Transcript HANC QI Peer Network Day

HANC QI PEER
NETWORK DAY
September 20, 2013
Today’s Agenda
1. Welcome and Introductions
2. HANC QI Progress
3. HANC Patient Experience Data
4. Using the Triple Aim to Guide Change
5. CPCA Patient Center Health Home Update
6. Partnership Healthplan QIP Review
7. Identification of HANC QI Priorities
HANC QI History
Initiative
Description
Timeline
Accelerating
Quality
Improvement in
California
Clinics
(AQICC)
Track and improve diabetes clinical quality measures (A1c and LDL
management) and access to care measures (third next available
appointment and cycle time). The project was led by CPCA at the statewide
level. Data was aggregated by consortia at the regional level and publicly
reported. Funder: California HealthCare Foundation (CHCF)
2007-2009
Tools for
Quality
Provided seed funding for registry systems (e.g., i2i Tracks), enabling clinics
and health centers to perform proactive care management as well as
measure and report on clinical quality measures. Supported aggregation of
HANC member UDS data. Funders: CHCF, the Blue Shield of California
Foundation, The California Endowment, The Community Clinics Initiative
(Tides/TCE), and Kaiser Permanente.
2008 - 2011
AQICCMeaningful Use
Second phase of AQICC moved to the regional level and grouped consortia
/clinics into super regions. The project continued to collect data on diabetes
but also helped prepare clinics for meaningful use reporting. Funder: CHCF
2010-2011
Regional
Information for
Shared
Excellence
(RISE)
Supported clinic consortia and health centers to build data analytic capacity
for optimally utilizing EHR data to achieve Meaningful Use and prepare for
pay-for-performance reimbursement. HANC FQHCs selected metrics of
relevance. Funder: CFHC; Managed by: Center for Care Innovations (CCI)
2011-2013
HANC QI Activities
• Supporting implementation of HIT systems: many of the
initiatives have supported the purchase and implementation of
disease registry, EHR, and data analytics systems.
• Standardizing measures: consortia and clinics are developing
and utilizing consistent definitions for measures to allow for
comparisons across sites and regions.
• Redesign of workflow processes: the implementation of QI
processes and HIT systems requires changes in how care team
member carry out their responsibilities; these changes have been
supported through training and technical assistance.
• Improving data quality: improving data quality through training,
TA and data validation activities. A key focus has been ensuring
accurate information is systematically captured and reported.
HANC QI Activities
• Utilizing data to improve patient care: as data has become
more accessible and reliable, HANC members have begun
utilizing the data to assess population health and operational
efficiency and implement process improvements to enhance
patient care.
• Sharing data: developing dashboards, benchmarking
performance, and sharing quality data at the local, regional and
statewide levels.
• Disseminating learnings: sharing their experience and best
practices through peer networking and presentations at
convenings.
HANC Patient Experience Data
• RISE Initiative Review
• What the data tells us
• Lessons learned from the survey process
• What are you going to do with the data
PCMH – Patient Experience Crosswalk
Patient Experience Question
2011 NCQA PCMH Standards
I would recommend this
clinic/health center to my family
and friends.
PCMH 6: Measure and Improvement
Performance
Element B: Measure Patient/Family Experience
In the last 12 months, my
provider explained things in a
way that was easy to
understand.
PCMH 1: Enhance Access and Continuity
Element F: The practice engages in activities to
understand and meet the cultural and linguistic
needs of its patients/families
In the last 12 months, when I
phoned my provider's office to
get an appointment for care I
needed right away, I received an
appointment as soon as I
needed.
PCMH 1: Enhance Access and Continuity
Element A: Access during office hours
1 Providing same-day appointments
PCMH 1: Enhance Access and Continuity
Element B: After-hours access
1 Providing access to routine and urgent care
appointments outside the regular business hours
I would recommend this clinic/health
center to my family and friends.
