Providing Patients With Our “BEST” (Bold Efforts to Secure Transformation) Better Health for the ESRD Population through Innovation Pilot Projects to Achieve Quality Improvement Outcomes and Reduce Disparities in Care QualityNet 2012 Presenters: Renee Dupee, JD and Melissa D orsey, MHA December 12, 2012, 10:30am -11:30am

2 WELCOME! Continuing our Partnership Successful Quality Improvement Projects –Network 17 –Network 18

Purposes for Today Get acquainted with the Aim 2 Innovation Pilot Project Review the expected outcomes, measures and timelines Share insights and ideas for bold innovation Leave this session IN ACTION 3

How to “Be” Today Focused on aligning with the goals of the Redesigned ESRD Network Contract Aim 2 Projects Actively engaged in hearing and sharing thoughts and creativity Preparing to implement the ideas and wisdom gleaned from this presentation and the entire 2012 QualityNet 4

5 Past vs. Present

The Past… 6

The Present… 7

“EVOLVING” 8

The Past… 9

The Present… 10

“INCLUSIVE” 11

The Past… 12

The Present… 13

“FASTER ” 14

15 Aim 2 Population Health Innovation Pilot Project: Bold Efforts to Secure Transformation

Project Characteristics Rapid Cycle Improvement Customer Focus/Stakeholder Input Sustainable Improvement Innovation Boundarilessness Teamwork approach 16

Project Overview: Network selects one of the following projects: Project A: Increase Hepatitis B, Influenza and Pneumococcal Vaccination Rates Project B: Improve Dialysis Care Coordination with a focus on Reducing Hospital Utilization Project C: Improve Transplant Coordination Project D: Promote Appropriate Home Dialysis in Qualified Beneficiaries Project E: Support Improvement in Quality of Life 17

Project Overview Baseline must demonstrate less than 85% achievement on all measures for selected topic –(e.g. <85% transplant referral) Conduct Disparity Assessment (highest ordered w/ ≥o5%) Must complete Project Approval by 1 st Qtr 2013 Projects have 1-3 Measures; must achieve prescribed goals on all measures for project Projects must use specified measure definitions and tools, as applicable 18

Overview of AIM 2 AIMDomainSub-Domain AIM 2: Better Health for the ESRD Population Population Health Innovation Pilot Project Reduce Identified Disparity Through Selected Project 1.Race (African-American vs. Caucasian) 2.Ethnicity (Hispanic vs. Non-Hispanic) 3.Facility Location (Rural vs. Urban) 4.Gender (Female vs. Male) 5.Age (< 65; 65+) Select a Project Project A: Increase Hepatitis B, Influenza and Pneumococcal Vaccination Rates Project B: Improve Dialysis Care Coordination with a focus on Reducing Hospital Utilization Project C: Improve Transplant Coordination Project D: Promote Appropriate Home Dialysis in Qualified Beneficiaries Project E: Support Improvement in Quality of Life 19

Innovation Pilot Project Subdomains 1.Reduce Disparity 2.Project Area Performance 20

21 Aim 2 Population Health Innovation Pilot Project Subdomain 1: Reduce Disparity

Reduce Disparity Five Ordered Disparity Categories 1.Race (African-American vs. Caucasian) 2.Ethnicity (Hispanic vs. Non-Hispanic) 3.Facility Location (Rural vs. Urban) 4.Gender (Female vs. Male) 5.Age (< 65; 65+) Must select highest ordered disparity with at least 5 percentage point difference at baseline Must improve disparate population by 1 percentage point 22

23 3 Part Group Activity

Part 1: Group Activity At your table, discuss which one of the five categories you believe experience the greatest disparity of care in your regions 24

Five Disparity Categories  Race (African-American vs. Caucasian)  Ethnicity (Hispanic vs. Non-Hispanic)  Facility Location (Rural vs. Urban)  Gender (Female vs. Male)  Age (65+ vs. < 65) 25

Part 2: Group Activity Using the most popular category of disparity at your table, if resources were unlimited what would you do to reduce the disparity of care? 26

