Let s All Pull Together: Effective Partnering Across Quality Networks at the Community Level Sven Berg, MD Chief Medical Officer, West Virginia Medical Institute Keith T. Kanel, MD Chief Medical Officer, Pittsburgh Regional Health Initiative 2016 Quality Summit: Defining the Future of Health Quality Now Baltimore, MD 2016 Pittsburgh Regional Health Initiative and Quality Insights
WVMI: History at a Glance 1970s 1980s 1990s 2000s Professional Standards Review Organization Medicaid Review Peer Review Organization (PRO) Expansion to DE VHA External Peer Review Program CMS PRO Health Care Quality Improvement Program Quality Improvement Organizations (QIOs) Expansion to PA Measures Development 2010s 2014 HIT Regional Extension Centers ESRD Network Organizations Quality Innovation Network QIO Expand QIN-QIO work to NJ and LA 2016 Pittsburgh Regional Health Initiative and Quality Insights
WVMI: Summary of Select Projects Client Projects CMS Medicare Quality Improvement Organization Quality Innovation Network in five states: WV, DE, LA, NJ, PA 3 ESRD Network contracts covering: NJ, PR, US VI; PA, DE; VA, DC, MD, WV National Home Health Campaign Measurement Instrument Development and Support contractor VHA External Peer Review Program ONC Health Information Technology Regional Extension Center: PA, DE; subcontractor in WV State Governments WV Bureau of Health cardiac catheterization safety monitoring Pennsylvania and Delaware HIT-enabled quality improvement Private American College of Cardiology Patient-Centered Medical Home Accountable Care Organizations 2016 Pittsburgh Regional Health Initiative and Quality Insights
Pittsburgh Regional Health Initiative Non-profit regional health improvement collaborative Founded 1997 by Pittsburgh business community to identify greater value for the healthcare dollar Comprised of physicians, nurses, pharmacists, researchers, designers, and community activists Trained over 9,000 caregivers worldwide in Lean Core focus on patient safety, quality improvement, readmission reduction, behavioral health integration, long-term care Founding member of 30-member Network for Regional Healthcare Improvement 2016 Pittsburgh Regional Health Initiative and Quality Insights
PRIMARY CARE RESOURCE CENTER CMMI COMPASS (Care Of Mental, Physical, And Substance Use Syndromes) SUB ON CMMI GRANT RAVEN (Reduce Avoidable Hospitalizations among Nursing Facility Residents) SUB ON CMS GRANT QUALITY INNOVATION NETWORK (QIN) SUB ON CMS GRANT QUALIFIED ENTITY CMS DESIGNATED REACH Regional Extension Center ONC-HIT PATIENT CENTERED PRACTICE TRANSFORMATION MINORITY AIDS INITIATIVE PA DOH AND SPBP HIV/AIDS FISCAL AGENCY HRSA PRHI s 2016 Portfolio PPC Universities And Coaching Tomorrow s HealthCare Motivational Interviewing Closure (End of Life & Palliative Care) CENTER FOR HEALTH INFORMATION ACTIVATION Salk Fellowship Patient Safety Fellowship QI 2 T Health Innovators Fellowship Death and Dying Fellowship PA HEALTH FUNDERS COLLABORATIVE Fine Awards for Teamwork Excellence Community Health Workers Champions Long-Term Care Champions Medical Assistant Champions Jewish Genetic Diseases Campus Rape HPV Vaccination Initiative Legionella 2016 Pittsburgh Regional Health Initiative 5
Stronger Together: Building on Complimentary Circles of Influence QI Focus: National programs Regional programs Contracts Task Orders Neutral convener HIT Supporting CMS payment programs QIN-QIO Home Health Quality Improvement National Campaign ESRD Network Organizations Measures and Instrument Development and Support Office of the National Coordinator (ONC) VA External Peer Review Program Network for Regional Healthcare Improvement Medicaid Private Foundations & Grantmakers Business Groups on Health Academic Organizations Hospital Associations Medical Societies Consumer Groups Rural health Quality Insights Pittsburgh Regional Health Initiative PRHI Focus: Regional programs Grants Neutral convener Payment reform End-of-life Long term care Behavioral health Workforce Readmissions Urban health HIV/AIDS
Pulling Together: Complimentary Roles in Joint Proposals Qualified Entity Program (QEP) CMS program to empower local qualified entities to use Medicare database to create meaningful public reports PRHI designated 7 th QE (of 13 to date) Quality Insights provides analytics, data security and warehousing, provider portal Quality Improvement Network (QIN) Quality Insights coordinating QIN activities in Pennsylvania, Louisiana, New Jersey, Delaware, and West Virginia PRHI contracted to provide and manage educational portal with Tomorrow s HealthCare 2016 Pittsburgh Regional Health Initiative and Quality Insights
QI s My Quality Insights QIN Portal Powered by PRHI s Tomorrow s Healthcare Quality Insights QIN portal configured to connect to a cloud-based version of PRHI s Tomorrow s HealthCare Quality Insights can accurately track login activity from providers in 5 states 823 active users as of April 2016 487 items in resource library
Pulling Together: Teaming Up to Blanket the Region Pennsylvania Regional Extension & Assistance Center for HIT (PA REACH) Providing outreach, education, and on-site technical assistance to support 5,000 primary care physicians (3,000 by PA REACH East and 2,000 by PA REACH West) to implement and meaningfully use EHRs in their practices Our focus is to assist smaller practices who are working with limited resources and who would most likely be late adopters of EHR technology PRHI lead subcontractor in Western PA (850 EPs, 350 practices) Post-REACH Innovation with PRHI (after 4 th year of contract) 1. Practice transformation support for medical home (PRHI: 80 practices) 2. MA-LPN Training Curriculum (over 100 trained in 6 PRHI-led workshops) 2016 Pittsburgh Regional Health Initiative and Quality Insights
Pulling Together: Other Present and Proposed Partnerships Pennsylvania SIM Planning Grant West Virginia SIM Planning Grant RADIUS Practice Transformation Network application with Health Insights: PRHI/QI partnership to cover Pennsylvania, Delaware, and West Virginia; delivered 186 letters-of-support, 1500 providers NRHI-proposed Center for Healthcare Transparency (CHT) CMS MACRA Technical Assistance contract 2016 Pittsburgh Regional Health Initiative and Quality Insights
How We Do It: A Partnership By Design 1. Regular communication 2. Board representation 3. Facilitating introductions to new regional partners 4. Proposal preparation and review 5. Advocacy and letters of support 6. Recruitment of organizations and practices 7. Sharing of programmatic materials and methods 8. Implicit loyalty when approaching potentially competitive spaces 2016 Pittsburgh Regional Health Initiative and Quality Insights
Northern New England Practice Transformation Network & Healthcentric Advisors A PTN/QIN-QIO Partnership for Practice Transformation Success Lisa Tuttle, MPH, Program Director, Practice Transformation, Maine Quality Counts H. John Keimig, MHA, FACHE, President & CEO, Healthcentric Advisors This material was prepared by Healthcentric Advisors, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOWQIN-H1_042016_0495.
