CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview Good morning. I am Tammy Geltmaker and I serve as the Qsource Quality Program Director for Kentucky. Qsource is a nonprofit healthcare quality improvement and information technology consultancy, has served as Tennessee’s QIO for more than 40 years, and will now serve as the QIN-QIO for the state of Kentucky. Qsource provides a range of expert services to assist organizations and providers with improving healthcare quality and delivery with better outcomes and cost savings. Some of those services include . . . Quality Improvement Quality Assurance Program Evaluation Data Analyses/Data Aggregation Health Information Technology Communication and Education While Qsource has been headquartered in Tennessee since 1973, we have associates placed remotely throughout our service areas, and offices located in Louisville, Indianapolis, Memphis, Nashville, and Knoxville to ensure access and availability to our stakeholders. CMS QIN-QIO Cardiac Health & Everyone With Diabetes Counts Overview Don Gettinger Sharon Barclay

Objective Provide an overview of the goals of the Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO) 11th Scope of Work (SoW) and Everyone With Diabetes Counts (EDC) initiative including what diabetes educators need to know to become involved in improving outcomes for those with or at risk for diabetes.

Restructuring Began exciting new, multi-state 5-year contract: August 1, 2014 - July 31, 2019 Beneficiary and Family Centered Care (BFCC)-QIOs #2 nationwide - Case Review and Monitoring www.keproqio.com Quality Innovation Network (QIN)-QIOs #14 nationwide - Quality Improvement (QI) Activities www.atomAlliance.org From Sue’s AADE PPT QIOs were established as Peer Review Organizations (PROs) in 1972 under an amendment to the Social Security Act (SSA), Sections 1152 – 1154, with an audit/inspection role The QIO mission is to improve the effectiveness, efficiency, economy, and quality of health care services delivered to Medicare beneficiaries 08/01/14 CMS changed QIO structure so now there are 14 orgs representing all 50 states plus Washington DC, Puerto Rico, and the US Virgin Islands. Work is still performed at a state level, each state just has a larger network of other states with which to closely collaborate and leverage resources. QINs represent from 2-6 states ------------------------------------ From CMS website A Quality Improvement Organization (QIO) consists of groups of doctors and health care experts to check on and improve the care given to people with Medicare. QIOs work under the direction of the Centers for Medicare & Medicaid Services (CMS) to make health care more patient-centered, safer, and coordinated. Beneficiary and Family-Centered Care (BFCC) QIOs - Handle beneficiary complaints, quality of care reviews, EMTALA, and other types of case reviews Quality Innovation Network (QIN) QIOs - Work with health care providers and the community on data-driven projects to improve patient safety, reduce harm and improve clinical care at the local level ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Earlier this year, the Centers for Medicare & Medicaid Services (CMS) redesigned its QIO program to further enhance the quality of services for Medicare beneficiaries. Three key QIO changes included . . . Extending the contract period from 3 years to 5 years Separating the Beneficiary Case Review activities from the traditional Quality Improvement functions, and having them performed by different contractors. Effective August 1, 2014, all case review activities for Kentucky, Indiana, Tennessee, Mississippi, and Alabama are now being conducted by KePRO located in Seven Hills, Ohio. http://www.keproqio.com

atom Alliance Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies. With the restructuring of the QIO program, Qsource is now part of a new multi-state consortia, composed of three healthcare quality improvement organizations. These organizations have joined forces to implement the five-year, five-state Quality Innovation Network (QIN)/Quality Improvement Organization (QIO) contract from the Centers for Medicare & Medicaid Services (CMS).

CMS 11th SoW Task Overview Goals Improve Cardiac Health Reduce Disparities in Diabetic Care Improve Prevention Coordination through Meaningful Use (MU) of Health Information Technology (HIT) Collaborate with Regional Extension Centers (RECs) Reduce Healthcare Associated Infections (HAIs) Improve Mobility and Decrease Healthcare Acquired Conditions in Nursing Homes Continue and Create Coordination of Care Community Coalitions Provide assistance in Value-Based Payment, Quality Reporting and the Physician Feedback Reporting Program HAIs Central Line Associated Blood Stream Infections (CLABSI) Catheter Associated Urinary Tract Infections (CAUTI) Clostridium Difficile (CDI)

Cardiac Health

Cardiac Health: atom Alliance Spread Million Hearts initiative Churches, providers, hospitals, communities, civic groups Physician Practices - Certified Electronic Health Record Technology (CEHRT) Report and track: Aspirin/Antithrombotic with IVD Controlled blood pressure Cholesterol LDL-C Tobacco cessation Home Health Agencies Join www.millionhearts.org Your Church can participate! 100 Congregations for Million Hearts  If you know of any congregation from any faith-organization that would also be interested in participating, please share this information with them. Feel free to contact us with questions at millionhearts@cms.hhs.gov. Spread Million Hearts initiative Prevent 1 million heart attacks and strokes by 2017 Churches, providers, hospitals, communities and civic groups Physician Practices - Certified Electronic Health Record Technology (CEHRT) Report and track: Controlled Blood Pressure ( <= 130/80) Tobacco Cessation Aspirin/Antithrombotic with IVD Cholesterol LDL-C (< 100) Home Health Agencies Report & track via Home Health Cardiovascular Data Registry Blood Pressure, Aspirin & Cholesterol The New HHQI CardioLAN Best Practice Intervention Packages (BPIPs)

