CQC 2018 Impact Report V5 031819 - CQC: …...en improvement, the supportive program addressed...

TABLE OF CONTENTS

Executive Summary 1

AIM 1: Managing Total Cost of Care 4

AIM 2: Practice Transformation 6

AIM 3: Improving Medically Complex Care 9

AIM 4: Advancing Independent Practices 13

Building Capacity for Improvement 15

Setting New Aims 17

CQC Team 18

Steering Committee 19

Sponsors 20

IMPACTREPORT 2018

California Quality Collaborative Impact Report 2018 1

Dear Colleagues,

With new strategic aims confirmed, the California Quality Collaborative sharpened its long held focus on advancing the quality and affordability of health care in California by supporting transformation in primary care and specialty care. As the preeminent statewide multi-stakeholder improvement organization in California, CQC assists providers and plans in meeting the demands of the current environment. All of CQC’s activities incorporate the fundamental belief that patient outcomes can only change when systems of care are redesigned.

CQC 2018 programs were focused on four Aims:

We are proud to share our many accomplishments in 2018:

1. Improving primary care through practice transformation: CQC’s practice transformation work with 4,400 clinicians is improving care for 3 million Californians

� Better Outcomes: As of September 2018, 52,126 patients with diabetes and hypertension experienced better care and outcomes

� Reduced costs: $176 million total cost savings achieved through reductions in hospital bed days, emergency department visits, and unnecessary testing

� High Impact: CQC was identified by CMS as one of the top 5 programs nationally (of 29) based on our results

2. Improving care for medically complex patients: CQC programs helped 18 organizations representing over 726,000 patients improve care for high-cost, high-need patients, training over 90 care coordinators in delivering person-centered care.

3. Working with small practices to improve outcomes and financial sustainability: CQC developed and im-plemented a successful model to work with small, independent practices, helping them to use patient data to improve care and qualify for bonus payments from CMS and a local plan.

4. Highlighting insights for innovation: CQC developed toolkits to support providers in opioid safety, inform care coordination program design and targeting, delivering person-centered care, and contracting for medi-cally complex populations. We also addressed specialty care, providing insights into high-value care in both cardiology and oncology.

5. Training the improvement workforce: Altogether, CQC’s programming in 2018 drew more than 650 unique attendees from more than 200 different organizations.

Sincerely,

Melora Simon and Dr. Bart Wald

Executive Summary

Aim #4

Improve care at small, independent practices

Aim #1

Build capacity to manage total cost of care

Aim #3

Expand the availability of intensive outpatient management for people with multiple, medically complex conditions

Aim #2

Transform practice to improve care for populations of patients where clinical quality scores are lowest


Californian Lives Touched by CQC Programs in 2018

2018 CQC Event Registrations Participating Organizations in 2018 CQC Events

CQC Events Held During 2018

1.63M

185

1.15M

620

184

5542

4

542

172

32

0.86M

0.10M

Payer

• Commercial• Medicaid• Medicare• Other

Practice Transformation Initiative (PTI)


Reg

istr

ants

Num

ber

of O

rgan

izat

ions

Building Capacity

(BC)

Building Care Solutions

(BCS)

Cost Action Community

(CAC)


(CAC)

Building Capacity

(BC)


(BCS)

Program Names

• Practice Transformation Initiative (PTI)• Building Capacity (BC)• Building Care Solutions (BCS)• Cost Action Community (CAC)

3.74MLIVES

40EVENTS

1,366REGISTRANTS

285ORGANIZATIONS

14

3

0

100

200

300

400

500

600

700

800

0

50

100

150

200




1.63M

185

1.15M

620

184

5542

4

542

172

32

0.86M

0.10M

Payer




Reg

istr

ants

Num

ber

of O

rgan

izat

ions

Building Capacity

(BC)


(BCS)


(CAC)


(CAC)

Building Capacity

(BC)


(BCS)

Program Names


3.74MLIVES

40EVENTS

1,366REGISTRANTS

285ORGANIZATIONS

14

3

0

100

200

300

400

500

600

700

800

0

50

100

150

200




1.63M

185

1.15M

620

184

5542

4

542

172

32

0.86M

0.10M

Payer




Reg

istr

ants

Num

ber

of O

rgan

izat

ions

Building Capacity

(BC)