Healthcentric Advisors Former QIO for Rhode Island QIN-QIO contractor for all 6 New England states Former CT QIO serving as sub 4 states previously served by QIOs now closed Visible, boots on the ground presence in each state Extensive outreach early in 11 th SOW to providers and stakeholders with no previous QIO involvement 13
NE PTN Landscape 14
Northern New England PTN Serves Maine, New Hampshire, and Vermont Maine Quality Counts leads, in partnership with and VT Program for Quality in Healthcare Serves primary, specialist, and behavioral health (BH) practices NNE-PTN Goal: enroll 1665 clinicians NH Citizens Initiative NNE-PTN enrollment currently closed, have enrolled 1732 clinicians (104% of our goal) Enrollment Breakdown: 35% BH, 46% Other Specialty, and 17% Primary Care 15
Early Challenges NE Geography overlapping PTN recruitment areas One national PTN, four state/regional PTNs One QIN-QIO, but multiple PTN Project Officers ACO formations accelerating throughout region Alignment between CMS contract (QIN) & cooperative agreement (PTN) Establishing a comfort level among parties 16
QIN-QIO Strategy for PTN Success Early SWOT analysis of environment / challenges and engagement of PTNs and stakeholders Regional Approach - all on the same team Serve as a neutral convener & catalyst The New England TCPi Tool Kit Continuous communication Shameless sharing Maintain engagement through PDSA pulse checks 17
Communication = Transparency & Engagement 18
Build on previous QIN-QC relationship Collaboration with QIN-QIO: QIN staff on NNE-PTN Leadership Team, planning meetings Partnered on TCPi webinars PTN Strategy for Successful QIO Engagement Leverage QIN-QIO expertise VBP subject matter expertise (webinars, learning session faculty), enrollment opportunities Include QIN-QIO staff in TCPi Project Officer mtgs, calls Align our PTN workflow processes for baseline assessments and follow-up meetings, so that all practices receive the same intervention 19
PTN/QIO Successes Joint participation in TCPi Pacing Events, Office Hours presentations, etc. Regional sharing QIN-QIO website promotes PTNs across region Collaboration on PTN practice assessments and QI work Regional QIN-QIO webinars held to promote PTN enrollment Bi-weekly Regional TCPI Stakeholder Newsletter 20
Take-Away s Align goals between QIO and PTNs Serve as a neutral convener promote all stakeholders Measure success - PDSA Transparency Communicate, communicate, communicate Relationships are key - Build on them 21
Collaboration Tom Evans, MD Iowa Healthcare Collaborative Paul Mulhausen, MD- Telligen
Shared Vision Drives Intentional Collaboration Where there is no vision, the people perish - Proverbs 29:18 Vision without execution is hallucination. -Thomas Edison Teamwork is the ability to work together toward a common vision. - Andrew Carnegie
Our Vision: Good Health and Healthcare for Our Patients
Our Vision: Care that Works for Our Patients Holistic, Person-Centered Effective Safe Interdisciplinary Health Promoting Coordinated & Integrated Supports functional goals Available, Accessible, and Affordable
Our Vision: Together We Can Do So Much
Shared Vision Drives Intentional Collaboration
Opportunities Telligen QIO/QIN- 11 th Scope of Work Case management Payer/purchaser perspective Iowa Healthcare Collaborative Hospital Engagement Network (HEN) TCPI Practice Transformation Network (PTN) State Innovation Model (SIM) technical assistance IDPH Statewide Strategies Provider/community perspective
Function Engagement Education Execution
Alignment Communication Monthly Partners Meetings initiated with HEN 1.0 Strategy Senior level strategic interchange (IHC, Telligen, Iowa Medical Society, Iowa Hospital Association, Iowa Department of Public Health) Weekly Friday operations teams meetings Statewide Strategies- Sense-making Iowa care alignment documents Cardiovascular and Stroke Obstetrics Healthcare-associated Infection Diabetes Medication Safety and Effectiveness
Application Statewide strategies in development: SIM Obesity Tobacco Falls Care Coordination Person and Family Engagement Social determinants of health Population-based, Community Applied TCPI Compass PTN Data management for eight state Compass PTN
Summary Shared Vision Sustained Transformation Intentional Collaboration