QIOSC Update

1. QIOSC Update AHQA Technical Conference February 23 - 26, 2009 Tampa, FL

2. Today’s Agenda Background QIOSC Team Major Tasks Current & Future Activities

3. Background Prevention QIOSC contractawarded 9/30/08 Start-up activities: Clarify CMS’ expectations for QIOSC work Develop QIOSC comprehensive work plan Define roles of Prevention andHealth Disparities QIOSCs QIO support defined:Core Prevention tasks (53 QIOs)and CKD tasks (11 QIOs)

4. Unique QIOSC Structure

5. Meet the QIOSC Team Prevention QIOSC Team – 7.68 FTEs Robin Weil, Director Erica Morrison, Community of Practice Manager Sandra Atkins, Project Assistant Sallie Cook, MD, Medical Director Linda Xu, Analytics Susan Brittman, QSource Lead & Disparities Subject Matter Expert and Analytics Monet Carnahan, CKD Subject Matter Expert Carol Stowell, Communications Anthony Culver, Communications Robert Canada, MD, Nephrologist Robin Kaiser, SoftDev Lead & Senior Applications Engineer Rich Kaiser, User Services Specialist Nancy Carlson, Data and Analytics Manager

6. Core Prevention Clinical Measures Breast Cancer screening (mammography) Colorectal Cancer screening: Fecal occult blood test (FOBT) Flexible sigmoidoscopy Double contrast barium enema Colonoscopy Influenza immunization Pneumococcal immunization

7. National Core Prevention Activities Recruit participating and non-participating practices (PPs and NPs); Provide post-recruitment care management training to PPs; Complete Assessment of Care processes for PPs and NPs;

8. National Core Prevention Activities Provide technical assistance to PPs for care management: Workflow analysis and redesign Interventions to increase patient self-management Provide technical assistance to PPs and NPs for data reporting: Retrieving data from EHR Reporting aggregate data(numerators and denominators)

9. National Core Prevention Activities Report activities to CMS: PP and NP progress with data reporting Monitoring of statewide ratesand disparities Plan for optimization of performance Annual report

10. How We Are Helping QIOs

11. QIOSC Role - How We Support QIOs Engage expert stakeholders andpartners such as: American Academy of Family Physicians American College of Physicians American Board of Internal Medicine American Medical Association Healthcare Information and Management Systems Society Medical Group Management Association Infectious Diseases Society of America American Cancer Society ROBIN: Please address some specific examples for Dr. Cook to cite here I know she should mention the calls with EHR vendors TEPR Conference: 1) liaison with all vendors that are exhibiting/presenting and, 2) recruit good TEPR speakers for future CoP Calls and/or other QIO educational opportunitiesROBIN: Please address some specific examples for Dr. Cook to cite here I know she should mention the calls with EHR vendors TEPR Conference: 1) liaison with all vendors that are exhibiting/presenting and, 2) recruit good TEPR speakers for future CoP Calls and/or other QIO educational opportunities

12. How We Support QIOs Conduct an inventory ofavailable interventions Develop and/or disseminate tools Provide educational information and resources Facilitate monthly Community of Practice sharing calls Identify QIO barriers, lessons learned and success stories Synthesize and disseminate “what works” information

13. How We Support QIOs Facilitate monthly EHR reporting workgroup calls Liaison with EHR vendors as needed Provide comprehensive Quest Index Monitor and evaluate to provide special assistance when needed Make the “business case”

14. QIO Issues and Concerns Core prevention recruitment was a challenge due to: Limited pool of practices with CCHIT certified EHRs Practice workflow issues preventing optimal use of EHR for care management Practices feared that data could not be retrieved from EHRs Practices saw data reporting as a burden Practices uneasy about how their data would be used Lack of buy in from EHR vendors Negative experiences with PQRI created resistance from some practices No perceived benefit for participation by NPs

15. QIO Issues and Concerns Logistical/technical issuesrelated to PATRIOT Lack of specifications forEHR reported measures Lack of clarity regarding definitions related to data reporting - “active patient” Evaluation criteria not finalized Limited national support for vendor relations

