STATE OF TENNESSEE€¦ · • QI 01 (Core): Monitors at least five clinical quality measures...
Transcript of STATE OF TENNESSEE€¦ · • QI 01 (Core): Monitors at least five clinical quality measures...
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STATE OF TENNESSEE
PCMH: Monitoring Data & Process Improvement7/27/18
Presented by: Rick Walker, Coach Lead, PCMH CCE
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1) Monitoring Data for Opportunities
2) Process Measurement
3) Process Improvement
4) Facilitated Discussion
a) Best Practices, Challenges and Novel Ideas
5) Wrap-up
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Chat box during the presentation:
Send to the Host
• BEST PRACTICES
• CHALLENGES
• NOVEL IDEAS
• QUESTIONS
CCWNC (Host)
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Today’s Concepts:
QI : Performance Measurement & Quality Improvement
AC : Patient-Centered Access and Continuity
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• QI 01 (Core): Monitors at least five clinical quality measures across the four categories.
(Must monitor at least 1 measure of each type)
A. Immunization measures
B. Other preventive care measures
C. Chronic or acute care clinical measures
D. Behavioral health measures
• QI 02 (Core): Monitors at least two measures of resource stewardship.
(Must monitor at least 1 measure of each type)
A. Measures related to care coordination
B. Measures affecting health care costs
• QI 03 (Core): Assesses performance on availability of major appointment types to meet
patient needs and preferences for access.
• QI 04 (Core): Monitor patient experience
• QI 05 (1): Assesses health disparities using performance data stratified for vulnerable
populations. (Must choose one from each section)
A. Clinical Quality
B. Patient Experience
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• Immunization measures – Examples:
o Influenza vaccine during flu season
o Pneumonia vaccine for patients over 65
o HPV vaccine for children 9 – 12 years
• Other preventive care measures – Examples:
o Mammograms for women 40-69 years
o Colorectal screening for patients 50 – 75 years
o Lead screening for all newborns by age 2
o Anemia screening for children 12 – 30 months
QI 01 (Core): Monitors at least five clinical quality
measures across the four categories. (Must monitor at least 1 measure of each type)
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• Chronic or acute care clinical measures – Examples:
o Patients with diabetes who have been seen in the past 6 months
o Patients with persistent asthma who are on an appropriate asthma controller
medication
o Patients with ADHD who have been seen in the past 6 months
• Behavioral health measures – Examples: (NEW for 2017)
o Patients with major depressive disorder who have had a suicide risk
assessment
o Children with ADHD that have been prescribed a new ADHD medication and
have had a follow up appointment within 30 days.
QI 01 (Core): Monitors at least five clinical quality measures across
the four categories. (Must monitor at least 1 measure of each type)
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• Measures related to care coordination – Examples:
o Medication Reconciliation at Transition of Care visit (MU)
o Summary of Care record provided when patient transfers to another
provider or is referred (MU)
• Measures affecting health care costs – Examples:
o Prescribing generic medications versus brand-name medications
QI 02 (Core): Monitors at least two measures of
resource stewardship. (Must monitor at least 1
measure of each type).
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• Consistently review the availability of major appointment types
- urgent care appointments
- new patient appointments
- routine exams
- follow-up appointments
• A common approach to measuring appointment availability
against a standard is to determine the third next available
appointment for each appointment type.
QI 03 (Core): Assesses performance on availability
of major appointment types to meet patient needs
and preferences for access.
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Provider New Well Check
Established Well Check
New Sick Visit
Established Sick Visit
Follow Up VIsits
Dr. Strange
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Dr. Pepper
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PA System
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QI 04 (Core): Monitors Patient Experience through:
A. Quantitative Data (Pt. Satisfaction Survey)
B. Qualitative Data
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• Examples of possible vulnerable populations are people at risk
because of:
o Financial circumstances (below poverty level)
o Residence (remote or substandard housing)
o Age (teenagers or post-retirement population)
o Personal characteristics (immigration status, ethnicity)
o Functional/developmental status (quadriplegia, autism)
o Ability to communicate effectively (non-English speaking, illiterate)
o Chronic illness (due to high burden of care)
QI 05 (1): Assesses health disparities using
performance data stratified for vulnerable
populations.
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• Clinical Quality
o HPV vaccine by gender (girls typically greater than boys)
o Colon cancer screening by insurance type
• Patient Experience
Ensure that your survey asks questions to identify vulnerability, such
as:
o Age
o Insurance type
o Employment status
o Primary language
o Education Level
QI 05 (1): Assesses health disparities using
performance data stratified for vulnerable
populations. (must choose one from each section)
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• All eCQMS (electronic Clinical Quality Metrics) are clearly defined by CMS
o You can find this info on the CMS website by searching Clinical Quality Measures
Is your EHR certified? Check here: https://chpl.healthit.gov/#/search
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What now?
• Select your measures for each PCMH category
• Pull your current performance data from the EHR
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Enter your data in an Excel spreadsheet…
Patients 40-69 who have received a mammogram
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Build your dashboard…create a run chart!
