july 2008 dick thompson – executive director qhn incorporated august 2004 live operations october...

July 2008Dick Thompson – Executive Director

QHN Incorporated August 2004

Live Operations October 2005

Quality Improvement - Health Information Exchange

Clinically Integrating Western Colorado:

Improving the Quality of Health Care Delivery

2

Rural Western Colorado Medical Trade Area

Copyright © Quality Health Network

Trade Area: 534,000 People – 40,000 Sq. MilesMesa County: 142,000 People, 3300 Sq. Miles

Health Professional Shortage Area

15.23% of population over age 65

High Rate of Poverty (US Census)

• Delta – 12.5%• Montrose – 11.8 %• Montezuma – 14.5%• San Juan 13.5%

Copyright © Quality Health Network QHN Confidential

6 Views of Mesa County Healthcare:

Collaboration Access Stability Quality Innovation Savings


History of Collaboration

1974 Non-profit Health Plan Established (RMHP)– Community Leaders– Physicians

Goal: Coordinate Community Delivery of Care– Medicare– Medicaid– Individual– Business– CHP+


Access & Stability

Every Person has Access to Care:– Including Medicare, Medicaid, CHP+

Primary Care Access (100%) Specialists (90%)

30+ years History of Physicians Serving:– Medicare & Medicaid Beneficiaries

Some with same plan & same Physician since 1974!

Not Just “Nice Thing to Do”– Directly results in higher quality care


Quality (RMHP HEDIS Reports):

– Pregnant Women (5 x likely timely prenatal care) 95% to 18%

– Children (4 x likely all immunizations) 68.4% to 16.8%

– Women (5 x likely timely breast cancer screen) 61.6% to 12.7%

– Adults (5 x likely comprehensive diabetic care)


Innovation

Collaborative Incentive Programs Established by RMHP & MCPIPA in 1991

– specific incentives to physicians of MCPIPA – Goal:

improve/change individual physician behavior relative to appropriate cost containment and quality improvement efforts


MCPIPA Incentive Program- Chronic Care

Focus on Chronic Illness Care – Diabetes and Asthma

Recognize Quality– Physicians determine measures– Evidence-based Guidelines

Reward Quality– Incentive payments using existing structure

Support Quality Improvement– Chronic Care Model– Case Management fee


Innovation

Prenatal Care:– B-4 Babies

Every Pregnant Woman – Regardless of Income– Can Receive Prenatal Care

HIE Quality Improvement– Quality Health Network

Shared Electronic Clinical Data throughout Area

Disease Management Programs– 2006 AHIP Award to RMHP & MCPIPA

Most Innovative Disease Management Program in USA


2004: Clinical Data Transition Problem

Patients use multiple Providers to receive care– Fragmented Information (Chart Chasing)

Primary Care Specialists Acute Care Public Health, Veterans Administration, Behavioral Health Home Health, Extended Care, Hospice “Doc in a Box” – Wal-Mart, Target, Pharmacies

Health Record “Islands of Information”– Both Paper & Many New Electronic Systems


Wall Street Journal October 5, 2007 – Bill Gates:

“Few Industries are so information-dependent. But today, isolated systems make it impossible for your doctor to see your complete medical picture”


2004 Funders & Founders(Competitors . . . & . . . Collaborators!)

$2.75 Million

Mesa County Physicians IPA - $1,050,000 Hilltop Resources - $50,000 Rocky Mountain Health Plans - $1,550,000 St. Mary’s Regional Medical Center - $50,000 Community Hospital - $50,000

Quality Health Network Inc. – 501(c)3– Quality Improvement Focus

“A-political, Non-exclusive, Trusted Organization”


Quality Improvement Goals

Achieve Optimal Health Status– Implement Population Management

Chronic Care / Disease State Management Improve Preventive Services

Improve Provider Access to Patient Medical Data– Create “Virtual” Practice (Clinical Integration)

– Electronically Link Disparate Providers & Systems

Improve Efficiencies & Eliminate Redundancies Improve Patient Safety & Outcomes


24 Month Plan: Improve Data Access

Electronically Collect & Route Clinical Data– Single Contact Point – Sources & Receivers– Data to/from EMR Systems

Securely Network Providers Together– Low Cost Access for All

Clinical Data at Point of Care EMR-lite & eRx & other Decision Support Tools

Deploy Web-based Chronic Care Registries– Collect Data, Management Tools, & Outcome Reports


Patient Data: “No Wrong Door”

Single Access Point - all Sources of Patient Data– Provider Centric View of Patient Data

Lab, Rad, Transcribed Notes, Discharge Summaries, H & P

– Patient Centric View (Aggregated) Urgent Care: “Break the Glass” Patient Data

KISS– Create Simple, Affordable, Highly Available Data Connectivity

WSJ: 68% of consumer electronics returns: “no trouble found”– “didn’t understand the product, not that it didn’t work”

% of EMR’s abandoned after year 1? Way too high!


