Achieving Efficiency and Scalability Through QIN/QIO Partnership in ADE. East Coast ADE Collaborative-Six States, Three QIN-QIOs, One Team

Transcription

1 Achieving Efficiency and Scalability Through QIN/QIO Partnership in ADE East Coast ADE Collaborative-Six States, Three QIN-QIOs, One Team

2 QIN/QIO Panel Presenters Karen Southard, RN, MHA, State Director, AQIN-SC Bonnie Horvath, MSHA, FACHE, CSSGB, State Director, AQIN-DC Cynthia Warriner, BS, RPh, CDE, Medication Safety Pharmacist, VHQC: Maryland/VA Adrienne Mims, MD, MPH, FAAFP, AGSF, Vice President and Chief Medical Officer, Medicare Quality Improvement, Alliant Quality: GA/NC 2

3 Objectives Describe the alignment of the QIN/QIO goals and how we united to develop our analytic strategy Present an overview of the ADE methodology Discuss how the ADE methodology is being used to help recruit community providers and monitor progress at a local level Review selected interventions that align to address current data trend 3

4 Parallel Journey Story of 3 QIN s to address ADE Different level of Expertise and Experience Staff new to QIO work Variance in Resources 4

5 Southeast Subject Matters Experts- ADE Partnership Cynthia Warriner, BS, RPh, CDE VHQC: Maryland, Virginia Jennifer Thomas, PharmD AQIN: District of Columbia Cheryl Anderson, BS, RPh AQIN: South Carolina Michael Crooks, PharmD Alliant Quality: North Carolina, Georgia 5

6 Overview and Collaboration SME = Subject Matter Expert; Task Lead Motivation: Recognized shared providers, patients and health systems between DC (AQIN) and MD (VHQC) Goal: Consistent reporting and messaging to shared providers and stakeholders. Synergy of resources, experience and spread. Growth: VA (VHQC) and SC (AQIN), then contiguous states: GA and NC (Alliant Quality) Process: Commitment to the team. Scheduled and adhoc calls with SMEs and analysts. Goal-driven timeline to standardize claims-based screening, deliverables, provider reports and interventions 6

7 Advantages of the Partnership Opportunity to explore and decide on resources and patient education QA of the data- shared among the QIN analytic team Interventions can be standardized or unique to each state depending on data trends Partnership has evolved into ADE strategy groupopen to suggestions and feedback Data driven reports helped recruit community providers 7

8 Where we began HRMB = High-Risk Med Beneficiary DM = diabetes agent AC = anticoagulant OP = opioid Data: Sources & Definitions AQIN (DC, SC) Denominator (HRMB) Medicare A ICD code as proxy for Med use Numerator (ADE) Medicare A ICD codes from literature review Timeframe: 3 months Coordination on ADE rates: DM only (AQIN & VHQC) VHQC (MD, VA) Medicare A ICD code as proxy for Med use Medicare A ICD codes from literature review Timeframe: 3 months Coordination on ADE rates: DM only (AQIN & VHQC) Alliant Quality (GA, NC) Medicare D Medicare A ICD Codes from TMF/IPRO sharing Timeframe: 12 months, rolling quarterly updates Coordination on ADE rates: none 25% 20% 15% 10% 5% 0% July 2015 Calculated ADE Rates AC-rate DM-rate OP-rate VHQC AQIN Alliant Quality 8

9 How we got here ICD = International Classification of Diseases; diagnosis code Aug 14 - Apr 15 DC, MD, VA Recognized value of alignment due to shared patients and health systems Used similar claimsbased screening, but state/territoryspecific SAS code SMEs scheduled planning calls, but limited analyst involvement Apr 15 - Jul 15 DC, MD, VA, SC Recruited newly hired SME from within QIN-QIO partnership Aligned definitions for denominator and numerator Saw value to include other contiguous states; NC and GA Aug 15 - Oct 15 DC, MD, VA, SC, NC, GA Adopt new, shared definitions for denominator from Part D data and numerator from validated ICD codes, adopted 12- month timeframe Scheduled monthly SME calls, formed analyst workgroup to share coding Nov 15 - Now DC, MD, VA, SC, NC, GA Continue SME calls Finalized method to attribute patients to providers Adopted universal SAS coding Conversion of ICD9 to ICD10 coding CMS Quality Conf. poster, PCC-IC interview and sharing presentation 9

10 Where we are now Universal, Shared SAS Coding: - Part D to identify denominator - Part A - ICD Codes for numerator - 12-month timeframe - Part A, B, D to attribute to providers Consistent Reporting: - Describes patient experience, not provider causality or blame - State-wide, community, provider-level - Same method for any care setting Maintain QIN-QIO Flexibility: - Targeted providers, care setting - Community, provider focus on medication classes, disease states 10

11 Where we re going next MTM = Medication Therapy Management CCM = Chronic Care Management TCM = Transitional Care Management Data: Opportunities for deeper-dive and reporting - Patient demographics, diseases and medication use - Provider setting, size and location - Impact of ICD-9 to ICD-10 conversion Teamwork: Collaboration on education and interventions - Webinars, resource sharing, and writing journal articles - Med Bags, Med Rec, and MTM/TCM/CCM training Mutual Support: Regular calls enhance problem-solving, brainstorming ideas, networking, and motivation 11

12 Scalability SC Incorporating Medication Reconciliation and Immunization education with targeted patient engagement medication bag events co-sponsored with Walgreens. 12

13 Interventions and Partnerships 13 Standardizing Medication Reconciliation Share developed tools and best practices with recruited partners Inpatient (hospital) monthly chart reviews Promote the adoption of Pharmacy Home Sharing medication accessibility tool with recruited partners to create safety net medication provisions for low income patients upon discharge. Collaborating with academia and a recruited geriatric provider to reduce hospital admissions related to Opiate Related Aspiration and Pneumonia while raising awareness of Opioid related ADEs.

