IHA District Meetings February-March, 2015 2015: Iowa Environmental Assessment in Quality and Patient Safety HEN, QIN, TCPI, SIM
Looking Back 10 Years Ago IHA, AHA, CMS, IFMC, State of Iowa, JCAHO, AHRQ and other organizations were all going in different directions with their quality strategies. IHC was formed by IHA/IMS to develop a unified quality strategy & serve as a filter for Iowa hospitals and providers
10 Years Keys to Success! Iowa Hospital/Health System Engagement & Support: Participation Sharing Best Practices Financial IHA/IMS Partnership: Physician Engagement IHC is Delivering
And Now Introducing in 2015: Hospital Engagement Network (HEN) 2.0 From Quality Improvement Organization (QIO) to Quality Improvement Network (QIN) Transforming Clinical Practice Initiative (TCPI) State Innovation Model (SIM)
Looking Ahead HEN + QIN + TCPI + SIM = The Need for Engagement, Communication and Coordination Tom Evans, MD, President/CEO, IHC Paul Mulhausen, MD, CMO, Telligen and the Other Guy, IHA
National Efforts to Transform Health Care Tom Evans, M.D. and Paul Mulhausen, M.D. Iowa Hospital Association District Meetings First Quarter, 2015 100 E. Grand Ave., Ste. 360 Des Moines, IA 50309-1835 Office: 515.283.9330 Fax: 515.698.5130 www.ihconline.org
National Aims Better Care Healthy People/Healthy Communities Affordable Care
Hospital Engagement Network (HEN)
Partnership for Patients Campaign Nationwide over three years, reduce Preventable inpatient harm by 40% Readmissions by 20%
Hospital Engagement Networks (HENs) CMS contract through the Innovation Center Work with an identified set of hospitals (127) Achieve the Partnership for Patients aims
PfP Scope of Work Readmissions Adverse drug events Venous Thromboembolism (VTE) Falls Pressure Ulcers OB adverse events Catheter associated UTI Surgical Site Infection (SSI) Ventilator-associated Pneumonia (VAP) Central line infection
5,000,000 4,000,000 HACs for PfP Campaign (Stacked by Count) 4,745,000 894,000 4,650,000 875,000 4,316,000 837,000 All Other HACs* Venous Thromboembolisms (VTE) Ventilator Associated Pneumonias (VAP) 3,000,000 1,320,000 1,320,000 Surgical Site Infections (SSI) 1,300,000 Pressure Ulcers 2,000,000 260,000 260,000 400,000 370,000 230,000 350,000 Obstetric Adverse Events* Falls 1,000,000 1,621,000 1,594,000 2010 Count of HACs (Rounded) 2011 Normalized Count of HACs (Rounded) 1,372,000 Preliminary 2012 Normalized Count of HACs (Rounded) HACs/1000 145 142 132 120 Central Line Associated Bloodstream Infections (CLABSI) Catheter Associated Urinary Tract Infections (CAUTI) Adverse Drug Events (ADE) * Preliminary 2012 PSI data is based on inputs from only 29 states.
