Record of Learning Primary Care Quality Reporting (PCQR) Work Session 2 February 1, 2013 Mid-Ohio Foodbank, Grove City, Ohio On February 1st, 26 participants (attachment 1) from diverse health care organizations spent time collaborating on wise steps to implementing local Primary Care Quality Reporting in 2013. This session followed the design shaping of Work Session 1 that took place November 9, 2012 (https://accesshealthcolumbus.egnyte.com/h-s/20130128/d26dcd2340974722). Objectives of the February 1st session1.
Reach a design decision on a 2013 prototype for Primary Care Quality Reporting (a good place to start).
2.
Based on a design decision, obtain guidance on prototype implementation.
A presentation was made regarding key related initiatives, the proposed local project path, and Access HealthColumbus’ recommendation for a 2013 PCQR prototype (attachment 2). Small group work sessions were held at tables of three to discuss and provide adjustments to the recommended prototype description. Participants were then asked to provide guidance on two important implementation questions. The first “What organizations should be considered for collecting and reporting the data and why?”. In the second question, regarding audiences for the reports, participants were asked for their reflections on those listed. The resulting updated 2013 PCQR prototype description and questions’ responses are below. The work session ended with 21 participants indicating they would like to join the PCQR Collaborative Project Team to guide the project throughout the year (attachment 3). Access HealthColumbus will coordinate the project team and continue to communicate progress to the broader collaborative.
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Primary Care Quality Reporting 2013 Prototype Design (Decision 2/1/2013) •
Build a local prototype in 2013
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Begin with an invitation to all Primary Care practices, include choice of determined measures
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Collect data and report semi-annually on several National Quality Forum measures
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Use measures that reflect Central Ohio priorities (identified at the 11/9 work session) that are aligned with the SW Ohio region’s Comprehensive Primary Care Initiative
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Measures – Participating practices can choose to provide EMR data for, at a minimum five measures (Diabetes(3) , Asthma(1), Blood Pressure Control (1)) or eight desired measures (Diabetes(3), Composite Diabetes (1), Asthma(1), Influenza Immunization(1), Blood Pressure Control(1), and Access to Care (1))
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Guidance on Prototype Implementation, Question #1
What organization(s) should be considered for collecting and reporting the data and why? Responses – Explore the following: 1. Access HealthColumbus (AHC); AHC should disseminate the data 2. Unknown trusted neutral organization 3. COHIE/OHIP tools with AHC as dispenser 4. Ohio Hospital Association infrastructure 5. The Health Collaborative infrastructure 6. Valence Health (MGO and Nationwide Children’s use them*) 7. Truven Healthcare Analytics *Valence only used for Partners for Kids
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Guidance on Prototype Implementation, Question #2 Based on learning from others, we envision the reports being available to these audiences: • Participating primary care practices • Local health care community • Local business community • Local health plans What are your reflections on this approach? Responses-Explore the following: 1. Begin with 1st two, overtime 3 & 4. With the notion it will ultimately be made public. 2. Concern with health plans, dinging physicians or patients rather than helping. 3. PCP first, then others 4. Has to start small, but then open fast and get to public/shared with employees fast. 5. All, but don’t assume they know how to use. Provide guidance. What’s quality improvement (e.g when 42% is good)? 6. Concern – a small self selected, self motivated set of practices’ results should not be judged as representative of the community. 7. Depends on what info would be shared (e.g. PCMH or group level). Would want to know how report would be used. Would PCMH be compared to a community norm, NCQA stds for the measures, etc. 8. We don’t want to be dinged for sharing this information. As a community, we are not doing a good job.. 9. Start with primary care practices, move on to others only if high % of practices participating. 10. All, but in a way that is non-threatening to participants and encourages joiners beyond the early adopters.