QHN Health Information Exchange Status: Live Operations 2 Years+

Shared Electronic Health Records– Electronic Clinical Data Collection & Delivery

85% of Area Physicians & Staff are “connected” EMR-lite, eRx, Break-the-Glass

Electronic Care Coordination Center– Care Transitions Focus

Referrals & Consults - Discharge Planning & Care Plans– Meds Reconciliation (2008 Target)

Chronic Care Management– Automatic Data Feed to Health Plan

Diagnostic Tests Web-based Chronic Care Office Data Collection Forms Decision Support & Patient Education Tools

– Graphs & Charts, Mail Merge Reminders


QHN “Connected” Participants300+ Providers – 1300+ online users

Acute Care Hospitals Ambulatory Care

– Primary & Specialty Care

Urgent Care Extended Care Behavioral Health Public Health Surgical Centers

Specialty Hospitals Reference Labs Home Health Pharmacies Payor Safety Net Providers Hospice . . . And Many more!

Visible Efficiency Improvements87% of Data Collected is Electronically Managed

3,847,807 = Clinical Results Collected

Copyright © Quality Health Network

Process TransformationElectronic Shipping & Receiving - Physician Practices

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Gathered Sent


Quality Improvement

“In healthcare, if you choose cost savings over quality, you can attain neither. If you choose quality, you can attain both.”


Healthcare: Improving Quality Costs Less

Difficult to Measure What Doesn’t Happen!– In a growing population?– In an aging population?

Clinical Result Volumes vs Norms?– Expect Year over Year +3.2% due to population growth– Expect at least National Norms increase due to population age– Managed Care.com National Analysis – 1.5 Million Lives

Lab CAGR = +2.04% Rad CAGR = +4.56%

QHN Collected Data – All Types – 2005 Baseline– 2007 declined 6.3% versus 2006

National Norms @ + 6.6% (Net Change 12.9%)– 2007 Savings Estimate on 23,000 lives @ $1.8 Million


Improving Data Management

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1,567,221 April Server Requests

52,240 Requests per Day

Electronic Usage Per Practice Doubled!


Improve Quality of Care TransitionsReduce “Administrivia” Costs

Electronic Referral Network(Organization Participation)

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Printing Form / QHN

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Diabetes Outcomes

Diabetes Measures Improved – A1c from 43% to 52%

Pop. Average from 7.10 to 6.88

– BP Target from 25% to 36%– LDL Target from 29% to 44%

Pop. Average from 100.1 to 95.1

– ASA Daily Usage Target from 56% to 78%


RMHP Cost Savings: Diabetes

Costs for diabetic population– +7%/yr over 3 years

Costs for non-diabetic population– +15%/yr.

$900,000 net savings to Health Plan– Net after incentives, case management fee, etc


May 2006 Mesa County Study

Dartmouth Medical School & RW Johnson– Medicare Beneficiaries: 12 chronic diseases

“The Most cost-effective delivery of Medicare Services in the country was in in Mesa County, CO”

– Medicare spending 2 year period < $21,000 / person vs $60,000 / person

– Average Hospital Days 6 month period 6.5 days versus 19.4 days

– Study Concluded: “if utilization patterns were to mirror these” . . . “Medicare Spending would be reduced by $34.3 BILLION”


Study after Study Affirms:Better Quality Costs Less!

CO Dept Healthcare Policy/Finance (Medicaid)– Mesa County saved the State + $2,000,000

Each year for FY 03-04, 04-05, and 05-06

Chatfield Consulting Study– Medicare Program saved Federal $13.7 Million

2000 to 2002


Success Keys:

Medical Home for Every Person– Hospitals: No pre-set limits on hospitalizations– Pharmacy: Generics encouraged

But: what drug to prescribe is left to doctor discretion

– Disease Management: Incentivized Behavior & Case Management Dollars Electronic Data Collection Published Results within Physician Population


Who Benefits?

Physicians

Patients & Payors

Hospitals & Labs

Pharmacies

Other Allied Participants


Physicians are the Key Ingredient

Scientists . . . . Making Data Based Decisions . . . . That Alter Lives!


Quality, Timeliness, Efficiency, & Costs Improved!


Leadership: Key Ingredient

july 2008 dick thompson – executive director qhn incorporated august 2004 live operations october...

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