Promoting Primary Care for South FloridaA Community Dialogue

HRSA/BPHC Quality and the National Landscape

Presentation to :Presentation to :

Health Foundation of South FloridaHealth Foundation of South Florida November 15, 2007, 9:00 a.m. – 3:00 p.m.November 15, 2007, 9:00 a.m. – 3:00 p.m.

Jungle Island Jungle Island Miami, FloridaMiami, Florida

Vanessa Watters, MHAChief, Quality BranchU.S. Department of Health and Human ServicesHealth Resources and Services AdministrationBureau of Primary Health CareOffice of Quality and Data

Presentation Purposes

• Illustrate how quality is defined by HRSA/BPHC

• Provide national examples of organizations that demonstrate the HRSA/BPHC Quality Strategy

• Offer dialogue which supports organizational assessment and planning next steps

Some Key Questions

• What is the HRSA/BPHC Quality model?

• Based on this model, what is working for HRSA grantees and partners in other parts of the country?

• How can South Florida health care organizations link with and benefit from the HRSA/BPHC quality strategies?

OFFICE OF QUALITY AND DATA

OFFICE OF THE DIRECTORKay Felix, MD

OFFICE OF THE DIRECTORKay Felix, MD

Data BranchAngela Damiano-Holder

Performance MeasuresUDS

Data System ConsolidationPatient Survey

Data BranchAngela Damiano-Holder

Performance MeasuresUDS

Data System ConsolidationPatient Survey

Quality BranchVanessa Watters, MHA

FTCARisk Management

Care Model ImplementationAccreditationOral Health

Mental/Physical HealthHIV

Quality BranchVanessa Watters, MHA

FTCARisk Management

Care Model ImplementationAccreditationOral Health

Mental/Physical HealthHIV

HRSA/BPHC/OQD Quality Strategy

PATIENTACCESS

CLINICALCARE

CONTROLS&

MONITORS

ACCESSREDESIGN

PT SAFETYRISK MGMT

PI MEASURES

HRSA/BPHC/OQD Quality Strategy

PATIENTACCESS

CLINICALCARE

CONTROLS&

MONITORS

PI MEASURES

HRSA/BPHC Quality StrategyPerformance Improvement Measures

BPHC Clinical Measures• National Clinical Performance Reporting Efforts

– NQF, AQA and HEDIS alignment• Build upon clinical performance reporting efforts

– HRSA’s Healthcare Disparities Collaborative – quality improvement approach that uses evidence based models to transform clinical, leadership, operational and community systems

– The United Health Foundation/George Washington University Study – multi-site demonstration project which examines health centers against standard indicators of high quality performance

– HRSA’s Office of Performance Review Measures – a menu of national performance measures for use during performance reviews of HRSA funded programs.

New Proposed Clinical Measures

• New clinical measures– Cervical cancer screening– Childhood immunization– Childhood lead blood levels– Hypertension (blood pressure levels)*– Diabetes (HbA1c levels)*

*The measures indicated with an asterisk would be reported by total, race/ethnicity and special population

• Existing clinical measures – Prenatal Care– Low birth weight

Test Specifications: Childhood Clinical Process Measures

MEASURE ALIGNMENT NUMERATOR DENOMINATOR

Percentage of children by 2 years of age with appropriate immunizations.

AQA, NQF, HEDIS (adds 4x pneumococcal conjugate)

Number of children who have received 4XDTP/DTaP, 3xIPV, 1xMMR, 3xHib, 3xHepB = “43133” & Varicella.

Number of children who turn two years of age during the measurement year

Percentage of patients 9 -36 months of age with a blood test for elevated blood lead levels

Congressional MandateSection 330(b)(1)(A)(i)(III)(ee) of the Public Health Service Act, HEDIS (measure under development)

Number of children ages 9-36 months tested for elevated blood lead levels

Number of children ages 9-36 months

Test Specifications: Adult Clinical Process MeasuresMEASURE ALIGNMENT NUMERATOR DENOMINATOR

Percentage of women 18-64 years of age who received one or more Pap tests.

AQA, NQF, HEDIS One or more Pap tests during the measurement year or the two years prior to the measurement year.

All female patients ages 21-64 years of age during the measurement year - with “look back" period to include 18 year olds

Test Specifications: Adult Clinical Outcome Measures

MEASURE ALIGNMENT NUMERATOR DENOMINATOR

Percentage of adult patients, 18 years and older, with diagnosed hypertension (HTN) whose blood pressure (BP) was less than or equal to 140/90 (adequate control)

NQF Patients with last systolic blood pressure measurement ≤ 140 mm Hg and diastolic blood pressure ≤ 90 mm Hg during the measurement year.

All patients ≥ 18 years of age as of December 31 of the measurement year with diagnosis of hypertension (HTN).

Percentage of adult patients with type 1 or 2 diabetes with most recent hemoglobin A1c (HbA1c) < or = 7%, > 7% or < 9%, or > or = 9% (poor control)

AQA, NQF, HEDIS (all measure levels > 9)

Number of adult patients whose most recent hemoglobin A1c level during the measurement year is < or = 7%, > 7% or < 9%, or > or = 9%, respectively.

Number of adult patients 18-75 years of age as of December 31 of the measurement year with a diagnosis of type 1 or 2 diabetes.

