Regional Learning Session December 4, 2015 Record of Learning Note: Themes derived from learning in italics
What was the value of today’s session? Very High Value: High Value: Medium Value: Low Value: No Value:
40% 59% 1% 0% 0%
Break Out: Medical Neighborhood Referral Infrastructure
Excitement for the project’s potential o Clearly this is just beginning—potential is very exciting. o Good start. I can see this eventually as a very helpful tool for PCPs once the majority of social services are participating. o Great information and the potential of the tool is very promising and exciting. I didn’t realize all of the services that are available for consumers in our community so this tool will be extremely valuable. o Important emphasis on what MNRI can become in addition to what is possible now. o Love the concept of CliniSync. Hoping they continue to develop additional connectivity! o This sounds like it could be really useful, but not enough information. o Very exciting information. I am looking forward to getting on board. o Very impressive initiative. Important work bringing social services into the care process o Do all of the collaborative partners know about the social services partners? o Great to hear about services available through LifeCare Alliance. o I love that a free clinic is involved. o It is encouraging to hear the robust role social services are playing in this learning session dialogue. o Very interested how we can engage social service partners with needing them to be covered entities. o What can LifeCare Alliance do to help providers and care coordinators understand how we can work together? o What information can the social service agencies be giving the collaborative to better inform the success of the collaborative? o Will software be open to Allied Health Partners like home health? Questions and comments around project process o Are there community healthcare workers that can be the middle person to assist in referral of communications? o Create a survey for consumer to fill-out, base on their need to be compliant to assist in their healthcare needs. o Have each of the participating organizations reach out and recruit those organizations with which they engage regularly in order to build the neighborhood and increase the number of participating organizations. o Moving in the right direction. Consider looking to partner with State health department to assist with expanding referral network based on grants provided by CDC. 1
Questions and comments around the referral tool o Does the fact that referral was sent and received flow into the PCP’s EHR? o Does the information flowing through the referral infrastructure populate fields in the HER of providers? o How much information and what info is included in the referral to the social service agency? o Seemed to be some concern with MNRI wide tracking/capacity and data analysis to work smarter in the future. o Will client be reminded that they have the options to opt out of consent to have their information removed? Elderly people, mentally ill forget that they consent too support. Should be doing more to promote the project o Needs more publicity to others. o 6.5 million Ohioans on CliniSync should be publicized! Suggestions for improving the session o CliniSync/OHIP rep needed to be on the panel. o Disappointed that there was no demo of the tool to help understand. Maybe this was premature? o Enjoyed the panel. Would like to learn more about the actual referral process starting with the healthcare provider and how they are communicating to the support staff about who to refer to. o Excellent—Need handouts to take home info o Good group discussion. Would like to see the big picture in the process steps. o Interesting, but would have been helpful to see a demo of the tool. Valuable information sharing and lessons learned o Appreciate hearing how CliniSync is being used in the “real” world. o Great session and panel presenters. Very interesting to learn more about the shared referral infrastructure. o Great sharing of info in this session. o Panel provided useful info and workflow strategies for success. o Presenters did a great job conveying the value and challenges that they each see.
