2017 QUALITY PLAN WORK PLAN. Kaiser Permanente of Washington 2017 Quality Work Plan

Transcription

1 Kaiser Permanente of Washington 2017 Quality Work Plan 1

2 Achieve 2017 Quality Goals: Improve population health, the quality, safety and satisfaction of the customer experience while improving affordability by committing to the integration of reliability as an organizing principle that results in care processes that are performed as intended consistently over time. Rationale and Hypothesis for Improvement Activity: The Patient Protection and Affordable Care Act have reduced payment for Medicare Advantage plans such as for Medicare, which accounts for about 98% of our Medicare patients. At the same time, a bonus payment system linked to quality of care has been implemented, potentially minimizing the impact of the payment reduction. In addition, an increasing number of purchasers and employee groups have introduced various payment incentives related to clinical and service quality performance. KPWA fully supports the shift in health care payments from quantity (number of procedures) to quality (a fully immunized population) resulting in high quality outcomes at lower costs. The quality bonus payments will be based on Medicare "Star Rating" system to rate health plans on a one-to-five scale, with five stars representing the highest quality. KPWA s (formerly Group Health Cooperative) current rating is 4.5 stars, demonstrating performance in the top 10 th percentile amongst Health Plans in the country to achieve this rating in KPWA is well positioned to sustain and improve its clinical quality performance measured by the Star rating program and NCQA in 2017 and beyond, but will need to continue a focus on improvement as other plans improve their performance Quality Hypothesis to Achieve Goals The execution of a focused Action Plan with critical tactics will achieve the 2017 quality goals. This will result in a more highly reliable organization with demonstrated improvement in the patient experience of care, including safety, service and clinical quality and will contribute towards reducing the per capital cost of health care. The hypothesis for achieving the 2016 goals includes: Committing to the integration of reliability as an organizing principle will result in more fully engaged leaders, providers and staff to achieve and sustain a patient safety, service and quality culture that optimizes the patient experience. Closing the gap from current performance to the 90 th percentile for cancer screening, immunizations, diabetes, heart disease, depression and asthma by increasing patient and provider activation, opportunistically addressing the care gaps during each touch, giving timely feedback to the engaged provider and care team will result in improved clinical performance. If we continue to invest in the primary care medical home by refining the roles and responsibilities of the team including our proactive work by providers, pharmacy and nursing for chronic disease management, we will improve clinical outcomes for specific chronic disease populations. If we reliably execute the use of consistent workflow and use of tools across operational areas, conduct reliable checking and monitoring with leadership rounding, use process and outcome metrics with targets, then we will return to a consistent trend of improvement. Extending patient activation strategies and tactics across the Enterprise including our ability to evaluate effectiveness of impact to broaden use of tools and technologies to reach patients more often and in new ways will result in increased patient activation and improved outcomes. Commitment to the need for a vision and investment in strategies that create a genuine culture of service will result in patients that say they had outstanding service every time they interacted with any staff in KPWA. 2

3 STRATEGY: IMPROVE RELIABILITY CULTURE TO ELIMINATE SERIOUS SAFETY EVENTS TACTICS INCLUDE: Strengthen the implementation of reliability practice habits with: Development, implementation and spread of transformation coaches. Consistent use of transformation leadership teams focused on safety, quality and service performance.. Continue to improve the accountability and culture for high reliability by: Sustaining the practice habits for leaders and staff by assuring integration of reliability behaviors into ongoing training including new staff. Extending into teams outside of Care Delivery. Investing in supporting and developing operational leaders and adjusting metrics and feedback loops for performance. Birmingham, K Hert, R with CDLT Birmingham, K Hert, R Q1-2 Improve the measurement system to maximize learning by: Implementing a new/improved unusual occurrence reporting system. Enhancing the detection of events (e.g., serious service events, events related to worker safety). STRATEGY: IMPROVE POPULATION HEALTH AND CLINICAL OUTCOMES TO ASSURE MEDICARE 5 STAR, WASHINGTON HEALTH ALLIANCE AND NCQA PERFORMANCE. TACTICS INCLUDE: Improve Quality Tools and Measurement Systems Birmingham, K Hert, R Clinical Tools and Reporting: Improve and/or re-design the available Epic and Reporting tools that support patient centered strategies as well as improvements in documentation and coding to address chronic conditions by: McDonald, S Thayer, C Re-design and implement improvements to monthly quality reporting as needed to align with KPHP. 3

