michigan ipip/pcmh

CJSI: JNG 10.14.10Working Together for a Healthier Michigan

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Michigan IPIP/PCMH

Transformation of Primary Care Practice Project with ABMS & RWJF


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Sponsors & Gold Supportersfor Michigan IPIP/PCMH Project

Diabetes Section


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Spring 2007 – Michigan was ready for IPIP!

• MPCC – The Michigan Primary Care Consortium formed a Practice Transformation Committee to evaluate practice needs and opportunities for improving care delivery

• AIAG – The Automotive Industry Action Group Health Focus group, in collaboration with Michigan Medical Group Management Society, was piloting the use of industry trained quality improvement experts to redesign health care facilities.

• Industry/Health Care CollaborationIPIP offered a great partnership opportunity


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Improving Performance in Practice (IPIP)

• A state-based, nationally led quality improvement initiative

• Created and sponsored by the American Board of Medical Specialties to

• Primary care physicians that include participation in quality improvement activities

• Funded in large part by the Robert Wood Johnson Foundation.

• Four phases:– Cohort 1: Prototype through

CO and NC (2006)– Cohort 2: Re-focus with MI

and PA (2007)– Cohort 3: Spread through MN,

WA and WI (2008)– Cohort 4: Associate Partners

www.ipip.qiteamspace.com


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Mission & Purpose for Michigan IPIP/PCMH Project

• A Primary Care Quality Improvement Initiative & Collaboration between industry (AIAG) & primary health care (MPCC)

• Goals:– Improve the chronic care practices of patient

populations– Move primary care practices towards PCMH– Target inefficiencies & waste– Increase spread to other practices


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IPIP Project Development

2004

State begins addressing challenges in primary care & options for addressing them

June - Aug 2007IPIP idea is born, ABMS/RWJF Grant submission, August 6, 2007

2008Planning & strategizing IPIP MI model detail; Establishing Committees & focus groups

November 2008First wave of IPIP practice

teams start & beginreporting to IPIP National

MATCHING FUNDS: Secured with Sanofi-Aventis, Pfizer, Allergan, & MDCH

IN KIND: MDCH Diabetic Educator, Automotive sector QI coaches & SSMBB from Ford

September 2007Champions are identified & ABMS notifies team of award

Jan - May 2008Full-time Director MI IPIP, Program Manager, & Project Support hired

May & June 2008MAY: Recruitment of practices

beginsJUNE: Interviewing & screening

IPIP project coaches start

August 2008Interviewing & screening IPIP practices for Readiness

2005 - 2006MMGMA/AIAG process improvement pilot projects


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Michigan IPIP/PCMH Methodology

• Use methods successful in the manufacturing environment to improve the quality in the healthcare environment

• Select coaches with backgrounds in:– Quality Improvement– Lean– Quality System Management– System Integration

• Select practices ready to “change”• Match practice + 2 coaches• Facilitate the transformation


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IPIP Project Implementation

Mar 2010Learning Collaborative III:

Outcomes & Lessons Learned

November &December 2008End of Year 1 of ABMS/RWJF Grant

February & July 2009Learning Collaborative I:

Introduction to PCMH & CCM

(repeated to roll in later practices)

Jan 2010Changing of the guards (State Director)

June 2010IPIP MI project & funding is complete

IPIP MI sharing of data & metrics

Sept 2009Learning Collaborative II:

Understanding Diabetes, Asthma & Self ManagementJune 2009

Second wave of IPIP practice teams

Final wave of IPIP practice teams

Sept 2010Final evaluation & project

summary


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Sharing the Data

• The Final Report Data:– IPIP Leadership Team

Evaluation– MPHI External

Evaluation

• Organization:– Project Outcomes– Clinical Outcomes – Lessons Learned– Next Steps


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IPIP Project: Start to FinishStats Jan 2009 June 2010

Number of Practices18

(Diabetic)

33(Diabetic + Asthma)

