Building a Learning Health Center System to Advance Quality Indiana HCCN Meeting October 5, 2017

Transcription

1 Building a Learning Health Center System to Advance Quality Indiana HCCN Meeting October 5, 2017 Suma Nair PhD, MS, RD Director, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA)

2 Overview Health Center Program Strategic Goals Quality Improvement Priorities UDS Reporting and Modernization HCCN Role in the Learning Health Center System Q & A 2

3 Increasing Access to Primary Health Care 3

4 Bureau of Primary Health Care: Strategic Goals Increase Access to Primary Health Care Advance Health Center Quality and Impact Optimize Bureau of Primary Health Care Operations Mission: Improve the health of the nation s underserved communities and vulnerable populations by assuring access to comprehensive, culturally competent, quality primary health care services 4

5 Strategic Goal 1: Increase Access to Primary Health Care Objectives Increase the number of underserved communities and vulnerable populations with access to primary health care Expand access to comprehensive services Primary Medical Oral Health Mental Health Substance Abuse/Opioid Treatment Vision Services Enabling Services (case management, transportation, patient education) Clinician education and training Strengthen health center capacity to respond to urgent and emergent issues 5

6 Expand Access to Comprehensive Services Number of Health Centers Services provided by Health Centers Service Types Medical Dental Behavioral Health Vision Enabling Number of Service Types Provided 6

7 Strategic Goal 2: Advance Health Center Quality & Impact Objectives Promote and advance quality of care Improve performance management and operations Build a Learning Health Center System 7

8 Patient-Centered Medical Home (PCMH) Key Elements of Practice Transformation Enhance team-based care Enable access to care Advance patient experience Shared decision making Performance measurement Meet social, cultural, and linguistic patient needs Goal: 70% by 2017

9 Fiscal Year 2017 Quality Improvement Awards # of Health Centers # of QIA awardees % of QIA awardees National 1,370* 1, % Indiana % Type of Awards National Indiana QUALITY AWARDS National Quality Leader Award 47 0 Health Center Quality Leader Award E H R Reporter Award Clinical Quality Improver Award 1, ACCESS ENHANCERS HIGH VALUE HEALTH CENTERS 21 2 HEALTH DISPARITIES PATIENT-CENTERED MEDICAL HOME (PCMH) Source: Uniform Data System, HRSA Electronic Handbooks, *3 health centers achieving PCMH recognition did not submit a 2016 UDS Report 9

10 Diabetes Quality Improvement Initiative - Health Center Trends Percentage of Patients Goal: Weight Assessment and and Counseling for Nutrition and Physical Activity for Children and Adolescents Body Mass Index (BMI) Screening and Follow-up (Adults) Uncontrolled Diabetes (HbA1c >9%) Source: Uniform Data System,

11 Comparative Performance on Weight Screening and Follow Up Low Birth Weight Adult Weight Screening & Follow Up Child & Adolescent Weight Screening & Follow Up Indiana 50.0 Percentage of Patients Health Center National Average Source: Uniform Data System, HRSA Electronic Handbooks,

12 Diabetes Performance Across Indiana Variance of Uncontrolled Diabetes Uncontrolled Diabetes by Race/Ethnicity Percentage of Patients Percentage of Patients Highest Performing Health Center Lowest Performing Health Center State Performance Average State Performance Average: 36.3% Healthy People 2020 Goal: 16.2% *Diabetes: Hemoglobin A1c Poor Control: Change to the denominator: Age 18 through 75 years (previously age 18 through 74), eligibility no longer limite d to patients with at least 2 medical visits during the measurement year. Please see Source: Uniform Data System, HRSA Electronic Handbooks,

13 Diabetes Quality Improvement Initiative - Goals Increase Diabetes Prevention Efforts Increase the percentage of adults who receive weight screenings & counseling Increase the percentage of children who receive weight screenings & counseling Improve Diabetes Treatment And Management Reduce the proportion of persons with diabetes with an HbA1c value greater than 9 percent Increase the proportion of health centers that meet the Healthy People 2020 goal for uncontrolled diabetes for each racial/ethnic group 10% 8% 6% 4% 2% 0% 6.8% 8.8% 8.5% 6.5% % of HRSA Health Centers that Met the HP 2020 Goal for Uncontrolled Diabetes 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 37.9% American Indian/ Alaska Native 22.5% Asian 34.4% 33.4% Black/ African American Hispanic or Latino % of Uncontrolled Diabetes Patients by Race/Ethnicity for % Native Hawaiian 42.6% Other Pacific Islander 29.6% White (NonHispanic/ Latino) 13

14 14 Diabetes Quality Improvement Initiative Implementation Strategies 1. Quality Improvement Priority Alignment Focus on Diabetes Quality Measures during Oversight Activities Quality Improvement Investments and Activities focus on Diabetes 2. Using Data and Evidence to Drive Improvement 3. Developing and Implementing Technical Assistance Resources 4. Establishing and Leveraging Partnerships/Collaborations

15 Strategic Partners Technical Assistance Strategies to Prevent and Manage Diabetes Improving Health Systems & Infrastructure Optimizing Provider & Multidisciplinary Teams Facilitating Behavior Change in Patients EHRs with Diabetes Modules Diabetes Informatics Health Information Exchange (HIE) & Telemedicine Patient Centered Medical Home (PCMH) Use Patient Portals Team Based Care Promote National Standards New Techniques for Early Detection Screening Case Management Sharing of Diabetes Management Promising Practices Eye, Foot, Dental, & Kidney Screening Provider Counseling of Patients CHW Directed Patient Education Lifestyle/Self- Management Promote Physical Activity and Healthy Diets Address Childhood & Adult Obesity Increase Patient Health Literacy 28