(BCS)


(CAC)


(CAC)

Building Capacity

(BC)


(BCS)

Program Names


3.74MLIVES

40EVENTS

1,366REGISTRANTS

285ORGANIZATIONS

14

3

0

100

200

300

400

500

600

700

800

0

50

100

150

200




1.63M

185

1.15M

620

184

5542

4

542

172

32

0.86M

0.10M

Payer




Reg

istr

ants

Num

ber

of O

rgan

izat

ions

Building Capacity

(BC)


(BCS)


(CAC)


(CAC)

Building Capacity

(BC)


(BCS)

Program Names


3.74MLIVES

40EVENTS

1,366REGISTRANTS

285ORGANIZATIONS

14

3

0

100

200

300

400

500

600

700

800

0

50

100

150

200

Executive Summary


San Francisco

Santa Cruz

San Mateo

La Paz

Yuma

Maricopa

Yavapai

ARIZONA

Pima

Pinal

Gila

Program

Building Care Solutions (BCS)

Cost Action Community (CAC)


Executive Summary

Program Organization City StateBuilding Care Solutions (BCS)

Alameda County Health System Alameda CaliforniaCommunity Health Center Network San Leandro CaliforniaEpic Redlands CaliforniaHeritage ACO Northridge CaliforniaKaiser Permanente - Santa Clara Santa Clara CaliforniaLos Angeles Jewish Home Reseda CaliforniaProvidence MSO Los Angeles CaliforniaRegal Medical Group Northridge CaliforniaRiverside University Health System Moreno Valley CaliforniaSan Francisco Health Network San Francisco CaliforniaScottsdale Partners ACO Scottsdale ArizonaSeaView IPA Oxnard CaliforniaSharp Rees-Stealy San Diego CaliforniaUniversity of Southern California Los Angeles CaliforniaVeteran’s Administration - Palo Alto Palo Alto California

Cost Action Community (CAC)

Applecare Buena Park CaliforniaBrown and Toland Oakland CaliforniaCare 1st - Antelope Valley Palmdale CaliforniaPIH Health Whittier California


Allied Pacific Alhambra CaliforniaApplecare Buena Park CaliforniaCentral Valley Collaborative Fresno CaliforniaEpic Management Redlands CaliforniaHealthCare Partners Arcadia CaliforniaHill Physicians San Ramon CaliforniaMedpoint Management Woodland Hills CaliforniaMolina Healthcare Long Beach CaliforniaNorth Coast Health Improvement and Information Network Eureka CaliforniaPalo Alto Medical Foundation Mountain View CaliforniaPhysicians Medical Group of San Jose San Jose CaliforniaProspect Medical Orange CaliforniaRiverside Riverside CaliforniaSharp Community Medical Group San Diego CaliforniaSt. Joseph Hoag Health Anaheim CaliforniaSutter Pacific Medical Foundation San Francisco California


Aim DescriptionAccountability for total cost of care is a growing factor in contractual arrangements across all lines of business. CQC offers organizations a roadmap of process changes to better manage cost of care for populations of patients.

Program OverviewThe Cost Action Community (CAC) was an eighteen- month learning community program designed to help provider organizations identify and address low value cost and utilization drivers. Featuring short learning sessions, hands-on coaching, and data-driv-en improvement, the supportive program addressed organizational infrastructure, provider network per-formance, and patient behavior strategies. CAC curriculum leveraged CQC’s 2015 research with 15 high-performing organizations. Interview fi nd-ings were published by the California Health Care Foundation in 2016.

Beginning with an in-depth diagnostic phase, the collaborative sought to establish baseline perfor-mance for different lines of business, identify levers for change, and isolate potential barriers. Teams then convened for an in-person meeting to develop their utilization reduction targets and develop new or re-fi ne existing strategies. Each professional learning session included both expert faculty and extensive time for teams to discuss with one another and apply innovation and best practice to their own organiza-tion. The program concluded in December 2018.

Lessons Learned• Provider organizations joining the CAC joined the

project with existing infrastructure and programs to reduce utilization and improve outcomes (e.g., transitions of care, care management, etc.). At each stage in the project, CQC teams worked with participants to take a critical look at their infrastructure to see what changes could improve performance.

