Community Care Physicians Community Care Physicians Quality of Care Initiatives Quality of Care Initiatives

20062006

Bridges to ExcellenceBridges to Excellence Performance Improvement ProjectsPerformance Improvement Projects EMR ImplementationEMR Implementation

Bridges to Excellence Status Bridges to Excellence Status ReportReport

17 Practices representing 84 Physicians achieved recognition17 Practices representing 84 Physicians achieved recognition Improved patient outcome and responseImproved patient outcome and response Quality brandingQuality branding Significant monetary reward: >$470,000 and counting from Significant monetary reward: >$470,000 and counting from

the collaborativethe collaborative An additional $188,000 anticipated by year’s endAn additional $188,000 anticipated by year’s end ~ $500,000 received in related incentives (Healthplans)~ $500,000 received in related incentives (Healthplans) Corporate Application in progress with EMR implementationCorporate Application in progress with EMR implementation

BTE Related ActivitiesBTE Related Activities

Diabetes Care InitiativeDiabetes Care Initiative

Diabetes Case Management ProgramDiabetes Case Management Program

Diabetes Self Management Education ProgramDiabetes Self Management Education Program

ProCareProCare

EMREMR

DCIDCIDiabetes Care InitiativeDiabetes Care Initiative

Diabetes Performance Measurement and ImprovementDiabetes Performance Measurement and Improvement

- Develop Diabetic registry - Develop Diabetic registry - Conduct process audit - Conduct process audit - Provide benchmarking data- Provide benchmarking data- Develop interventions and implement- Develop interventions and implement- Re-measure- Re-measure

Phase 1 conducted at 5 Practices involving 40 Practitioners Phase 1 conducted at 5 Practices involving 40 Practitioners and 3000 patientsand 3000 patients

Phase 2 expanded to total of 10 Practices, 60 PractitionersPhase 2 expanded to total of 10 Practices, 60 Practitioners4500 patients4500 patients

Areas of Opportunity and InterventionsAreas of Opportunity and Interventions

Tobacco screeningTobacco screening- Staff education on Diabetic patient prep and Tobacco screening- Staff education on Diabetic patient prep and Tobacco screening

Scheduling of follow-up visitsScheduling of follow-up visits- Process changes in the way we schedule patients - Process changes in the way we schedule patients

Comprehensive foot careComprehensive foot care- Diabetes Tool Kits filled with tools for the provider and the patient – to - Diabetes Tool Kits filled with tools for the provider and the patient – to facilitate foot examsfacilitate foot exams

Annual dilated retinal examAnnual dilated retinal exam- Documentation Tools: flow sheets, standing order sets etc. - Documentation Tools: flow sheets, standing order sets etc.

Nephropathy testingNephropathy testing- Educational information on nephropathy testing - Educational information on nephropathy testing

Self Management EducationSelf Management EducationADA Certified Diabetes Self Management Education ProgramADA Certified Diabetes Self Management Education Program

Relationship of # of Visits per Year to A1C LevelsSelected CCP Practices (2004)

6

6.1

6.2

6.3

6.4

6.5

6.6

6.7

6.8

6.9

7

1 1.5 2 2.5 3 3.5 4 4.5

Number of Visits/Year

A1C

Lev

els

Practice Experience

Linear (Practice Experience)

Practice 1

Practice 2 Practice 3

Practice 4

Practice 5

Note: Demographics of each practice - including age, sex, geographic location

and insurance all very similar.

Diabetes Case Management ProjectDiabetes Case Management Project

CDPHP Health Plan CDPHP Health Plan and and

Community Care Physicians Community Care Physicians Diabetes Case ManagementDiabetes Case Management

2004 - 20052004 - 2005

The Collaborative ProjectThe Collaborative Project

Patients were included in the project if their Patients were included in the project if their HbA1c was >9.0% (Case Management Trigger)HbA1c was >9.0% (Case Management Trigger)

CDPHP Case Managers worked with patients on CDPHP Case Managers worked with patients on lifestyle modifications, medication and diabetes lifestyle modifications, medication and diabetes management and provided general diabetes management and provided general diabetes disease education.disease education.

The Case Manager sent a follow-up report to the The Case Manager sent a follow-up report to the patient’s physician documenting the intervention.patient’s physician documenting the intervention.

The Provider incorporated the intervention into The Provider incorporated the intervention into the plan of care thereby reinforcing the message.the plan of care thereby reinforcing the message.

Average A1c - Case Management

10.138

8.676

7.5

8

8.5

9

9.5

10

10.5

# of Lab Draws

A1c

Val

ue

Last Draw

First Draw

Average A1c Without Case Management - 2005

9.459.96

0

2

4

6

8

10

12

Average A1c for the First Draw Average A1c for the Second Draw

Case Management Results Case Management Results

YearAverage A1c Pre-Case

ManagementAverage A1c Post-Case

Management N Change

2004 10 8.2 98 1.8

2005 10.1 8.6 76 1.5

Combined 2004 2005 10.05 8.4 174 1.65

Diabetes Self Management Education Diabetes Self Management Education ProgramProgram

ADA certified ADA certified Multiple sites, times, group and individual classes - Multiple sites, times, group and individual classes -

accessaccess

Improve patient outcome by providing a previously Improve patient outcome by providing a previously un-reimbursable form of patient intervention. un-reimbursable form of patient intervention.

