NC AHEC’s Role in Healthcare Quality, Technology and Reform Ann Lefebvre MSW, CPHQ

NC AHEC The mission of the NC AHEC Program is to meet the state’s health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina.

NC AHEC Statewide Map Mountain Area L Greensboro Charlotte South East Northwest Southern Regional Area L Charlotte Wake Eastern Source: NC AHEC Program

NC AHEC’s Core Services 1. Community-Based Student Training. Each year over 10,000 student months of student training 2. Primary Care Residency Programs. Over 1,500 physicians in NC graduated from an AHEC residency program. 3. Continuing Education. Served nearly 200,000 health professionals in 2009 4. Library Services. Last year over 7,000 individual health professionals used the AHEC Digital Library 5. Health Careers and Workforce Diversity. Over 35,000 young people were served by health careers programs in 2009

North Carolina’s Improving Performance in Practice Mission: To provide primary care practices with the systems and support to provide high quality care to improve patient health. Emphasize is that its support system for primary care and can include all initiatives and align with what practices want/need to do (meaningful use)

Lean Techniques Act Plan Study Do Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Name each model. With lean mention workflows. Lean Techniques

Examples of Practice Results Need 3 things…. Data, full engagement and continual tests of change – With those.. We succeed almost every time!

Challenges of QI in Primary Care Practices are overworked and don’t have time to do redundant systems to collect data to evaluate care. EHRs are good for documentation and improving some efficiencies, but are not currently built to produce data on clinical systems. The only way to know if we are providing the “right” care is to use data. Obtaining the data becomes the focus of the QI process instead of improving office systems.

American Recovery and Reinvestment Act $787 billion. The Act includes federal tax cuts expansion of unemployment benefits &social welfare provisions domestic spending in education, health care, and infrastructure, including the energy sector. The Act also includes numerous non-economic recovery related items that were either part of longer-term plans or desired by Congress

Health Information Technology for Economic and Clinic Health (HITECH) Act Funds will be distributed through Medicare and Medicaid incentive payments to eligible professionals “EPs”, who are “meaningful EHR users.” The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users.

HITECH Act Continued Payments for Certified EHR use from 2011 – 2015 Medicaid Providers (up to $63,750 per provider) Based on Medicaid Patient Volume MD, DO, DDS, NP, CNM & PAs with exceptions OR Medicare Providers (up to $44,000 per provider) Based on % of allowable charges MD, DO

Meaningful Use in a Nutshell Successful Meaningful Use in Stage One: Qualify for Incentive program under Medicare or Medicaid Use of an ARRA Certified EHR system Attesting to the successful completion and use of 15 Core Elements Attesting to the successful completion and use of 5 of the 10 Additional Items

US Department of Health and Human Services (DHHS) Centers for Medicare & Medicaid Services Medicaid and Medicare incentive structure Meaningful use definitions Office of the National Coordinator for HIT Health Information Exchange (1 per state) Regional Extension Centers (per undefined region) Work force training (Community Colleges) 10 state region EHR certification

State and Regional Levels NC Health Information Exchange (HIE) Strategic plan submitted Operational plan submitted 8/30/10 12.9 million dollars + Medicaid support NC Regional Extension Centers (REC) Preliminary application accepted 9/29/09 Full application submitted 11/03/09 Awarded 2/12/10 13.6 million dollars

NC REC Program Requirements and Goals Entire state of NC (100 counties) No charge for services for now Priority Primary Care Providers Small practices (less than 10 providers), or Rural, or Underserved or Medically underserved, or FQHC, or RHC, or CAH 3465 providers (estimated 800 - 1000 practices) The REC helps us to support the work of QI. –Primary care only

Specialized Practice-based services at AHEC EHR Specialists QI Consultants Technical Assistance Specialist

Levels of Support NC Medical Society Foundation State HIE Board Associate Director, Statewide QI IPH Carolinas Center for Medical Excellence HIT Manager QI Manager Community Care of NC Others Others… NCHICA, NCCHCA, NC DPH, NCAFP, NCPS

Practices will transition through AHEC Services Application received Practices will transition through AHEC Services Do they have an EHR? No EHR Implementation Specialist works with practice Successful EHR Implementation Yes Meaningful use gap analysis and data pull All services lead to improving clinical outcomes QIC works on IPIP and PCMH

On-site consulting with Paper Practices Financial Assessments Readiness Assessments Computer skill Assessments Hardware Assessments Environmental Scan Workflow Assessments Establishing realistic goals for the EHR RFP for Vendors Vendor Demos Vendor references Vendor Selection Vendor Contracting Template building Interface building Vendor set up Vendor training Data loading System testing – back up training Go-live Post live evaluation Touch upon process of implementation

On site consulting with Electronic Practices Meaningful use gap analysis Guidance/assistance with template building to ensure that data is entered “meaningfully” Evaluation of interfaces Evaluating mapping/coding where needed Training checklists/security and back ups Trouble shoot post go live evaluation issues Assistance with Query and Report building Assistance with or evaluation of eRx Assistance with HIE connection

On site consulting to Improve Quality with Technology Improvement in outcomes, meaningful use and Patient Centered Medical Home Recognition Maintenance of Board Certification Part IV CME for practice-based QI work for providers Model for Improvement Care Model Rapid Cycle Tests of Change Template tweaking Implementation of guideline based protocols for care delivery Implementation of self management support techniques

Where does healthcare reform fit? Patient Centered Medical Home Improved Clinical Outcomes Meaningful use of HIT Electronic Health Records Paper Charts Learn how to: Meet the requirements of the NCQA Recognition program for PCMH Approach the PCMH application process with improvement techniques Learn how to: Produce population –based reporting to test the efficacy of your care Use proven methods and techniques to improve the outcomes of your patients Learn how to: Use your EHR to meet the federal requirements for the HITECH Act Meaningful Use Incentive Payments from Medicare or Medicaid Learn how to: Select a certified EHR that meets your needs Implement an EHR for optimal use in your practice Learn how to: Assess the needs of your practice in an EHR system. Redesign your paper practice to ready for an EHR.

TRHCA Physician Quality Reporting Initiative The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period).

Accountable Care Act Physician reporting (PQRI)to a compare website LTC, inpt rehab, and inpt psych hospitals, and hospice pgms all to report quality data Pay for performance incentives (Value-based payment modifier for physician fee schedule: measures) Health Benefits exchange to include quality ratings for health plans Demonstration program to integrate quality improvement and patient safety training in to clinical education of health professionals Patient-centered outcomes research

Discussion? Contact Information Ann_lefebvre@med.unc.edu