Break Out: Quality Transparency
Comments on the websites functionality and content o Having the regional providers and direct links to Medicare data is a definite value-add for the website. o I like the tabs for patients to link/thank their providers to the website. o I liked the fact that organizations are not compared directly with one another since subtle variations in data reporting can make a significant difference in the result. It allows an organization to understand what their data reporting process might be inaccurate and how they can improve it over time. o I love that the new website is simple and clean to use. It is easy to throw a bunch of information on the website. It takes skill to cut through the mass of information and present useful information. o Linking to Medicare sites is helpful. o New site looks good. I am sure there are more measures/data to grow into. o Thank you for providing the different websites. Even though I work for a managed care company these kinds of things help me as a consumer. Excitement around the website and project o Anxious to explore the website and provide feedback. o Extremely interesting. Discussion was good. 2
o o
Fantastic presentation and concept. Good—movement in the right direction. It is never perfect, always an area of continuing improvement. o Great session! Nice to see how the quality work is moving forward. As soon as there are enough data points it would be good to look at reducing variation. o Very helpful explanation of first steps in new quality program. Excellent idea—early adopters are to be congratulated for taking on this tough task. o Very interested in the chronic condition focus. o Very realistic goal and good path to achieve that. Free clinics are currently working toward similar goals. The patient engagement is always the most challenging. Another challenge may end up being the creation of a common best practice and measurement tool. Project approaches and strategies o How are practices approached about sharing data—strictly voluntary? Were there any entities asked that declined? Did they give a reason? Was it only because they couldn’t be confident in the quality/validity? o How much engagement from patients is included in planning and intervention strategy? o How to get patients interested in quality that matters? o How to provide quality data to broader population. o I agree three quality measures that were presented are the best ones to start with. o What is the place for small independent primary care o What liability does imperfect data put on your shoulders? o Will be important to get website link out to the practices and patients and educate on how to use the website. Suggestions for improving website o A good start to transparency for transparency’s sake, but until we have accurate data on physician’s quality and patient satisfaction and reliable info on price I am not sure what value this will have for consumers. o Directory list is a great addition in future reiteration. o Do you need to put advertisements or warnings to clearly make consumers aware of price tool issues and how the consumer can verify the price accuracy and not be surprised? o Glossary on website/define measures. “X does not look at the entire population at “location A”. The measure is any patient seen one time in a certain date range.” o Including behavioral health data into site, especially if depression is a targeted condition. o Link to other nursing home quality. Link to Medicare star ratings. o Please build racial and ethnic disparities into the process. o Price menu button and consumer tools should be omitted. It takes people down a different rabbit hole than the one they started in. I think unintentionally it changes the mind of the customer/consumer from quality to cost. Other comments and feedback o Data transparency depends on adequate infrastructure to operate the data transmission—does this need additional $$ to support? o Loose but interesting conversation from a consumer’s point of view. o National Quality Startegy great resource. o Quality reporting is important to change. If you don’t measure you don’t fix. o Still problems with HIPAA concerns—plans not allowing data to be shared.
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Break Out: High Value Primary Care – Coordinating Care Across the Medical Neighborhood
Payment innovation is important to this model of care o Collaborations with Medicaid managed care orgs are creative and innovative. o Dr. Vallangeon’s take away to “do the right thing” can only last so long. God bless these physicians but it is not reasonable to continue care coordination and addressing real social determinants of health. We have a lot of work to do to advocate for payment innovation. o I heard payment for other types of care are not reimbursed. What are you doing to highlight your outcomes? o It is unfortunate to hear that financial and reimbursement barriers are still an issue that affects care coordination. o Sad that promise of better reimbursement for becoming PCMH did not pay off! Whole person approach is important to getting patients the right care o A whole person approach is a meaningful step forward. Understanding the individual can more quickly move HCPs to a better matched plan. o Comprehensive patient care approach is critical to improving health of population o Food access and education on diet should have impact on all and it sounds like it is. Have you presented this data? o Food is a medicine. o I would like to learn how Lower Lights created a sustainable whole person model serving the underserved. Work to eliminate barriers of access to the medical neighborhood o Documenting available services and communicating their availability is a great need. o Need to develop forum of state policy and admin leaders, payors/insurers, providers and social service agencies to share and discuss obstacles to emerging care models. Hopefully develop ways to eliminate these barriers and increase our citizen’s positive health outcomes. For example, sustainable support for care coordination. o What is needed to gain access to the substantial population of those outside the healthcare system beyond the emergency room? Those who don’t have a “PhD” in navigating the healthcare system? Other comments and feedback o Excellent program. Impressive innovations in practices. o I really appreciated the real-life lessons learned, and the reinforcement of the idea to do what’s right because it’s the right thing to do. o I thought it was very interesting that Lower Lights takes the approach of integrated patient care. I enjoyed the whole panel of the federally funded health centers. o Inspiring stories from high performing practices. o It was nice to hear the good, bad, and ugly about this issue. o Nice to hear what is happening in this mission-based space. Will have a huge impact on population health. Be good to see more advertising and advocacy for FQHC’s and related social work and care coordination. o Wonderful to hear from early Access Health practices are thriving and speaking about continued challenges.
