A Report from the Alliance Clinical Practice Improvement Network January 30, 2013

Today Briefly review highlights from the Alliance’s 2012 Community Checkup Share results from the Alliance’s 2012 Medical Group Survey Presenting: Susie Dade, Puget Sound Health Alliance Commentary: Peter McGough, MD, Chief Medical Officer, UW Neighborhood Clinics Scott Kronlund, MD Chief Medical Officer, Northwest Physicians Network 2

Community Checkup 2012: Ambulatory Highlights  Sixth Community Checkup  Includes results for: 81 medical groups with 4 or more clinicians in more than 300 locations Claims covering 2 million lives Measurement year: July June 2011  30+ performance measures  New: Generics individual provider level  New: Generic anti-hypertensives measure  Medicaid data back in!  Comparison of results over time 3

Data Suppliers  Aetna  The Boeing Company  Carpenters’ Trust  CIGNA  City of Seattle  Community Health Plan of Washington  First Choice  Group Health  King County  Molina Healthcare of Washington  Premera Blue Cross  Recreational Equipment Inc. (REI)  Regence Blue Shield  Sound Health and Wellness Trust  Snohomish County  UnitedHealthcare  Washington State Health Care Authority – Public Employees  Washington State Health Care Authority – Medicaid  Washington Teamsters Welfare Trust 4 Alliance’s data repository includes approximately 2 million covered lives!

Alliance Vision Physicians, other providers and hospitals will achieve top 10% performance in the nation in the delivery of equitable, high quality, evidence-based care and in the reduction of unwarranted variation, resulting in a significant reduction in the rate of medical cost trend. 5

Progress in Achieving Top 10% Performance At or Above NCQA 90 th Percentile, Commercial  Screening for Colon Cancer** (but still only at 61%)  Screening for Cervical Cancer  Antidepressant Medication Adherence (12 weeks)  Diabetes – HbA1c Testing  Diabetes – Kidney Disease Screening  Avoidance of Antibiotics for the Common Cold  Avoidance of Imaging for Low Back Pain  Use of Spirometry – COPD **Measures the newly eligible 2012 Community Checkup Results 6

Progress in Achieving Top 10% Performance Below NCQA 90 th Percentile, Commercial  Antidepressant Medication Adherence (6 months)  Diabetes – Cholesterol Testing  Heart Disease – Cholesterol Testing  Heart Disease – Use of Beta Blockers  Avoidance of Antibiotics for Bronchitis  Appropriate Use of Medication – Asthma Way Below NCQA 90 th Percentile, Commercial  Adolescent Well Child Visits  Screening for Chlamydia 2012 Community Checkup Results 7

Prevention 2012 Community Checkup Results 8 Opportunity!

Appropriate Use of Care 2012 Community Checkup Results 9 Opportunity!

10 There is still a lot of variation among medical groups. 10

11 Generics Prescribing: Statins Tremendous variation within medical groups 11

Bottom Line...  Significant variation persists in our region  Some medical groups perform among the best in the nation on some measures; others have significant room for improvement  No one medical group excels at everything, so opportunities for all to learn  While Medicaid results are generally lower, some clinics do as well as high performing clinics in commercial population  Low rates translate into thousands of people not getting the right care or having a good experience “…the gap between what we know works and what is actually done is substantial enough to warrant attention. These deficits, which pose serious threats to the health and well-being of the U.S. public, persist despite initiatives …” Elizabeth McGlynn, NEJM,

To see detailed Community Checkup results, go to: 13 Comments from Drs. McGough and Kronlund

Adoption of Processes and Tools to Advance Effective Patient Care Medical Group Survey Results October

Background and Purpose of the Survey  Collect and share information that describes whether or not activities and tools are being implemented in the practice setting Survey developed with physician guidance Focuses on activities and tools that have been shown to positively impact performance and support the delivery of evidence-based care  Provide community-wide scan of progress being made (compared results to 2010)  Share results to (1) provide broad view of overall clinic management and care coordination, and (2) identify opportunities for improvement 15

Survey Overview  Sent to 53 Medical groups 5-county region, included in Community Checkup  42 respondents, up from 33 in 2010 (62% response rate to 79%) 32 medical groups with multiple locations 10 individual clinics 7 medical groups declined to respond 4 medical groups declined to participate  Survey assessed practice activity in several domains: Understanding Healthcare Disparities Access and Communication Chronic Conditions Management Care Coordination Data Management Improving Quality and Patient Experience 16

Access and Communication 17

Access and Communication 18

High Level Results for the Region 19

Management of Chronic Conditions 20 BIG Opportunity !

Management of Chronic Conditions 21

Management of Chronic Conditions Use of Patient Reminders Point of Care Computer Prompt Reminder Send Postcards/ Letters by Mail Outbound Calls to Patients for Specific Reminders Secure Contact for Specific Reminders Yes, in All Clinics 62%52%62%19% Yes, in Some Clinics 19%31%29%12% Not Used19%17%9%69% 22 Processes to Educate Patients with Chronic Health Conditions Schedule Longer Visits for Counseling and Education Proactively Call Patients to Check and Counsel Proactively or Write to Patients Yes, in All Clinics48%29%17% Yes, in Some Clinics31%33%36% Not used21%38%47%

Care Coordination 23

Care Coordination Patient Reminders for Preventive Services Breast Cancer Screening Colorectal Cancer Screening Cervical Cancer Screening Flu Vaccine Pneum. Vaccination Well Child Visit Yes90%71%79%81%67%81% No10%29%21%19%33%19% 24 Process to Ensure Medication Reconciliation Response Yes, at each visit, all clinics74% Yes, at each visit, some clinics9% No process in place17%

Use of EHRs to Manage and Improve Care Not surprisingly, EHR adoption is improving in the region and the number of capabilities being used is increasing compared to 2010 (55% to 69%) Strengths:  Patient appointment scheduling  Clinical documentation of each visit  Documentation of current medical list  Lab results reporting Moderate Improvement:  Complete, standardized problem lists  RX ordering w/ability to highlight drug interactions/correct dosing  Lab/radiology order entry  Alerts re: abnormal values 25

Uses Lagging Behind:  Point-of-care clinician alerts based on evidence  Decision support tools (easy access to clinical guidelines or protocols)  EHR-linked patient registries  Access to clinical documentation from ED and inpatient stays  Secure patient portal On line appointment scheduling Patient reminders for needed tests or follow-up care Secure Access to clinical information (e.g.,lab/radiology/biometric results, medication lists and ordering, visit summaries, immunization records) Use of EHRs to Manage and Improve Care 26

Community Progress – High Performers  Implemented majority of tools and resources: Group Health Cooperative The Everett Clinic Virginia Mason  Implemented or in the process of implementing majority of tools and resources: MultiCare Medical Associates Pacific Medical Centers Swedish Medical Group UW Medicine Neighborhood Clinics 27

What’s Ahead?  2013 Community Checkup Beginning statewide-expansion, starting at county level first  Fielding 2 nd Ambulatory Patient Experience Survey  Updated “Resource Use Report” on Common Hospitalizations, to include utilization/service intensity, quality and pricing  Potentially Avoidable ED Visits by Hospital & Medical Group  30-day All Cause Readmissions without an MD Visit 28

For more information: Susie Dade Deputy Director Puget Sound Health Alliance Please visit our new website: 29 Comments from Drs. McGough and Kronlund Questions?