3.00
A
B
C
A
E
E
B
D
G
2.80
A - Hill Country Health
and Wellness Center
F
D
C
G
B - Mountain Valleys
Health Centers
C - Northeastern Rural
Health Centers
2.60
D - Shasta Community
Health Centers
E - Shingletown Medical
Center
2.40
F - Sierra Family Medical
Clinic
2.20
F
n/a
2.00
Baseline
G - Western Sierra
Medical Clinic
Q1
Patients rate response on a scale of 1 (No) to 3 (Yes, definitely)
Patients rate response on a scale of 1 (No) to 3 (Yes, definitely)
HANC Average
In the last 12 months, my provider explained
things in a way that was easy to understand.
4.00
A
3.80
C
A - Hill Country Health and
Wellness Center
E
F
A
B
G
D
E
B
C
D
G
B - Mountain Valleys Health
Centers
C - Northeastern Rural
Health Centers
3.60
D - Shasta Community
Health Centers
3.40
E - Shingletown Medical
Center
3.20
F - Sierra Family Medical
Clinic
F
n/a
3.00
Baseline
Patients rate response on a scale of 1 (Never) to 4 (Always)
Q1
G - Western Sierra Medical
Clinic
HANC Average
In the last 12 months, when I phoned my provider’s
office to get an appointment for care I needed right
away, I received an appointment as soon as I needed.
A - Hill Country Health
and Wellness Center
4.00
B - Mountain Valleys
Health Centers
3.80
A
3.60
3.40
A
B
E
C
G
E
B C
F
G
D
D
C - Northeastern Rural
Health Centers
D - Shasta Community
Health Centers
E - Shingletown Medical
Center
F - Sierra Family
Medical Clinic
3.20
F
n/a
G - Western Sierra
Medical Clinic
3.00
Baseline
Patients rate response on a scale of 1 (Never) to 4 (Always)
Q1
HANC Average
Telling the Story
Triple Aim
Measuring the Triple Aim
Dimension of the
IHI Triple Aim
Population Health
Outcome Measures
Health Outcomes:
• Mortality: Years of potential life lost; life expectancy; standardized mortality ratio
• Health and Functional Status; Single-question assessment (e.g., from CDC
HRQ0L-4) or multi-domain assessment (e.g., VR-12, PROMIS Global-10)
• Healthy Life Expectancy (HLE): Combines life expectancy and health status into
a single measure, reflecting remaining years of life in good health
Disease Burden:
Incidence (yearly rate of onset, average age of onset) and/or prevalence of major
chronic conditions
Behavioral and Physiological Factors:
• Behavioral factors include smoking, alcohol consumption, physical activity, and
diet
• Physiological factors include blood pressure, body mass index (BMI),
cholesterol and blood glucose
Experience of Care
Standard questions fro patient surveys, for example:
• Global questions from Consumer Assessment of Healthcare Providers and
Systems (CAHPS)
• Likelihood to recommend
Set of measures based on key dimensions (e.g., IOM six aims for improvement:
safe, effective, timely, efficient, equitable, and patient-centered)
Per Capita Cost
Total cost per member of the population per month
Hospital and emergency department (ED) utilization rate and/or cost
Using the Triple Aim to Guide Change
1. Who’s responsible for evaluating overall health
improvement at your CHC?
2. What tools do you use for data analysis and reporting?
Are they efficient?
3. Provide an example of health improvement that has
occurred with your patients as a result of utilizing data.
4. What are you doing to operationalize Triple Aim? Please
identify any support that you need.
5. How are you going to benchmark your performance?
Review of HANC Member QI Priorities, Nov 2011
Best
Practices
Challenges /
Solutions
Ways to
Increase
Efficiency
Workforce
and
Training
Needed
Short & Long
Term
Priorities
Ways HANC/
CPCA Can
Help
Clinician
specific report
cards for
quality
indicators
Quarterly
board
reporting
Data is not
uniform
Technology
tools
Limited
staffing
Expand
HANC QI
group
Partnership
s with
schools of
public health
Data Base
Training
Short
Develop data
inventory
Utilize Share
Portal for QI
Expand peer
reporting
Long
Epidemiology
– data analysis
Public
Reporting
Hospital
interface
Training
Facilitation
of QI Peer
Network
Develop
data inventory
Utilize Share
Portal for QI
Expand peer
reporting
Public
Reporting
HANC Priority Setting for QI
Identify
• 2-3 priorities for 2014-2015
• Workforce and Training Needed
• What should HANC’s role be?
• What should CPCA’s role be?