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Follow up items (to be on the first agenda with the Collaborative Project Team)
• • • •
Clarity on Asthma measure, dispensing or ordered Diabetes composite measure definition Access measure definition CG CAHPS survey for future consideration
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Attachment #1
Primary Care Quality Reporting, Work Session 2 Participants, 2/1/2013 First Name: Michael Parminder Melissa Jeff Susan Phil Michael Carol Sarah Diana Deanna Lynne Mary John Lisa Christine Lori Geoffrey Shane Kim John Kam Margaret Bruce Bill Bob
Last Name: Anthony Bajwa, MD Bayus Biehl Butler Cass Curtin Deibel Durfee Riggsby Gardner Gingrich Hamilton Jordan Leite Kaiser Lester Lewellen Losekamp Olson Raderstorf Schmeling, MD Sigafoos Snow Wall, MD Wulf, MD Ziff, MD
Organization: Mount Carmel Medical Group Columbus Neighborhood Health Centers Mount Carmel Medical Group Access HealthColumbus The Ohio State University Wexner Medical Center Columbus Medical Association Foundation UnitedHealthcare Access HealthColumbus Ohio Public Employees Retirement System The Dispatch Printing Company Lower Lights Christian Health Center State Teachers Retirement System of Ohio UnitedHealthcare Access HealthColumbus Health Action Councit Nationwide Children's Hospital The Dispatch Printing Company Anthem Humana Access HealthColumbus The Medical Group of Ohio OSU Physicians, Inc., OSU Faculty Group Practice Franklin County Cooperative Health Benefits Program The Ohio State University Health Plan Central Ohio Primary Care Humana
Attachment 2- Primary Care Quality Reporting Record of Learning, 2/1/2013
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Primary Care Quality Reporting Work Session 2 February 1, 2013
Welcome! Shaping Project Design (Version 1.0)
What wise steps can we take to implement local Primary Care Quality Reporting?
Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate 2 Donations
Primary Care Quality Reporting Shaping Project Design (Version 1.0) Today’s Objectives: 1. Reach a decision on a 2013 prototype for Primary Care Quality Reporting (a good place to start). 2. Based on a design decision, obtain guidance on prototype implementation.
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Primary Care Quality Reporting Work Session 2 8:00 Registration and networking with colleagues 8:30 Welcome & Framing, Refresh on Work Session #1 Small Group Introductions 8:50 Key related regional initiatives Access HealthColumbus’ recommendation for a 2013 prototype Collaborative design decision 9:30 Guidance on prototype implementation Small Group Work Session 10:15 Planning Next Wise Steps Closing
Primary Care Quality Reporting Proposed Local Project Path
11/9/2012
2/1/2013
2nd Qtr 2013
3rd & 4th Qtrs 2013
WHY & WHAT
DESIGN
INVITE & ENROLL
BUILD & SHARE
Begin Shaping Project Design (version 1.0)
Finalize Project Prototype Design (version 1.0)
Primary Care Practices invited to share their data
Local Prototype Primary Care Quality Reporting built
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Primary Care Quality Reporting Overview What could be different? Physicians and providers have accurate information to identify areas for quality improvement
Primary care teams improve quality of care and demonstrate increased value by measuring performance and care outcomes
Purchasers provide incentives to high-value primary care teams to accelerate transformation of care
More patients have improved health status and economic productivity
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Primary Care Quality Reporting 11/9/2012 Work Session 1 Question 1: In determining what to report/measure, where is a good place to start? A few measures of both prevention and chronic conditions. By measuring both clinical process and outcomes. Question 2: What are top conditions that would be a good place to start with Primary Care Quality Reporting in Central Ohio? Diabetes Mellitus Prevention – Immunization Status Hypertension/Elevated Blood Pressure Prevention – Obesity Etc.
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Primary Care Quality Reporting (PCQR) Small Group Introductions 1- Please share your name and organization.
2- See slide 5, from your perspective, what is your reflection on what could be different?
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Key related regional initiatives Comprehensive Primary Care Initiative (CPCI) – Center for Medicare & Medicaid Innovation (CMMI) multipayer initiative fostering collaboration between public and private health care payers to strengthen primary care. -Seven markets in the nation were selected including Cincinnati-Dayton region (75 practices) -Significant provider payments from CMS & commercial payers
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CMMI: Comprehensive Primary Care Initiative (CPCI)
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CMMI: Comprehensive Primary Care Initiative (CPCI) Testing two models simultaneously: a service delivery model and a payment model 7 regions • 500 primary care practices • 2,144 providers • 313,000 Medicare beneficiaries
Ohio & Kentucky: Cincinnati-Dayton Region • 75 Primary Care Practices • 261 Providers • 10 Payers • Estimated 44,500 Beneficiaries Served • Aetna CareSource (Ohio only), Centene Corporation (Ohio only), Amerigroup (Ohio only), Anthem Blue Cross Blue Shield of Ohio, Humana, HealthSpan, Medical Mutual, Ohio Medicaid, UnitedHealthcare
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CPCI– brief list of the 21 adopted SW Ohio quality measures (from the National Quality Forum measures set) 1. 2. 3. 4.