Patients 40 – 69 who have received a mammogram
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Not a perfect world…
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• QI 08 (core): Sets goals and acts to improve upon at least five measures across
at least three the four categories.
A. Immunization measures
B. Other preventive care measures
C. Chronic or acute care clinical measures
D. Behavioral health measures
• QI 09 (core): Sets goals and acts to improve upon at least one measure of
resource stewardship.
A. Measures related to care coordination
B. Measures affecting health care costs
• QI 10 (core): Sets goals and acts to improve on availability of major
appointments types to meet patient needs and preferences.
• QI 11(core): Sets goals and acts to improve on at least one patient experience
measure.
• QI 12 (2): Achieves improved performance on at least
2 performance measures.
This Photo by Unknown Author is licensed under CC BY
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• QI 13 (1): Sets goals and acts to improve disparities in care or service
on at least 1 measure
• QI 14 (2): Achieves improved performance on at least 1 measure of
disparities in care or service.
• AC 11 (core): Sets goals and monitors the percentage of patient visits
with selected clinician or team.
• QI 18 (2): Reports clinical quality measures to Medicare or Medicaid
agency
• Q 19 (1-2): The practice is engaged in Value-Based Contract
Agreement. (Maximum 2 credits)
A. Practice engages in up-side risk contract (1 credit)
B. Practice engages in two-sided risk contract (2 credits)
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Why are only 20% of our pts getting mammograms?
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
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Well care visit template reminds Provider to discuss Mammograms with Pt
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders Mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
What if the patient doesn’t come in for an annual well
care visit?
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Well care visit template reminds Provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, Age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders Mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call Specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
This takes 5 minutes of provider time.
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews pteligibility: Female,
age 40-69, No documented screen
in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
Who does this work?
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Well dare visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call Specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
What if the patient never schedules or shows up for
the mammogram?
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders Mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call Specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
This is a dead end. How do we close the loop?
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders Mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did Provider receive report
from specialist?
No
Eligible
Call Specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
Does documenting in the flowsheet populate the
report?
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31BMJ Video Series PDSA 101
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32BMJ Video Series PDSA 101
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33BMJ Video Series PDSA 101
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34BMJ Video Series PDSA 101
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35BMJ Video Series PDSA 101
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36BMJ Video Series PDSA 101
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Well care visit template reminds Provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
PLAN
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NCQA PCMH Quality Measurement and Improvement Worksheet
Practice Name: World’s Best Practice Date Completed:
Measure 1:
MAMMOGRAPHY
BREAST CANCER
SCREENING
1. Measure selected for improvement; reason
for selection
Reason: Only 20% of our eligible patients
receive mammograms every 2 years.
2./3. Baseline performance measurement;
numeric goal for improvement (QI 03)
Baseline Date: June 2018
Baseline Performance Measurement (% or #):
20%
Numeric Goal (% or #): 80%
4. Actions taken to improve and work toward
goal; dates of initiation (QI 10)
(Only 1 action required)
Action:
Date Action Initiated:
Additional Actions:
5. Remeasure performance
Note: Continuing QI is encouraged, but is not
required for QI 10. Performance Re-measurement (% or #):
6. Assess actions; describe improvement.
Note: Continuing QI is encouraged, but is not
required for QI 10.
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
DO
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NCQA PCMH Quality Measurement and Improvement WorksheetPractice Name: World’s Best Practice Date Completed:
Measure 1:
MAMMOGRAPHY
BREAST CANCER
SCREENING
1. Measure selected for improvement; reason
for selection
Reason: Only 20% of our eligible patients
receive mammograms every 2 years.
2./3. Baseline performance measurement;
numeric goal for improvement (QI 03)
Baseline Date: June 2018
Baseline Performance Measurement (% or #):
20%
Numeric Goal (% or #): 80%
4. Actions taken to improve and work toward
goal; dates of initiation (QI 10)
(Only 1 action required)
Action: MA to review chart for eligibility
criteria. If patient meets criteria and no
mammogram report is in the chart MA asks the
patient “Have you had a mammogram in the past
2 years?”
Date Action Initiated: June 15, 2018
Additional Actions:
5. Remeasure performance
Note: Continuing QI is encouraged, but is not
required for QI 10. Performance Re-measurement (% or #):
6. Assess actions; describe improvement.
Note: Continuing QI is encouraged, but is not
required for QI 10.
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Well care visit template reminds provider to discuss mammograms with patient
Provider reviews patient eligibility:
Female, age 40-69, no documented
screen in 2 years, no mastectomy
Provider asks patient if they’ve
had a mammogram in
last 2 years
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
Did provider receive report
from specialist?
No
Eligible
Call specialist to obtain report
Did not
Yes
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
STUDY
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NCQA PCMH Quality Measurement and Improvement WorksheetPractice Name: World’s Best Practice Date Completed:
Measure 1:
MAMMOGRAPHY
BREAST CANCER
SCREENING
1. Measure selected for improvement; reason
for selection
Reason: Only 20% of our eligible patients
receive mammograms every 2 years.