Early Elective Delivery Rates
Primary Cesarean Delivery Rate
Adverse Drug Event Outcome Measure
IHC HEN Safety Across the Board HEN Baseline 2012
2013 Cost-Savings In 2013, it is estimated the hospitals saved: Total Events Avoided 4344 Decrease the Length of Stay 17,758 Lives Saved Cost Savings 32 $51,240,122
Hospital Engagement Networks (HENs) 2.0? CMS Innovation Center announced exploring extension of HEN project Continue the Partnership for Patients aims Encouraged to expand into LEAPT topics: Sepsis Radiology over use Worker safety
Quality Innovation Network (QIN)
Iowa QIN QIO A partner for quality Winter 2015
Take Home Points The work of the Telligen QIN QIO has changed with the restructuring of the CMS QIO program. The Telligen QIN QIO is available for technical assistance to hospitals for Quality Improvement programs focused on infections, use of HIT, and Value Based Incentive Programs. Telligen will be partner with communities of providers around a number of goals: heart disease, diabetes care, vaccination use, HIT, nursing home care, home health care, depression and substance abuse, and readmission prevention. 22
Changes to the QIO Program 23
Changes to the QIO Program CMS has separated medical case review from quality improvement work creating two separate structures BFCC QIO Medical case review to be performed by Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC QIOs) QIN QIO Quality improvement and technical assistance to be performed by Quality Innovation Network Quality Improvement Organizations (QIN QIOs)
Kepro is Iowa BFCC QIO
Telligen is the Iowa QIN QIO
Quality Innovation Network Quality Improvement Organization (QIN QIO) QIN QIOs have performance based contracts with the Centers for Medicare & Medicaid Services (CMS) with results measured by CMS QIN QIOs help achieve national quality CMS goals through focused efforts at the community level by providing technical assistance and convening learning and action networks to support healthcare quality improvement Current work extends over 5 years ending July 31, 2019
QIN QIO Program Approach to Quality
Key Strategies Across Goals Champion local level, results oriented change Facilitate learning and action networks Teach and provide technical assistance Organize Communities of Providers Patient and Family Centered Participation
QIN QIO Strategic Initiatives Improve Cardiac Health Improve Diabetes Care Meaningful Use of HIT Reduce Healthcare Associated Infections Reduce Healthcare Acquired Conditions Improve Care Coordination Quality Reporting & Value Based Incentives ** Achieve high rates of Immunization for Influenza, Invasive Pneumococcal Disease, and Herpes Zoster (Shingles) ** Improve screening and care coordination for behavioral health patients with depression and alcohol abuse ** Telligen is preparing proposals
Reducing Healthcare Acquired Infection Harmonizing with the HEN Our Shared Goals Implement data driven improvement efforts and reduce HAI rates Safe care, healthier beneficiaries Positively impact value based incentive program performance Assistance Available Comparison Data: Unit Specific, Facility, State and National Data Tracking of HAIs for participating ICU and Non ICU areas Prevention Best Practices Monitoring of NHSN HAI data
Improving Meaningful Use of HIT Working with the ONC REC Our Shared Goals Collaborate with Regional Extension Centers to assist providers and hospitals with meaningful use criteria Increase screening and delivery of preventative services for beneficiaries Assistance to be provided Educational Resources Related to Benefits of HIT Best Practices for Patient Engagement and Self Care Management Collecting, Tracking, Reporting Data via CEHRT (Certified Electronic Health Record Technology)
Support Quality Reporting and Our Shared Goals Value Based Incentives Support all venues of healthcare in improving outcomes and lowering costs Assistance to be provided Quality Improvement Tools & Techniques Physician Quality Reporting System support Value Based Modifier and Hospital Value Based Purchasing Programs Obtaining Meaningful Use for Incentive Payment
Organize Communities to Improve Care Coordination and Medication Safety Our Shared Goals Foster community coalitions of patients, caregivers and clinical teams to improve the quality of patients transitions between health care settings and reduce avoidable hospital readmissions and adverse drug events Assistance to be provided Community Developed Logic Models Community Organizing and Relationship Development Evidence Based Tools & Resources Using Data to Drive Change Identifying Root Causes of Readmissions Implementing and Monitoring of Interventions