• Because so many variables infl uence avoidable utilization, effective teams need active engage-ment from senior leaders across the organization. This may be different from other quality-focused initiatives. Ensuring organizational buy-in and alignment with project goals from the outset is crucial to success.

• Integrating fl exibility into the CAC curriculum enabled organizations to focus on emergent issues, such as high admissions and ED utilization from an intense fl u season or refi ning strategies around urgent care.

Aim 1: Managing Total Cost of Care


Results• Inpatient bed days and ED utilization were

measured quarterly across lines of business. One provider organization reduced their Medi-Cal managed care acute inpatient admissions from 83 per 1000 patients at baseline to 71.7 in the last reporting period. Another participant reduced their 30-day readmissions rate for the commercial population from 8 per 1000 at baseline to 1.9 during the final reporting period.

• Two participants focused intensely on post-discharge services to improve the management of patients with complex conditions. One developed a “high-risk” hub while the other leveraged a primary care strategy to deliver care management and other wrap-around services.

• One participant focused on an in-depth evalu-ation of current programs and their impact on utilization and patient experience prior to mak-ing any infrastructure changes. This approach en-abled them to leverage existing strengths while still focusing on improving performance.

Next StepsCQC will apply best practices from the CAC in future work. These lessons will be relevant for two of our new aims: Advanced Primary Care and Specialty Variation.

Participants• AppleCare Medical Group

• Brown & Toland Physicians

• Care 1st-Antelope Valley

• PIH Health

Aim #1 Managing Total Cost of Care


Aim DescriptionAn unprecedented number of Californians gained health care coverage through Medi-Cal expansion and the public exchange. CQC aims to bring its experience with population management and its work with primary care practices to scale, using triple-aim improvement to support practices in transformation to serve those newly covered and prepare for alternative payment models.

Program OverviewThe Practice Transformation Initiative (PTI) engages 4,400 clinicians contracted with 13 provider orga-nizations to improve performance across a set of clinical and utilization measures in California. CQC receives funding through the Centers for Medicare & Medicaid Services’ Transforming Clinical Practice Initiative which includes 29 other programs national-ly and ends September 2019. CQC partners with the Center for Care Innovations (CCI) and the Integrated Healthcare Association (IHA) to execute the program. CQC’s network of clinicians is unique nationally, as 90% of participating practices are primary care made up of 1 or 2 providers, representing a signifi cant por-tion of the care provided by small independent prac-tices in our state.

PTI deploys a train-the-trainer model by providing ro-bust technical assistance – including training and seed funding of practice facilitators, in-person quarterly convenings, monthly virtual learning sessions, indi-vidualized coaching, and data systems support – to

Aim 2: Practice Transformation

2015-2019

2015-2019

2015-2019

2015-2019

PTI IS A

4 YEARINITIATIVE

ENGAGING

4,400CLINICIANS

CONTRACTED WITH

13 PROVIDERORGANIZATIONS

The Practice Transformation Initiative (PTI)

TO IMPROVE MEASURES OF COST, QUALITY AND PATIENT EXPERIENCE FOR

3 MILLIONCALIFORNIANS


the 13 provider organizations to effectively engage in transformation work with their practices. Care redesign at practice sites follows UCSF’s 10 Building Blocks of High-Performing Primary Care, adapted for the small practice. Provider Organizations also evolved their centralized services and systems to meet the needs of small practices. Data on PTI’s 13-measure set is submitted quarterly on a rolling 12-month basis and shared back to the Provider Organizations through an online portal where participants can compare perfor-mance within their organizations and to PTI peers.

Lessons Learned In 2018, several PTI organizations experienced turn-over in leaders and practice facilitators which impact-ed momentum and organizational engagement, and led to delays engaging practices as planned. Despite this challenge, however, demonstration of real progress during the year proved pivotal for many in prioritizing the work within their organizations. This is especially apparent in some of the IPAs where this type of work is quite new. One example includes AppleCare Medical Group (a Southern California-based IPA), winner of the national 2018 Advanced Primary Care Practice Award from the Patient Centered Primary Care Collaborative for their outstanding work with one of their PTI practic-es. Another example is Prospect Medical (an IPA also based in Southern California) that showed impressive levels of sustained improvement across our measure set, earning them an incentive payment for their ef-forts. These payments are based on achieving signifi-cant improvement over baseline, either on a monthly basis for at least 12 months or a 20% relative improve-ment over baseline as of the reporting quarter on four clinical measures and two cost of care measures.