Patient Experience-CG-CAHPS Health/Functional Status Prevention-Colorectal Screening Prevention-Influenza Immunization 5. Prevention-Tobacco Assessment/Cessation Intervention 6. Prevention-Glaucoma Screening 7. Prevention-Mammography Screening 8. Diabetes HbA1c Poor Control 9. Diabetes LDL Control 10. Diabetes Blood Pressure Control 11. Ischemic Vascular-Lipid Profile & LDL Control 12. Hypertension-Blood Pressure Control
13. Coronary Artery Disease-ACE or ARB for CAD+Diabetes and/or LVSD 14. Heart Failure-Beta Blocker Therapy for LVSD 15. Asthma-Use of Appropriate Asthma Medications 16. Children-Appropriate Treatment for Upper Respiratory Infections 17. Care Coordination-Risk-Std, All condition readmission 18. Care Coordination-COPD Admission Rate 19. Care Coordination-CHF Admission Rate 20. Future-Depression Screening 21. Future-Screening for fall risk 12
Ohio’s State Innovation Model Proposal 1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe 2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe SOURCE: State Innovation Model Design Grant Application, Ohio Office of 13 Health Transformation, September 21, 2012.
Primary Care Quality Reporting Proposed Local Project Path
11/9/2012
2/1/2013
2nd Qtr 2013
3rd & 4th Qtrs 2013
WHY & WHAT
DESIGN
INVITE & ENROLL
BUILD & SHARE
Begin Shaping Project Design (version 1.0)
Finalize Project Prototype Design (version 1.0)
Primary Care Practices invited to share their data
Local Prototype Primary Care Quality Reporting built
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Shaping Project Design, Primary Care Quality Reporting --
Access HealthColumbus is providing a “good place to start� recommendation for a 2013 prototype for Primary Care Quality Reporting.
Primary Care Quality Reporting 2013 Prototype
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Shaping Project Design, Primary Care Quality Reporting -Access HealthColumbus’ “good place to start” recommendation • Build a local Prototype in 2013 • Begin with an invitation to all Primary Care practices • Collect data and report semi-annually on several National Quality Forum measures • Use measures identified at the 11/9 work session that are aligned with the SW Ohio region’s Comprehensive Primary Care Initiative Primary Care Quality Reporting 2013 Prototype 16
Recommended Measures -- Primary Care Quality Reporting - based on data from EMR Participating practices can choose to provide data for 1. at a minimum, Diabetes & Asthma measures (8, 9, 10, 15) OR 2. the six desired, Diabetes, Asthma, Influenza Immunization, & Blood Pressure Control measures (4, 8, 9, 10, 12, 15). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Patient Experience-CG-CAHPS Health/Functional Status Prevention-Colorectal Screening Prevention-Influenza Immunization Prevention-Tobacco Assessment/Cessation Intervention Prevention-Glaucoma Screening Prevention-Mammography Screening Diabetes HbA1c Poor Control Diabetes LDL Control Diabetes Blood Pressure Control Ischemic Vascular-Lipid Profile & LDL Control Hypertension-Blood Pressure Control
13. Coronary Artery Disease-ACE or ARB for CAD+Diabetes and/or LVSD 14. Heart Failure-Beta Blocker Therapy for LVSD 15. Asthma-Use of Appropriate Asthma Medications 16. Children-Appropriate Treatment for Upper Respiratory Infections 17. Care Coordination-Risk-Std, All condition readmission 18. Care Coordination-COPD Admission Rate 19. Care Coordination-CHF Admission Rate 20. Future-Depression Screening 21. Future-Screening for fall risk 17
Measures and the National Quality Forum (NQF) National leading health care quality advancement organization for • National quality priorities and goals • National standards for measurement and reporting • Education and outreach
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Measure – Influenza Immunization #0041 • All patients aged 6 months and older • Seen between October 1 and end of February • Patient received immunization OR reported previous receipt • Excludes medical, patient, and system reasons for nonreceipt
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Measure – Diabetes: Hemoglobin A1c Poor Control #0059 • Patients with diabetes (type 1 or type 2) 18-75 • Diabetes diagnosis during measurement year or year prior • Patients Hba1c >9%, or missing a result, or test was not done during measurement year • Exclusions include clinical items e.g. polycystic ovaries, gestational or steroid-induced diabetes. 20
Measure – Diabetes: Low Density Lipoprotein (LDL) Mgmt #0064 • Patients with diabetes (type 1 or type 2) 18-75 • Diabetes diagnosis during measurement year or year prior • Patients LDL-C<100 mg/dL • Exclusions include clinical items e.g. polycystic ovaries, gestational or steroid-induced diabetes.