Reducing Healthcare Acquired Conditions in Nursing Homes Our Shared Goals Reduce Healthcare Acquired Conditions (HAC) and antipsychotic use in nursing homes Safer residents with improved outcomes of care Assistance to be provided for Quality Assurance and Performance Improvement (QAPI) Reductions in pressure ulcers, restraint usage, falls, antipsychotic drug use, avoidable hospitalizations Education and support on consistent staffing, regulatory compliance, communications, accountability, and engagement of residents and families
Promote Effective Prevention and Treatment of Cardiac Disease and Diabetes Cardiac Disease Align with Million Hearts Initiative to prevent one million heart attacks and strokes Improve ABCS Reduce disparities Diabetes Mellitus (Everyone with Diabetes Counts) Help eliminate diabetes health disparities Increase opportunities for diabetes self management education among underserved populations with diabetes Improve quality of life for diabetics
Proposals Under Development Immunization Improve immunization rates to as high as 90% Influenza, pneumococcal vaccine, herpes zoster (shingles) Medicare goal: Increase new immunizations by 1 Million Behavioral Health Increase screening dramatically for depression and alcohol abuse Work in each state with minimum 200 physician practices and 5 inpatient psychiatric units Improve post discharge care transitions
Presentation Summary The Telligen QIN QIO will no longer be providing BFCC QIO services to Iowa; KEPRO is the current BFCC QIO. The Telligen QIN QIO is here to partner with Iowa healthcare providers to achieve the goals of the national quality strategy. The Telligen QIN QIO is collaborating with the Iowa Healthcare Collaborative to harmonize Federal quality initiatives in Iowa. The Telligen QIN QIO has a number of resources and opportunities available to support Iowa providers in pursuit of the strategic initiatives of CMS. 38
Primary Staff Contact Joyce Taylor Director Iowa QIN QIO XXX XXX XXXX jotaylor@telligen.com Paul Mulhausen, MD Medical Director Iowa, Illinois, and Colorado QIN QIOs 515 440 8504 pmulhausen@telligen.com Pat Merryweather Executive Director, Iowa, Illinois, and Colorado QIN QIOs 630 928 5860 pmerryweather@telligen.com 39
Transforming Clinical Practice Initiative (TCPI)
Transforming Clinical Practice Initiative (TCPI) A Service Delivery Innovation Model Better Health. Better Care. Lower Cost. 41
Context for Transforming Clinical Practice With the passage of the Affordable Care Act in 2010 came renewed efforts to improve our health care system. Efforts guided by focus on better health, better health care, and lower costs through quality improvement. Clinicians want to improve care for their patients, and to position their practices to thrive in a pay for value system. Increasing accountabilities from care delivery reform programs (e.g. Medicare Shared Savings Program). 16% (185,000) of clinicians are currently participating in CMS advanced care delivery models or model tests. With Innovation Center support, successful clinical practice leaders can support their peers with direct technical assistance to help them transform their practices. 4
Clinical Practice Leaders Have Already Charted the Pathway to Practice Transformation Traditional Approach Patient s chief complaints or reasons for visit determines care. Care is determined by today s problem and time available today. Care varies by scheduled time and memory/skill of the doctor. Patients are responsible for coordinating their own care. Clinicians know they deliver high quality care because they are well trained. It is up to the patient to tell us what happened to them. Transformed Practice We systematically assess all our patients health needs to plan care. Care is determined by a proactive plan to meet patient needs. Care is standardized according to evidence based guidelines. A prepared team of professionals coordinates a patient s care. Clinicians know they deliver high quality care because they measure it and make rapid changes to improve. You can track tests, consults, and follow up after the ED and hospital. Adapted from Duffy, D. (2014). School of Community Medicine, Tulsa, OK. 43
Transforming Clinical Practice Initiative Model Aligns with the criteria for innovative models set forth in the Affordable Care Act: Promoting broad payment, practice reform and care coordination Establishing community based health teams to support chronic care management, and Promoting improved quality and reduced cost through collaborative networks that support practice transformation. Moves clinician practices through 5 stages of transformation Supported by Practice Transformation Networks, Support & Alignment Networks, Quality Improvement Organizations and others. 44
Transforming Clinical Practice Initiative Phases of Transformation Set Aims Use Data to Drive Care Achieve Progress on Aims Achieve Benchmark Status Thrive as a Business via Pay for Value Approaches 45