Part 3: Group Activity Working within the reality of resources what innovative quality improvement ideas/tools could you undertake to make a reduction (even a small one)? 27

28 Aim 2 Population Health Innovation Pilot Project Subdomain 2: Project Area Performance

Project A: Increase HBV, Influenza, and Pneumococcal Vaccination Rates MeasureDefinition Staff influenza vaccinationProportion of eligible staff who received influenza vaccination Patient hepatitis B vaccinationProportion of eligible patients who received HBV vaccination Patient pneumococcal vaccination Proportion of eligible patients who received pneumococcal vaccination 29

Increase HBV, Influenza, and Pneumococcal Vaccination Rates 30 Identify At Least 10 Low-Performing Facilities Project Goal by End of 3 rd Quarter or Network Evaluation: Achieve a 10 % point increase over baseline in Facility Staff Influenza Vaccinations Achieve a 5% point increase in Patient HBV and Pneumococcal Vaccinations

Increase HBV, Influenza, and Pneumococcal Vaccination Rates Group Activity: What Are Your Best Ideas To Secure Transformation Through Project A? 31

Project B: Dialysis Care Coordination with a Focus on Reducing Hospital Utilization MeasureDefinition Hospital admission rateNumber of inpatient admits/number of patients 32

Dialysis Care Coordination with a Focus on Reducing Hospital Utilization 33 Note: Measurement will be obtained from CMS-specified Hospitalization measures in CROWNWeb, with data reported to CMS for the targeted facility population on a monthly basis.

Dialysis Care Coordination with a Focus on Reducing Hospital Utilization Group Activity 34 What Are Your Best Ideas To Secure Transformation Through Project B?

Project C: Improve Transplant Coordination MeasureDefinition Transplant referral ratePercent of eligible patients referred for transplant 35

Improve Transplant Coordination 36 Note: Measurement will be obtained from a CMS-specified Transplant Referral measure in CROWNWeb

Improve Transplant Coordination Group Activity 37 What Are Your Best Ideas To Secure Transformation Through Project C?

Project D: Promote Appropriate Home Dialysis in Qualified Beneficiaries MeasureDefinition Promote home dialysis in qualified beneficiaries Increase percent of eligible patients receiving home hemodialysis or peritoneal dialysis 38

Promote Appropriate Home Dialysis in Qualified Beneficiaries 39 Note: Measurement shall be obtained from a CMS-specified Modality measure in CROWNWeb

Promote Appropriate Home Dialysis in Qualified Beneficiaries Group Activity 40 What Are Your Best Ideas To Secure Transformation Through Project D?

Project E: Support Improvement in Quality of Life Option 1* MeasureDefinition Overall quality of lifeKDQOL items

Support Improvement in Quality of Life 42 Project Goal by End of 3 rd Quarter or Network Evaluation: Demonstrate at least 10% point improvement on the overall KDQOL score Project Goal by End of 3 rd Quarter or Network Evaluation: Demonstrate at least 10% point improvement on the overall KDQOL score Project Includes: Sufficient number of dialysis facilities to comprise a patient population that represents at least 10% of the Network in-center hemodialysis population

Support Improvement in Quality of Life Option 1* Group Activity 43 How will a patient benefit from your work in Project E?

Project E: Support Improvement in Quality of Life Option 2* MeasureDefinition Ability to accomplish desired tasks KDQOL items Depression and anxietyKDQOL items How much kidney disease interferes with daily life KDQOL items

Support Improvement in Quality of Life Option 2 45 Project Goal by End of 3 rd Quarter or Network Evaluation: Achieve at least 6% point improvement for each of the renal-specific subcomponents Project Includes: Sufficient number of dialysis facilities to comprise a patient population that represents at least 10% of the Network in-center hemodialysis population

Support Improvement in Quality of Life Option 2 Group Activity How will a patient benefit from your work in Project E? 46

Discussion: Call to Action! What is one action step that are you going to take to provide patients with your “BEST”: Bold Efforts to Secure Transformation? 47

Questions 48 If you have additional questions, please contact Renee Dupee at or Melissa Dorsey at