Heart of Virginia Healthcare Kick-off March 2, 2016 Full Logo Blank Page

The Heart of Virginia Healthcare is one of seven cooperatives funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW initiative. Through this $10.6 million grant initiative, participating practices will have the opportunity to participate in a prestigious learning collaborative to improve quality, team function, satisfaction and revenue. Benefits to Signature Partners include: Clinical Integration facilitation by expert faculty from George Mason University Consultative expert medical faculty from Virginia Commonwealth University Process improvement and practice resources from our state’s quality improvement organization, VHQC, and the American Medical Association Additional reporting resources on clinical quality measures that we are already targeting and required to report to CMS Financial incentives to the network and providers

SPN Infrastructure Agenda Introductions/attendance – 5 min Quality and Clinical Integration Coordinators – 10 min The Case for the Heart of Virginia Healthcare Cooperative – 15 min Required Data for the HVH Evaluation – 15 min Measuring the ABCS: Current Recommendations to Prevent Control Cardiovascular Disease – 30 min Joy in Practice – 45 min Closing and additional resources Inside Page Option A

SPN Infrastructure Signature Partners Snapshot (as of January 2016) Innovation Health 180,000 total members; 50,000 from HIX 21,000 attributed to SPN Goal: increase to 43,000 attributed by end of 2016 MSSP 31,000 attributed Medicare Advantage 4700 total in Aetna MA plan; approximately 500 attributed to SPN Intent to shift to Innovation Health MA product in 2018 with aggressive marketing Hospitals 12 5 Inova hospitals 6 Valley Health hospitals (4 Critical Access Hospitals) Fauquier (effective March 2016) Primary Care Physicians (peds/adult): 288 Employed PCPs: 92 (65 Inova, 27 Valley) Independent PCPs: 196 Specialists 586 IMG Employed: 151 Valley employed: 113 Independent: 322 Hospital/facility based: 2,000 Inside Page Option A

Signature Partners Quality and Clinical Integration Program and the Heart of Virginia Healthcare

Quality and Clinical Integration Coordinator Role Practice-based quality subject matter experts Aligns Signature programs, initiatives, grant work, etc. to the goals of the practice Facilitates clinical data integration to the network Assists in data interpretation in order to create meaningful, practice-based, quality improvement projects

SPN Quality Initiatives Medicare Shared Savings Program – 34 accountable care organization measures Innovation Health - narrow network – clinical and efficiency measures The Advanced Illness Model (C-TAC/VQHC) - to improve care for patients with advanced illness and their families. - Virginia’s Physician Orders for Scope of Treatment Diabetes: Together 2 Goal® - AMGA program - Retinal Group of Washington Diabetic Eye Exam pilot Million Hearts® Campaign COPD, Early Diagnosis and Appropriate Management - American Association of Respiratory Care Spirometry Training Heart of Virginia Healthcare (George Mason University and VCHI/VQHC)

HVH Practice Coaches/SPN Quality Coordinators Our Quality Coordinators will work cooperatively with HVH Practice Coaches and provide all of the necessary documentation EXCEPT for the surveys (addressed later in the presentation) which must be submitted directly to George Mason University We will use the HVH Toolkit AMA STEPS Forward modules https://www.stepsforward.org/modules VCU expert faculty are available to discuss practice improvement techniques We will schedule on-site visits with each practice’s manager and physician/clinical leaders and continue to touch base weekly (or more frequently if necessary) We will help facilitate EvidenceNow Advancing Heart Health in Primary Care MOC which may be applied to ABFM and ABIM through August 2017

HVH Kick-Off The video excerpts that follow were originally recorded on February 13, 2016, in Williamsburg, VA by the Heart of Virginia Healthcare Team and featured the following speakers: Kurtis Elward, MD, MPH is Co-Chair, VAFP Practice Improvement Committee. He has extensive experience in practice redesign and quality improvement and maintains a full scope family medicine practice near Charlottesville. Mark Greenawald, MD is Vice Chair for Academic Affairs and Professional Development, Department of Family and Community Medicine at the Virginia Tech Carilion School of Medicine. He has presented at both VAFP and AAFP meetings on strategies to improve professional well-being and practice culture. Stephen Horan, PhD is the founding president of Community Health Solutions, bringing more than 25 years of professional experience to each client and project. Under Steve’s leadership Community Health Solutions has helped hundreds of organizations achieve better results through focused assessment, design, capacity building, and execution. James Jenkins, MD is the managing partner for Fairfax Family Practice Centers and has presented many times at regional and statewide meetings on keys to maximizing reimbursement for office care. Alex Krist, MD, MPH is an Associate Professor of Family Medicine and Population Health at Virginia Commonwealth University. He is a member of the US Preventive Services Task Force and has been active in the creation and dissemination of evidence based guidelines for many years. Anton Kuzel, MD, MHPE is Professor and Chair of Family Medicine and Population Health at Virginia Commonwealth University and the principal investigator for Heart of Virginia Healthcare. He has worked for years to identify innovations in primary care practice that lead to better outcomes, better care, lower costs, and more enjoyable practice. He has published on practice transformation and practice team function in Family Practice Management. Susan Miller, MD has championed transforming VCU Family Medicine clinics to idealized designs and is an Institute for Healthcare Improvement Idealized Design of Clinical Office Practice trainer. Christine Sinsky, MD and Thomas Sinsky, MD are general internists from Dubuque, Iowa and have developed much of the practical strategies for practice redesign that is part of the Heart of Virginia Healthcare curriculum. Christine was one of the authors of “Finding Joy in Primary Care”.

