Diabetic Care within the Military Health System

1. Diabetic Care within the Military Health System The Institute of Federal Health Care Roundtable on “The Role of Collaboration in Improving Diabetes Care” COL John P. Kugler, MC, USA Deputy Chief Medical Officer, DoD, TMA(HA)

2. Overview of MHS-wide Programs • The System-wide surveillance of diabetic outcome measures as indicators of quality clinical performance. • The System-wide promotion of evidenced-based practices in diabetic care. • The System-wide analysis of diabetic disease management programs.

3. The System-wide surveillance of diabetic outcome measures as indicators of quality clinical performance.

4. Diabetic Disease Burden for the MHS • There is an estimated population of nearly 1700 diabetics under the age of 18 receiving care within the MHS. • As part of the MHS Disease Management Demonstration Study, it was estimated that there are approximately 230,000 diabetics receiving care in CONUS in both the direct and purchased care sector, between the ages of 18 and 64. • The MHS Population Health Portal tracks nearly 100,000 diabetics receiving care in the direct care sector (military treatment facilities).

5. Senior Medical Management Advisory Committee Clinical Proponency Steering CMTE MHS Clinical Quality Forum • Credentials and • Privileging • TJC/AAAHC Oversight • Risk Management • RM Committee • DoD Dept Legal Medicine • Credentials • URAC/TRO oversight • Patient Safety/PQI’s • External peer review • PSI’s (AHRQ) • UM chart review • Patient grievance • Contractor QM program • TRO/URAC oversight • Patient Safety • PSC Reporting • Alerts/Focused Studies • TJC National Patient Safety Goals • TeamSTEPPS Direct Care Network • Prevention/Chronic Disease • Selected HEDIS® measures (MHSPHP) • Preventable Admissions • MTF DM Programs • MTF QIAs • TJC or AAAHC Oversight • NQMP Focused Studies • Prevention/Chronic Disease Measures • Selected HEDIS® measures (MHSPHP) • DM programs (CHF, diabetes, asthma) • Contractor Quality Improvement Activities • URAC oversight • Inpatient Quality • JC ORYX • HCD website • NPIC • NQMP focused studies • Inpatient Quality Measures • CMS/HQA/JC publicly reported measures for network facilities • NQMC focused studies

6. MHS Clinical Quality Organizational Reporting Structure Senior Military Medical Advisory Committee ASD/HA, DASDs, Surgeons General, President-USU, Joint Surgeon, Medical Officer of the Coast Guard Clinical Proponency Steering Committee DASDs ; Deputy Surgeons General MHS Clinical Quality Forum Senior Quality Leaders from HA, TMA, Services, and TROs with representation from NQMC and NQMP as requested (Scientific Advisory Panel, Clinical Measures Steering Panel and Newborn Screening IPT working groups)

7. All DoD inpatient facilities participate in ORYX as part of the Joint Commission accreditation requirements Data collection for the majority of measures is via chart abstraction Data is provided electronically to the MTFs and Service leadership The MHS Clinical Quality Measures Panel continually oversee the processes and review ORYX  data Core Measure Sets Acute Myocardial Infarction Heart Failure Pneumonia Pregnancy and Related Conditions Surgical Care Improvement Program Children’s Asthma Care Non-Core Measure Sets Disease Management of Diabetes Asthma Care Hypertension Management Joint Commission ORYX

8. Outpatient Measures MHS Population Health HEDIS® And Scorecard Measures

9. MHS Population Health Portal HEDIS-like Measures • Breast Cancer Screening • Colorectal Cancer Screening • Cervical Cancer Screening • Appropriate Asthma Medication • Diabetes - HbA1C test in past year • Diabetes – HbA1C control (direct care only) • Diabetes – LDL test in past year • Diabetes – LDL control (direct care only)

10. Other Senior Scorecard Clinical Quality Measures • MHS Tobacco Use Rate • Influenza Immunization Rate • MHS Body Mass Index rate • No Problem Getting Needed Care Rate • Beneficiary Satisfaction and Perception of MHS Quality

11. The System-wide promotion of evidenced-based practices in diabetic care

12. Evidenced-Based Practice • DoD/VA Evidenced-based Working Group develops, implements, and promotes clinical practice guidelines and toolkits for use throughout both Systems. • Updated regularly and available to DoD providers on the DoD/VA CPG website at https://www.qmo.amedd.army.mil/pguide.htm • Upcoming plans to develop and deploy an automated clinical practice guideline as point of service option in the Electronic Health Record. One of the earliest guidelines to be launched will be the diabetic CPG.

13. The System-wide analysis of diabetic disease management programs

14. MHS-wide Disease Management • Several MTF-specific, local Disease Management programs are available for diabetes care. • A demonstration project was launched in 2007 to assess the programs from three different managed care support contractors providing Disease Management Services in the area of diabetes. • Diabetes disease management program enrolls ages 18-64, in the both the direct and purchased care sectors in CONUS. Outcomes to be assessed include impact on utilization, costs, effectiveness, and acceptability. • Analysis of data will take place in Spring and Summer 09 for purpose of advising on future system-wide DM options for the entire MHS.

15. Questions Point of Contact Information: COL John Kugler Deputy Chief Medical Officer Office of the Chief Medical Officer TRICARE Management Activity (703) 681-0064 John.kugler@tma.osd.mil