Leveraging Data for Performance Improvement Jack Millaway, LPHI Chatrian Kanger, AHL

Why is it Important? Data has always been important in healthcare, but its scale continues to expand – Individual patients – Chart Sampling – Patient Registries – Organization-wide – Whole population (community and beyond)

Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives In the past few years, data and its impact on payment has expanded drastically: – ACO’s and other shared savings or incentive contracts with payers – UDS Quality Awards – Patient Centered Medical Home – Meaningful Use

Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives And its impact will only continue to expand! – Medicare payments 30% of contracts by the end of this year 50% by the end of 2018 MIPS and MACRA – Meaningful Use Stage 3 – UDS whole population reporting – Grants and other initiatives

Electronic Health Records and Data Timeline

THE FUTURE Image source: SAS Analytics (blog.SAS.com)

Source: bobdylan.com Healthcare Analytics Evolution

Best Practices to adopt today 1.Evaluate your current environment a)Active payer contracts b)UDS, PCMH, Meaningful Use, and other Quality Incentive programs 2.Make a plan a)Where does it make sense to target efforts? b)Capacity to implement change 3.Make it a priority a)Regular monitoring b)Integrate data into all QI projects

DATA IN PRACTICE Chatrian Kanger, MPH Quality Assurance Manager Access Health Louisiana

Who We Are Established as St. Charles CHC in practice sites (CHCs + SBHCs) 9 parishes 92 providers total 40k patients & ~125k visits / year

Internal Structure: Care Teams Support Teams Training Department, QA/Reporting/ EMR staff, Call Center Athena

Current Performance / Quality Improvement Process Collect and review data from multiple data sources Prioritization of Quality Measures Categorize by roles Leverage internal structures & technologies when feasible (e.g. EMR, call center, training team, etc)

Priority Area – Care Coordination AHL focus: Ensure timely access to follow-up care after a hospital discharge

Emergency Dept / Hospitalizations GNOHIE

Issues with Current Flow:  Introducing RISK: – Losing patients to timely f/u care – Increasing likelihood for readmission or inappropriate ED usage again  Losing $$$  Ability to document & track: - Scheduler (appt types) -Pre-built Templates -Pre-built Reports

What’s on the Horizon? increase Patient load in GNOHIE is about to increase once our interface completes with Athena Additional patient load & awareness of ED / hospital visits w/ other interfaces + payers Reducing ED/ hospital visits Incentive $$$ focus on ensuring timely access to f/u care Care coordination

Emergency Dept / Hospitalizations GNOHIE Scheduling:  Add drop down for appointment reason Clinical Documentation:  Rx reconciliation  HPI template – “Emergency F/U Record” Reporting Templates:  Use “ED Followup Report” & “Hospitalizations Report” Other Systems

Considerations: Added workload on Nurse Care Managers: – Explore opportunities to reduce inefficiencies Suggestion: Triage to Medical Records? Give lookup access to Patient Care Coordinators  Training Nurse Care Mgrs on Scheduling? Leverage templates within Athena – HPI Template: “Emergency F/U Record” – Report: “ED Followup” & “Hospitalization Report” – Scheduling: Add in drop-down for “appt reason”

RECAP: “Data” can be quantitative and qualitative Work backwards Steps or Tools: – Review data reports to id trends against targets – Workflow mapping of current state & future state – Explore options within our EMR system to automate functions: Scheduling Documentation Reporting – Deliver training / update protocols accordingly