1 / 41

June 2012 Eric Christensen

Patient-centered Medical Home (PCMH)/ Medical Home Port (MHP) Evaluation (with emphasis on chronic conditions, particularly diabetes). June 2012 Eric Christensen. Overview. Context MHS/Navy Medicine moving rapidly to PCMH/MHP models

kenaz
Télécharger la présentation

June 2012 Eric Christensen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Patient-centered Medical Home (PCMH)/Medical Home Port (MHP) Evaluation(with emphasis on chronic conditions, particularly diabetes) June 2012 Eric Christensen

  2. Overview • Context • MHS/Navy Medicine moving rapidly to PCMH/MHP models • Literature shows the potential of PCMHs, but success is not automatic • “78% of health spending is devoted to people with chronic conditions”* • Purpose • Assess the impact of the Bethesda PCMH on access, quality, and cost • Assess whether the MHP model is effective for different patient types and in different settings • Outcome • Resource allocation should consider the effectiveness of MHP model • Which populations to target first with MHP * Anderson and Horvath, “The Growing Burden of Chronic Disease in America,” Public Health Reports, 2004, 119(3):263-270

  3. Topics/outline • Results on access and quality • HEDIS metrics • Patient satisfaction survey • Results on use and costs • Overall • Chronic versus non-chronic patients • By chronic condition • Clinical Practice Guidelines (CPGs) adherence—diabetes • Note • Some slides use NNMC and others WRNMMC as some of the work was completed before the Bethesda-Walter Reed merger • Results in this brief are for the WRNMMC internal medicine MHP

  4. WRNMMC HEDIS scores (pre- and post-implementation) Note: The values for the pre-period are monthly averages for January-May 2008 compared to February-December 2009 for the post-period. The transition period was from June 2008 through January 2009.

  5. PCMH impact on access and patient satisfaction

  6. How to increase satisfaction and PCM rating? • Those reporting high levels of access and provider communication report high satisfaction and PCM rating • Access (OR: 2.1; CI: 1.4-3.2) • Provider communication (OR: 1.9; CI: 1.2-3.0) • Implies that increasing access and provider communication will increase satisfaction and PCM rating • But, how to do this? • Drivers of access • Ease of scheduling appointments (OR: 4.6; CI: 3.0-7.0) • Ability to get appt for routine care when needed (OR: 4.4; CI: 3.2-6.2) • Ability to get appt for urgent care when needed (OR: 3.7; CI: 2.5-5.5) • Drivers of provider communication • PCM listens carefully (OR: 13.5; CI: 6.4-28.4) • PCM provides complete and accurate info (OR: 12.9; CI: 5.2-31.9)

  7. Use and cost analysis • Conducted retrospective data analysis (FY07-10) • Transition period from June 2008 to January 2009 • Used differences-in-differences approach • Used two-step process for analyzing health care use and costs • Step 1: binary regression for user or non-user of a particular service • Step 2: OLS regression for amount of services for users only • Used NMC Portsmouth, NMC San Diego, and NHP Pensacola internal medicine clinics as comparison sites • Focused on chronic conditions • Diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), and mental health

  8. PCMH impact on use – all enrollees

  9. PCMH impact on use – chronic patients

  10. PCMH impact on use – non-chronic patients

  11. PCMH impact on cost – all enrollees

  12. PCMH impact on cost – chronic patients

  13. PCMH impact on cost – non-chronic patients

  14. Cost impacts associated with chronic enrollees

  15. WRNMMC PCMH impact by condition *Model would not converge.

  16. Diabetes CPG metrics • Screening/exam • HbA1c exam (at least yearly) • Eye exam (every two years) • Lipid (LDL-C) screening (yearly) • Nephropathy (yearly) • Level/control • HbA1c control (> 9.0%) • Lipid control (LDL-C < 100 mg/dL) • Blood pressure control

  17. Diabetes CPG adherence rates—HbA1c exam

  18. Diabetes CPG adherence rates—eye care

  19. Diabetes CPG adherence rates—lipid control

  20. Diabetes CPG adherence rates—nephropathy

  21. Are changes in CPG adherence rates significant? • Controlling for demographic differences and other chronic conditions, PCMH patients are more likely to have yearly nephrology and lipid control panels than patients at control sites • HbA1c results are not meaningful because of the change in coding practice at WRNMMC in 2010 • Eye exams are recommended every two years, but with a 1-year comparison (2007 to 2010), there is a significant decline in patients receiving eye exams

  22. Staff survey – continuity and coordination of care • How often do you feel that you can exercise autonomy as opposed to having to utilize a standard procedure? • The question was only asked of providers

  23. Enrollment status of diabetics (Navy catchment areas)

  24. Chronic disease burden • “78% of health spending is devoted to people with chronic conditions. Quality medical care for people with chronic conditions requires a new orientation toward prevention of chronic disease and provision of ongoing care and care management to maintain health status and functioning.” • Health spending attributable to people with chronic conditions • 1 or more conditions: 88% for prescriptions, 72% for physician visits, 76% for inpatient • 2 or more conditions: 67% for prescriptions, 48% for physician visits, 56% for inpatient • Source: Anderson and Horvath, “The Growing Burden of Chronic Disease in America,” Public Health Reports, 2004, 119(3):263-270

