Slide 1 Regional Care Collaborative March 26, 2015

Slide 2 Quality Reporting Presenters: Deborah Johnson Ingram, PCDC Carleetha Lankster, NOELA

Slide 3 1.History of quality 2.Quality reporting programs 3.QI improvement strategies AGENDA

Slide 4 What is Quality Improvement?

Slide 5 History

Slide 6 Early History of QI 1966 Donabedian, a health researcher at UMichigan Quality measurement across three domains: StructureProcessOutcomes The tools and resources available to providers and their physical and organizational settings Changes in a patient’s current and future health status The normative behaviors of providers and the interactions between them and their patients

Slide 7 QI is Heresy? Early 1980’s No (QI) structure QI was regarded as contrary Some observed healthcare process that was wasteful, variable & outcomes that were suboptimal Dr. Don Berwick, a pediatrician studied other industries QI techniques o W. Edwards Deming, a statistician & engineer revolutionized Japan’s auto industry by focusing on quality

Slide 8 W. Edwards Deming Deming developed an approach to measuring and improving industrial processes In the mid-1980s began training health care professionals on how to apply them – PDSA- PDCA Cycle

Slide 9 The Critical Role of Measurement o 1991 HEDIS: Health Plan set of measures of healthcare quality showed suboptimal performance o 1999 To Err is Human: IOM report, projected between 44,000 and 98,000 deaths annually in hospitals due to quality deficiencies o 2001 Crossing the Quality Chasm: IOM report Measurement of healthcare quality led to mainstream recognition of problems and the need to improve them.

Slide 10 What is needed for QI?

Slide 11 Five Factors in QI Success 1.Measurement/reporting 2.Incentives 3.Improvement methods 4.Best practices 5.Systems

Slide 12 Quality Measurement “If you can’t measure it, you can’t improve it” What are challenges to measurement? Are they different for structure, process, and outcome measurement?

Slide 13 Quality Reporting Programs CMS: Quality Compare – Health plans – Hospitals – Nursing homes – Home health agencies – Physicians The Joint Commission: top performer hospitals NCQA: health plan HEDIS State programs: hospitals and health plans Commercial programs: Leapfrog Safety, HealthGrades hospitals and physician reviews

Slide 14 Other Quality Reporting Programs LPHI: – BP Analysis – Depression (PHQ-2/PHQ-9/VDS) – A1C Analysis – BH pts and Comorbid conditions CQI: – Care Coordination – CVD – Hepatitis (screening and markers) – No Show reports – Staff and Provider Productivity – Colorectal Cancer Screening – Immunizations UDS: Asthma Treatment (Appropriate Treatment Plan) Cholesterol Treatment (Lipid Therapy for Coronary Artery Disease Patients) Heart Attack/Stroke Treatment (Aspirin Therapy for Ischemic Vascular Disease Patients) Blood Pressure Control (Hypertensive Patients with Blood Pressure < 140/90) Diabetes Control (Diabetic Patients with HbA1c <= 9%)

Slide 15 Reporting Is Helpful But Not Sufficient for QI “In studies showing either limited or no improvement researchers have attributed the results to practice burdens, inadequate computer training and support, and confusion with program requirements. Still other critiques speak to the size of the financial incentive relative to the effort required and whether the paradigm contributes to improving quality of care.” ACPE Healthcare Quality: The Physician’s Primer - p29

Slide 16 Payment Reform is now CMS: Value-Based Payment Modifier – For or more providers /1 TIN payment based on 2013 – For or more providers/ 1TIN- payment based on 2014 – For 2017 all providers affected Null if participant in Medicare Shared Savings Program, Pioneer ACOs, or the Comprehensive Primary Care Initiative

Slide 17 Best Practices PDSA, and QI more generally, depends on having change ideas that result in effective improvement Scenario My Town Clinic has two physicians and one nurse practitioner. The next available appointment for non-urgent care is in six weeks. What best practices might help them improve accessibility?

Slide 18 SPOTLIGHT ON QUALITY IMPROVEMENT Carleetha Lankster, NOELA

Slide 19 SPOTLIGHT on NOELA’s Quality NOELA demographics – mixed Vietnamese-American, African-Americans and Latino community in the far eastern, urban portion of Orleans Parish – low-income, uninsured, geographically and/or linguistically isolated population

Slide 20 NOELA Patient Demographics

Slide 21 NOELA Patient Demographics

Slide 22 Patient Distribution by Federal Poverty Level (FPL)

Slide 23 Population by Language Spoken at Home ENGLISH 338 FRENCH2 VIETNAMESE267 SIGN LANGUAGE1 SPANISH46 Grand Total654

Slide 24 NOELA QI Reporting UDS – Migrant patients* – Tracking birth weight* LPHI – BP Analysis – Depression (PHQ-2/PHQ- 9/VDS) – A1C Analysis – BH pts and Comorbid conditions CQI – Care Coordination – CVD – Hepatitis (screening and markers) – No Show reports – Staff and Provider Productivity – Colorectal Cancer Screening – Immunizations

Slide 25 NOELA’s Pathway to Improvement UDS – Migrant patients – Tracking birth weight LPHI – Depression Screening – HTN Issues Activities Solution Outcomes

Slide 26 Pros and Challenges of PDSA Pros – Emphasis on planning before making changes: setting aims, mapping process issues, selecting process improvements – Emphasis on measuring impact of changes – Emphasis on rapid cycles Challenges – Requires resources – Focuses on process – not much emphasis on systems – Has a tendency to be incremental, rather than making large changes

Slide 27 THANK YOU Deborah Johnson Ingram, PCDC Carleetha Lankster, NOELA