.

TypicalProcessPDSA….

EXAMPLEFROMNICHQPROJECT: ImprovingFollow-UpafterNewbornHearingScreeningbyApplyingQualityImprovementStrategiestotheHealthCareSystem

Exampleofprocess:PDSAmaytrackifaudiologistsaregivinginformationtotheMedicalHome(i.e.faxbackforms)

Ask:Howdidthatimpactparents?“DidthePhysiciandiscussyourchild’sscreeningresultswithyou?”

ThinkingaboutQIpointofviewasaparent….

HowwilltheoutcomesofQIbeutilizedtoimproveyoursystem?(Parents,askyourselftheinternal,‘sowhat?’questionwhentalkingaboutPDSA’s)

Theconceptof‘Value-Driven’orthe‘SoWhat?’inQIwork…

HowwilltheoutcomesofQIWorkbeutilizedtoimproveyoursystem?(Parents,askyourselftheinternal,‘sowhat?’questionwhentalkingaboutPDSA’s)

BeyondPROCESSEvenbeyondIMPACTONFAMILIES/PATIENTS

GOAL:Measuring/ImprovingParent/PATIENT-CENTEREDVALUESandDesiredoutcomes -individuallyandcollectively

YESwedid!QualityImprovement

∗ Googleit∗ About3,050,000results

∗ TheCitizenScientists(WiredMagazine,2001)∗ “Andbytheway,don'tgo

ontheInternet.”

GettingThere:Clinician–ParentPartnership

ExampleofParentInvolvement

NICHQhasworkedwithHRSA-MCHBon5collaborativestoimproveoutcomesforchildrenwithhearinglossandtheirfamilies,across52statesandterritories:∗ ImprovingFollow-uptoNewbornHearingScreeningbyWorkingthrough

theMedicalHomeLearningCollaborative∗ AZ,CA,FL,KS,MI,NE,PA,WI(2006-2007)

∗ ImprovingSystemsofCare(ISC)forChildrenandYouthwithSpecialHealthcareNeedsLearningCollaborativesA&B∗ LC-A:NHS:CO,MA,MN,NV,NY,UT,WA(2007-2009)∗ LC-B:NHS:HI,IL,IN,IA,ME,NC,VA(2009-2010)

∗ ImprovingHearingScreeningandInterventionSystems(IHSIS)LearningCollaborativesA&B∗ LC-A:AL,AK,GA,ID,KY,LA,MS,MO,NH,NM,OH,RI,SC,DC(2011-2012)∗ LC-B:AR,CT,DE,MD,MT,NV,NJ,ND,OK,OR,PR,TN,TX,USVI,VT,WV,WY(2012-2013)

NICHQNewbornHearingCollaboratives

IHSISfundedbytheUSDeptofHealth&HumanServices,HealthResources&ServicesAdministration,MaternalandChildHealthBureau,ContractNo.HHSH250201000021C

∗ Planning∗ Involvementatthebeginningofeachproject∗ Guidingthedevelopmentofcollaborativecontentfromthefamilyperspective∗ Mandatedparentparticipationonteams

∗ Facultylevel∗ Roleequaltothatofotherfaculty∗ Askedtocontributebeyond‘parentstuff’

∗ Teams∗ T.A.inensuringtheirparentsareinvolved∗ Presentatlearningcollaboratives∗ Supportparent-driveninitiatives

∗ Parentinvolvementsupport∗ Spendtimewithparentsasagroupatlearningsessions∗ Createandsharetoolsformeaningfulinvolvement

NICHQParentFacultyRole

∗ PowerfulPartnerships:AHandbookforFamiliesandProvidersWorkingTogethertoImproveCare

Downloadfrom:www.nichq.org

http://www.nichq.org/how-we-improve/resources/powerful-partnerships

Resources:

The“HOWTO”!

Disturb the Peace

Sustain Tension

Contain Anxiety

Provide Leadership

Janet DesGeorges

You can reach Janet at janet@handsandvoices.org

303-492-6283

archildrens.org uams.eduarpediatrics.orgarchildrens.org uams.eduarpediatrics.org

VALUE-DRIVENQUALITYIMPROVEMENTINPRIMARYCARE:Thepediatricsperspective

DennisZ.Kuo,MD,MHSAssociateProfessorofPediatrics,UAMS

November12,2015

Pediatrics

• Children– 48%ofMedicaidenrollees– 21%ofspend(KaiserFamilyFoundation)

• Mostchildrenaccessingprimarycare– Preventivecarevisits– Immunizations

• ~1%=25-33%ofcosts(Neff,2004;Cohen,2012)

ChildrenareNOTlittleadults!

The5D’s Implicationforchildren

Development • Enhancedevelopmentandgrowth

Dependency • Dependentonadults–notautonomous

DifferentialEpidemiology • Largenumberofrelativelyrarechronicconditions• Subspecialistsbasedinacademicmedicalcenters

DemographicPatterns • Highpoverty• Moreracialandethnicdiversity

Dollars • ROIoverlongtermlifecourse

Stilleeta.TheFamily-CenteredMedicalHome:SpecificConsiderationsforChildHealthResearchandPolicy.AcademicPediatrics2010;10:211-7.

Healthcarespendingbychildren

Kuoetal(2015)Pediatrics.Inpress

Highresourceutilizers:childrenwithmedicalcomplexity

• Multiplechronicconditions• Highincidenceofneurodevelopmentaldisability• Technologyneeds• Socialcomplexity• Muchofcareintertiarycaresetting

Cohenetal.Pediatrics(2011)

The Chronic Care Model

Wagner EH. Figure from Antonelli R (2005). Adapted from Bodenheimer (2002)

Drivingvalueinprimarycare

• PCMH/practicetransformation– Primarycareisinexpensiveandhighvolume– Savingsconcernasmallnumberofpatients

• Challenges– Commonmetricsarenotpediatric-based– Mosthighresourceutilizerspendisintertiarycarecenter– WhatistheROIonmore$$inprimarycare?– Whatistheclinicalmechanismtogeneratevalue?