16 16 UDS Modernization Project UDS Submission Process Goal: To streamline reporting burden by automating data submission Scan current health center reporting processes and challenges Develop potential solutions Prototype new capabilities and pilot with health centers Share findings and implementation plan Implement business process and governance improvements UDS Content Goal: To ensure UDS reflects improvements in patient-centered care and an evolving primary care setting Identify data elements to streamline, add or update Conduct an impact analysis and pilot Share findings and implementation plan

17 Components of Process Modernization 17

18 CY 2017 Reporting Capabilities 18

19 CY 2018 Reporting Capabilities 20

20 UDS Content Modernization: Environmental Scan and Current State Analysis 21

21 UDS Content Changes Under Consideration Summary of Transformational UDS Content Modernization Data Quality Data Usage Describes Impact Transform Reporting of Countable Visits Lead the Field in Measuring & Reporting Clinical Quality Data by Patient Cohorts Configure Patient Sub-Populations by All Demographics & Social Determinants Expand Patient Engagement Data by Patient Sub-Populations Expand Models of Care Reporting by Patient Sub-Populations Enhance Ability to Report on Culturally Competent Care - Culturally Competent Care Initiatives & Community Partnerships - Patient Experience - Staff Satisfaction - Patient Empanelment 21 22

22 Health Center Controlled Networks Impact of HCCN Participation : 96.5% of HCCN HCs report using EHR for UDS reporting HCCN HCs are 27% more likely to have PCMH recognition 50 HCCN Grantees HCCN Program Scope: 70% of health centers participating 99.1% of HCCN HCs using EHRs report sending prescriptions electronically 18M patients and 20,000 EPs impacted 99.8% of HCCN HCs using EHRs have implemented Clinical Decision Support HCCN HCs are 20% more likely to use HIT for patient engagement 12 HCCNs include multistate participation Key Focus Areas: Health IT Implementation and Meaningful Use (MU) Data Quality and Reporting Health Information Exchange (HIE) and Population Health Management Quality Improvement 22

23 HCCN Year One Accomplishments Data Quality & Reporting, Goal B2 Health Centers Generating QI Reports at Site & Clinical Team Level 2016 QI Reports at Site & Team Level 66% 2017 QI Reports at Site & Team Level 83% 17% Improvement Sources: 2016 HCCN Applications 2017 HCCN Continuation Reports 24

24 HCCN Year One Accomplishments Health Information Exchange (HIE) & Population Health Management Goal C1 - Health Centers that improve care coordination through HIE with unaffiliated providers/entities Goal C1 0 34% 60% Sources: 2016 HCCN Applications 2017 HCCN Non-competing Continuation Reports Goal C1 HIE with Unaffiliated Providers 26% Improvement 25

25 HCCN Year One Accomplishments Quality Improvement Goals D1 and D3 5% Improvement % Decrease 12% 10% HP2020 Measures, Five or More UDS CQMs Sources: 2016 HCCN Applications 2017 HCCN Continuation Reports 51% 56% Sites with PCMH Recognition

26 Increasing Focus on Value and Impact Health Care Delivery System Managed Care Accountable Care Alternative Payment Methodologies Quality Payment Program Community-wide Community Centered Health Homes Accountable Health Communities Public Health

27 Building a Learning Health Center System Other Partners Federal Agencies Health Centers Learning Health Center System BPHC NCAs HCCNs PCAs Learning Health System Attributes: Science and Informatics Real time access to knowledge Digital capture of the care experience Patient-Clinician Relationships Engaged, empowered patients Incentives Incentives aligned for value Full transparency Culture Leadership instilled culture of learning Supportive system competencies Best Care at Lower Cost: The Path to Continuously Learning Health Care in America Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in- America.aspx 28

28 28 HIT Enabled Quality Improvement HHS/ONC: Health IT Enabled Quality Improvement -

29 29 Using HIT to Improve Quality and Value Quality Improvement Initiatives and Resources o Information exchange across services and settings o Clinical Decision Support, Clinical Workflow, EHR Templates o Patient Engagement/Self Management Investments in and support for: o Data/Analytics, Population Health, HIE, Workforce o Understanding the Social Determinants of Health and related interventions o Research

30 UDS Resources UDS Modernization Page nization.html UDS Resources Webpage UDS Helpline Phone: UDS-HELP BPHC Helpline Phone:

31 Health Center Program Resources Website: bphc.hrsa.gov Includes many Technical Assistance (TA) resources Weekly E-Newsletter: Primary Health Care Digest Sign up online to receive up-to-date information BPHC Helpline: hrsa.gov/about/contact/bphc EHB questions/issues FTCA inquiries BPHC Project Officer: Address specific questions about your health center s grant or look-alike designation National Cooperative Agreements & Primary Care Associations: bphc.hrsa.gov/qualityimprovement/strategicpartnerships 31

32 Thank You! Suma Nair PhD, MS, RD Director, Office of Quality Improvement Bureau of Primary Health Care (BPHC) Health Resources and Services Administration (HRSA) facebook.com/hhs.hrsa 32