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Break Out: High Value Primary Care – Using Data to Manage Populations
Collaboration is important to collecting and using data well o Evolution to acceptance just illustrates the need to start with a collaborative pilot and then build upon it from lessons learned. o I appreciate hearing the multiple challenges involved with data sharing, collection, and use, especially across multiple organizations. o It is good to know we all share the same challenges. Collaboration helps us use lessons learned from others. o Data sharing is a two way street, the provider should share results with the payor’s insured in working to establishment of a palatable reimbursement mechanism. Valuable discussion and information shared o Appreciate honesty of providers and concise practical information presented. o Great comment “data doesn’t think (individual) patients have different needs.” o Great discussion incremental change/improvement. o Great discussion on data. o Very helpful info. o Very valuable. Interesting to hear how practices implement protocols in the practice and how the infrastructure is set up. Other comments and feedback o Health planets (EHR tool) – need to understand this capacity. o I can appreciate how large clinically integrated health systems help practices provide population health management. What about the smaller practices. The writing is on the wall for the demise of the small, solo practice. o Importance of payment reform to get to high value in earnest. o OSU compensation reform is surprising. Importance of incentives. o Value of tracking/data/benchmarks competition/data leads to better results.
Impact on Chronic Conditions
Important to engage the right stakeholders o Bring consumers to the table. o Consumer buy-in/involvement. o Don’t forget the kids with health program. The kids are our future! Kids must focus on prevention and in long run lower need for chronic care. o Getting buy-in from home health is essential. o Has any effort been made to bring ADAMH into the collaborative? With a depression focus, faith communities need to be a part of the conversation. o How do you involved Community Healthcare Workers? Like helper to the education for the consumer. o How to engage the endocrinologist and get on the same page? o How to get recruited and trained patients in the room for input and feedback on what works. o I work in long term care and with much of the focus on primary care, our medical home service line would be the one most involved. It would be great to get to the point where we can share best practices/case studies of actual quality improvement work—once the discussion on measurement settle. o Include pediatric measures in quality efforts. o Please don’t leave out pediatrics in the work.
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New evolution is the right direction for HCGC and our region o Headed in correct direction. Need to start from top down. If we don’t have alignment from the top this will never work. With alignment need to share data and be transparent. o I agree need to move to disease state management rather than isolated medicine. o Strategic focus is a good change/evolution. The six methods to reduce variation are a space HCGC is competent and ready to contribute. o The program sounds rewarding and complete to build support, communication with our clients. Questions and comments regarding data and measurement o Align quality measures with SIM, CPCi, etc. o Careful with data. o How will you collect meaningful data on treatments and impact of depression—what clinical quality measures are used? o It is exciting that quality data is becoming more transparent—however it will continue to be challenging to get to a more composite measure of diabetes control that is transparent. It seems a source of the challenge will be provider hesitance because of their inability to influence the condition on some patients who are difficult to remain connected to. o Shouldn’t there be a measure for individuals over 75 years old. Probably different than NQF. Reducing variation in the use of best practices is a key to success o Common best practices are essential. o Education on depression for PCPs—how to discuss and manage with patients could be very helpful. It we think approach to education of providers varies, the education to patients probably varies even greater o End variation in guidelines. o Establishing best-practices and aligning providers. o Huge variations in patient education just within health systems. o I was happy to see the focus on reducing variation. Statistically speaking that is how you really make an impact on outcomes, but most of us are looking at data points—looking for an improvement in each data point. Where we should be focused on reducing variation. Looking forward to participating. o Recognizing that there are multiple ways to treat or educate on a condition, but only a few that are improving outcomes. Drilling down to those best practices will take cooperation in collaboration. There needs to be more than discussing it. Creating a plan that requires accountability for results improvement. o Single standard of treatment of diabetes. My answer.. pick 1 or 2 and use it. Reduce variability even if its second best. o Use kid appropriate screenings for children. Starting with the right chronic conditions o Agree that diabetes and depression were good choices. o As a social service provider I am excited to see a focus on depression. Many of those that we serve are facing this issue. o Depression is such a stigmatized disease—bringing it into focus will hopefully only help with this. o Diabetes great choice. o Diabetes is easy to control A1c. Depression—standard questionnaire is PHQ9 o Focus on intersection of diabetes and depression. o Integration of behavioral health and primary care is key. o Many patients may have both depression and diabetes. 6
Other feedback o Coverage for diabetes and diabetes prevention program. o Have you considered creating a baseline, comprehensive understanding and documentation of diabetes and depression services for participating providers and publishing it for all to see? o How will increased collaboration be tied to reimbursement needs to be explored?
