April 2015 Campaign Updates - Measure Up/Pressure Down2015/04/16 · National Day of Action Toolkit...

April 2015Campaign Updates

May 7: National Day of Action

National Day of Action Toolkit

• Event overview• Participation checklist• Sample action ideas• Reporting details• Promotional and

educational materials• Videos• Fact Sheets• Press Release Template• Social Media Posts• Web Content• And More…

Share Your May 7 Plans!(as of April 14th)

• American Kidney Fund• American Medical Group Foundation• Arch Health Partners• Baptist Medical Group• Carle Physician Group• Esse Health• Ralphs• Watson Clinic

Email your plans to [email protected]!

New Campaign Resources

Washington, DC Health Expo

Q1 2015 Reporting Open

• Q1 2015 data is currently accepted through the campaign portal• To report your data, please visit:

https://members.measureuppressuredown.com/

Q1 2015 Reporting Deadline:

June 30, 2015

https://members.measureuppressuredown.com/

EvolveMeasureManageChange

Achieving Breakthrough

HTN Results

Presented To:

AMGA/MUPD

Participants

Bob Matthews

April 16, 2015


PriMed Physicians

• Greater Dayton, OH

• 20 offices throughout the

region

• Physician owned and led

medical group

• 60+ physicians

• Mostly PCPs plus

Cardiology, Endocrinology,

Neurology

MediSync

• Management side of

PriMed since 1996

• Manage one additional

group in Southwest OH

• Invent new ways for

groups to succeed

• MediSync solutions in

~150 medical groups

nationwide

Introduction


PriMed’s Motivation

For PriMed,

our work on chronic diseases in general

and our on HTN work in particular

have always been

about value.

IF

The amount your group is paid for

medical services

AND/OR

The number of patients who can gain

access to your care

Depends upon your group’s medical

quality and/or cost effectiveness

IF

The amount your group is paid for

medical services

AND/OR

The number of patients who can gain

access to your care

Depends upon your group’s medical

quality and/or cost effectiveness

VALUE

ValueQuality

• Wellness, Risk

Assessments and

Preventive Care (WRAP)

• High control of major

chronic diseases

– HTN

– LDL

– Diabetes

– Asthma

– COPD

– Renal disease

– Depression

– CHF

Cost Effectiveness

• Admissions and re-

admissions

• Preventable bad events

– MI, stroke, renal damage

• Manage the worse 2%

• Optimal cancer care

• Informed patient

directives

• Unnecessary care

– Diagnostic testing, etc.

• ER visits

• Appropriate generics

LDL

Renal disease

HTN

Diabetes

CHF


What Physicians Do

1. Treat acute problems

2. Manage chronic disease(s)

3. Provide WRAP (Wellness, Risk

Assessments and Preventive Care)


Cost of Chronic Disease

“Seventy-five percent of the (monies) spent

on health care in the U.S. is for treatment

of the chronically ill.”

- The Commonwealth Fund


In Medical Groups There Are ALWAYS Two

Components to Significant, Successful Change

1. Intention and willingness to change

– Starts with leaders

– Leaders develop a plan (could be a good plan or a bad plan)

– For medical groups, change will fail unless physicians adopt the new

2. Method

– Some methods are a lot more powerful than others

Outcomes are driven by BOTH Intention and Method


How Does It Happen In Your Group Today?

• There are likely various reminders

• Staff may alert the doctor about patient being in/out of control

• Staff may have phoned patient or pre-interviewed patient

• So: patient’s blood pressure is >150/90 in office

• What’s next?


Physician Will Evaluate & Tx Pt

• How?

• If you have 100 PCPs and 15

cardiologists, how many ways are there to

evaluate and treat HTN?

• Are they all equally effective?


Physicians, NPs, PAs

• Trained at different times and in different schools

• Read different journals

• Attend different CMEs

• Have different intellectual capabilities

• Understand different amounts of the literature

• Therefore, get different results


So, what method(s) do we choose?

-- To improve quality?

-- To reduce costs?


Before We Talk About HTN…

• Inventory: “stuff we need to change”

• Define the “degree of success” we aspire

to achieve

• Decide how to do ALL of this


Oh, and don’t forget…

• Running a practice is more challenging

each day:

– Growing overhead

– Flat to reduced compensation in real $

– Rising expectations


“Big” Chronic Diseases

HTN

Diabetes

Lipids (CAD & Vascular Diseases)

Asthma

Heart Failure

COPD

Depression

Osteoporosis


“Normal” Quality/Cost Improvement

In Virtually All Medical Groups

1. Remind physicians about evidence based

standards, goals, pathways, etc.

– Put quality “pop ups” in EHR

– Generate a registry with lists of patients

2. Generate metrics and publish – (un)blinded

3. Hire additional staff to support the effort, remind

the patients, remind the doctors (i.e. PCMH)

4. Link outcomes to pay


WHAT DO THE NORMAL METHODS

GAIN IN IMPROVEMENT?


