Healthcare Transformation Learning Session December 5, 2014
Regional partners sharing lessons learned in Greater Columbus
Upcoming Regional Learning Sessions
Featured Learning: Primary care organizations sharing quality data
Please save these dates from 8:30-11:30am:
Break-Out Session Topics
May 15, 2015
• Patient-Centered Medical Home Transformation
August 21, 2015 December 4, 2015
• Integrating Healthcare • Choosing Wisely
Healthcare Transformation Learning Session December 5, 2014
The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. We serve as a catalyst, convener, and coordinator of healthcare transformation & learning in Greater Columbus. www.hcgc.org
Our Public-Private Funding Partners Lead Supporter
Major Supporters
Additional Supporters 100% of our Board of Directors & Staff www.hcgc.org
Individual & Corporate Donations
Agenda Topic: Regional partners sharing lessons learned in Greater Columbus Agenda 8:30-8:45
8:45-9:15
9:30-10:25
Welcome & framing • Jeff Biehl, Healthcare Collaborative of Greater Columbus • Krista Stock, Healthcare Collaborative of Greater Columbus Primary care organizations sharing quality data • Mike Anthony, Mount Carmel Medical Group • Larry Blosser, MD, Central Ohio Primary Care • Rob Strohl, Central Ohio Primary Care • Randy Wexler, MD, The Ohio State University Wexner Medical Center Break-out session – Round 1
10:35-11:30 Break-out session – Round 2
Transforming to Value-Based Healthcare… clinical integration care coordination population health management cultural, language & health literacy health information technology
health literacy assistance engagement in how to use cost and quality information promote positive behavior change
Providers
Consumers
Health Plans
Employers
payment incentives based on value partner with providers on care coordination streamline administrative processes value-based insurance design health and wellness programs partner with providers on care coordination
Transforming culture of healthcare organizations…
Measure value: achieving good outcomes as efficiently as possible Medicine is in for a radical change as we shift to performance-driven teams
Integrating care to be patient-centered
All members of performance-driven teams will need to function at “the top of their license”
Public & Private: Payment Reform Framework
Source: Catalyst for Payment Reform www.catalyzepaymentreform.org
Public and Private Sector Purchasers (employers, government)
Employers are rapidly increasing their participation in regional health improvement collaboratives Employers are demanding more value from health care delivery systems Employers are shifting from “payors” to “purchasers” of high value health services Employers are beginning to change benefits to provide incentives for use of high-value health services and disincentives for lower value services
Medicare & Medicaid Innovation Center Initiatives Primary Care Transformation Comprehensive Primary Care Initiative
Federally Qualified Health Center Advanced Primary Care Practice Multi-payer Advanced Primary Care Practice Accountable Care – Payment Reform Bundled Payment for Care Improvement Accountable Care Organization (ACO) State Demonstrations to Integrate Care for Medicare-Medicaid (dual) Enrollees Financial Alignment Model Demonstrations
Ohio: Current Initiatives Modernize Medicaid Reform nursing facility reimbursement Integrate Medicare and Medicaid benefits Rebalance spending on long-term services and supports Create health homes for people with mental illness Restructure behavioral health system financing Improve Medicaid managed care plan performance Streamline Health and Human Services Consolidate mental health and addiction services Create a cabinet-level Medicaid department Modernize eligibility determination systems Integrate HHS information capabilities Coordinate programs for children Share services across local jurisdictions Improve Overall Health System Performance Pay for health care based on value instead of volume Encourage Patient-Centered Medical Homes Accelerate electronic Health Information Exchange
Our Regional Strategic Areas of Focus
PATIENT ENGAGEMENT …improve engagement between patients and providers
PATIENT-CENTERED MEDICAL NEIGHBORHOOD …improve care coordination between providers & social services
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
QUALITY TRANSPARENCY …improve the use of quality data
www.hcgc.org
COLLABORATIVE LEARNING …improve the application of learning in Greater Columbus
Quality Transparency… improve the use of quality data
Collaborative activity with Patient-Centered Medical Homes in Greater Columbus Quality Reporting Pilot
PCMH Public Reporting (emerging)
www.hcgc.org
Quality Reporting Pilot Participating Providers Pilot Purpose: Based on nationally endorsed measures • Central Ohio Primary Care (34 practice sites) for managing chronic conditions:
• Compile all-payer data every six months from electronic medical records (EMRs) at participating primary care practice sites.