PTI demonstrated in 2018 that focusing on a few crit-ical measures and QI fundamentals is powerful. A rigorous analysis demonstrated statistically significant relationships between higher performance on clinical care measures and the following key levers of change:

• reviewing regular and transparent performance reports as a care team,

• consistently managing care and documenting care plans for high-risk patients,

• expanding the roles of care team members, and

• actively building QI capability within the practice.

In addition, investment in a small number of promising practice facilitators (through our ACE master coaching program) contributed to improvement in 2018. These coaches also increased capacity for other coaches.

Results

8,000patients with improved blood pressure control

16,000diabetic patients with improved HbA1c control

45,000additional diabetic patients receiving regular screenings (HbA1c tests, eye exam, nephropathy exam)

47,000fewer inpatient bed days and 10,000 fewer emergency department visits representing $176 million in cost savings to the healthcare system.

Practice Transformation’s ResultsAs of June 30, 2018

Aim #2 Practice Transformation

“The ability to have open conversations

around workflows and process improve-

ment, and to be able to show clinics

some new tools to better take care of

their patients has been transformative.”


Next Steps:In 2019, PTI has set a program goal of improving blood sugar control for 10,000 additional patients with diabetes, a measure that impacts both clinical outcomes and hospital utilization. PTI will contin-ue to track performance on the full measure set but wanted to bring focus for the final year. PTI will also be expanding investment in promising practice facil-itators in 2019. In addition, teams will direct their energy toward supporting each organization in cre-ating and delivering on sustainability plans to enable the transformation work to continue beyond the pro-gram’s official end. PTI will also pilot EHR extraction of quality measures for submission to IHA. Lastly, the 13 Provider Organizations will participate to a much greater degree as peer teachers and faculty, stepping forward to design and lead parts of convenings and trainings. The student becomes the master in 2019!

Current Participants:• Allied Pacific IPA

• AppleCare Medical Management

• Central Valley Collaborative

• EPIC Management, L.P.

• HealthCare Partners IPA

• MedPOINT Management

• Molina Health Care

• Palo Alto Medical Foundation

• Physicians Medical Group of San Jose

• Prospect Medical

• Riverside Physician Network

• St. Joseph Heritage Healthcare

• Sutter Pacific Medical Foundation

Aim #2 Practice Transformation

Our priority for 2019 is “to make

sure that all we’ve learned and

the processes we’ve put in

place become established and

thrive beyond the end of the

PTI collaboration. We already

know that PTI works. We need

it to endure after the technical

support and contagious en-

thusiasm by the PTI team is no

longer available.”


Aim DescriptionWithin any population, health care spending is con-centrated among a small population of patients who use a disproportionately large number of services. CQC offers continuing support to organizations to strengthen outpatient programs to improve care and reduce use of expensive services.

Program OverviewBuilding Care Solutions for Older Adults with Complex Needs (BCS) was an action-oriented learning com-munity, with the goal of improving care for medically complex populations. Building on the successful work of the Intensive Outpatient Care Program (IOCP), the California Quality Collaborative expanded the mod-el to include the latest research on person-centered care and strategies to create a strong business case for program sustainability.

BCS offered three action communities in two regions of California, with fi ve provider organizations in each cohort. Fifteen systems were engaged through a combination of learning sessions, technical assis-tance and staff training.

Lessons Learned • Person-centered care requires new competen-

cies and partnerships: Complex populations have clinical as well as social and behavioral health needs, and BCS groups are expanding care teams to include social workers and increasing-ly using home visits to build trust, reach isolated

patients, and better understand the context of the patients’ life, situation and needs. They are also increasingly seeking to address behavioral health issues like depression and anxiety and substance use occurring in conjunction with physical health conditions like diabetes and congestive heart fail-ure. Providers face barriers in achieving a systemic person-centered approach, including limitations on covered benefi ts, behavioral health carve-outs, and challenges in coordinating care across multi-ple systems, locations, and professional cultures. Some also expressed frustration that reimburse-ment differences limited enrollment of medically complex patients to only specifi c lines of business.