General Comments
Appreciate receiving the handout for the HPIO event at the registration desk. Be sure acronyms are spelled out. Not everyone is familiar with all healthcare lingo or all the organizations. Break-out sessions didn’t need to be an hour long. 30 minutes is plenty. Could have had additional topics addressed in 30 min sessions. Did not rate very high because I believe there needs to be increased patient advocacy involvement. Future topic – how is HCGC aligning with rest of the state, especially Appalachia. Good job! HCGC’s evolution is consistent with the federal trends and standards. It is nice to have a local group for discussion and education. Headed in the right direction. Great to hear about data transparency and sharing. I always value these collaborative trainings. I’m always energized by the direction that coordinated change is happening in Central Ohio. It is interesting how closely related our organizations are tracking similar projects. It would be advantageous of us to talk about aligning on quality programs for a common voice. Very exciting work—you all do a fantastic job! Look how far this has come from “access” to collaboration and quality improvement. The absence of an organized consumer voice prevents the HCGC from being effective at improving health because you can’t improve patient care and health without input from wellorganized consumers. Carefully recruited and trained advisory councils in the work and a method and communicate with the community. The collaborative effort is exciting. Cooperation is so important for the potential for progress. Spend some time working on understanding how the good outcomes you experience from the endeavor can be replicated by others. The outcome should be derived from data others should be able to access within their organization to be capable of pursuing replication. There are so many objectives it is hard to narrow our focus. Partnerships help with patient education. These regional learning session are very valuable. We need to work on getting the three health systems integrally involved in the collaborative. CMO’s and CEO’s need to step up. Would have liked to attend all sessions. Great meeting.
Thank you to everyone that was able to participate! Participant Breakdown Business 29% Healthcare 44% Government 7% Social Sector 17% HCGC 3% 7
First Name John Parminder Amy Douglas Donald Lori Lori Jeff Larry Meggen Erica Phil Lee Pete Susan Hannah David Aaron Linda Becky William Gail Cindy Sarah Connie Rob Slessor Melodie Sean Justin Diane Will Charlena Audrey Molly Donna Leigh Anne Soley Beth Kevin
Last Name Arnold Bajwa, MD Bashforth Bennett Bennett Bergman Bergman Biehl Blosser Brown Brown Bruns Burkam Bush Butler Carlson Ciccone Clark Clem Cornett Cotton Croskey, BSN, RN Deep Durfee, RN Emerson Fitzgerald Fombang, MD Gee Gleeson, MD Golias Gordon Hancock Hargitt Harkonen Haroz Hedrick Hehr Hernandez Hickerson Hinkle
Organization UHCAN Ohio PrimaryOne Health Ohio Department of Health The Ohio State University Wexner Medical Center Ohio State University College of Pharmacy cha Hsag Healthcare Collaborative of Greater Columbus COPC The Little Clinic OhioHealth Group Duet Health Summit Orthopaedic Home Care Sanofi The Ohio State University Wexner Medical Center Mount Carmel Medical Group United Way of Central Ohio PrimaryOne Health Mount Carmel Health Partners The Ohio State University Wexner Medical Center Nationwide Chldren's Hospital Mt Carmel Medical Group Anthem OPERS Concord Counseling Services Exact Sciences PrimaryOne Health Lower Lights Christian Health Center Nationwide Childrens Hospital National Church Residences OSU University Hospital East Novo Nordisk Anthem, Inc. Consultant LifeCare Alliance DAH Solutions American Cancer Society Syntero Inc OhioHealth Group Anthem