Deepthoughts

• Understandthehighresourceutilizer• Emphasizetheroleoftheprimarycarephysician

– BuildcapacitywithQI,careteams,registry– Community-basedtherapies,familyengagement

• Alignprimarycarewithaco-managementarrangementwithtertiarycareservices

• Supportivepaymentstrategies

Value Driven Quality Improvement in Primary Care

Richard Snow, DO, MPH System Vice President, Clinical Transformation, OhioHealth

Model of Patient Centered Care Moving Towards Value Following Donnabedian Model of Health Care Measurement

• Structural orientation – Accreditation

• Process oriented – HEDIS measures

• Outcomes focused – Value oriented

• Clinical and financial quality • Payers increasingly moving towards

– Comprehensive Primary Care – Commercial

Approach of OhioHealth• Large hospital system in Central Ohio with

– 28,000 associates and family members in self insured – Clinically integrated network with Medical Group of Ohio

with ~ 160,000 covered lives • Developing Pathways to Value

– Series of value oriented projects focused on improved clinical and financial quality – all projects link the 2 outcomes

• Deploying at a system level – Describe what we want for our primary care practices

• Aligning force – Per Member Per Month

•DiabetesPreventionProgram •ChronicKidneyDisease •PreventionofMusculoskeletalSurgery

•ObstructiveSleepApnea •AmbulatoryEDUtilization •HospitalObservation •PreventableHospitalization •EDCTUtilization •TotalKneeReplacement

•EndStageRenalDisease •ChronicObstructive PulmonaryDisease •CongestiveHeartFailure •PathwaystoWellness

Pathways to Value Initiative in OhioHealthy

Physician Leadership and Engagement

Prevention

Matching Medical

Necessity with Intensity of

Service

Managing Chronic Disease

Demonstrated Value Differential

How Does This Translate to a Primary Care Office and Patient Centered Care

• Diabetes Prevention Program – Cost of care doubles as patients progress from pre-DM to DM – DPP reduces progression to DM by 58% – Managing to value – percent enrollment

• Reduction of progression of high risk patient CKD-3 – Hypertension management, nephrotoxic drug avoidance, guideline

adherence • Conservative management of low back and joint problems

– Identification of patients – Referral and co-management

Implications for Primary Care Office

• Providing primary care with direction to provide value – Who is at risk? – What is the modifiable portion of risk? – What can my office do to reduce the risk?

• Reengineering Payment – How do we incentivize and support the office to be successful?

Value-Driven Quality Improvement in Primary Care · Value-Driven Quality Improvement in Primary...

Documents

Transcript of Value-Driven Quality Improvement in Primary Care · Value-Driven Quality Improvement in Primary...

Primary Care

Transforming primary care (integrated care)

Webinar: Comprehensive Primary Care Initiative - For Primary Care Physicians

CPC Primary Care Practice Solicitation · Primary Care Practice Solicitation . Contents. ... Eligibility Criteria for Primary Care Practices .....8 VIII. Primary Care Practice Selection

Primary Care Challenges: Data, Teams and Primary … Care Challenges: Data, Teams and Primary Care. ... JAP. $0 $500 $1,000 $1,500 ... Primary Care Challenges: Data, Teams and Primary

Missouri Primary Care Association March 2011 Missouri Primary Care Association1.

primary care strategy - hammersmithfulhamccg.nhs.uk€¦ · care home’ concept to become ‘Primary Care Networks’ The ‘primary care home’ concept preserves and improves the

Primary Solutions for Primary Care

Levels of harm in primary care - Health FoundationTHE HEALTH FOUNDATION Research scan: Levels of harm in primary care 5 1.2 Definitions Primary care Primary care is the first point

Integrated primary care needs integrated research infrastructure: The Netherlands Primary Care Database Robert Verheij, NIVEL Primary Care Information.

Health Systems Development Primary Health Care Primary Health Care Resources

Nottinghamshire Primary Care Alcohol Misuse Guidelines · Nottinghamshire Primary Care Alcohol Community Detoxification Protocol – v5 1 Title Nottinghamshire Primary Care Alcohol

Primary Care Physicians-Distribution and Population to ......Wisconsin’AHEC’Health’Workforce’Data’Brief! primary!care! physicians! primary!care ! ! ! ! ! ! !!!!! Primary!care!physicians!!

Primary Palliative Care in Ireland · PRIMARY PALLIATIVE CARE IN IRELAND Primary Palliative Care in Ireland Identifying improvements in primary care to support the care of those in

Primary Maternal Care: Antenatal Care

Primary Care Commissioning Committee , Part 1 … Care...South East London Primary Care Team Nora Simon (NS) NHS England Assistant Head of Primary Care, South East London Primary Care

PRIMARY CARE One Pagers/2019 primary_care_brochure.pdf · PRIMARY CARE 2019 Discovery Primary Care You can choose to offer your employees Discovery Primary Care Comprehensive or Discovery

STEM: 2015 - Hartford HealthCare Library/Publications...New Primary Care Patients: 32,652 Primary Care Visits: 319,799 Provider of primary care, surgical care, urgent care and specialty

Primary Care Spending 2020 - Primary Care Collaborative

Integrating Primary Care & Behavioral Health: … Primary... · Certificate Program in Primary Care Behavioral Health© The Center for Integrated Primary Care Integrating Primary