Dean Medical Center Dean Health Plan

Dean Medical Center Dean Health Plan

Improving LDL Screening Following an Acute Coronary Event

Project Team Jennifer Close-Goedjen, MS Dean Health Plan William Koller, Jr., MD Dean Health Plan, Dean Medical Center Albert Musa, MD Dean Medical Center Daniel Staddler, MD Dean Medical Center Penny Bogrand Dean Health Plan Jack Bowhan Dean Health System Leslie Gruendel Dean Health Plan Jill Hanson Dean Health Plan Mark Kaufman, MD Dean Health Plan Timothy Lechmaier, MD Dean Medical Center Francis Pagel Dean Health Plan

ABBREVIATED ORGANIZATION CHART DHS, Inc. Physician Shareholders SSM SSM Health Care Care Corporation Dean Health Systems, Inc. SSM Health Care of Wisconsin, Inc. Inc. Dean Physician St. St. Marys Practice Association Dean Health Plan Hospital Medical Medical Center Center Dean Medical Center Clinical Practice Committee St. Marys Dean Venture, Inc. Multiple other health care facilities

Lipid Testing after an Acute Coronary Event: The Importance Total cost of cardiovascular disease in US estimated to be $329.2 billion (American Heart Association, 2002) Increasing prevalence of cardiovascular disease in DHP population (DHP Population Analysis, 2004) Scientific evidence supporting importance of routine lipid testing and active lipid control in prevention of subsequent coronary events (e.g., Cannon, et al. 2004, Nissen, et al., 2004)

Lipid Testing after an Acute Coronary Event: The History 2000 HEDIS results in 25 th percentile 2001 -- Quality Improvement Medical Management Committee (QIMMC) identified as system-wide clinical opportunity for improvement 2002 Member intervention implemented as part of IHC-ATP project (Dr. Mark Kaufman) LDL screening reminder mailed to member LDL educational brochure included

Why remind members at 270 days post-event? LDL Testing 60-365 Days Percent Tested 60 50 40 30 20 10 0 1997 1998 1999 2000 2001 Year LDL Testing 60-365 days post-event LDL Testing 60-270 days post-event

Aim Statement In the next 12 months, we will improve the 60-300 day post-acute coronary event (i.e., AMI, PTCA, CABG) LDL screening rate by 10%.

Primary Customers Patients/Members Clinicians (PCPs and Cardiologists) Employers (Purchasers) NCQA

Project Process Flowchart Identify population Agree to clinical recommendation Develop baseline (post-pilot intervention) measure and goal Develop enhanced intervention retrospective prospective Use HEDIS criteria Identification at SMH by Cardiac Rehab. Staff 1st year: LDL test between 60 and 365 days post event HEDIS 2004 data: LDL test 83.03% LDL control 69.97% Barriers analysis; Cause and Effect Diagram Build patient registry; 12/31/99 and forward Develop data collection tool Subsequent years: annual LDL testing Goals (by 2005) LDL test: 90% LDL < 100: 75% Discuss potential interventions and change ideas Implement monthly registry update process Enter data into laptop LDL order prior to discharge Implement pilot intervention Select enhanced intervention Identify enhanced intervention population

Cause and Effect Diagram Information systems no central database lack of system EMR Patient unaware of need for LDL medication compliance no master member index medication cost Coordination of care multiple providers variable clinical follow-up primary care cardiology cardiac surgery physician extender HIPAA concerns no patient registry HEDIS LDL value is 130 revenue codes no follow-up protocol no performance data no clinical consensus no standard follow-up doesn t believe LDL needed who is in charge? financial system QI structure lack of dedicated staff Lack of follow-up LDL after AMI, PTCA, or CABG Follow-up LDL control not < 100 Data Physician System resources

Improvement Opportunity Actively engaging practitioner in improvement Practitioner letter Practitioner alert Copy of member materials Request assistance Why focus on practitioners? 2002-2004 addressed member, data, and information systems causes Implemented member registry Implemented member intervention Resolved revenue code issues

Data Specifications Identify members with an acute coronary event HEDIS Technical Specifications for Cholesterol Management after an Acute Coronary Event Measure Administrative Medical Claims Member Identification Number Member Name ICD-9 Code (410.x1, 36.01, 36.02, 36.09, 36.1, 36.2) or DRG Code (105, 107, 109, 112, 121, 122, 516) Event date Determine if LDL Test received in 60-270 days following event date HEDIS Technical Specifications for Cholesterol Management after an Acute Coronary Event Measure Administrative Medical Claims Member Identification Number Member Name CPT code (80061, 83715, 83716, 83721) Date of Service Identify assigned primary care practitioner for members without an LDL screening Imputation Algorithm Quarterly Imputation File Member identification Number PCP Code Primary Care Practitioner Name/Clinic Location

Data Sources Administrative Medical Claims Member Number (11 digits) Member Name (Last Name, First Name, Middle Initial) ICD-9 code or 410.x1, 36.01, 36.02, 36.09, 36.1, 36.2) DRG Code(105, 107, 109, 112, 121, 122, 516) Date of Acute Coronary Event (mm/dd/yyyy) CPT Code (80061, 83715, 83716, 83721) Date of LDL Screening (mm/dd/yyyy) Quarterly Imputation File (internally generated SAS database) PCP Code Primary Practitioner Code (xxxxx) Primary Care Site Code (xxx)

80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% LDL Test Following an Acute Coronary Event (60-300 Days) Member Letter Clinician Letter 11/00 12/00 01/01 02/01 03/01 04/01 05/01 06/01 07/01 08/01 09/01 10/01 11/01 12/01 01/02 02/02 03/02 04/02 05/02 06/02 07/02 08/02 09/02 10/02 11/02 12/02 01/03 02/03 03/03 04/03 05/03 06/03 07/03 08/03 09/03 10/03 11/03 12/03 Event Date Percent of Members

Next steps Evaluate effectiveness of practitioner intervention Collaborate with CPC task force to improve system-wide screening rates Implement automated reminders and lab orders through EMR Compare performance to local competitors using HEDIS 2005 data