2./3. Baseline performance measurement;
numeric goal for improvement (QI 03)
Baseline Date: June 2018
Baseline Performance Measurement (% or #):
20%
Numeric Goal (% or #): 80%
4. Actions taken to improve and work toward
goal; dates of initiation (QI 10)
(Only 1 action required)
Action: MA to review chart for eligibility
criteria. If patient meets criteria and no
mammogram report is in the chart MA asks the
patient “Have you had a mammogram in the past
2 years?”
Date Action Initiated: June 15, 2018
Additional Actions: MA determined that she
could easily call for a report from the specialist
as part of the new process.
5. Remeasure performance
Note: Continuing QI is encouraged, but is not
required for QI 10.
Performance Re-measurement (% or #):
6. Assess actions; describe improvement.
Note: Continuing QI is encouraged, but is not
required for QI 10.
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Well care visit template reminds provider to discuss mammograms with patient
MA reviews the chart & completes
the eligibility document
Provider orders mammogram
Scan report to the encounter and document on flowsheet
Not eligible
Did
MA asks about mammogram in last 2 years if nothing in
chart
Did provider receive report
from specialist?
No
Eligible
MA Calls Specialist to obtain report
Did not
Yes
?
MAMMOGRAM WORKFLOW –Opportunities for
Improvement
ACT
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NCQA PCMH Quality Measurement and Improvement WorksheetPractice Name: World’s Best Practice Date Completed:
Measure 1:
MAMMOG-
RAPHY
BREAST
CANCER
SCREENING
1. Measure selected for improvement; reason for selection
Reason: Only 20% of our eligible patients receive
mammograms every 2 years.
2./3. Baseline performance measurement; numeric goal for improvement (QI 03)
Baseline Date: June 2018
Baseline Performance Measurement (% or #): 20%
Numeric Goal (% or #): 80%
4. Actions taken to improve and work
toward goal; dates of initiation (QI 10)
(Only 1 action required)
Action: MA to review chart for eligibility criteria. If patient
meets criteria and no mammogram report is in the chart MA
asks the patient “Have you had a mammogram in the past 2 years?”
Date Action Initiated: June 15, 2018
Additional Actions: MA determined that she could easily call
for a report from the specialist if the patient could tell her which specialist ordered the mammogram.
5. Remeasure performance
Note: Continuing QI is encouraged, but is
not required for QI 10.
Process Measure: Monitor 10 charts/week for 6 weeks to
ensure process does not change . Look to see that MA is
reviewing eligibility, asking the question about recent
mammogram as appropriate and calling for results when
needed.
Outcome Measure: Quarterly review of % of eligible patients
receiving mammograms every 2 years. Start with Oct-Dec
quarter.
Performance Re-measurement (% or #):
6. Assess actions; describe improvement.
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40
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• BEST PRACTICES
• CHALLENGES
• NOVEL IDEAS
• QUESTIONS
HOUSEKEEPING• The host will read comments from the
chat box• Please raise your hand to engage in
discussion – we will unmute you when we call your name.
• Please lower your hand when you are finished speaking
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Evidence-Based Careand
Access to Care
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Provide Evidence-Based Care
KM 12 (core): Proactively and routinely identifies populations of patients and reminds them, or their
families/caregivers about needed services (practice must report at least 3 categories)
o Preventive care services
o Chronic or acute care services
o Patients not recently seen by the practice
KM 20 (core): Implements clinical decision support following evidence-based guidelines for care of: (Practice
muster demonstrate at lease 4 criteria):
A. Mental health condition
B. Substance use disorder
C. A chronic medical condition
D. An acute condition
E. A condition related to unhealthy behaviors
F. Well child or adult care
G. Overuse/appropriateness issues
• CC 03 (2): Uses clinical protocols to determine when imaging and lab tests are necessary
• CC 05 (2): Uses clinical protocols to determine when a referral to a specialist is necessary
Train Staff on Population Management:
• KM11 (core): Identifies and addresses population-level needs based on the diversity of the practice and the
community. Demonstrate at least 2.
A. Target population health management on disparities in care
B. Address health literacy of the practice
C. Educate practice staff in cultural competence
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Access to Care:
• AC2 (core): Provides same-day appointments for routine and urgent care to meet identified patients’ needs.
• AC3 (core): Provides routine and urgent appointments outside regular business hours (generally considered
8-5 M-F) to meet identified patients’ needs
• AC4 (core): Provides timely clinical advice by telephone.
• AC5 (core): Documents clinical advice in patient records and confirms clinical advice and care provided
after-hours does not conflict with patient medical record.
• AC6 (1): Provides scheduled routine or urgent appointments by telephone or other technology supported
mechanisms.
• AC7 (1): Has a secure electronic system for patients to request appointments, prescription refills, referrals
and test results.
• AC8 (1): Has a secure electronic system for two-way communication to provide timely clinical advice