16. Persistence and Ingenuity Pays Off! 98% of QIOs recruited their target number of PPs (target numbers range from 4 to 125) 94% of QIOs recruited their target number of NPs 94% of QIOs provided required post-recruitment training to PPs 29% of QIOs have reported some practice level data

17. Core - Next Steps Focus of QIOSC support will switch from recruitment to: Care management interventions Support for practice data reporting Updated MedQIC coming very soon Launch of national campaign focused on stakeholder/partner engagement

18. CMS’ CKD Quality Initiative Focus on three clinical areas: early detection of CKD inbeneficiaries with diabetes; appropriate medication treatment (angiotensin converting enzyme inhibitors/angiotensin receptor blockers) to slow the progression of kidney failure; and adequate counseling prior to initiation of dialysis which leads to placement of an arteriovenous fistula for hemodialysis patients.

19. CMS’ CKD Quality Initiative Collaborate to achieve sustainable CKD system-level changes Partners community health centers community representatives, ESRD Network Organizations, health department diabetes grantees local chapters of kidney organizations patient representatives, provider groups,state and county government representatives, and others

20. CKD States Florida Georgia Missouri Montana Nevada New York Rhode Island Tennessee Texas Utah U.S. Virgin Islands

21. Recruitment Phase Successful! CKD recruitment Previous work maderecruitment less difficult All now at 100% of goals

22. QIOSC Role - How We Support QIOs Engage expert stakeholdersand partners Conduct an inventory ofavailable interventions Develop and/or disseminate tools Provide educational information and resources Engage expert stakeholders and partners – National Kidney Foundation, Renal Physicians Association Conduct an inventory of available interventions – RPA Tool Kits – Great response from QIOs Develop and/or disseminate tools – QIOSC has conducted needs assessment of of CKD QIOs to determine what would help them the most Implement national prevention theme campaign – GTLs are working to clarify goals and working with Kelly Anderson the Communications GTL who is without a Comm QIOSC at this time – Expect feedback soon Monitor and evaluate – First reports are coming in and QIOSC is giving feedback to QIOs Assist with reporting requirements – Soft Dev is working on templates and ways to ensure CMS will get the information they need Make the business case – This will be done later in the SOW Engage expert stakeholders and partners – National Kidney Foundation, Renal Physicians Association Conduct an inventory of available interventions – RPA Tool Kits – Great response from QIOs Develop and/or disseminate tools – QIOSC has conducted needs assessment of of CKD QIOs to determine what would help them the most Implement national prevention theme campaign – GTLs are working to clarify goals and working with Kelly Anderson the Communications GTL who is without a Comm QIOSC at this time – Expect feedback soon Monitor and evaluate – First reports are coming in and QIOSC is giving feedback to QIOs Assist with reporting requirements – Soft Dev is working on templates and ways to ensure CMS will get the information they need Make the business case – This will be done later in the SOW

23. QIOSC Role - How We Support QIOs Facilitate bi-weekly sharing/educational calls with CKD QIOs Identify QIO barriers, lessons learnedand success stories Synthesize and disseminate“what works” information Provide comprehensive Quest Index Monitor and evaluate to providespecial assistance when needed Make the “business case”

24. CKD Prevention Issues & Concerns PATRIOT Issues $4 Generic PrescriptionsEffect on Measures AV Fistula Placement Reimbursement

25. CKD - Next Steps Focus of QIOSC support will switch from recruitment to interventions Updated MEDQIC coming very soon CKD Community Tool Kit Under Discussion with CMS National Kidney Month Activities “March Madness” CKD News Release

26. Summary Physician office HITassistance is welcomed by practices Prevention topics are extremely important quality perspective business case perspective QIOSC welcomes ideas to optimize support to QIOs

27. Contact Information Prevention QIOSC Virginia Health Quality Center (VHQC) 9830 Mayland Drive, Suite J Richmond, VA 23233 (804) 289-5320 (Main) Robin Weilrweil@vaqio.sdps.org Prevention QIOSC Director Erica Morrisonemorrison@vaqio.sdps.org Prevention Community of Practice Manager

28. Thank You!QIOSC Update AHQA Technical Conference February 23 - 26, 2009 Tampa, FL