The Case for the Heart of Virginia Healthcare Cooperative http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/ed75c149-20bf-4556-8fc9-4aeffaf2b68f/2016-02-13%2009.40_Kuzel%20Horan.mp4

Required Data for the HVH Evaluation

SPN Infrastructure 2 Research Expectations Data Collection for 4 measures Signature is already collecting the necessary data, so we will provide this data to George Mason University/HVH in a de-identified aggregated state We will working with George Mason University/HVH to help facilitate data collection for newer practices that have not yet become clinically integrated Surveys Providers will receive financial incentives when they complete the set of surveys: One-time survey is a little longer and best completed by your practice manager as it collects information about structural HIT, practice characteristics, and QI capacities Interval Surveys (total of 3/staff member over the 3 year grant) very short surveys that assess the perceptions of change management TIMELINE: NOW, then 12 months and then 9 months from then Inside Page Option A

SPN Infrastructure ABCS Clinical Quality Measures A: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic. Percentage of patients aged 18 years and older with IVD with documented use of aspirin or other antithrombotic B: Hypertension (HTN): Controlling High Blood Pressure. Percentage of patients aged 18 through 85 years who had a diagnosis of HTN and whose blood pressure was adequately controlled (<140/90) during the measurement year C: Preventive Care and Screening: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease. Percentage of high-risk adult patients 21 and older who were previously diagnosed with, or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR adult patients 21 and older with a fasting or direct Low-Density Lipoprotein Cholesterol (LDL-C) level >= 190 mg/dL; OR patients aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL; who were prescribed or are already on statin medication therapy during the measurement year S: Preventive Care and Screening: Tobacco Use. Percentage of patients aged 18 years and older who were screened about tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user Inside Page Option A

SPN Infrastructure Surveys Inside Page Option A

Measuring the ABCS: Current Recommendations to Prevent and Control Cardiovascular Disease http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/e839bac1-f806-4d4b-b583-34927115ae77/Krist%20Combined%20Edit.mp4

Joy in Practice http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/65da5745-7cd2-4d72-a629-c355c9678562/Sinsky%20and%20Sinsky%20Edit.mp4

Additional Resources

SPN Infrastructure Additional Videos Contact Signature Partners Quality Director, Darlene Almanza, RN, MPH, for more information at 703.914.2905 or email Darlene.Almanza@inova.org The Journey to Joy in Practice http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/62eea63b-8b03-42cb-a0c3-8764aa9d6027/Kuxel%20Elliott%20GTT%20Edit.mp4 Optimizing Teamwork: Building Personal Resilience and Creating Culture by Design http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/4443831e-552b-4d41-b5d1-af0001324f76/Greenawald%20Edit.mp4 Optimizing the Financial Picture http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/374d39bc-c61f-429e-8ac8-f79fe4a689d1/Jenkins%20Edit.mp4 Optimizing Key Workflows http://content.screencast.com/users/chsresults/folders/HVH%20Kickoff%20February%202016/media/7f00cfe2-27f6-4eef-87bb-2af03afd4068/Elward%20Miller%20Edit.mp4 Inside Page Option A

SPN Infrastructure 2016 MSSP Information 2016 MSSP Program Information Attachment A Attachment B Attachment C Inside Page Option A

SPN Infrastructure 2016 Innovation Health CQMs Innovation Health Attribution Methodology Innovation Health Quality Measures Inside Page Option A

SPN Infrastructure Together 2 Goal Together2Goal Campaign Together2Goal Measure Specifications Inside Page Option A

SPN Infrastructure Advance Care Planning C-TAC Advance Care Measures: 1) % of Enrollees with Advance Directive N = Enrollees with documented advance directive in the EMR D = All active enrollees 2) % of Enrollees with POLST N= Enrollees with POLST documentation in the EMR D= All active enrollees 3) % of Patients with Care Goals and Preferences Documented in the EMR and Updated Monthly N= Enrollees with monthly documentation of care goals and preferences Inside Page Option A