David K. McCulloch, MD, FRCP Medical Director, Clinical Improvement, and Diabetologist, Group Health PhysiciansClinical Professor of Medicine, University of Washington

Best Practices in Hypertension and Hyperlipidemia

General principles for quality improvement

• The effectiveness of any intervention is dependent on the

baseline risk, so identify those at highest risk and target them.

• Embed evidence-based interventions into routine standard work

so that doing the right care is easy.

• Develop robust tracking systems for both process measures and

outcome measures, make the data transparent, expect constant

improvement, and help develop countermeasures when targets

are not being met.

Cascade Dashboard

Philosophy of Patient Centered Care

Opportunistic Care Outreach

Feedback

Provider andTeam Strategies

• Post Bday Letter outreach• Case Management• CNS outreach

Provider IndexIncentive CompMissed Opportunities Report

Patient ActivationStrategies

• Birthday Letters• Interactive Voice Recognition• My Group Health• Health Profile• Health Coaching• HPD letters: Mam/Pap, Fx f/u

Provider andTeam Strategies: GPD

• Health Maintenance • Planned Care Exception Report• MHM Visit Prep

Contracted Provider Engagement/Interventions(Clinical Integration Model)•Relationship Management•Pay for Performance (P4P•Reporting•QI Consultation

Patient Activation • HM based Patient Handout• After Visit Summary

How do we track how we are doing?

• We use HEDIS measures plus ACE-inhibitor and Statin usage.

• Using LEAN we have developed standard work in primary care

teams.

Tier 1: Individual primary care provider

Tier 2: Each primary care clinic

Tier 3: Primary care overall

Tier 4: GPD overall

Tier 5: GH overall

The Number Needed to Achieve Target (NNAT)

• At the start of every year we get new enrollment and lose some

previous enrollees. Using HEDIS definitions we identify how many

“gaps in care” each of our members has (not just in hypertension

and lipids but in all HEDIS areas of prevention and treatment).

• Some enrollees have no gaps, others might have 1 or many more

than that. We set our targets for each of the 40+ measures to be

above the 90th percentile in the nation. The overall NNAT is the

number of “gaps” that need to be closed to achieve those targets.

• We challenge ourselves to be able to close at least 50% of that gap

during the upcoming year.

Tier 5 rollup of HEDIS prevention measures

Tier 3 time trend within primary care

Tier 3 time trend within primary care

Tier 3 time trend within primary care

Tier 3 time trend within primary care

Tier 1: Individual providers can track their own performance over time

Diabetic patients with BP<140/90

Initiative in Q4 to focus on BP management

This shows how many of his/her patients are >140/90

Individual providers can sort their own panel of patients to identify patients who need attention

Sorted by those patients with diabetes who BP is >140/90

Each row shows an individual patient with ALL of his/her unmet “gaps”

THANK YOU