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Medicare Advantage Chronic Care Improvement Program Training for Medicare Advantage Organizations

Medicare Advantage Chronic Care Improvement Program Training for Medicare Advantage Organizations . Marsha Davenport, MD MPH CAPT, USPHS Chief Medical Officer and Karla Taylor, PharmD Medicare Drug and Health Plan Contract Administration Group April 11, 2012. Presentation Overview: Part I.

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Medicare Advantage Chronic Care Improvement Program Training for Medicare Advantage Organizations

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  1. Medicare Advantage Chronic Care Improvement Program Training for Medicare Advantage Organizations Marsha Davenport, MD MPHCAPT, USPHS Chief Medical Officer and Karla Taylor, PharmD Medicare Drug and Health Plan Contract Administration Group April 11, 2012

  2. Presentation Overview: Part I • QI Program Overview • Background • Million Hearts Campaign • Disease Management • Components of a CCIP • Case Studies • Discussion • Brief break/Stretch

  3. Presentation Overview: Part II • CCIP Reporting process • Plan-Do-Study-Act (PDSA) • CY2011 and CY2012 submissions • Role of Central Office Quality Team • Role of Regional Office (RO) Account Managers (AM) and Clinicians • Review CCIP Reporting Tool • Case Studies • Questions and Wrap up

  4. QUALITY IMPROVEMENT (QI)PROGRAM OVERVIEW

  5. Quality Improvement (QI) Program • 42 Code of Federal Regulations (CFR) § 422.152 • Applies to all MAOs, including SNPs • Seven components of the QI Program • Serves to integrate and coordinate all of the assessment tools and reporting requirements

  6. QI Program -2- 1. Chronic care improvement program (CCIP) • Meet the requirements of 42CFR §422.152(c) • Addresses populations identified by CMS based on review of current quality performance 2. Quality improvement projects (QIPs) • Meet the requirements of 42CFR §422.152(d) • Expected to have a favorable effect on health outcomes and enrollee satisfaction • Address areas identified by CMS

  7. QI Program -3- • Develop and maintain a health information system • Encourage providers to participate in CMS and Health & Human Services (HHS) QI initiatives • Contract with an approved Medicare CAHPS vendor to conduct the Medicare CAHPS satisfaction survey

  8. QI Program -4- • Include a program review process for the formal evaluation of the QI Program that addresses at least the following areas on an annual basis: • Impact • Effectiveness • Take remedial action to correct problems identified using ongoing quality improvement

  9. Defining Quality

  10. BACKGROUND

  11. Background • Identified need to improve reporting tools for both the CCIPs and the QIPs • Follow the QI cycle of Plan, Do, Study, Act • More focused on interventions and outcomes • Participate in national health initiatives • CCIPs must be clinical • QIPs may be clinical or non-clinical

  12. Background -2- • CMS is involved in several important Department of Health and Human Services (HHS) Initiatives • Want to ensure that our beneficiaries enrolled in the Medicare Advantage (MA) program have the opportunity to benefit from these initiatives

  13. Background -3- • The required topic for the CY 2012 CCIPs is reducing risks for cardiovascular disease • This topic is the focus of the national Million Hearts Campaign

  14. Background -4- • The required topic for the CY 2012 QIPs is decreasing plan all cause readmissions • Current HEDIS® measure • One of the goals of the national CMS Partnership for Patient Initiative

  15. MILLION HEARTS CAMPAIGN

  16. Heart Disease and Strokes • Also referred to has cardiovascular disease (CVD) • Over 2 million heart attacks and strokes each year • Leading killers in the U.S. • Cause 1 of every 3 deaths ~ 800,000 deaths • Leading cause of preventable death in people < 65 Source: Million Hearts Campaign 2012

  17. Heart Disease and Strokes -2- • Billions of dollars (~ $444 ) in health care costs and lost productivity • Treatment accounts for ~ $1 of every $6 spent • Greatest differences in racial disparities for life expectancy Source: Million Hearts Campaign 2012

  18. CVD Leading Cause of Shorter Life Expectancy Among African Americans Source: Million Hearts Campaign 2012

  19. Improving CVD Care • Aspirin • Blood pressure • Cholesterol • Smoking Source: Million Hearts Campaign 2012

  20. Status of the ABCS Source: Million Hearts Campaign 2012

  21. Million Hearts Outcomes • 10M more people with HBP controlled • 20M more people with high cholesterol controlled • 4M fewer people will smoke • 20% drop in average sodium intake • 50% drop in average trans fat intake Source: Million Hearts Campaign 2012