National Examples

 

NETWORK STANDALONE

EHR/Registry EHR Registry PaperSpecial

Population

URBAN CANY 

 UT  TN MD(Homeless)

 RURAL  WV  MS  AK

HRSA/BPHC/OQD Quality Strategy

PATIENTACCESS

CLINICALCARE

CONTROLS&

MONITORS

ACCESSREDESIGN

HRSA/BPHC Quality StrategyAccess/Redesign

Access/Redesign Curriculum• Builds off of HDC successes• Patient-centered care through effectiveness and

efficiency• Increases patient access to care• Increases the efficiency of the patient visit• Improves provider, staff, and patient satisfaction• Gets the waiting time out of the system• Decrease cost/visit• Improves the bottom line

HRSA/BPHC Quality StrategyAccess/Redesign

Key Principles of the Model• Continuity of care - the patient routinely sees his

own provider.• Provider Panel - each provider has an identified

panel of patients for which he is accountable.• Demand and Supply of Appointments are in

balance - patient demand for appointments from the provider and the number of provider appointments available are in balance.

National Examples

Community Health Center, Inc.• Large, multi-sight HC in Connecticut; Medical,

Dental, Mental Health, Ryan-White Services• Uses an open-access model where patients are

encouraged to schedule same day appointments to reduce no-show rates, improve patient access and care continuity

• Goal to minimize system waste by doing “today’s work today”

• Increased patient and staff satisfaction while sustaining/slight improvements in productivity

National Examples

White River Rural Health Center• Multi-site Health Center located in Rural

Arkansas; Medical, Dental, and Pharmacy• Uses fiscal health and business operations to

improve access and sustain the care model.• High emphasis on data to link financial

outcomes with patient care outcomes - the “big picture”

• Patient-focused visit with less waiting time and increased revenue

What about you…..

• What are your insights and reactions to these quality examples?

• What actions or next steps would you take?

• What might you do to connect with these components of the HRSA/BPHC Quality Strategy?

HRSA/BPHC/OQD Quality Strategy

PATIENTACCESS

CLINICALCARE

CONTROLS&

MONITORS

PT SAFETYRISK MGMT

HRSA/BPHC Quality Strategy FTCA Program Goals

•  GOAL 1: Improve access to health care by eliminating the need to purchase professional liability insurance - savings to be used to increase the number of patients served.

• GOAL 2: Minimize risk to the Judgment

Fund through deeming process and health center oversight and monitoring.

FTCA Malpractice Incident SummaryNature of Allegation, 1992-2006

Medication Related

8%

Surgical Related

5%Other10%

Treatment Related

22%Obstetrics Related

23%

Diagnosis Related

32%

Source: KePRO, Harrisburg, PA, FTCA HC Med Mal Cases, September 30, 2006

HRSA/BPHC Quality StrategyPatient Safety and Pharmacy Initiative

Goals• Improve Patient Safety

– Increased Compliance w/ NQF Guidelines– Fewer Errors, Fewer Injuries, Less Harm– Possible Reductions in Size & Number of

Tort Claims

• Increase High Quality, Cost-Effective Pharmacy Services

• Improve Health Outcomes

Phase 1: Study & Capability Development

October, 2007 to April, 2008

Phase 2: Implementation, Action & Results

May, 2008 to October, 2009

Patient Safety and Pharmacy Initiative2 Phases of Work

• Identify and learn from HRSA grantees and partners with results and successes – especially 2-fers and 3-fers

– Patient Safety– Pharmacy Services – Outcomes in Core Measure Areas

• Document best practices of high performers• Conduct HRSA Patient Safety Inventory to identify

already existing tools and resources • Enroll high performers as faculty and leaders in

national improvement initiative

Patient Safety & Pharmacy Initiative Study Phase

• Establish quantitative aims to guide improvement

• Enroll HRSA grantees and their partners in national peer-to-peer technical assistance & collaboration initiative

• Help these teams generate rapid improvements

Patient Safety & Pharmacy Initiative Implementation Phase

National Examples

University Maryland Medical Center • DSH hospital and AMC located in Baltimore MD• Focus on pharmacy safety to reduce errors,

adverse events and improve quality• Strong emphasis on the use of technology

– Strike the balance between access and controls– Support the “shift to the right” where pharmacist has a

heightened role in clinical care and greater time to focus on patient education

National Examples

El Rio Health Center • HC located in Tucson, AZ with a pharmacist

managed DM clinic• Focus on the appropriate use of medications

and the tracking diabetes measures to generate positive health outcomes and demonstrate improvements

• Increased patient access and improved patient outcomes in diabetes through pharmacy-based disease management

What about you…..

• What are your insights and reactions to the Patient Safety & Pharmacy initiative?

• What improvements or additions would you make to this plan?

• What are your insights and reactions to the national examples?

• What actions or next steps would you take?• What might you do to connect with this

component of the HRSA/BPHC Quality Strategy?

Contact Information

Vanessa Watters, MHA

Chief, Quality Branch

U.S. Department of Health and Human Services

Health Resources and Services Administration

Bureau of Primary Health Care

Office of Quality and Data

5600 Fishers Lane 15 C 26

Rockville, MD 20857

vwatters@hrsa.gov

301-594-0818