1e-1 Learning-Collaborative-Summary-AMGA Casanova...May 01, 2019 ·...
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 1
Adult Immunization Best Practices Learning Collaborative
May 14, 2019
Acknowledgements
AMGA Foundation Team • Danielle Casanova, MBA, Senior Director,
Population Health Initiatives• Earlean Chambers, RN, MS, CPHQ, Director,
Population Health Initiatives• John Kennedy, MD, Chief Medical Officer,
AMGA, President, AMGA Foundation• Erin Leaver-‐Schmidt, MPH, Senior Manager,
Population Health Initiatives• Senait Temesgen, Program Manager,
Population Health Initiatives
AMGA Analytics Team• Elizabeth Ciemins, PhD, MPH, MA, Senior
Director, Research and Analytics • John Cuddeback, MD, PhD, Chief Medical
Informatics Officer• Vaishali Joshi, Senior Data Analyst• Jill Powelson, Dr.P.H., M.P.H., M.B.A., R.N., CPC
Senior Director, Collaborative for Performance Excellence
Collaborator• Optum Analytics -‐ Distinguished Data and
Analytics Collaborator
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 2
Program Sponsor
3
AMGA Organizational Overview
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 3
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§ Mission AMGA advances multi-‐specialty medical groups and integrated systems of care as the preeminent model to deliver high performance health care
§ Purpose Advance High Performance Health
§ Vision We are leading the transformation that results in healthier people
AMGA Mission, Purpose, Vision
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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2019 National Adult and Influenza Immunization Summit – 5/14/2019 4
AMGA Members
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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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2019 National Adult and Influenza Immunization Summit – 5/14/2019 5
Acclaim AwardBest Practices
Learning Collaboratives
National Campaigns
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Foundation Programs
AMGA’s Collaborative for Performance Excellence
amga.org/CPX
Total Cost of Care
Practice Efficiency
High-‐Risk Patients
Clinical Quality
and Safety
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 6
Collaborative Overview
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12©2018 All Rights Reserved
ObjectivesIdentify gaps and ways to address gaps in recommended vaccination practices
Demonstrate value of a data-‐driven partnership
Identify gaps in data capture
Evaluate the program’s impact
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 7
13©2018 All Rights Reserved
Pilot(Group 1)
• 7 participating orgs• Only CPX members
145/14/19
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 8
5/14/19 15
Pilot(Group1)
Group 3
Group 2
• 7 participating orgs• Only CPX members
• 19 participating orgs• Open to ALL AMGA members
• 19 participating orgs• Open to ALL AMGA members
Participants (Pilot, Groups 2 & 3): 42 organizations in 27 states
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 9
Objectives
Identify gaps and ways to address gaps in recommended vaccination practices
Encourage use of a combination of intervention tools
Demonstrate value of a data-‐driven partnership
Identify gaps in data capture
Evaluate the program’s impact
18©2018 All Rights Reserved
Collaborative Timeline
Group 3
Group 2
Group 1
November 2014 – June 2016
January 2017-‐September 2018
August 2017 -‐April 2019
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 10
19©2018 All Rights Reserved
Group 3 October 2018 Meeting Attendees
Best Practices/Lessons Learned
Eliminate scheduled immunization appointments
Vaccine Champion program established
Annual Wellness Visits-‐ pneumonia and influenza immunizations included
Physician compensation-‐ influenza and pneumonia on scorecard
Daily Gap reports created to capture patients in need of vaccines at the Point of Care.
Pharmacy training and education to administer vaccines
Uni/Bi-‐directional interface with state adult immunization registry
Transparent data reports sharing (provider and clinic)
Improve access to vaccines at the point of care
Engaging specialty departments
Patient reminders
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 11
Best Practices/Lessons Learned
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Pt reminders
Access
AWVs
Best Practices Learning Collaborative Results
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 12
Data Source
• Most data was self-‐reported by participating organizations, using standardized specifications provided by AMGA and Optum Analytics for each measure
• Data source for approx. one-‐third of the groups in the learning collaborative was Optum Analytics, who maps and normalizes EHR data from ~30 AMGA member organizations to allow valid comparisons across organizations. Overall, data provided by Optum Analytics represents ~15% of AMGA member organizations and 25% of patients seen by all AMGA members or approximately 25 million patient lives.
24Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Custom Measures for Collaborative
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Measure Eligible Ages Eligible ConditionsPneumococcal 65+ 65+ AllPneumococcal High Risk1 19 – 64 cerebrospinal fluid leak, cochlear implants,
hemoglobinopathies, asplenia, chronic renal failure, nephrotic syndrome, organ transplant, kidney disease, immunodeficiencies, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, general malignancy
Pneumococcal At Risk2 19 – 64 diabetes, chronic heart conditions, lung disease, chronic liver disease, alcoholism, smoker
Influenza 18+ All
1 High risk conditions require both PCV and PPSV before age 65. 2 At risk conditions require PPSV before age 65.
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 13
25Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
BL Q1 Q2 Q3 Q4 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
77.8%80.8% 81.6%
Measure1(65+)
AnyPV
BL Q1 Q2 Q3 Q4 Q5
43.3%
54.2%
Measure1(65+)
BothPPSVandPCV
BL Q1 Q2 Q3 Q4 Q5
30.4%
36.6%
Measure2(19–64)HighRisk
AnyPV
BL Q1 Q2 Q3 Q4 Q5
40.4%
33.0%
Op onalMeasure2A(19–64)AtRisk
AnyPV
PV Measures (G2): Baseline → Qtr1 → Qtr2 → Qtr3 → Qtr4 → Qtr5
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• Group weighted averages across 19 participating AMGA member organizations
BL: 1/1/16–12/31/16 Q1: 1/1/17–3/31/17 Q2: 4/1/17–6/30/17 Q3: 7/1/17–9/30/17 Q4: 10/1/17–12/31/17 Q5: 1/1/18–3/31/18
Absolute ∆ 3.8%
Relative ∆ 4.9%
26Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
BL Q1 Q2 Q3 Q4 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
77.8%80.8% 81.6%
Measure1(65+)
AnyPV
BL Q1 Q2 Q3 Q4 Q5
43.3%
54.2%
Measure1(65+)
BothPPSVandPCV
BL Q1 Q2 Q3 Q4 Q5
30.4%
36.6%
Measure2(19–64)HighRisk
AnyPV
BL Q1 Q2 Q3 Q4 Q5
40.4%
33.0%
Op onalMeasure2A(19–64)AtRisk
AnyPV
PV Measures (G2): Baseline → Qtr1 → Qtr2 → Qtr3 → Qtr4 → Qtr5
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• Group weighted averages across 19 participating AMGA member organizations
BL: 1/1/16–12/31/16 Q1: 1/1/17–3/31/17 Q2: 4/1/17–6/30/17 Q3: 7/1/17–9/30/17 Q4: 10/1/17–12/31/17 Q5: 1/1/18–3/31/18
Absolute ∆ 3.8%
Relative ∆ 4.9%
Absolute ∆ 10.9%Relative ∆ 25.2%
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 14
27Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
BL Q1 Q2 Q3 Q4 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
77.8%80.8% 81.6%
Measure1(65+)
AnyPV
BL Q1 Q2 Q3 Q4 Q5
43.3%
54.2%
Measure1(65+)
BothPPSVandPCV
BL Q1 Q2 Q3 Q4 Q5
30.4%
36.6%
Measure2(19–64)HighRisk
AnyPV
BL Q1 Q2 Q3 Q4 Q5
40.4%
33.0%
Op onalMeasure2A(19–64)AtRisk
AnyPV
PV Measures (G2): Baseline → Qtr1 → Qtr2 → Qtr3 → Qtr4 → Qtr5
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• Group weighted averages across 19 participating AMGA member organizations
BL: 1/1/16–12/31/16 Q1: 1/1/17–3/31/17 Q2: 4/1/17–6/30/17 Q3: 7/1/17–9/30/17 Q4: 10/1/17–12/31/17 Q5: 1/1/18–3/31/18
Absolute ∆ 3.8%
Relative ∆ 4.9%
Absolute ∆ 10.9%Relative ∆ 25.2%
Absolute ∆ 6.2%Relative ∆ 20.4%
28Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
BL Q1 Q2 Q3 Q4 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
77.8%80.8% 81.6%
Measure1(65+)
AnyPV
BL Q1 Q2 Q3 Q4 Q5
43.3%
54.2%
Measure1(65+)
BothPPSVandPCV
BL Q1 Q2 Q3 Q4 Q5
30.4%
36.6%
Measure2(19–64)HighRisk
AnyPV
BL Q1 Q2 Q3 Q4 Q5
40.4%
33.0%