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Measure – Diabetes: Blood Pressure Control #0061 • Patients with diabetes (type 1 or type 2) 18-75 • Diabetes diagnosis during measurement year or year prior • Patients BP < 140/90 mm Hg • Exclusions include clinical items e.g. polycystic ovaries, gestational or steroid-induced diabetes.
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Measure – Controlling High Blood Pressure #0018 • Patients 18-75 with diagnosis of hypertension • Hypertension diagnosis during first six months of measurement year • Patients BP <140/90 • Exclusions include clinical items e.g. end stage renal disease, pregnancy, and patients with admission to nonacute inpatient setting prior to 12/31
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Measure – Use of Appropriate Medications for Asthma #0036 • Patients 5-64 with moderate to severe persistent asthma during measurement year • Patients dispensed at least one prescription for a preferred therapy • Exclusions include clinical items e.g. emphysema, COPD, cystic fibrosis, acute respiratory failure any time prior to 12/31 24
Primary Care Quality Reporting “good place to start” recommendation – -Build a local Prototype in 2013 -Begin with an invitation to all Primary Care practices with EMR -Collect data and report on the measures
Advantages
Prototyping increases local readiness for multistakeholder regional and national initiative participation An invitation to practices from this collaborative shows local positive energy for Quality Reporting Measures • reflect Central Ohio priorities • are aligned with other multi-stakeholder efforts • use national standards (National Quality Forum)
Primary Care Quality Reporting 2013 Prototype 25
Are there questions of clarity on what we have learned since the 11/9/2012 work session?
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Primary Care Quality Reporting 2013 Prototype Recommendation
• Build a local prototype in 2013 • Begin with an invitation to all Primary Care practices • Collect data and report semi-annually on several National Quality Forum measures • Use measures identified at the 11/9 work session that are aligned with the SW Ohio region’s Comprehensive Primary Care Initiative • Measures –
Participating practices can choose to provide EMR data for 1. at a minimum, Diabetes(3) & Asthma(1) measures OR 2. the six desired, Diabetes(3), Asthma(1), Influenza Immunization(1), & Blood Pressure Control(1) measures 27
Collaborative Decision â&#x20AC;&#x201C; Is the recommended prototype a good place to start in 2013?
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Guidance on Prototype Implementation 1. What organization(s) should be considered for collecting and reporting the data and why? 2. Based on learning from others, we envision the reports being available to these audiences: • Participating primary care practices • Local health care community • Local business community • Local health plans What are your reflections on this approach?
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Primary Care Quality Reporting Project Path Next Steps
11/9/2012
2/1/2013
2nd Qtr 2013
3rd & 4th Qtrs 2013
WHY & WHAT
DESIGN
INVITE & ENROLL
BUILD & SHARE
Begin Shaping Project Design (version 1.0)
Finalize Project Prototype Design (version 1.0)
Primary Care Practices invited to share their data
Local Prototype Primary Care Quality Reporting built
Please complete the collaborative project team participation handout at your table. Thank you! 30
Primary Care Quality Reporting Work Session 2
THANK YOU! Lead Support
Major Support
Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate 31 Donations
Attachment #3
Primary Care Quality Reporting, Work Session 2 Project Team, 2/1/2013 First Name: Michael Parminder Jeff Susan Michael Carol Sarah Mary Lisa John Christine Lori Geoffrey Judy Kim Diana John Kam Bruce Bill Bob
Last Name: Anthony Bajwa, MD Biehl Butler Curtin Deibel Durfee Jordan Kaiser Leite Lester Lewellen Losekamp Minaudo Raderstorf Riggsby Gardner Schmeling, MD Sigafoos Wall, MD Wulf, MD Ziff, MD
Organization: Mount Carmel Medical Group Columbus Neighborhood Health Centers Access HealthColumbus The Ohio State University Wexner Medical Center UnitedHealthcare Access HealthColumbus Ohio Public Employees Retirement System UnitedHealthcare Health Action Councit Access HealthColumbus Nationwide Children's Hospital The Dispatch Printing Company Anthem Central Ohio Primary Care Partners in Performance LLC The Dispatch Printing Company The Medical Group of Ohio OSU Physicians, Inc., OSU Faculty Group Practice The Ohio State University Health Plan Central Ohio Primary Care Humana