Transitions in Care-Heart Failure ACC Quality 2009 D2B-Sustain the Gain Transitions in Care-Heart Failure Patient Centered Care Transformation The IC3 Program

Goal Improving Continuous Cardiac Care Help clinicians thrive in a performance-based reimbursement system through the systematic practice, timely reporting, and continuous improvement of quality Goal Improving Continuous Cardiac Care

Outpatient Performance Measures CAD, Afib, HTN, Heart failure, Diabetes, Rehab ----------- ACC/AHA PCPI PQRI NQF There is not much emphasis

Quality improvement Practice workflow redesign Transactional quality and management Incentives

Office-based quality improvement program that enables participants to select, based on practice characteristics, the most appropriate level of engagement What is it?

The IC3 Program Community Education Data Incentives Research Performance Improvement Data Incentives Research

Interactive communication. Community Building The IC3 national network of practices dedicated to high quality CV care. Interactive communication. Best practices. There is not much emphasis

Education Educational programming. Clinical guideline updates. Selection of EHR vendors. Billing and coding. There is not much emphasis

Data Collection Office-based registry. Collect and use patient care data more effectively. Coordinate care. Benchmarking. Demonstrate quality of care.

Performance Improvement Practice assessment. QI tools. Decision support (CardioPATH). CardioPATH used IC3 data dictionary

Recognition and Rewards Incentives. Recognition. ABIM MOC. Payers. Malpractice. tipping points

Research New insights on care delivery. Impact of program. Practice-Based Research Network.

Current ACC/AHA Performance Measures CAD Performance Measures BP Measurement Symptom & Activity Assessment Smoking Assessment Anti-platelet Therapy Lipid Profile Use of Lipid Therapy -blocker post-MI ACE/ARB in EF & DM Screening for Diabetes CHF Performance Measures LVEF Assessment Weight Measurements BP Measurements Clinical Symptom Assessment Activity Assessment Signs of Volume Overload Patient Education -blocker in EF ACE/ARB in EF Warfarin for Afib Initial Lab Tests

Current ACC/AHA Performance Measures Afib Performance Measures Thromboembolic Risk Prior CVA/TIA Age ≥75 Hypertension Diabetes Heart failure or EF Warfarin use in High-risk pts Monthly INR in pts on warfarin Cardiac Rehabilitation PMs Referral to a Rehab Program Within 12 months of ACS PCI CABG Valve Surgery Transplant Stable Angina Diabetes Performance Measures Poor HbA1c (>9%) LDL Control (<100) BP Control (<140/80)

Quality Vision, near and far 2009: prepare practices to succeed 2010: make quality business case 2011: link learning, performance, $ 2012: Quality First Network