CJ Systems: JNG Working Together for a Healthier Michigan 1 Michigan IPIP/PCMH Preliminary Project Summation on the Transformation of Primary Care Practice

CJ Systems: JNG Working Together for a Healthier Michigan 2 Insert Longitudinal IPIP Project Development

CJ Systems: JNG Working Together for a Healthier Michigan 3 Insert Longitudinal IPIP Project Implementation

CJ Systems: JNG Working Together for a Healthier Michigan 4 IPIP Project: Start to Finish StatsJan 2009June 2010 Number of Practices 18 (Diabetic) 33 (Diabetic + Asthma) Number of Active Coaches 3043 Number of Physicians Involved Number of Patients Affected (Total Population) 148,080276,499 Number of Practices with an EHR/EMR 1023 Number of Practices with a Registry 824 Number of Practices with PCMH /BCBSM Designation 1227 Coach Time Estimated versus Coach Time Needed for project (hours per week) 410

CJ Systems: JNG Working Together for a Healthier Michigan 5 Practice Enrollment 1 Based on data submission Enrollment: –Wave 1 = Nov 2008 to Mar 2009 (17 practices) –Wave 2 = June 2009-Aug 2009 (8 practices) –Wave 3 = Sept 2009-Jan 2010 (4 practices) –Practices not reporting (4 practices) Engagement occurred within 3 months of starting

CJ Systems: JNG Working Together for a Healthier Michigan 6

CJ Systems: JNG Working Together for a Healthier Michigan 7 Time Commitment & Coach Involvement Quality improvement tools & techniques knowledge possessed by all QI Coaches QI Coach involvement with practice underestimated 3-4xs more time needed with practices to assist in transformation than planned Engaged, strong facilitation skills & vigor lead to more transformation

CJ Systems: JNG Working Together for a Healthier Michigan 8 Diabetic Measures: Start to Finish OUTCOME: More engagement, Closer to goal

CJ Systems: JNG Working Together for a Healthier Michigan 9 Asthma Measures: Start to Finish OUTCOME: More engagement, Closer to goal Percent

CJ Systems: JNG Working Together for a Healthier Michigan 10 Diabetes Measures by Activity: Start to Finish

CJ Systems: JNG Working Together for a Healthier Michigan 11 Asthma Measures by Activity: Start to Finish

CJ Systems: JNG Working Together for a Healthier Michigan 12 IPIP Reporting Criteria: Nov Feb 2009

CJ Systems: JNG Working Together for a Healthier Michigan 13 IPIP Reporting Criteria: Feb - May 2010

CJ Systems: JNG Working Together for a Healthier Michigan 14 Implementation of Electronic System(s) EHRRegistry Access/Excel 14 AllScripts 41 Ariphron 06 Care Tracker 10 Centricity 40 Cielo 02 CDEMS 01 eClinicals 11 EPIC 20 Kryptic 04 Misys 20 NextGen 50 Other 20 Synamed 10 WellCentive 05 Total 2324

CJ Systems: JNG Working Together for a Healthier Michigan 15 Learning Collaborative Date of LCFocus Attendance / Occurrences February 2009 Introduction to PCMH, CCM & the need for change 142 July 2009 Repeat of February 2009 to bring second wave of practices on board 42 September 2009 Diabetes, Asthmas & Self Management efforts 156 March 2010 Practices sharing to build community amongst IPIP team, seeing some best practice examples 118 Monthly Practice LC Call-ins (March 2009 – June 2010) Webex conducted 3 rd Wednesday & 4 th Thursday of the month Average 10 practices per call Monthly QICs meetings (June 2008 – June 2010) First Monday of month at AIAG offices & via webex Average 34 coaches per meeting Individual JIT & Assistance Weekly handled based on needs of practice or coach 2 incidences per week

CJ Systems: JNG Working Together for a Healthier Michigan 16 Lessons Learned: People & Culture Engage everyone! Get physician buy- in/engagement early Make the “Big Picture” visible: –Understanding the process –Understanding how their actions impact others –Different views = valuable Transformation takes longer than you think “Coaching” is critical

CJ Systems: JNG Working Together for a Healthier Michigan 17 Lessons Learned: Process Change Improving the process improves the patient care Think simple, be creative & resourceful Standardizing the work improves the outcomes Elimination of waste: –Unnecessary steps –Redundant actions –Duplication of documentation –Identification of inefficiencies –Accuracy of data/information –Lack of accountability Success breeds more success Important to understand what you “want to improve” to avoid frustration

CJ Systems: JNG Working Together for a Healthier Michigan 18 Lessons Learned: Outcomes Realization that current way is not necessarily the best way Registry allows for more “active” care of the patient population Be specific on what you measure! Measures & tracking drive the improvements Consistency in direction & efforts Tailoring tools to the user works best! Coaching time needed for practice assistance was underestimated Automation of metrics facilitated transformation

CJ Systems: JNG Working Together for a Healthier Michigan 19 Skill/Tool Number of Coaches Possessing Skill Value Stream Mapping 42 Lean Manufacturing Principles 42 Process Flow Mapping 47 PDSA/PDCA 42 Kaizen 37 DMAIC 42 Structured Problem Solving 47 5-S 40 Root Cause Analysis 48 5 Whys 44 Fish Bone 47 Data Collection 48 Error Proofing 42 Team Building 45 Standardized Work 40 Visual Controls 41 Facilitation/Coaching 47 Good Problem Definition/Scoping (Defining Boundaries) 46 Educational Presentation Experience 47 Other 24 QI Coach Skills Inventory Summary

CJ Systems: JNG Working Together for a Healthier Michigan 20 Things to Change & Keep CHANGE Plan more time for transformation Make website/library easier to use Plan LCs by region & practice size Better funding Create a database for reporting/tracking Upgrade Coach Handbook for easier use (make on-line?) Practice tool box/ guideline Stronger link between coach & practice Change Management training KEEP Coach actively present within practice Energetic leadership for driving the program/process Engaged leadership for the program/process National IPIP reporting system Learning Collaboratives Access to coaches TQM & PDSA Process mapping