• ROI critical to program sustainability and growth: All BCS groups see the value in continuing their programs for complex patients and many are frustrated that they can’t expand beyond a sin-gle payer type or to other sites and populations. Many are in the process of seeking funding to continue and/or expand their programs. To move from pilot to sustainability at scale, BCS pro-grams articulated the need to demonstrate a posi-tive return on investment (ROI) in order to secure program funding. Those organizations that suc-cessfully demonstrated ROI did so with clinical, operational and fi nance staff working together to create a program business case. Some orga-nizations in the program were not able to fi nd partners in other parts of their organizations to

Aim 3: Improving Medically Complex Care


Aim #3 Improving Medically Complex Care


Program Model

support their efforts to calculate ROI. In addition, some organizations that did not have access to full claims data or were only taking profession-al risk took into account factors such as clinical staff satisfaction and retention or more accurate documentation of conditions for risk adjustment in order to make their business case. At a more structural level, investments in caring for com-plex populations are often beleaguered by the “wrong pockets problem” where the investing entity does not receive the full benefi t of their in-vestment (e.g., a medical group invests in home-based primary care for a patient with congestive heart failure, COPD and agoraphobia, prevent-ing costly exacerbations that would likely result

in a long term custodial placement in a nursing home). New fi nancing mechanisms, like pay for success, social impact bonds, and other innova-tive approaches, may create an opportunity for system-wide ROI measurement with a broader perspective and longer time horizon than that of a medical group.

• Data collection and transparency is critical to measurable improvement: The program was not initially scoped to include robust data collection and measurement of outcomes, costs, or per-son-centeredness. This made it more diffi cult to engage groups in quantitative goal-setting and to identify data-driven improvement strategies

within the cohorts. As a result, we could not fos-ter the transparency and accountability that can help sustain engagement both between learning sessions and over the course of the collabora-tive. It is our experience that data collection and transparent data sharing engages groups in deep-er peer learning and provides motivation that ac-celerates improvement.

Results The organizations engaged in BCS are large and diverse with over 530,000 patients represented, in-cluding Medicare, Medi-Cal, commercial and du-al-eligibles.1 In addition to traditional delegated groups, BCS program engaged safety net organiza-tions, a long-term care facility, an academic medical center, and integrated systems like Kaiser Permanente and the VA. BCS support included technical assis-tance with ROI, clinical consulting and training for more than 90 care coordinators in person-centered care. As a result, groups implemented the following sustainable, person-centered strategies:

• 7 organizations demonstrated ROI for their program

• 4 organization increased the scale of their pro-gram, expanding the team and/or spreading to additional sites

• 4 organizations changed team composition or care model whether by adding team members (e.g., social worker, palliative care, pharmacist), increasing skill levels for medical assistants to become care coordinators, or expanding their ability to do home visits.

• 2 organizations refined their algorithms and strat-egies for patient identification

CQC developed two toolkits from work in this area:

Pathways to Person-Centered Care: This toolkit takes the American Geriatrics Society definition of per-son-centered care and helps translate the elements of the definition into manageable steps, that put togeth-er will lead to transformation. For providers interest-ed in implementing person-centered care, this tool breaks down the definition elements into specific op-erational changes in healthcare settings.

Building Care Solutions Toolkit: This toolkit analyzes 10 of the programs participating in our Building Care Solutions collaborative, looking at the common care model elements, program design choices, and oper-ational considerations undertaken by each program. Based on structured interviews and a common pro-gram template, the toolkit provides insights that may be helpful to organizations developing and evolving programs for medically complex patients.

CQC also partnered with the Health Care Transformation Task Force to co-author a white pa-per and tool on medically complex care contract-ing strategies (https://www.bettercareplaybook.org/resources/care-management-contracting-com-plex-populations-best-practices-and-tools).


1. Total participation is approximate, as four organizations did not provide group enrollment data. For these groups, we used a conservative estimate based on totals from Cattaneo & Stroud medical group reports (http://cattaneostroud.com/wp-content/uploads/2016/06/7-Web.pdf).