Promote continuum of carePromote continuum of care

DSME OutcomesDSME Outcomes

9.75%

6.93%

0%

2%

4%

6%

8%

10%

12%

Pre DSME Program HbA1c 6-month Post DSMEProgram HbA1c

*Mean difference between HbA1c pre and post DSME Program was -2.8% (95% CI -2.09 to -3.55)

* p≤.001

Post DMSE HbA1c DistributionPost DMSE HbA1c Distribution

18%

23%

41%

18%

>8.0%7.0-7.9%6.0-6.9%5.0-5.9%

*68.18% of patients who participated in the DMSE Program achieved a HbA1c≤7.0%

Disease Management Disease Management “Pro-Care”“Pro-Care”

Systematic method of identifying patients in need of care and Systematic method of identifying patients in need of care and contacting them for follow upcontacting them for follow up

Evidenced based management of chronic illnessEvidenced based management of chronic illness

Utilizes data mining of internal and external information Utilizes data mining of internal and external information sourcessources

Improves Provider payor profiles by “cleaning” claims dataImproves Provider payor profiles by “cleaning” claims data

ProCare ROI - 5 PracticesProCare ROI - 5 PracticesPilot Project 2Pilot Project 2ndnd half 2005 half 2005

Using “3 Most Prevalent ConditionsUsing “3 Most Prevalent Conditions””

# of Pts Identified ------------- # of Pts Identified ------------- 23512351

# of Visits scheduled ---------- # of Visits scheduled ---------- 677677

Success rate --------------------- Success rate --------------------- 28%28%

Total charges ------------------- Total charges ------------------- $151,367$151,367

Expenses ------------------------- Expenses ------------------------- $4,158$4,158

EMR ROI COST SAVINGSCOST SAVINGS

CHARTS – SUPPLIES, PAPER, FORMS, SUPERBILLS, FOLDERS, SCRIPT PADSCHARTS – SUPPLIES, PAPER, FORMS, SUPERBILLS, FOLDERS, SCRIPT PADS CHART AVAILABILITY – ALL THE TIME IN MULTIPLE PLACESCHART AVAILABILITY – ALL THE TIME IN MULTIPLE PLACES CHART PULLS – TIMECHART PULLS – TIME CHART PREP – TIMECHART PREP – TIME TRANSCRIPTION – COSTS (50 – 90%)TRANSCRIPTION – COSTS (50 – 90%) SCANNED EOBsSCANNED EOBs DIRECT CHARGE ENTRYDIRECT CHARGE ENTRY REDUCED CALL BACKSREDUCED CALL BACKS STREAMLINED ePRESCRIBINGSTREAMLINED ePRESCRIBING DECREASE OVERTIME DECREASE OVERTIME

REVENUE ENHANCEMENTSREVENUE ENHANCEMENTS PAY FOR PERFORMANCE – e.g. Bridges to ExcellencePAY FOR PERFORMANCE – e.g. Bridges to Excellence BETTER CODING – BETTER DOCUMENTATION (5 – 15 %)BETTER CODING – BETTER DOCUMENTATION (5 – 15 %) CLINICAL RESEARCH CAPABILITIESCLINICAL RESEARCH CAPABILITIES ENHANCED INCENTIVES FROM PAYERSENHANCED INCENTIVES FROM PAYERS

REDUCED MEDICAL ERRORREDUCED MEDICAL ERROR ENHANCED SPACE UTILIZATIONENHANCED SPACE UTILIZATION IMPROVED QUAILTY CAREIMPROVED QUAILTY CARE

LEGIBILITYLEGIBILITY DISEASE MANAGEMENTDISEASE MANAGEMENT REFERRAL TRACKINGREFERRAL TRACKING HIGH RISK TRACKINGHIGH RISK TRACKING PREVENTIVE MANAGEMENTPREVENTIVE MANAGEMENT DECISION SUPPORT TOOLSDECISION SUPPORT TOOLS

EMR Improvement on EMR Improvement on Documentation of CareDocumentation of Care

Network Comparison: November 2004 vs November 200598.1

1%

89.5

8%

70.7

7%

65.2

6%

51.2

7%

63.0

7%

43.2

6%

28.1

1%

52.9

1%

37.3

0%

36.0

5%

10.9

4%

0.0

0%

96.6

0%

87.4

8%

79.2

5%

74.2

4%

70.4

8%

62.7

9%

56.5

3%

50.6

3%

49.7

3%

42.7

5%

31.4

8%

12.8

8%

11.0

9%

99.8

1%

98.3

0%

94.7

0%

83.3

3%

79.3

6%

72.9

2%

72.9

2%

62.5

0%

69.7

0%

54.9

2%

36.5

5%

39.5

8%

18.1

8%

12.6

9%

99.6

6%

100.0

0%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Blo

od P

ressure

Med R

evie

w

Lip

id

Glu

cose

Tobacco S

cre

en

Die

t

Follo

w U

p V

isit

Exerc

ise

Foot E

xam

Mic

roalb

um

in

AS

A U

se

Eye E

xam

MN

T w

/RD

Sm

oker

Jan 04 thru Sept 04

November 2004

November 2005