14 Provider Education Campaign to Address Opioid Abuse Equip South Carolina prescribers and dispensers of controlled substances with: 1. the SCORxE toolkit risk assessments for substance use disorders urine drug screenings opiate agreements 2. education and training on proper use of the SCRIPTS program legislation online trainings 3. academic detailing on "Gold Standard" practices prioritized by need and targeted areas 4. education of project to pharmacy community through established SCPhA contacts Small Doses, Journal, RxAlerts 14

15 Scalability DC 15 Incorporating ADE review and reporting within the medication reconciliation audit Providing AQIN-DC ADE reports with NCC ADE reports and hotmaps to recruited providers, Compare and contrast with the providers internal reports i.e. hospital, home health agency ADE reports Raises awareness of potential harm and differences/disparities across the wards and the ranking of the District high risk medicine use and potential harm as compared to other states Results have been used as part of the justification for a Transitions of Care Pharmacist position in one hospital and the movement forward on an opioid safety team in a hospital Sharing of methodology and results in discussion across other payers DC Medicaid

16 Alliant Quality- Case Presentation A 79-year-old man comes to the office with his wife. He complains of weakness and hematuria. He was seen last week by urology for dysuria. He has a history of hypertension, stable renal insufficiency, Afib, CAD, with MI 2 years ago (ejection fraction, 35%). Meds: aspirin 81 mg/day, warfarin 5 mg qd, furosemide 20 mg b.i.d., metoprolol 25 mg b.i.d., pravastatin 40 mg qd, Lisinopril 20mg qd. Cipo 500 bid for 14 days Labs INR 7; WBC 10,000; Hct 32; UA Many RBC s 16

17 RISK FACTORS FOR ADEs 6 or more concurrent chronic conditions 12 or more doses of drugs/day 9 or more medications Prior adverse drug reaction Low body weight or low BMI Age 85 or older Estimated CrCl < 50 ml/min 17

18 Indications for Long Term Warfarin Atrial fibrillation PE & venous thromboembolism Selected patients post- CVA or TIA Left Atrial diameter > 5.5 cm with emboli Cardiomyopathy with EF< 25% Prosthetic valves Mechanical aortic and mitral Caged ball or disk valves 18

19 Warfarin A leading cause of hospital admission for ADE * Half life is hours steady state in 5-7 days post adjustment Drugs may increase or decrease the INR when used with Warfarin INR should be checked q 4-6 weeks Home INR monitoring available 19

20 Warfarin Drug Interactions 818 drugs 20

21 Medication Reconciliation Three Step Process Compile a list * of current medications from patient history, list, bag (incl. OTC) Compare list * to prescribed medications from chart, orders, consultant notes, hospital records Resolve any discrepancies Success Current, Complete & Communicated to All * Name, strength, dose, frequency, route, indication 21

22 Medication Reconciliation When to Perform: Hospital admission Hospital discharge or transfer New patient to your practice Patients return from consultant care Annually (at least) Success Current, Complete & Communicated to All 22

23 Supporting Medication Reconciliation- My Meds Bags Following up on success in 9 th SOW with My Med Bags Alliant Quality continues to spread this proven intervention to support medication reconciliation Recent pilot test of direct-to-beneficiary mailing of bags and supporting materials to users of warfarin, a medicine with high-risk for Adverse Drug Events Intent is to encourage patients to review their medicines with primary care provider 23

24 My Meds Bags - Materials Med Bags sent to 1823 community-dwelling patients of 160 physician partners in NC and GA Beneficiaries kit included: Med Bag + Explanatory Letter + Simple Med List + postagepaid Feedback Postcard 24

25 My Meds Bags MD Letter 25

26 My Meds Bags - Evaluation PCP completes during office visit Simple, low-effort, no-cost method to asses the uptake, perceived value & impact of the intervention Of 9 returned cards, 8 patients brought all medicines, 8 providers valued the review and 8 found medication discrepancies 26

27 My Meds Bags Next Steps 4 practices have requested additional Med Bags 2 are implementing a QI project to track and measure use of bags Alliant Quality will make available to other care provider who wants to measure improvement Will distribute through Diabetes Empowerment Education Program any use and Will consider other audiences for direct-to-beneficiary distribution 27

28 Partnership Makes A Difference- Care Coordination: Three QIN-QIOS Collaborate to Improve Medication Safe...The 2015 Quality Improvement Organization (QIO) Program Progress Report from the Centers for Medicare & Medi

29 Questions- Contact Us Karen Southard Bonnie Horvath Cindy Warriner Adrienne Mims 29