It was “so valuable to have

time out with our team; we

were able to spend time re-

flecting and bring back the

goals to work. It was helpful

to be in the room with people

doing similar work. We loved

having Ann coming to our of-

fice for technical assistance.”

http://www.calquality.org/storage/documents/Toolkits/PathwaystoPerson-CenteredCare.pdf

http://www.calquality.org/storage/documents/Toolkits/bcs_analysisofcarecoordination.pdf


Next Steps While this aim wrapped up in 2018, the CQC Steering Committee affirmed the importance of person-cen-tered care in its new strategic plan, integrating this work in toward this new aim on Advanced Primary Care, which also expands the scope to address social risk factors and behavioral health in support of serv-ing high need populations based in part on feedback from this program. The goal is to continue work in this area, securing funding to launch programming that is responsive to the needs of our shared stakeholders.

Participants:

ACTION COMMUNITY 1 - SOUTHERN CA

Heritage California ACO

Innovation Care Partners

Regal Medical Group

SeaView IPA

Sharp Rees-Stealy Medical Group

ACTION COMMUNITY 2 - BAY AREA

Alameda Health System

Community Health Center Network

Kaiser Permanente

San Francisco Health Network

VA Palo Alto Health System

ACTION COMMUNITY 3 - SOUTHERN CA

EPIC Management

Los Angeles Jewish Home

Providence Health & Services

Riverside University Health System

University of Southern California


We loved “hearing from other

groups, hearing about similar

challenges, and how they han-

dled the situation differently.

We enjoyed the activities,

and have used some of them

with our own teams. We like

hearing about things outside

of our own experience, and

being exposed to different

backgrounds. It was nice to see

other people’s take on how to

use care coordinators.”


Aim DescriptionDespite the state’s higher penetration of managed care and large risk-bearing medical groups, 29% of physicians in California operate in solo practices and an additional 31% practice in small or medium size practices. A signifi cant subset of these do not have a strong connection to an Independent Practice Association (IPA), either because they do not contract with an IPA or because they contract with multiple IPAs. These practices face unique challenges in the shifting health care landscape. CQC tested a new model to meet the needs of these practices.

Program OverviewIn order to support independent practices, and pre-pare them for the unique challenges they face, CQC developed a pilot program to test several key objec-tives. They included improving clinical outcomes measures and reporting for non-IPA affi liated prima-ry care physicians, targeting those with low perfor-mance on diabetes measures. The pilot also explored offering cost-effective, scalable practice coaching services, running an intensive, short-duration prac-tice facilitation model to determine the most effective approach to drive improved outcomes, and evaluate health plan-sponsored incentive payment programs.

Conducted in partnership with:

• Blue Shield of California

• CalHIPSO

• Elevation Health Partners

The project identifi ed small, independent practices with an Electronic Health Record (EHR) and improve-ment opportunities in diabetes care performance measures. Practices were offered fi nancial incentives to participate in an improvement coaching interven-tion with experienced, local practice coaches through Elevation Health Partners. The intensive, 2-month intervention included pre- and post-practice assess-ments about care processes, a quality improvement plan, and in-person and virtual coaching focused on improving diabetes outcomes through expanded use of EHR functionality for panel management, popula-tion health, and performance monitoring.

Data was collected from each participating practice through pre- and post assessments of care process-es and monthly data submissions of numerators and denominators for diabetes clinical quality measures.

Aim 4: Advancing Independent Practices


Lessons Learned: • The short, intensive coaching model is effective,

producing quick process changes

• Recruitment required in-person contact and rela-tionships and ongoing engagement required fre-quent check-ins to build trust and maintain pace and commitment.

• A few common coaching interventions were critical: � Setting up and running panel reports in the EHR� Specifying workflows for documentation in the

EHR� Training on billing CPT II codes.

• Incentive payments proved helpful, but were not the primary motivator for clinicians to participate and complete the coaching. Practice desire to align with federal reporting requirements (MIPS) proved to be a big motivator.

• EHR vendors are challenging to work with, so practices benefited from experienced advocacy of coaches.

Results:• Successfully recruited 18 practices with Electronic

Health Records (engaged a pool of 100).

• 16 practices (89%) completed the improvement coaching and submitted monthly data.� 100% of practices used their EHR to identify

numerator(s) and denominator(s) for at least one diabetes clinical quality measure.

� 75% of practices use population reports or reg-istries to identify care gaps and act to reduce them.

• 69% of practices regularly produce and share reports on performance at both the organization and provider/care team level, including progress over time and how performance compares to goals, and has a system in place to assure follow up action.

• 44% of practices built QI capability in the practice and empowered staff to innovate and improve.