Medical Quality Goal:Move One Variable (i.e. BP)

Gro

up M

ean P

erc

ent

to G

oal

10

70

60

50

40

30

20

80

90

100

Time in Months

1st 3rd2nd 5th4th 6th 8th7th 9th 10th11th12th13th14th15th16th

Proportion of Patients with HTN whose Blood

Pressure is in Control (140/90) – AMGA Second

Quarter 2014

LDL Control Success Percentage

0 10 20 30 40 50 60 70

Wheaton Franciscan Medical Group

UW Health

ThedaCare Physicians

ProHealth Care

Primary Care Associates of Appleton

Prevea Health

Monroe Clinic

Meriter Medical Group

Mercy Health System

Mayo-Franciscan Healthcare

Mayo Health System in Eau Claire

Marshfield Clinic

Holy Family Memorial

Gunderson Clinic

Froedtert & Medical College of Wisconsin

Dean Clinic

Columbia St. Mary's Physiciasn

Bellin Medical Group

Aurora UW Medical Group

Aurora Medical Group

Aurora Advanced Healthcare

Aspirus Clinics

Agnesian Healthcare


How High Do You Want To Go?

What % of patients do you want at goal

for EACH measure?


Three Goals @ 60% Each

»1st Goal 60%

»2nd Goal 36%

»3rd Goal 21.6%

2010 Diabetes Outcomes(Using Wisconsin Measures)

0 5 10 15 20 25 30 35

Aurora Advanced

Aurora Medical Group

Aurora UW Medical

Bellin Medical

Columbia St. Mary's

Dean Clinic

Froedtert/West Bend

Gundersen Clinic

Marshfield Clinic

Mayo/Franciscan

Mayo/Eau Claire

Medical College

Mercy Health

Monroe Clinic

Prevea Health

ProHealth Care

ThedaCare

UW Health

Wheaton Franciscan

Percentage

The “All or None” Hurdle1 goal @ 90% / 60% each 90% 60%

2 goals @ 90% / 60% each 81% 36%

3 goals @ 90% / 60% each 72.9% 21%

4 goals @ 90% / 60% each 65.6% 12%

5 goals @ 90% / 60% each 59% 7.5%


How High Do You Want To Go?

What percent of patients do you want at goal

for EACH measure?

+

How many measures?

ValueQuality

• Wellness, Risk

Assessments and

Preventive Care (WRAP)

• High control of major

chronic diseases

– HTN

– LDL

– Diabetes

– Asthma

– COPD

– Renal disease

– Depression

– CHF

Cost Effectiveness

• Admissions and re-

admissions

• Preventable bad events

– MI, stroke, renal damage

• Manage the worse 2%

• Optimal cancer care

• Informed patient

directives

• Unnecessary care

– Diagnostic testing, etc.

• ER visits

• Appropriate generics

LDL

Renal disease

HTN

Diabetes

CHF


So now what methods do you choose?


What EVERY High Performance Organization

Outside of Healthcare Does:

1. Commitment to quality theory and practice

– Six Sigma, Lean, TQM, Deming, CQI, etc.

2. Must use processes

– Process is the foundation of every quality theory and

practice, the common thread the unites all approaches

3. Over time processes make organizations and work

more and more manageable

– Complexity is the core challenge of all modern

organizations and businesses


MediSync/PriMed “Special Sauce”

– High levels of improvement/performance is

impossible without process

– Improvement in multiple areas is impossible without

process

Processes


Definition of Process

A process is a series of steps that are

collectively designed to get you

to your desired goal or outcome.


Creating the HTN Process

1. Use Six Sigma

2. Establish baseline performance – 41 and 42%

3. Start with an “Ishikawa” or “Fishbone”

4. Create a true process that

• Addresses every HTN patient, every visit

• Includes Impedance Cardiography

• Guides drug selection and dosing

5. Solve controversy with statistics (i.e. ICG)


In Medical Groups ALWAYS Two Components

to Significant, Successful Change

1. Intention and willingness to change, especially from physicians

– Answers the “Why change?” and the “What kind of change?”

– Tends to build over time

– Start with nidus of doctors and then expand to entire group

– All the normal rules of change management apply

– Managers must be developed along with physicians

2. Method

– Answers the “How to change?” and the “Who/when of change?”

– Some methods are a lot more powerful than others

Outcomes are driven by BOTH Intention and Method



5. Measure use of HTN Process and outcomes

6. Unblinded publication of data

• What do you do with doctors who do not use

HTN Process?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dr. A Dr. B Dr. C Dr. D Dr. E Dr. F Dr. G Dr. H Dr. I Dr. J

PriMed % HTN to Goal vs. % Copy of Algorithm vs. % Algorithm Followed

August 2005

% BP at Goal

% Copy of Algorithm

% Algorithm Followed

Average:

% HTN to Goal = 83%

% Algorithm Followed = 66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dr. K Dr. L Dr. M Dr. N Dr. O Dr. P Dr. Q Dr. R Dr. S Dr. T


August 2005

% BP at Goal

% Copy of Algorithm


Average:

% HTN to Goal = 70%


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


August 2005

% BP at Goal

% Copy of Algorithm


Average:

% HTN to Goal = 61%


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


August 2005

% BP at Goal

% Copy of Algorithm


Average:

% HTN to Goal=49%

% Algorithm Followed=37%



5. Measure: HTN Process use and outcomes

6. Publish results

• What do you do with doctors who do not use the HTN Process?

