The Case for Quality in 2006

1. The Case for Quality in 2006 CCNV 2nd Annual Client Conference October 17, 2006 Colleen Lynch, RN, MSN, CPHQ Community Care Network of Virginia

2. Problem Statement • More than 90 million Americans live with chronic illnesses • Chronic diseases account for 70% of all deaths in the United States • The medical care of people with chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care costs

3. Burden of Chronic Disease The United States cannot effectively address escalating healthcare costs without addressing the problem of chronic diseases. National Center for Chronic Disease Prevention and Health Promotion

4. Why Pursue Quality in the Office Setting? • Heart disease, diabetes and hypertension are significant public health problems in the United States • The majority of chronic disease care is managed in the physician office • Chronic conditions account for significant costs to the healthcare system

5. Chronic Disease in the Office Setting: • In 2002 • Individuals with heart disease accounted for 20.8 million office visits • Individuals with diabetes accounted for 24.9 million office visits • Individuals with hypertension accounted for 17.2 million office visits Centers for Disease Control and Prevention Fast Stats

6. Chronic Disease in the Office Setting: • The direct and indirect costs attributed to coronary heart disease and congestive heart failure are projected to be $170 billion in 2005 • The total direct healthcare cost attributed to diabetes in 2002 was $92 billion with an additional $40 billion in indirect costs (disability, work loss and premature death) • The total direct and indirect costs of hypertension in 2005 were $59.7 billion

7. Quality as a National Focus Crossing the Quality Chasm: A New Health System for the 21st Century “Quality problems are everywhere, affecting many patients. Between the health care we have and the care we could have lies not just a gap, but a chasm.” Institute of Medicine, 2001

8. Key Institute of Medicine Recommendations • All health care organizations should adopt as their explicit purpose: • to continually reduce the burden of illness, injury and disability • to improve the health and functioning of the people of the United States. Crossing the Quality Chasm, 2001

9. Key Institute of Medicine Recommendations • All health care organizations should pursue six major aims: health care should be safe, effective, patient-centered, timely, efficient and equitable Crossing the Quality Chasm, 2001

10. Key Institute of Medicine Recommendations • Congress should continue to authorize and appropriate funds for the establishment of, monitoring and tracking processes for use in evaluating the progress of the health system • The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of care provided to the American people. Crossing the Quality Chasm, 2001

11. National Healthcare Quality Report • First national comprehensive effort to measure the quality of healthcare in America • Report includes a broad set of performance measures to measure quality in cancer, diabetes, end-stage renal disease, heart disease, HIV and AIDS, metal health and respiratory disease

12. Key Findings of National Healthcare Quality Report • High Quality Healthcare is not universal • Opportunities for preventive care are frequently missed • Management of chronic diseases presents unique quality challenges • There is more to learn • Greater improvement is possible

13. HRSA Goals: • Improve access to Health Care • Improve Health Outcomes • Improve the Quality of Health Care • Eliminate Health Disparities • Improve the Public Health and Health Care Systems • Enhance the Ability of the Health Care System to Respond to Public Health Emergencies • Achieve Excellence in Management Practices

14. Mission of the Bureau of Primary Health Care: • To increase access to comprehensive primary and preventive healthcare • To improve the health status of underserved and vulnerable populations

15. Quality: What is it? “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are current and consistent with current professional knowledge” - Institute of Medicine

16. Quality: What is it? • A proactive task of management aimed at the continual monitoring of processes/outcomes within a business/organization • Using information to develop ways to enhance the future performance of these processes

17. Improved Quality comes from Improvement in Work Processes

18. Quality = Process Focused “Each system is designed perfectly to get the results that it gets.” -W. Edwards Deming • Eliminate blame • Redesign system

19. An Important Concept… From a Toyota Senior Executive: “We get brilliant results from average people managing brilliant processes”