• Share comparable quality data across participating providers and regional purchasers. • Apply learning from quality reports to catalyze quality improvement.
www.hcgc.org
• Mount Carmel Medical Group (17 practice sites) • The Ohio State University Wexner Medical Center (13 practice sites) Participating Purchasers Aetna, Anthem Blue Cross and Blue Shield, Cardinal Health, County Employee Benefits Consortium of Ohio, Employers Health, Franklin County Cooperative, Health Benefits Program, Health Action Council, MediGold, Nationwide Insurance, Ohio Bureau of Workers' Compensation, Ohio Public Employees Retirement System , OSU Health Plan, School Employees Retirement System of Ohio, State Teachers Retirement System of Ohio, The Dispatch Printing Company, The Ohio State University, UnitedHealthcare
Quality Reporting Pilot Overview
A good place to start!
www.hcgc.org
Quality Reporting Pilot Overview – Terms of Use Primary Care Practices
Purchaser Learning Group
Healthcare Collaborative of Greater Columbus
www.hcgc.org
use reports to improve quality of care provided by your organization share lessons learned to help improve healthcare transparency in Greater Columbus will not use pilot content to promote or publicize physician practices share lessons learned to help improve healthcare transparency in Greater Columbus will not use pilot content to promote or publicize physician practices provide technical services sufficient to support the pilot maintain safe-space to enable the sharing of learning with pilot participants apply learning to catalyze best practices to improve healthcare transparency in Greater Columbus will not use pilot content to promote or publicize physician practices
Quality Reporting Pilot: Q3/2013 – Q2/2014 # Patients
(data not risk adjusted)
Lowest
Average
Highest
Diabetes Patients 18-75, Hemoglobin A1c (HbA1c) Poor Control (>9%) NQF #0059
44,947
35%
11%
3%
Diabetic Patients 18-75, Blood Pressure Management (<140/90) NQF #0061
37,018
50%
73%
92%
Diabetes Patients 18-75, Low Density Lipoprotein (LDL) Management NQF #0064
13,884
40%
56%
79%
Hypertensive Patients 18-85, Blood Pressure Management (<140/90) NQF #0018
79,254
51%
70%
89%
www.hcgc.org
Quality Reporting Pilot – Share Learning
Today’s Panel Mike Anthony, Mt. Carmel Medical Group Rob Strohl, Central Ohio Primary Care Larry Blosser, MD, Central Ohio Primary Care Randy Wexler, MD, The Ohio State University Wexner Medical Center
Discussion What has been your major learning so far from participating in the quality reporting pilot?
www.hcgc.org
Quality Transparency – Next Steps Continue primary care quality reporting pilot with focus on quality improvement • invite current/additional providers to share EMR-based data aligned with PCMH/CPC measures • frequency of data submission every six months
• coordinate pilot until such time Ohio’s SIM infrastructure is standardized across the state for measuring PCMH/CPC quality improvement
In 2015 – Public Reporting Phase in collaboration with Robert Wood Johnson Foundation and Consumer Reports • Design and implement a quality data portal via a collaborative process with participating primary care providers and the Purchaser Learning Group
In 2016 - Regional quality data insert in Consumer Reports Magazine www.hcgc.org
DOCTOR Project – Public Reporting Participating Providers • Central Ohio Primary Care • Columbus Neighborhood Health Center, Inc.
DOCTOR Project Vision Data on Clinicians to Optimize Results People across the region will have a new way to find and share reliable information on health care performance resulting in an overall improvement in health.
www.hcgc.org
• Heart of Ohio Family Health Centers • Lower Lights Christian Health Center • Mount Carmel Medical Group • OPEN invitation to others in Greater Columbus
DOCTOR Project – Public Reporting – Learning from other regions
www.hcgc.org
DOCTOR Project – Public Reporting – Learning from other regions Lessons Learned • Consumers very receptive to ratings inserts • Consumers asked why certain medical groups were not included – useful in medical group recruitment
• Mutual consent needed between providers and reporting organizations • Listing practices in alpha order better than by rankings www.hcgc.org
Quality Transparency… improve the use of quality data Collaborative activity with Patient-Centered Medical Homes in Greater Columbus Quality Reporting Pilot PCMH Public Reporting (emerging)
Please join me in congratulating our panel and the organization’s they represent for leading quality transparency in Greater Columbus! www.hcgc.org