4 Continue improvements and alignment in the Epic dashboard, PCER, MCER, QFR and other clinical tools AND develop Roadmap for improvements that are in alignment with KP leadership priorities. Participate in planning for implementation of Epic Healthy Planet functionality and facilitate integration with clinical quality reminders and outreach as appropriate. Improve the reliability of key processes that support clinical quality in Care Delivery Group by: Improve the reliability of key processes that support clinical quality in the Care Delivery system by: Pre-visit and outreach standard work in clinical teams: Strengthen the standard work processes and, where needed, re-design processes and roles within primary care and Specialty for pre-visit workflow and clinical team outreach. Leadership rounding: Continue routine cadence and structure for leadership rounding for safety, quality, and service, use of visual systems with in process and outcome metrics and posted action plans. Ancillary Services: Pharmacy, Radiology, Eye Care: Assure that care teams integrate population outreach or opportunistic reminders for targeted populations including but not limited to: pharmacy medication adherence, medication reconciliation post discharge, retinal eye exams, asthma, breast cancer screening, etc. Chronic Disease Management: Re-design processes for chronic disease management specific to diabetes, post fracture care and others to be determined in collaboration with pharmacy, primary care, Specialty and quality teams. Fletcher, P Eng, A Taylor, C Stanford, K Fischer, G Trehearne, B Fischer, G 4

5 Improve provider engagement across the Enterprise for the Contracted Network by: Improve the reliability of key processes that support clinical quality in the Contracted Network by: Spread the use of value-based contracting strategies to incentivize network providers to improve/maintain quality performance. Engage network providers in quality improvement through consultation about quality performance; regular sharing of quality performance reports and outreach lists, best practices, and clinical tools/knowledge. Target specific populations for local improvement efforts in contracted network. Conduct monthly review of performance by Quality and Network Management leaders to check performance, identify gaps, and adjust action plans. Mora, M Delostrinos,W Assure reliable performance management system in the Care Delivery Leadership Teams for meeting quality metrics: Assure reliable performance management system in Care Delivery for quality metrics: Conduct monthly review of performance by Care Delivery leaders to check performance, identify gaps, and adjust action plans. Use Care Delivery forums for training, dissemination and spread of quality work (e.g., SQS and primary care forum, Network Services team, other leadership forums). Consider adoption of a coordinated clinical value leadership team with quality, Care Delivery to oversee the creation and prioritization of improvement work associated with safety, clinical quality, service, MCR and clinical value work. Leff, E Sherman, P Trehearne, B Q1-2 5

6 Optimize Enterprise wide patient activation and outreach Improve patient activation through Enterprise wide outreach: Continue patient activation and outreach capabilities across the Enterprise by increasing and/or improving patient touches for those with care gaps through letters, IVR, my group health. Use IVR and targeted f/u for the Health Outcomes Survey. Incorporate learning from evaluation of outreach into operations. McDonald, S Bradford, S-C Integrate population based strategies into care management interventions across the Enterprise of KP Washington Population Strategies: Determine priority, interventions and accountability to address clinical strategies for: End State Renal Disease Efficient Care After Total Joint Replacement Depression Care Management Life Care Planning, Specialty Palliative Care Complex Care Integrated Behavioral Health Trehearne, B STRATEGY: DESIGN AND IMPLEMENT TACTICS TO IMPROVE THE CUSTOMER EXPERIENCE Tactics include: Reassess the customer experience resources necessary in the Care Delivery System to develop an overall vision and key strategies to effectively guide a fundamental change and improvement in the service culture. Trehearne, B Grice, J COUNTEMEASURE Improve the patient care experience in the Group Practice as demonstrated by meeting the target mean score for the medical practice with the tactics: 6