  25. Pharmacy VariationUtilization and variation for maintenance and scheduled drugs Nevin Aragam, CNA Analysis and Solutions

  26. FOR OFFICIAL USE ONLY Outline • We investigate Navy pharmacy utilization and variation for FY 2011 to identify and understand patterns among our population of maintenance and scheduled pharmaceutical users • Methods • All drugs • Maintenance drugs • Scheduled drugs

  27. FOR OFFICIAL USE ONLY Methods • FY 2011 PDTS via MDR • Used catchment area of record to identify the eligible populations surrounding navy catchment regions • Identified all eligible beneficiaries in FY 2011 using DEERS and the demographic information from the most recent FM the beneficiary appeared • Maintenance drugs are identified with the MDR PDTS field Maintenance Drug = ‘Y’ • Scheduled drugs and identified using the MDR PDTS field DEA Class = 1, 2, 3, 4, or 5* * note, there were no drugs identified as having DEA class 1 in PDTS

  28. FOR OFFICIAL USE ONLY All pharmacy age distribution Age distribution for all pharmacy users

  29. FOR OFFICIAL USE ONLY All pharmacy utilization 60,000 30 days supplies implies the average 80 year old takes about 5 medications daily 30 day supplies per 1,000 Navy region beneficiaries by age

  30. FOR OFFICIAL USE ONLY Popular fill source • AD beneficiaries fill almost exclusively at MTF pharmacies • Active duty family members and retirees fill mostly at MTFs and a sizable proportion at retail pharmacies • Retirees and their dependents fill fairly evenly across MTFs and retail pharmacies Source: MHS Data Repository (MDR PDTS table FY2011).

  31. FOR OFFICIAL USE ONLY Types of maintenance drugs • Top 5 Maintenance drugs (15% of all maintenance drugs prescribed) • IBUPROFEN • SIMVASTATIN • LISINOPRIL • NEXIUM • LIPITOR

  32. FOR OFFICIAL USE ONLY Maintenance drug age distribution Age distribution for maintenance pharmaceutical users

  33. FOR OFFICIAL USE ONLY Maintenance drug utilization 50,000 30 days supplies implies the average 80 year old takes about 4 maintenance medications daily 30 day supplies of maintenance drugs per 1,000 Navy region beneficiaries by age

  34. FOR OFFICIAL USE ONLY Maintenance drug regional variation High: NH Pensacola (13,307 30 day supplies) Low: NCA MSMA (9,460 30 day supplies) High/Low: 1.41 (Beneficiaries in NH Pensacola use 1.4 times as many maintenance drugs as those in the NCA MSMA) Regional variation for maintenance drug prescriptions per 1,000 beneficiaries

  35. FOR OFFICIAL USE ONLY Scheduled drugs

  36. FOR OFFICIAL USE ONLY Types of scheduled drugs • Top 5 Scheduled drugs (55% of all schedules drugs prescribed) • HYDROCODONE-ACETAMINOPHEN • ZOLPIDEM TARTRATE • OXYCODONE-ACETAMINOPHEN • ALPRAZOLAM • DIAZEPAM • Scheduled drugs can also be maintenance drugs: • CLONAZEPAM • CONCERTA • LYRICA • ADDERALL XR • VYVANSE

  37. FOR OFFICIAL USE ONLY Scheduled drug age distribution Age distribution for scheduled pharmaceutical users

  38. FOR OFFICIAL USE ONLY Scheduled drug utilization 1,900 30 days supplies implies the average 80 year old takes about 1.5 scheduled drug medications daily 30 day supplies of scheduled drugs per 1,000 Navy region beneficiaries by age

  39. FOR OFFICIAL USE ONLY Scheduled drug regional variation High: NH Pensacola (1,073 30 day supplies) Low: NCA MSMA (567 30 day supplies) High/Low: 1.89 (Beneficiaries in NH Pensacola use nearly twice as many scheduled drugs as those in the NCA MSMA) Regional variation for scheduled drug prescriptions per 1,000 beneficiaries

  40. FOR OFFICIAL USE ONLY Questions? • Nevin Aragam • AragamN@CNA.org

  41. FOR OFFICIAL USE ONLY Appendix • Navy region definitions by catchment area DMIS ID: • 0067 0066 0037 0123 - NCA MSMA • 0124 0120 – Tide Water MSMA • 0024 0029 - San Diego MSMA • 0125 126 127 - Puget Sound MSMA • 0104 - NH Beaufort • 0091 - NH Camp Lejeune • 0039 - NH Jacksonville • 0028 - NH Lemoore • 0038 - NH Pensacola • 0030 - NH Twentynine Palms

More Related