HANC QI PEER NETWORK DAYSeptember 20, 2013

1. Welcome and Introductions

2. HANC QI Progress

3. HANC Patient Experience Data

4. Using the Triple Aim to Guide Change

5. CPCA Patient Center Health Home Update

6. Partnership Healthplan QIP Review

7. Identification of HANC QI Priorities

Today’s Agenda

Initiative Description Timeline

Accelerating Quality Improvement in California Clinics (AQICC)

Track and improve diabetes clinical quality measures (A1c and LDL management) and access to care measures (third next available appointment and cycle time). The project was led by CPCA at the statewide level. Data was aggregated by consortia at the regional level and publicly reported. Funder: California HealthCare Foundation (CHCF)

2007-2009

Tools for Quality

Provided seed funding for registry systems (e.g., i2i Tracks), enabling clinics and health centers to perform proactive care management as well as measure and report on clinical quality measures. Supported aggregation of HANC member UDS data. Funders: CHCF, the Blue Shield of California Foundation, The California Endowment, The Community Clinics Initiative (Tides/TCE), and Kaiser Permanente.

2008 - 2011

AQICC-Meaningful Use

Second phase of AQICC moved to the regional level and grouped consortia /clinics into super regions. The project continued to collect data on diabetes but also helped prepare clinics for meaningful use reporting. Funder: CHCF

2010-2011

Regional Information for Shared Excellence (RISE)

Supported clinic consortia and health centers to build data analytic capacity for optimally utilizing EHR data to achieve Meaningful Use and prepare for pay-for-performance reimbursement. HANC FQHCs selected metrics of relevance. Funder: CFHC; Managed by: Center for Care Innovations (CCI)

2011-2013

HANC QI History

• Supporting implementation of HIT systems: many of the initiatives have supported the purchase and implementation of disease registry, EHR, and data analytics systems.

• Standardizing measures: consortia and clinics are developing and utilizing consistent definitions for measures to allow for comparisons across sites and regions.

• Redesign of workflow processes: the implementation of QI processes and HIT systems requires changes in how care team member carry out their responsibilities; these changes have been supported through training and technical assistance.

• Improving data quality: improving data quality through training, TA and data validation activities. A key focus has been ensuring accurate information is systematically captured and reported.

HANC QI Activities

• Utilizing data to improve patient care: as data has become more accessible and reliable, HANC members have begun utilizing the data to assess population health and operational efficiency and implement process improvements to enhance patient care.

• Sharing data: developing dashboards, benchmarking performance, and sharing quality data at the local, regional and statewide levels.

• Disseminating learnings: sharing their experience and best practices through peer networking and presentations at convenings.

HANC QI Activities

• RISE Initiative Review

• What the data tells us

• Lessons learned from the survey process

• What are you going to do with the data

HANC Patient Experience Data

Patient Experience Question 2011 NCQA PCMH Standards

I would recommend this clinic/health center to my family and friends.

PCMH 6: Measure and Improvement PerformanceElement B: Measure Patient/Family Experience

In the last 12 months, my provider explained things in a way that was easy to understand.

PCMH 1: Enhance Access and ContinuityElement F: The practice engages in activities to understand and meet the cultural and linguistic needs of its patients/families

In the last 12 months, when I phoned my provider's office to get an appointment for care I needed right away, I received an appointment as soon as I needed.

PCMH 1: Enhance Access and ContinuityElement A: Access during office hours1 Providing same-day appointments

PCMH 1: Enhance Access and ContinuityElement B: After-hours access1 Providing access to routine and urgent care appointments outside the regular business hours

PCMH – Patient Experience Crosswalk

Patients rate response on a scale of 1 (No) to 3 (Yes, definitely)

Baseline Q12.00

2.20

2.40

2.60

2.80

3.00 A AB

B

C

CD D

E E

GG

F

A - Hill Country Health and Wellness Center

B - Mountain Valleys Health Centers

C - Northeastern Rural Health Centers

D - Shasta Community Health Centers

E - Shingletown Med-ical Center

F - Sierra Family Med-ical Clinic

G - Western Sierra Medical Clinic

HANC AveragePatients rate response on a scale of 1 (No) to 3 (Yes, definitely)

Fn/a

I would recommend this clinic/health center to my family and friends.