• Early results show improvement in nephropathy screening and blood pressure control measures.

Next Steps:While the pilot has ended, the intervention will grow in 2019 to provide direct coaching to 80 small prac-tices participating in the Practice Transformation Initiative and enrolled with multiple IPAs in Southern California.

Current Participants:• 16 independent solo clinician practices in the

Inland Empire

Aim #4 Advancing Independent Practices


Aims DescriptionIn addition to its enrolled collaboratives designed for provider organization teams, CQC offers train-ing programs, toolkits and one-day conferences for individuals. These sessions are designed to improve knowledge and skills critical to making the improve-ments represented by CQC’s Aims. CQC offers pro-gramming in three formats:

1. Conferences: Topics in Healthcare Symposia2. Toolkits3. Skills-based training sessions

Topics in Healthcare Symposia:Program OverviewTopics in Healthcare Symposia are one-day confer-ences on emerging topics of interest to CQC’s com-munity and focus primarily on subjects important to quality improvement. Symposia feature presenta-tions from experts in the fi eld and are designed to foster in-depth discussion and networking with col-leagues cross California health plans and healthcare delivery organizations.

Partnering for Improvement in Opioid Safety, March 6In alignment with the statewide opioid safety efforts of Smart Care California and the California Health Care Foundation, CQC is working to identify and spread best practices across California for improving opioid safety through four strategies: prevent new

starts, manage pain safely, treat addiction, and stop deaths through harm reduction. 42 leaders from 32 organizations joined CQC for this multi-stakeholder discussion.

Complex Care Summit: Shifting the Paradigm to What Matters Most, May 24In partnership with the Hospital Association of Southern California and with the sponsorship of the SCAN foundation, CQC hosted a one-day confer-ence to share accomplishments and challenges of serving medically complex populations, facilitating discussion towards problem solving around current and future needs and defi ning ways to address them. More than 90 clinical and administrative leaders from 45 organizations participated in sharing their perspectives and generating solutions.

Impact• Each symposia covers a different topic, using in-

teractive formats to encourage connections be-tween participants.

• In 2018, CQC convened more than 132 health-care clinical and administrative leaders for two cross-disciplinary, cross-functional symposia focused on generating collaboration among or-ganizations related to highly complex issues of statewide signifi cance.

Building Capacity for Improvement


Toolkits:

Accelerating Opioid Safety: Ambulatory Care Toolkit and WebinarOrganizations share common paths on their opioid safety improvement journeys

Pathways to Person-Centered CareCritical steps along the journey to delivering Person-Centered Care

Building Care Solutions Toolkit: Analysis of Care Coordination Programs or Medically-Complex PatientsCommon core model elements, program design choices, and operational considerations

Care Management Contracting for Complex Populations: Best Practices and ToolsStrategies from organizations that operate sustainable, effective programs

Building Capacity for Improvement

Best Practices in Care Management Contracting for the High-Need, High-Cost Population

_____

July 2018

Skills-Based Training Sessions:

Program OverviewTraining sessions offer individuals opportunities to build skills foundational to improving patient care. In 2018, CQC offered three virtual training series:

1. Person-centered Care� The Case for Patient Activation: Research

Findings & Real World Experience Webinar

� Trauma Informed Care: Impact of Adverse Childhood Experiences Webinar

� Webinar: Dementia Centered Care - Supporting Cognition and Function

2. High-Value Cardiology� Best Practices: Congestive Heart Failure

� Best Practices: Electrophysiology

� Best Practices: Interventional Cardiology

3. High-Value Oncology (continuing in 2019)� Value & Limitations of Guidelines

� Personalized Medicine

We also offered three trainings on Practice Facilitation and Improvement Coaching, including one for Health Net

• Practice Facilitation Basics Training: January 2018

• Practice Facilitation Basics Training: Mar 2018

• Practice Facilitation Basics Training: Sep 2018

ImpactCollectively, these trainings were attended by more than 450 individuals from more than 160 organizations.

http://www.calquality.org/storage/documents/Toolkits/bcs_analysisofcarecoordination.pdf

http://www.calquality.org/storage/documents/Toolkits/PathwaystoPerson-CenteredCare.pdf

http://www.calquality.org/storage/documents/Toolkits/AcceleratingOpioidSafety_Ambulatory_Care_Toolkit.pdf

https://hcttf.org/care-management-contracting-for-high-need-high-cost-populations-best-practices-and-tools/


In September 2018, CQC’s Steering Committee met for a strategic planning retreat, and established new aims for 2019-2021. These aims are:

Aim 1: Practice Transformation FundamentalsImprove the quality of care for all patients through primary care practice transformation

In enrolled groups, improve relative performance by 20% and reduce variation by 10% on hypertension and diabetes measures. Enroll practices that are in the bottom three quarters of performance measures and address specifi c network challenges for plans.