Shawna Shanna Leroy Isi Dawn Kathy Lucinda Joseph Stephanie Lisa Caitlin Sam Liz Stephanie Patty John Cathy Kate Kay Margaret Carol Amy Alex Deborah Lynn Lori Judith Michelle Jodi Buhari Mark Susan Jason Colleen Kevin Diane Lynette Lisa Malcolm Jill Christine
Hite Huber Hushak Ikharebha Ingles Jefford Jeu Jeu Jursek Kaiser Kapper Khozin Kitchen Koscher Lattimer Leite Levine Mahler Mavko McDonald McFarland McGee Meyer Miller Miller Miller Minaudo Missler Mitchell Mohammed Mollenkopf Moser Neuenschwander O'Brien Orr Oye Palmer Perry Porter Pric Pullen
OSU Extension, Family & Consumer Sciences Ripple Life Care Planning BREAD Physicians CareConnection Ohio Department of Health, BCCP OUHCOM Hilliard Family Medicine, Inc. Hilliard Family Medicine, Inc. Consultant PP 189 Benefits Columbus Public Health Health Data Intelligence Ohio Department of Health Prevent Blindness Mount Carmel Medical Group Healthcare Collaborative of Greater Columbus UHCAN Ohio Ohio Academy of Family Physicians Ohio Academy of Nutrition and Dietetics Johnson & Johnson V. George Zochowski, D.O., Inc. Health Policy Institute of Ohio CompDrug Ohio Association of Free Clinics Ohio Dominican University Mount Carmel Health Partners Central Ohio Primary Care Physicians National Church Residences Health Action Council PrimaryOne Health Mid-Ohio Foodbank Abbvie TechSolve Lean Healthcare Solutions The Ohio State University Wexner Medical Center Pfizer NA Lower Lights Christian Health Center UnitedHealthcare Malcolm Porter, Consultant State of Ohio Novo Nordisk
Caroline Larke Audrey Rhiannon Mark Mindy Chris Nina David John Jason Theresa Shawn Kaitlin Scott Keith Amanda Krista Katie Heather King Staci Linda Dana Arlene Bruce Andrew Eleanor Daniel Colleen Randy Gregory Beth Kathie Emily Ashley Luke Ted Matthew Tonia
Rankin Recchie Regan Richman Ridenour Ridgeway Sams Santarelli Schlatter Schmeling, MD Schwettman Shipley Smith Smith Solsman Spalsbury Stidam Stock Stone Stumpf Stumpp Swenson Szczyt Vallangeon, MD Vance Wall, MD Wapner, DO Watson Wendorff Wesley Wexler, MD Whisman Whitted Williams Williams Wood Woods Wymyslo, MD Yannie Zochowski
YMCA of Central Ohio Ohio Association of Area Agencies on Aging Columbus Public Health Ohio Department of Health the Ridenour Group Central Ohio Surgical Associates Merck National Church Residences Sanofi The Medical Group of Ohio Exact Sciences The Ohio State University Health Plan Abbvie Ohio Academy of Family Physicians National Church Residences National Church Residences Healthcare Collaborative of Greater Columbus Columbus Public Health Syntero, Inc. Netcare Access PrimaryOne Health Mount Carmel Health Partners Lower Lights Christian Health Center Primary One Health Aetna OSU College of Public Health OSU Health Plan Mount Carmel Health Partners The Breathing Association Ohio State MGO/OhioHealth Group PrimaryOne Health The Medical Group of Ohio Pfizer Janssen Merck & Co., Inc. OACHC United Way of Central Ohio V. George Zochowski, D.O., Inc.