Baseline Q13.00

3.20

3.40

3.60

3.80

4.00

A

ABB

C

CD D

E

EG G

F

A - Hill Country Health and Wellness Center

B - Mountain Valleys Health Centers

C - Northeastern Rural Health Centers

D - Shasta Community Health Centers

E - Shingletown Medical Center

F - Sierra Family Med-ical Clinic

G - Western Sierra Med-ical Clinic

HANC AveragePatients rate response on a scale of 1 (Never) to 4 (Always)

Fn/a

In the last 12 months, my provider explained things in a way that was easy to understand.

Baseline Q13.00

3.20

3.40

3.60

3.80

4.00

A AB

BC C

DD

E EGG

F

A - Hill Country Health and Wellness Center

B - Mountain Valleys Health Centers

C - Northeastern Ru-ral Health Centers

D - Shasta Com-munity Health Cen-ters E - Shingletown Medical Center

F - Sierra Family Medical Clinic

G - Western Sierra Medical Clinic

HANC AveragePatients rate response on a scale of 1 (Never) to 4 (Always)

Fn/a

In the last 12 months, when I phoned my provider’s office to get an appointment for care I needed right away, I received an appointment as soon as I needed.

Telling the Story

Triple Aim

Measuring the Triple AimDimension of the

IHI Triple AimOutcome Measures

Population Health Health Outcomes:• Mortality: Years of potential life lost; life expectancy; standardized mortality ratio• Health and Functional Status; Single-question assessment (e.g., from CDC

HRQ0L-4) or multi-domain assessment (e.g., VR-12, PROMIS Global-10)• Healthy Life Expectancy (HLE): Combines life expectancy and health status into

a single measure, reflecting remaining years of life in good health

Disease Burden:Incidence (yearly rate of onset, average age of onset) and/or prevalence of major chronic conditions

Behavioral and Physiological Factors:• Behavioral factors include smoking, alcohol consumption, physical activity, and

diet• Physiological factors include blood pressure, body mass index (BMI), cholesterol

and blood glucose

Experience of Care Standard questions fro patient surveys, for example:• Global questions from Consumer Assessment of Healthcare Providers and

Systems (CAHPS)• Likelihood to recommend

Set of measures based on key dimensions (e.g., IOM six aims for improvement: safe, effective, timely, efficient, equitable, and patient-centered)

Per Capita Cost Total cost per member of the population per month

Hospital and emergency department (ED) utilization rate and/or cost

1. Who’s responsible for evaluating overall health improvement at your CHC?

2. What tools do you use for data analysis and reporting? Are they efficient?

3. Provide an example of health improvement that has occurred with your patients as a result of utilizing data.

4. What are you doing to operationalize Triple Aim? Please identify any support that you need.

5. How are you going to benchmark your performance?

Using the Triple Aim to Guide Change

Best Practices

Challenges / Solutions

Ways to Increase Efficiency

Workforce and Training Needed

Short & Long Term Priorities

Ways HANC/ CPCA Can Help

Clinician specific report cards for quality indicators Quarterly board reporting

Data is not uniformTechnology tools Limited staffing

Expand HANC QI group

Partnerships with schools of public health Data Base Training

ShortDevelop data inventory Utilize Share Portal for QIExpand peer reporting LongEpidemiology – data analysisPublic Reporting Hospital interface

TrainingFacilitation of QI Peer NetworkDevelop data inventoryUtilize Share Portal for QIExpand peer reportingPublic Reporting

Review of HANC Member QI Priorities, Nov 2011

Identify • 2-3 priorities for 2014-2015• Workforce and Training Needed • What should HANC’s role be?• What should CPCA’s role be?

HANC Priority Setting for QI