Aim 2: Advanced Primary careSupport provider organizations in developing ad-vanced primary care models, including approaches that address behavioral health needs, social risk fac-tors, and/or high need patients

Increase the number of organizations offering advanced primary care models

Aim 3: Specialty Variation Reduce clinical practice variation in specialty conditions

Improve outcomes and resource use for specifi c conditions, including but not limited to oncology, arthritis, multiple sclerosis, infl ammatory bowel dis-ease, and/or dermatology infl ammatory conditions to align with IHA measurement.

Setting New Aims


Melora Simon, MPH Senior Director

Crystal Eubanks, MS-HQ Senior Manager, Practice Transformation Initiative

Jose Ordonez Program Coordinator

Bart Wald, MD Medical Director

April Watson, MPH, RD Director, Practice Transformation Initiative

Sandra Newman, MPH Consulting Director, Cost Action Community

Peter Robertson, MPA Senior Manager, Data Use & Reporting

CQC Team

We would also like to acknowledge the following past CQC team members for their contributions to our impact in 2018:

Jen Burstedt CorreaKaren HsuMargie PowersScott RuthrauffAlexandria StackDiane Stewart


Phyllis Adams, RN, BSNVice President, Regional Care ManagementHealthCare Partners

Parag Agnihotri, MDCMO, Population Health ServicesUCSD Health

Sean Atha, MHASVP Business & Network DevelopmentRiver City Medical Group

Laura Clapper, MDMedical Market ExecutiveCigna

Tanya Dansky, MD*Chief Medical OfficerBlue Shield Promise Health Plan

Mary Fermazin, MD, MPAChief Medical OfficerHealth Services Advisory Group

Scott Flinn, MDRegional Medical DirectorBlue Shield of California

Peggy Haines, RN, Co-Chair *Vice President, Quality Management Health Net, Inc.

Marc Hoffing, MD, MPHMedical DirectorDesert Oasis Healthcare

Phil JacksonCEO, Health Plan ProductsSutter Health

Lance Lang, MD*Chief Medical OfficerCovered California

Helen Macfie, PharmDChief Transformation Officer MemorialCare Health System

Julie Morath, RN, MSPresident/CEO, Hospital Quality InstituteCalifornia Hospital Association

Amy Nguyen Howell, MD, MBA *Chief Medical Officer America’s Physician Groups

Terence Offenberger, MD, MBAVP, California Medical DirectorSCAN Health Plan

Kathryn Phillips, MPH Senior Program Officer, Improving Access California Health Care Foundation

Ellen Piernot, MD, MBAChief Medical OfficerGolden Valley Health Centers

David Pryor, MD RVP Medical Director, Commercial Accounts Anthem Blue Cross

Michael Siegel, MDMedical DirectorMolina Healthcare of California

Rich Seidman, MDChief Medical OfficerL.A. Care

Bruce Spurlock, MD *President and CEOCynosure Health

Mike Weiss, DO, Co-Chair *Vice President, Population HealthCHOC Children’s

Claudia Williams, MSChief Executive OfficerManifest MedEx

Fiona Wilson, MD *Chief Medical and Transformation OfficrerBrown & Toland Physicians

Michelle Wong, MPH, MPP Director, Care for Complex NeedsKaiser Permanente Care Management Institute

Dolores Yanagihara, MPH *Vice President, Analytics & Performance InformationIntegrated Healthcare Association

* Also serves on CQC Executive Committee

2019 Steering Committee


2018 Sponsors

CQC 2018 Impact Report V5 031819 - CQC: …...en improvement, the supportive program addressed...

Documents

Transcript of CQC 2018 Impact Report V5 031819 - CQC: …...en improvement, the supportive program addressed...