coordinating care to improve healthcare in kern county jennifer wieckowski, msg state program...
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Coordinating Care to Improve Healthcare in Kern County
Jennifer Wieckowski, MSGState Program Director
Health Services Advisory Group (HSAG)May 2015
HSAG: Your Partner in Healthcare Quality
• HSAG is California’s Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO).
• QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS).
• The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level.
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HSAG’s QIN-QIO Responsibility
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HSAG is the Medicare QIN-QIO for California, Arizona, Florida, Ohio, and the U.S. Virgin Islands.
Nearly 25 percent of the nation’s Medicare beneficiaries
Centers for Medicare & Medicaid Services (CMS) Care Coordination Community Expectations
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SustainableCommunity
Engage community
partners
Develop coalition charter
Develop leadership structure
Refresh root cause analyses
Select interventions
Evaluate interventions
Kern County Medicare Fee-for-Service Hospital Readmission Rates
Hospital Readmission RateQ2 2013 to Q1 2014
A 27.70%B 21.40%C 21.10%D 20.40%E 20.40%F 19.90%G 19.70%H 18.30%I 17.10%J 11.10%
5The ASAT data file representing Q2 2013 to Q1 2014 was used for the analyses in this report. The ASAT data file is provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS). The ASAT data file includes Part-A claims for Fee-for-Service beneficiaries.
Kern County Medicare Fee-for-Service Hospital Readmission Rates (cont.)
Calendar Year Readmission Rate
2010 22.3%
2011 21.3%
2012 20.7%
2013 20.8%July 2013 to
June 2014 20.1%
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9.9% relative improvement rate
The ASAT data file representing calendar year 2010 to Q2 2014 was used for the analyses in this report. The ASAT data file is provided to Health Services Advisory Group (HSAG) by the Centers for Medicare & Medicaid Services (CMS). The ASAT data file includes Part-A claims for Fee-for-Service beneficiaries.
Kern County’s Progress: All-Cause, 30-Day Readmission Rate
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California NationKern County
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30-Day Readmission Rate by Setting After Inpatient Hospitalization for All Causes: Q3 2013–Q2 2014
Setting Discharged To
30-Day Readmit Rate
Nursing Home 22.1%Home with Home Health 20.6%Home 19.3%Total 20.1%
Kern County Providers Connected by a Minimum of 30 Transitions
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Kern County Workgroups Focused on Medication Safety
• Hospital to Nursing Home• Hospital to Home/Home Health• Nursing Home to Home/Home Health
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HCAHPS® Measures of Interest
16. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?
17. Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand?
25. When I left the hospital, I clearly understood the purpose for taking each of my medications.
11 HCAHPS=Hospital Consumer Assessment of Healthcare Providers and Systems
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Bakersfield M
emorial H
ospita
l
Good Samaritan Hosp
ital
Mercy Hosp
ital
Kern M
edical C
enter
San Joaquin Community
Hospita
l
Delano Regional Medica
l Center
Bakersfield Heart
Hospita
l
Tehachapi H
ospita
l 0
10
20
30
40
50
60
70 63 6660
54 57 5459
66
Patients Who Reported That Staff "Always" Explained About Medicines Before Giving it to Them
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While Great Strides Have Been Accomplished…
Further Progress on Behalf of Our Patients Is Essential.
Creative Commons/Flicker. BXP135677. Tableatny, August 5, 2013. https://www.flickr.com/photos/53370644@N06/4976497160/
Thank you!Health Services Advisory Group
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services
(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-C.3—05292015-01