7 Support the culture for high reliability in adoption of service behaviors by: Assure the implementation of the transformation coaches includes service behavior content and accountability processes. Continue to develop and provide training and coaching in use of behavior observation tools, in the moment coaching, empathy: communication skills. Continue to improve the measurement and reporting systems to maximize learning and target improvements by: Establishing goals and metrics for the Group Practice including those specific to service areas. Maintain and improve the care provider transparency reports, monthly data and analysis, identification of best practices for use by Care Delivery leaders to target focused areas for improvement. Care Delivery Access: Improve the drivers of likelihood to recommend provider practice by: Improvement efforts in access to care, information, advice including: Develop and implement strategies in each medical center to reduce backlog and increase capacity for demand in primary care. Implement three new walk-in clinics in South similar to Care Clinic models. Invest in resources to increase urgent care capability to provide rapid flow and increased capacity to enhance access and improve patient satisfaction. Continue to spread the implementation of the centralized secured messaging advice center that supports primary care. Member Experience Improvements Across the Enterprise: Establish a Health Plan member services dedicated team to triage immediate care needs and support new member welcome processes. Enhance the communication methods to support new member physician selection, online engagement, pharmacy transfers, and other identified member needs. Develop a standard welcome to the practice messaging and processes. Improve a patient s first visit experience when seeking care from a primary care provider. Align and build sustainable call center service levels for member services, appointing, and pharmacy financial assistance. Enhance the online and mobile application features to help members navigate care and coverage needs. McDonald, M Desimone, C Fletcher, P Taylor, C Gelazis, J Grice, J Boudy, F 7

8 Establish member satisfaction baselines for the health plan and investigate additional satisfaction survey options to better identify improvement opportunities and leverage best practices. Medicare 5 Star Part D Metrics: Sustain and continue to improve the implementation efforts to support the Medicare Part C& D metrics for: Member complaints and appeals Customer Service Member experience with the drug plan Drug pricing and medication safety Lewis-Smith, K Improve clinical value by providing cost effective care, reducing low value services and reducing unintended clinical variation. Rationale and Hypothesis for Improvement Activity: With the philosophical underpinning of the Dartmouth Atlas framework, clinicians (with support from quality and data experts) will provide better clinical care to our members and reduce medical costs while improving their satisfaction with their care. Critical elements in this strategy include clinicians leading the design and implementation of care processes incorporating evidence-based care, shared decision making, and identified best practices that reduce clinical variation. STRATEGY: REDUCE UNWARRANTED CLINICAL VARIATION THAT REULTS IN IMPROVED QUALITY AND AFFORDABILITY TACTICS: Develop a structure and system to improve clinical value by: Implementing evidence based clinical improvement focused on specific low value care issues including: Reducing antibiotic use for viral illnesses Reducing unnecessary imaging for evaluation of headaches Sustaining improvements in too-frequent cervical cancer screening Targeting other improvement in Specialty McCulloch,D McDonald, S Improve the use and adoption of Shared Decision Making throughout the Delivery System: Promote shared decision making communication skills as a core competency for 8

9 all clinical staff through uptake of the CME courses. Promote continued adoption of shared decision making conversations and use of decision aids in primary care and Specialty. Continue Clinical Variation Reporting in the global use of services: Continue the efforts to provide transparent peer comparison reporting in the overall use of specific services to reduce unnecessary clinical variation in the global use of services in primary care and extending to Specialty. Conduct variation analysis for specific specialties, targeting high volume, high cost services and the variation in how these conditions are managed. McDonald, S Monitoring and Evaluating the QI workplan Rationale and Hypothesis for Improvement Activity: Continuous monitoring and evaluation is an important component of the QI program, as described in the Quality Program Description. Monitoring and evaluation of our QI program is part of the check adjust process to inform future actions. TARGET INITIATIVES Monitor and evaluate QI workplan and program (Quarterly per available KPWA-QC meeting dates) KPWA-QC Q1 Q2 Q3 Q4 Please refer to the KPWA-QC 2017 Quality Dashboard for explanation of metrics to support the Quality Plan and Work plan. 9