7. Link HTN Process compliance to physician compensation

• NOT based upon outcomes, based upon participation in the process

8. Constant work on “group culture”

Changing Medical Group Culture:Quality vs. Tradition

• Changing the group culture requires its own process

• LOTS of time discussing– Group meetings

– Section meetings

– Site meetings

– Task Force meetings

– Board meetings

• Some doctors decided to leave due to differences

100% 100% 100% 100% 100% 100% 100%98% 98% 98% 98% 98%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% BP@Goal PriMed

Quartile 1September 2009

% BP @ Goal

%Protocol Followed

Averages:% BP@Goal = 99%% Protocol Followed = 100%

Dr. A Dr. B Dr. C Dr. D Dr. E Dr. F Dr. G Dr. H Dr. I Dr. J Dr. LDr. K

96% 96% 96% 96%94%

92% 92% 92% 92% 92% 92% 92% 92% 92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% BP@Goal PriMed

Quartile 2 September 2009

% BP @ Goal

%Protocol Followed


Dr. M Dr. N Dr. O Dr. P Dr. Q Dr. R Dr. S Dr. T Dr. U Dr. V Dr. XDr. W Dr. ZDr. Y

91%

90% 90% 90%

88%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

AHMAD SHAH WELLER ADIB PORTER

% BP@Goal PriMed


% BP @ Goal

%Protocol Followed


Dr. ABDr. AA Dr. ADDr. AC Dr. AE

88% 88% 88%86% 86%

84% 83% 82%

75% 74% 73% 73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% BP@Goal PriMed


% BP @ Goal

%Protocol Followed

Averages:%BP@Goal = 82%% Protocol Followed = 96%

Dr. AGDr. AF Dr. AIDr. AH Dr. AJ Dr. ALDr. AK Dr. ANDr. AM Dr. AO Dr. AP Dr. AQ

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Elite Medical Groups Post Intervention

Average US Performance

Percent of Patients Reaching JNC-7 BP GoalHTN Outcomes With or Without Co-Morbidities

MediSync Groups

ClinicThe

D5

Blood

Pressure

Bad

Cholesterol

Blood

Sugar

Tobacco

Free

Daily Aspirin

Use

My Doctor 66% 86% 93% 85% 93% 100%

PriMed 57% 93% 76% 77% 89% 99%

Internists of

Wyoming52% 93% 65% 83% 87% 99%

TriHealth

Practices43% 85% 66% 78% 88% 99%

TriHealth

Group41% 83% 66% 76% 87% 99%

Queen City 39% 80% 67% 76% 87% 98%

Health First 39% 87% 57% 74% 87% 97%

Summit FP 37% 86% 56% 73% 83% 100%

Overall Rate 35% 80% 60% 72% 84% 97%

Mercy

Health35% 81% 61% 72% 86% 97%

UC Health 32% 74% 58% 73% 85% 99%

St. E East 32% 76% 59% 69% 81% 97%

St. E West 29% 77% 58% 71% 80% 94%

Christ PCP 25% 76% 53% 68% 83% 93%

Crossroad 14% 74% 36% 55% 67% 99%

HC Connect 8% 72% 29% 42% 67% 94%

Group/Clinic Results > Optimal Diabetes Care – 2013 DOS


What Makes PriMed Different?

It is NOT that:

– Dayton patients are

more eager to

make lifestyle

change or adhere

to Rx therapies

– PriMed doctors are

better educated


Why Medical Groups Should

Embrace Process and Quality Practices

• Medicine today = too much really complicated stuff

– Medicine is now beyond human memory or mastery

• Process makes you able to outperform others in

region/nation

– Process achieves higher results per measure

– Process allows us to master more “measures” or

goals

• Process and quality offers = solution to PCP ‘burn-

out’


Process vs. No Process

• You have choices:

– Continue with every doctor

doing every disease

his/her favorite way

or

– Move to use of process*

*Requires “change

management”

Process Competency

• Not every process is

equally effective

– In other words: Some

processes work better

than others

– This is called “Process

Capability”

Two Decision Points:


Requirements for Success

1. Commitment to both high(er) goals and process as the means

2. Seriously talented “change management”

3. You need to acquire or develop processes– Processes do not grow on trees (especially the good ones)

4. Avoid pitfalls– You can’t boil the ocean. You need to plan larger quest

into phases that show regular progress and build one step of success upon another

– MOMENTUM is critical


Questions / Comments?

[email protected]

513-533-6006

www.medisync.com

mailto:[email protected]

http://www.medisync.com/

April 2015 Campaign Updates - Measure Up/Pressure Down2015/04/16 · National Day of Action Toolkit...

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Transcript of April 2015 Campaign Updates - Measure Up/Pressure Down2015/04/16 · National Day of Action Toolkit...