1. Science to Practice: The ACC Tapestry The Quality Colloquium August 21, 2006 Janet S Wright MD FACC

2. American College of Cardiology Mission To advocate for quality cardiovascular care — through education, research promotion, development and application of standards and guidelines — and to influence health care policy. To advocate for quality cardiovascular care — through education, research promotion, development and application of standards and guidelines — and to influence health care policy.

3. ACC Goals ACC Goals  Recognized leader in cardiovascular science, knowledge, & best practices  Accelerate application of science, knowledge, & measurement into practice  Build partnerships to improve the delivery of high quality CV care

4. The Venn of ACC Quality AdvocacyEducation Science

5. Start with the Science Practice Guidelines (1984) Practice Guidelines (1984) Expert Consensus Documents Expert Consensus Documents Competence & Training Statements Competence & Training Statements Clinical Data Standards Clinical Data Standards Clinical Performance Measures Clinical Performance Measures Appropriateness Criteria Appropriateness Criteria

6. Accelerate Application  Guideline tools  Self Assessment Programs  Focus on outcomes: ACC-NCDR® GAP Medical Directors’ Institute Appropriateness Criteria

7. ACC-NCDR National CV Data Registry Diagnostic Caths/Coronary InterventionsDiagnostic Caths/Coronary Interventions > 700 labs and > 2.5 million pt records > 700 labs and > 2.5 million pt records Implantable Cardioverter DefibrillatorsImplantable Cardioverter Defibrillators Official CMS database Official CMS database Carotid InterventionsCarotid Interventions Meets CMS requirements for data collection Meets CMS requirements for data collection

8. Science and Quality Meet Guidelines Applied in Practice or GAP Guidelines Applied in Practice or GAP AMI in Michigan: 1=> 5=> 33 hospitalsAMI in Michigan: 1=> 5=> 33 hospitals Heart Failure in OregonHeart Failure in Oregon Stable Angina in AlabamaStable Angina in Alabama National Door to Balloon (D2B) InitiativeNational Door to Balloon (D2B) Initiative Highlight team-care, care coordination, power of data to improve outcomes

9. MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess

10. MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork

11. MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork Health plans & cardiologists at odds Health plans & cardiologists at odds

12. MDI Genesis, circa 2001 Healthcare is a mess Healthcare is a mess Solutions will require teamwork Solutions will require teamwork Health plans & cardiologists at odds Health plans & cardiologists at odds “Let’s put on a show!” “Let’s put on a show!”

13. The Medical Directors’ Institute is a national, action-oriented community committed to solving mutual problems on a local level.

14. MDI Objectives Build relationships among CV specialists, payers, and purchasers Build relationships among CV specialists, payers, and purchasers Identify opportunities for collaborative solutions Identify opportunities for collaborative solutions Execute plans of action on national & local levels to improve healthcare Execute plans of action on national & local levels to improve healthcare

15. MDI-The Early Years 2002-identified mutual problems 2002-identified mutual problems 2003 2003 Utilization of ImagingUtilization of Imaging Disease ManagementDisease Management Measuring & Paying for QualityMeasuring & Paying for Quality

16. MDI 2004 Information Technology and EMRs Information Technology and EMRs Who pays? Who benefits? What works?Who pays? Who benefits? What works? Employer/Purchaser input is KEY Employer/Purchaser input is KEY Crisis in Imaging Use and Cost Crisis in Imaging Use and Cost Advise us now or live with our remedies!Advise us now or live with our remedies! Go NuclearGo Nuclear

17. MDI 2005 Principles for Pay for Performance Principles for Pay for Performance Ambulatory Performance Measures Ambulatory Performance Measures Collaborative effort with PCPICollaborative effort with PCPI NQF endorsedNQF endorsed Staged implementationStaged implementation Appropriateness Criteria (AC) for Nuclear Imaging Appropriateness Criteria (AC) for Nuclear Imaging

18. MDI Pilots in Progress Clinical vs Administrative Data Clinical vs Administrative Data Physician Recognition Program Physician Recognition Program Ambulatory Discharge Contract in EMR Ambulatory Discharge Contract in EMR Medicare Health Support Programs Medicare Health Support Programs Aetna in Chicago metropolitan areaAetna in Chicago metropolitan area American Healthways in Maryland/DCAmerican Healthways in Maryland/DC Health Dialog in PennsylvaniaHealth Dialog in Pennsylvania

19. MDI 2005 Directives CMS is key partner CMS is key partner Formalize MDI Governance Formalize MDI Governance Provide input into design of CV COEs Provide input into design of CV COEs Participate in AQA work Participate in AQA work Ambulatory Registry for CV Disease Ambulatory Registry for CV Disease Appropriateness Criteria for Computed Tomography/MR, Echo Appropriateness Criteria for Computed Tomography/MR, Echo

20. What are Appropriateness Criteria? Evidence-based, clinical judgment-informed guidance to help physicians select Right test or procedure Right test or procedure Right Patient Right Patient Right Time Right Time

21. Why Appropriateness Now ? Explosive growth of CV imaging Explosive growth of CV imaging Substantial regional variation Substantial regional variation True nature of utilization unknown True nature of utilization unknown New technology on the horizon New technology on the horizon Clinicians, patients, payers, purchasers all seeking guidance Clinicians, patients, payers, purchasers all seeking guidance

22. MDI 2006 Systematic Appropriateness Coordinate care with primary physicians Coordinate care with primary physicians Design a utilization policy to drive AC Design a utilization policy to drive AC Identify the tools and systems to capture, measure, and report adherence Identify the tools and systems to capture, measure, and report adherence Establish the benefits of AC adherence Establish the benefits of AC adherence Educate consumers about AC-driven care Educate consumers about AC-driven care

23. Implementing Appropriateness Criteria 2006 2010 ACC Payers How can practices use AC to improve care? What resources do practices need to apply AC? How can HPs use AC? What impact can AC have on cost and quality? All patients receive EBM Physicians deliver EBM efficiently Payers buy quality Here are the data! 45% of patients are receiving EBM Physicians want to provide EBM Payers want to buy quality Show me the data!

24. Key Lessons Learned Science => practice takes > a village Science => practice takes > a village Focus on quality Focus on quality OVER-communicate OVER-communicate Build on successes/learn from failures Build on successes/learn from failures Data + incentive => change Data + incentive => change

25. More www.acc.org www.acc.org www.acc.org www.cardiosource.org www.cardiosource.org www.cardiosource.org janetwright@sbcglobal.net janetwright@sbcglobal.net