  22. Key Components of Million Hearts Community Prevention • Reduce the number of people who need treatment Clinical Prevention • Optimize care for those people who do need treatment Source: Million Hearts Campaign 2012

  23. Medical System Messages • Clinicians • Emphasize power of prevention • Create systems to get an “A” in the ABCS • Use decision supports and registries to drive performance • Deploy teams • Pharmacists • Monitor and influence refill patterns • Work in teams • Teach adherence Source: Million Hearts Campaign 2012

  24. Medical System Messages -2- • Insurers • Measure and incentivize performance on the ABCS; collect and share data for quality improvement; empower consumers • Individuals • Know your numbers—and goals • Take aspirin, if advised • Get aggressive with BP and Cholesterol • Cut sodium and trans fats • If you smoke, quit Source: Million Hearts Campaign 2012

  25. Community Messages -2- • Retailers and Employers • Offer blood pressure monitoring and educational resources • Focus on improving ABCS care in retail and worksite clinics • Advocacy groups • Monitor and demand progress toward goal • Promote actions that prevent heart attacks and strokes Source: Million Hearts Campaign 2012

  26. Community Messages • Government • Support community and systems transformation to reduce tobacco use and improve nutrition • Provide data for action • Foundations • Support consumer and provider outreach and activation Source: Million Hearts Campaign 2012

  27. Million Hearts: Getting to the Goal Source: Million Hearts Campaign 2012 1 Population-wide indicators 2 Clinical systems

  28. Take the Pledge at http://millionhearts.hhs.gov/

  29. DISEASE MANAGEMENT

  30. What is Disease Management? • Supports physician/patient plan of care • Emphasis on prevention • Outcomes evaluated continuously

  31. What Can Disease Management Do? • Improve safety and quality of care • Improve access to care • Improve patient self-management • Decrease costs • Provide health improvement based on plan on population

  32. Disease State Selection • Determine incidence and prevalence • Identify data sources • What data do I have to use to track and monitor progress for the patients • Is the disease relevant to the patients • Are there gaps in the current program

  33. Disease State Selection -2- • Is the disease clinically manageable • What is the current impact for the MA plan members • Will changing how the disease is managed have a positive impact

  34. Disease Management: Six Required Elements • Population identification • Evidence based guidelines • Collaborative care • Patient self-management • Process and outcome measures • Routine reporting/feedback loop

  35. Population Identification • Process of identification • Data sources • Target population

  36. Evidence Based Guidelines • Set of actions based on clinical research • Effectively manage or improve outcomes • Ensures consistency in treatment

  37. Collaborative Care Model • Structured interdisciplinary team • Patient centered CCIP • Designed to provide best possible outcomes

  38. Patient Self-Management • Systematic provision of education and supportive interventions • Increase patient skills and confidence in managing their health

  39. Process and Outcome Measures • Determines program stability • Reflects the impact on health status of the targeted population

  40. Routine Reporting/Feedback Loop • Process of communication • Keeps all care team members and patient in the loop

  41. COMPONENTS OF THE CHRONIC CARE IMPROVEMENT PROGRAM

  42. Required CCIP Disease Selection • New for 2012 • Cardiovascular Disease focus • Must still be individualized to meet the needs of the MA plan’s population

  43. Components of the CCIP • Disease state selection • Six disease management elements • Anticipated outcomes • Goal(s) • Interventions

  44. Anticipated Outcomes • Determining what the program will achieve • Must positively improve health outcomes • Important factor in evaluation of the CCIP

  45. Goals • Relevant to the program • Specific • Measureable • Positive effect on health outcomes • Attainable

  46. Interventions • Relates to the both the disease state selected and the goals • Designed to reach the goal • Some questions to consider • Can this intervention improve health outcomes • Can the impact of the intervention be measured • Is the intervention sustainable

  47. CASE STUDIES

  48. Case Study #1: Diabetes • Develop a Diabetes CCIP • Walk through the components of the CCIP • Provide specific examples for disease management elements and the CCIP components

  49. Diabetes

  50. Diabetes -2-

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