Number of Coaches 30 61*

Number of Physicians Involved 106 206

Total Population of Patients Potentially Affected 148,080 276,499

Number of Practices with an EHR/EMR 10 23

Number of Practices with a Registry 8 24

Number of Practices with PCMH /BCBSM Designation 12 27

Coach Time Estimated versus Coach Time Needed for project (hours per week)

4 10

* Data gathered from formal MPHI evaluation


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Diabetic Measures (30 practices)

OUTCOMES:• More practices engaged• PCPs measuring & monitoring their populations• PCPs are getting closer to goal• PCPs are tracking more clinical information

DM Measures Jun-2010

0

10

20

30

40

50

60

70

80

90

100

Goal lower = better

Start of Project Close of Project


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Asthma Measures (3 Practices)

OUTCOMES:• More practices engaged• PCPs measuring & monitoring their populations• PCPs are getting closer to goal• Integration of IT systems will allow for further measuring

Asthma Measures Jun-2010

0

20

40

60

80

100

Goal lower = better

Per

cent

Per

cent

Start of Project

Close of Project


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Measure Jan 2009 June 2010 % Change

PROCESS

ACE/ARBs 8 36 388%

Aspirin Use 7 23 229%

Referrals for Eye Exams

20 53 165%

Foot Exams 30 66 120%

Flu Vaccine 26 42 62%

Nephropathy Screening

58 60 3.4%

Pneumo Vaccine 8 28 250%

Self Management 11 27 145%

Smoking Cessation Counseling

63 65 3.2%

Statin Use 12 49 308%

OUTCOME

A1C>9 10 14 40%

A1C<7 43 44 2.4%

BP<130/80 44 47 6.8%

LDL<100 42 49 16.7%

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Measure Jan 2009 June 2010 % Change

PROCESS

Controller Meds 77 88 14.3%

Assessment of Control

18 66 267%

Flu Vaccines 10 53 430%

Queried on Smoking

6 31 417%

Counseled on Smoking

50 50 0%

3 Care Components 5 14 180%

OUTCOME

Patients >1 ER visit 3.5 3.9 11.4%

Patients >1 Hospitalization

No data No data NA

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Date of LC FocusAttendance / Occurrences

February 2009Introduction to PCMH, CCM & the need for change

142

July 2009

Repeat of February 2009 to bring second wave of practices on board

42

September 2009Diabetes, Asthmas & Self Management efforts

156

March 2010

Practices sharing to build community amongst IPIP team, seeing some best practice examples

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Monthly Practice LC Call-ins (March 2009 – June 2010)

Webex conducted 3rd Wednesday & 4th Thursday of the month

Average 10 practices per call

Monthly QICs meetings (June 2008 – June 2010)

First Monday of month at AIAG offices & via webex

Average 34 coaches per meeting

Individual JIT & Assistance

Weekly handled based on needs of practice or

coach

2 incidences per week

Lea

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Summation: Lessons Learned

• Practices found IPIP project to be helpful– Increase in knowledge of

PDSA– Increase in satisfaction of care– Increase in QI efforts

• Practices made improvements because of the IPIP model– Office efficiencies– Registries

• Small successes drove momentum

• Transformation takes longer than initially expected

• Build a more sustainable funding model

• Practice Coaching added value to the program– Industry engineers can assist

in transformation– Strong fits

• Practice Coaches needed to:– Be strong facilitators & change

managers– Start simply (PDSA &

standardization)– Eliminate waste– Start measuring & monitoring

• Learning Collaboratives + continually learning are helpful in the process

• MI IPIP Model was visionary, valuable, viable & exemplary


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Next Steps for Michigan IPIP/PCMH Project

• IPIP ABMS/RWJF Project ended June 30, 2010

• Finalizing official reports • Sharing our story• IPIP National in process

of defining how to proceed

• MPCC & AF4Q discussing ways to make an IPIP-like experience with coaching available

October 2010

www.mipcc.org

michigan ipip/pcmh

Documents

ipip idea

primary care physicians

primary care options

care deliveryaiag

ipip mi project funding

health care facilities

fulltime director mi

ipip nationalmatching