Transforming Clinical Practice Goals 1 Support more than 150,000 clinicians in their practice transformation work 2 3 4 5 Improve health outcomes for millions of Medicare, Medicaid and CHIP beneficiaries and other patients Reduce unnecessary hospitalizations for 5 million patients Generate $1 to $4 billion in savings to the federal government and commercial payers Sustain efficient care delivery by reducing unnecessary testing and procedures 6 Build the evidence base on practice transformation so that effective solutions can be scaled 46
Practice Transformation in Action Transforming Clinical Practice (TCP) would employ a three pronged approach to national technical assistance. This technical assistance would enable large scale transformation of more than 150,000 clinicians practices to deliver better care and result in better health outcomes at lower costs. Aligned Federal and State programs with support contractor resources Communities Practice Transformation Networks (PTNs) to provide on the ground support to practices Primary and Specialty Care Clinicians and Practices Ambulatory and Post Acute Care Support and Alignment Networks (SANs) to achieve alignment with medical education, maintenance of certification, more Hospitals and Healthcare Systems Public Health Services 47
Participant Expectations Join the Practice Transformation Network by signing a charter that you will focus on the initiative s aims Progress through five identified phases of practice transformation over four years using technical assistance and peer led support Identify a PTN touch point of contact at your clinic to receive and disseminate information to clinicians from the PTN, CMS and other contractors Establish clinic aims and work plan Collect and submit data monthly via secure web portal beginning late Summer 2015 Participate in monthly webinars Participate in 4 month PDSA improvement cycles coupled with in person (regional or statewide) learning sessions 48
IHC PTN Multistate Application 49
Participant Expectations 50
TCPI Summary Transforming Clinical Practice HEN for Docs Enhance outpatient skill in populationbased care to thrive in value-based reimbursement Five Phases of Transformation Multi-state application with rural focus
State Innovation Model (SIM)
National Aims Better Care Healthy People/Healthy Communities Affordable Care
State Innovation Model (SIM) CMS contract through the Innovation Center Provides financial and technical support to states Development and testing of state-led, multi-payer health care service delivery and payment models Goals: Improve health system performance Increase quality of care Reduce cost for Medicare, Medicaid, CHIP
Improve Population Health Improve Population Health/ Healthiest State Initiatives Tobacco Use Engage Patients/Improve Health Literacy Diabetes Obesity/Childhood Obesity Hospital Acquired Infections Obstetrics Adverse Events Build from Healthy Behavior Program Use HRA to measure Patient activation Utilize Public Partnerships for education & outreach Measure Member Experience Choosing Wisely Campaign Collect Social Determinants of Health Impact Individual patient care Implement Community SDH Transformation grants Study potential risk adjustment on ACO payment model
Transform Health Care Delivery Expand ACO Model to Full Medicaid Expand PCP Assignment Align with Other Payers Shared Savings with Risk Incrementally add LTC/BH Services Care Coordination payments for chronics (aligned with HH) Use VIS Develop VIS Star Rating Include Medicaid HMO/CHIP Plans Support ACO Delivery System Develop Community Care Teams Develop Admission Discharge Transfer (ADT) system (HIT/IHIN) Technical Assistance approach with IDPH
Decrease Per Capita Health Care Costs Evaluation and Monitoring Conduct Rapid Cycle Evaluations Achieve Scale within an ACO model Track Total Cost of Care Align and partner with Public Payers (CHIP/M-HMO) Track VIS Improvement Pubic Reporting of Results Align and partner with Private Payers Monitor VIS and TCOC relationship Identify sub populations needs improvements
State Innovation Model (SIM) Summary Phase 1 - Design (Iowa 2013) DHS work groups Phase 2 - Testing (Iowa 2015-2018) Topical focus in Diabetes, Healthcare-associated infection and Obstetrics (Statewide Plans) Operational focus across topics in Medication Safety, Patient and Family engagement, Care Coordination across the Community, Social Determinates of Health Work Plan in development
Summary Significant Federal Investment in Iowa HEN- Patient Safety QIN- Care Coordination TCPI- Transforming Outpatient Care SIM- Advance the Triple Aim
Looking Ahead HEN + QIN + TCPI + SIM = The Need for Engagement, Communication and Coordination Questions?????