Patient Education Key tools and resources Health literature Spanish translation version Many tools or patient resources

Patient & Family Engagement Have patient representatives involved Empower patients with Medicare to understand their care and be an active participant in their care Give patients with Medicare the knowledge and confidence to ask important health-related questions and get answers

Diabetes

Medicare Diabetes Prevalence & Expenditures 60% of Medicare beneficiaries have multiple chronic conditions* 14% of Medicare beneficiaries have 6 or more chronic conditions. Top 5 are: Hypertension, High Cholesterol, Ischemic Heart Disease, Arthritis and Diabetes* Dual Eligible beneficiaries (those with both Medicare and Medicaid coverage) are 1.4 times more likely to have diabetes* 26.9% of Medicare beneficiaries age 65+ (10.9 million Americans) have diabetes and account for about 32% of Medicare spending** Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14 *Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition **Source: 2013 testimony by the Congressional Diabetes Caucus in the US House of Representatives and the American Diabetes Association)

Everyone With Diabetes Counts (EDC) Initiative Pilot launched in Florida seven years ago Expanded to nine states/territories (NY, GA, LA, WV, TX, MS, MD, DC, US VI) Expanded nationally to all QIN-QIOs with 11th SoW Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

EDC Goals Improve health equity by improving health literacy EDC is a disparity reduction program. Engage both beneficiaries and health care providers Improve actual clinical outcomes in the six measures Facilitate sustainable diabetes education Improve health equity by improving health literacy and quality of care among Medicare and Dually Eligible beneficiaries with pre-diabetes and diabetes through knowledge empowerment, enabling them to become active participants in their care (patient engagement) EDC is a disparity reduction program. Target populations are minority underserved and rural (African American, Hispanic/Latino, American Indian/Native American and Asian/Pacific Islander) Engage both beneficiaries and health care providers to decrease the disparity in diabetes testing by improving testing for HbA1c, Lipids, Eye Exams, Foot Exams and to improve Blood Pressure control and Weight control Improve actual clinical outcomes of the six above measures Facilitate sustainable diabetes education resources by engaging public/private agency/organization partnerships at the community, state and national levels Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

EDC Components EDC’s five components: Recruitment and education of beneficiaries Recruitment and education of physician practices and staff Recruitment of partners/stakeholders Data collection and analysis Sustainability planning/implementation EDC is a continuous plan/do/study/act (PDSA) cycle; “keep or tweak” After spending so much time with partners, beneficiaries, providers, and other stakeholders getting this going, we want to make sure we have a plan on how to keep it going Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC Recruit, enroll, and teach beneficiaries utilizing a CMS-approved evidence-based DSME program Provide free DSME classes 6 consecutive weeks 1 class a week 1 ½ to 2 hours each class Family members or care-givers encouraged to attend The DEEP DSME curriculum will be implemented in 6 week periods We plan to express the importance of family and friends because they are the ones who can provide a better support system when they are more knowledgeable about diabetes Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC (Continued) Increase the number of diabetes educators, certified diabetes educators, community health workers (CHWs), and certified diabetes education sites in Indiana Recruit physicians Improve adherence to standards of care for people with diabetes Improve provider data collection and data analysis skills Improve use of electronic health records (EHRs) Educate provider staff Provide technical assistance to interested practitioners Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Accomplishing EDC (Continued) Recruit local and state partners and stakeholders Mutual disseminate of aligned tools, resources and program information Collaborate on the train-the-trainer and sustainability plans Utilize Data QIN‐QIO will obtain clinical results of diabetes measures for 10% of Medicare beneficiaries who complete DSME CMS will match the data to Medicare claims data Allows for following beneficiaries’ data longitudinally over time Collaborate with subject matter experts who will assist with increasing # of DEs and CD education site. Local Networking Groups (not Chapters) – For example, TRADE, GLADE, KADE, & DECA Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

DSME Program

Diabetes Education and Empowerment Program (DEEP) University of Illinois at Chicago Midwest Latino Health Research Training and Policy Center Developed to provide community residents with the tools to better manage their diabetes in order to reduce complications and lead healthier, longer lives. Based on principles of empowerment and adult education Two Components Train-the-Trainer Three day-workshop Training stresses development of skills and knowledge related to diabetes by using interactive group activities Diabetes Patient Education DSME content divided into eight modules Revised every two years (or as needed) to reflect the most current knowledge and information. Empowerment is narrowing the gap of understanding between a patient’s goals and how to achieve them. Empowerment is a process and an outcome Empowerment allows people to master their situations and make decisions that affect their lives Education for empowerment is the goal Education for empowerment must go beyond the acquisition of knowledge

DEEP DSME Modules Understanding the Human Body Exercises to establish trust and solidarity Systems and organs diabetes affects Description of what diabetes does to the Organs What is Diabetes Diabetes defined Risk factors Signs and symptoms of diabetes Monitoring Your Body Teach signs, symptoms, and monitoring of hypoglycemia and hyperglycemia and ways to monitor Teach diabetes management using glucose meter Get Up and Move: Diabetes and Exercise Teaching physical activity as a method to control diabetes Making time for regular physical activity