20. Why Pursue Quality? • Demonstrating improvement to regulatory and accreditation entities • JCAHO, OPR Reviews • Contracting leverage – payor quality incentive programs, P4P • Marketing purposes • Seeking additional funding opportunities

21. Why Pursue Quality? • Payor Quality Programs • CMS DOQ-IT project and Physician Voluntary Reporting Project • Medicare Care Management Performance Demonstration Project • Anthem Performance Extra Program • Asthma, Diabetes • United Healthcare • Ambulatory Quality Alliance measures

22. Why Pursue Quality? The overarching goal is to: • Continually reduce the burden of illness, injury and disability • Improve the health and functioning of the people in our communities

23. Where to begin…? • Opportunities for preventive care are often missed • Management of chronic diseases presents unique challenges • The majority of chronic disease care is provided in the physician office

24. Can we impact these rates? • Adults receiving recommended screening and preventive care – 49% • Adults with diabetes under control – 74% • Adults with hypertension under control – 29% “US Health System Performance: A National Scorecard” Health Affairs, September 2006

25. Can we impact these rates? • Needed mental health care and received treatment • Adults – 47% • Children – 59% • Adults with chronic conditions given self-management plan – 58% “US Health System Performance: A National Scorecard” Health Affairs, September 2006

26. Key Questions to Ponder: • How is your center managing the challenge of chronic illness? • How is the health in your communities improving as a result of your work? • Is quality a core business strategy of your operations?

27. The Vision: • To continually reduce the burden of illness, injury and disability • To improve the health and functioning of the people in our Virginia communities

28. How CCNV is helping you meet the challenge: Medical Management Program • Medical Management Committee • Randall Bashore, MD – Central Virginia • Bickley Craven, MD – Stone Mountain • Parker Dooley, MD – Eastern Shore • Roger Chinery, MD – Alexandria • Hellen Streicher, PhD – Central Virginia • Meghan Sullivan, FNP – Southwest Virginia

29. How CCNV is helping you meet the challenge: Medical Management Program • Updating CCNV Clinical Practice Guidelines for incorporation into EMR • Diabetes • Cholesterol • Hypertension • Obesity

30. How CCNV is helping you meet the challenge: Medical Management Program • Defining “core set of measures” that can be tracked across the network • Developing and testing reporting functionality to ensure meaningful and valid data capture • Setting “network goals” for care

31. How CCNV is helping you meet the challenge: Medical Management Program • Monitoring payor quality programs and Pay for Performance efforts to position the network appropriately for future activities

32. Role of EMR in Quality • Plan and deliver evidence-based care to individuals and groups of patients • Improve timeliness of patient tracking and follow-up • Identify and track patients with chronic disease • Compare practice performance with other benchmarks

33. But don’t forget… “If you always do what you’ve always done… You’ll always get what you’ve always gotten”…

34. Don’t forget about processes! • High quality care is only possible in systems that have fully integrated good practices into the care process. • Poorly designed systems are prone to errors and inefficiency. • Redesigning workflow is essential to increasing efficiency and ensuring quality care.

35. What we know now… “The current care systems can not do the job. Trying harder will not work. Changing systems of care will…” Crossing the Quality Chasm, 2001

36. How CCNV is helping you meet the challenge: Quality Improvement Program • “Revitalized” network Quality Improvement Committee in May 2006 • Core group: 14 individuals from 12 centers • Network “Knowledge-Sharing” • Sharing successes and challenges

37. How CCNV is helping you meet the challenge: Quality Improvement Program • Workflow analysis presentations: • “How to Map Your Office Processes” • July 2006 WebEx • “How to Examine Value and Waste in Your Office Processes” • August 2006 WebEx

38. The Challenge before us: “Better health is an individual responsibility, and it is an important national goal. We’re making great progress in preventing and detecting and treating many chronic diseases, and that’s good for America…We’re living longer than any generation in history. Yet we can still improve. And we can do more.” President George Bush, June 2002

39. We can still improve! And we can do more!