Op onalMeasure2A(19–64)AtRisk
AnyPV
PV Measures (G2): Baseline → Qtr1 → Qtr2 → Qtr3 → Qtr4 → Qtr5
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Absolute ∆ 3.8%
Relative ∆ 4.9%
Absolute ∆ 10.9%Relative ∆ 25.2%
Absolute ∆ 6.2%Relative ∆ 20.4%
Absolute ∆ 7.3%Relative ∆ 22.4%
• Group weighted averages across 19 participating AMGA member organizations
BL: 1/1/16–12/31/16 Q1: 1/1/17–3/31/17 Q2: 4/1/17–6/30/17 Q3: 7/1/17–9/30/17 Q4: 10/1/17–12/31/17 Q5: 1/1/18–3/31/18
15 Organizations
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 15
29Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Measure1(65+)AnyPVMeasure1(65+)BothPPSVand
PCV
Measure2(19–64)High-RiskAny
PV
Op onalMeasure2a(19–64)
At-RiskPPSVorUnknownPV
BL Q1 Q2 Q3 Q4 Q5 BL Q1 Q2 Q3 Q4 Q5 BL Q1 Q2 Q3 Q4 Q5 BL Q1 Q2 Q3 Q4 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PVRates
79.3%
77.1%
54.6%
45.9%32.5%
27.3%
33.8%
29.5%
PV Measures (G3): Baseline → Qtr1 → Qtr2 → Qtr3 → Qtr4 → Qtr5
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• Group weighted averages across 19 participating AMGA member organizations
Absolute ∆ 2.2%
Relative ∆ 2.9%
Absolute ∆ 8.7%
Relative ∆ 19.0%Absolute ∆ 5.2%
Relative ∆ 19.0%
Absolute ∆ 4.3%
Relative ∆ 14.6%
BL: 7/1/16–6/30/17 Q1: 7/1/17–9/30/17 Q2: 10/1/17–12/31/17 Q3: 1/1/18–3/31/18 Q4: 4/1/18–6/30/18Q5: 7/1/18–9/30/18
13 Organizations
30Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Influenza Measure (G2): Baseline → Qtr2 → Qtr5
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• Group weighted averages across 19 participating AMGA member organizations
BL: 1/1/16–12/31/16 Q2: 4/1/17–6/30/17 Q5: 1/1/18–3/31/18
BL Q2 Q5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
35.4%
41.6%
47.6%
45.0% 45.0%
Absolute ∆ 12.2%
Relative ∆ 34.5%
Collaborative Goal
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 16
31Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Influenza Measure (G3): Baseline → Qtr4
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• Group weighted averages across 17 participating AMGA member organizations
BL: 7/1/16–6/30/17 Q4: 4/1/18–6/30/18
32Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Estimate of vaccines administered or documented during the collaborative!
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Total of ~ 5.5 million vaccinations combined across 3 adult immunization learning collaboratives (Pilot, Groups 2 & 3)
Pilot Group 2 Group 3 CombinedPneumococcal 500K ~1M ~900K ~2.5M
Influenza 500K >1.5M >1.2M ~3M
Total 1M ~2.5M ~2M ~5.5M
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2019 National Adult and Influenza Immunization Summit – 5/14/2019 17
33Copyright © 2018 AMGA Analytics LLC and OptumIns ight Inc. All rights reserved.
Summary–What has contributed to improved immunization rates?
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• Staff Education, especially about high-‐risk and at-‐risk patients for PV• Physician Champion• Just calling attention to the program• Transparent data reporting• Bi-‐directional state registry feeds into EMR• Reminders and/or gaps in care prompts in EMR• Participating in vaccine programs (e.g. Sanford’s Vax Champ)• Vaccine reminders and alerts in EMR to alert providers • EMMI (Automated outreach program)
Next Steps
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