DEEP DSME Modules (Continued) Nutrition Basic nutritional concepts How to read food labels (calories) carbohydrates, salt, and trans fats MyPlate method and food portions Exercises on salt and fat hidden in food Preventing Diabetes Complications Smoking and circulatory problems The importance of daily foot care Reporting abnormalities to providers Visiting different specialists for prevention and control Introduction to Medications Medications for control of diabetes, hypertension and cholesterol Medications actions, cautions, and side effects Self-management care guides Coping with Diabetes Emotional aspects of diabetes (e.g., stress, depression and patients’ rights) Involving family and friends in care management

DEEP Goals Improve and maintain quality of life Prevent complications and disabilities Improve eating habits and maintain adequate nutrition Increase physical activity Develop self-care skills Improve patient and health care team relations Increase use of available resources

DEEP - Methodology & Teaching Methodology Based National medical care and self-care education guidelines Participatory education Adult education principles Group work techniques Progress towards a healthy lifestyle Role-playing Teaching Strategies Brainstorming Problem-solving Feed-back Demonstrations Modeling Role-playing

DEEP – Target Audiences DEEP is directed towards: Persons with diabetes Their relatives and caregivers DEEP is written to be implemented by: Professionals who care for persons with diabetes Community Health Workers

DEEP – Participatory Education Adults learn best when they are actively engaged and when they learn by doing Participants learn through discussion and experience Uses the facilitator concept Responds to needs of the group Group involvement for planning and action Facilitator and students set goals

DEEP - Participatory Education (Continued) Learning: WE REMEMBER: of what we read of what we hear of what we see of what we see and hear of what we do

Activity Example Visual representation of the amount of sugar and fat in a typical diet. Photo taken by Nancy Semrau, Quality Improvement Advisor

DEEP – Flexibility Modules can be covered in any order in 6 sessions without compromising the program’s integrity Two trainers for each workshop is recommended but not required Designed to be adapted to the needs and abilities of the organization and group Missed sessions can be made up at the discretion of the trainer and participants Supplies & materials can be made or purchased

Becoming a Part of EDC Person with diabetes or pre-diabetes Attend diabetes education classes when available in the community Encourage others to attend diabetes education classes Ask community leaders to volunteer a site for education in the community Partners and Stakeholders Contact the QIN-QIO to discuss potential collaborations related to increasing diabetes educators and/or diabetes education sites and cross spreading aligned tools, information and resources

Becoming a Part of EDC (Continued) Providers Volunteer to become an education site Refer patients to the free Medicare diabetes education classes Encourage diabetics and pre-diabetics to attend available classes Contact us to learn more about free QIN-QIO assistance in becoming a certified diabetes education site for Medicare billing and training appropriate staff to facilitate the DEEP DSME classes

Becoming a Part of EDC (Continued) CDE and Coordinating Body/Local Networking Group Collaborations Encourage health care providers to take the Certified Diabetes Educator (CDE) exam Volunteer to be a “CDE Champion” and speak on QIN hosted webinars Volunteer to be a “CDE Champion” for QIN hosted CDE exam study groups Collaboration ideas are always welcome! Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

Presentation Acronyms AADE American Association of Diabetes Educators ABCS Aspirin, Blood Pressure, Cholesterol, and Smoking ADA American Diabetes Association BFCC-QIO Beneficiary and Family-Centered Care-Quality Improvement Organization CDE Certified Diabetes Educator CHW Community Health Worker CMS The Centers for Medicare & Medicaid Services DEEP Diabetes Education and Empowerment Program DSME Diabetes Self-Management Education EDC Everyone With Diabetes Counts EHR Electronic Health Record

Presentation Acronyms (Continued) HAI Healthcare Associated Infections HHA Home Health Agency HHQI Home Health Quality Improvement HHS Department for Health and Human Services HIT Health Information Technology LAN Learning and Action Network PQRS Physician Quality Reporting System QI Quality Improvement QIN-QIO Quality Innovation Network-Quality Improvement Organization QIO Quality Improvement Organization REC Regional Extension Center SoW Scope of Work

For More Information Visit new Website for details www.atomAlliance.org

Indiana atom Alliance Team Don Gettinger Quality Data Reporting Manager 812-243-0847 dgettinger@qsource.org Jill Peterson, RN, CRRN Quality Improvement Advisor 812-562-0006 jpeterson@qsource.org Jean Brizzi, RHIA HIT Specialist 219-302-1458 jbrizzi@qsource.org Sharon Barclay, RN, MSN 317-646-0887 sbarclay@qsource.org Angela Goode Quality Improvement Advisor 317-670-6407 agoode@qsource.org Cathie Pritchard, LPN, RHIT 765-505-3529 cpitchard@qsource.org Deborah Garrison-Downey, MSHE/MBA-SSGA HIT Specialist 317-646-0201 ddowney@qsource.org This material was prepared by the atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not necessarily reflect CMS policy 14.A1.08.009