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Chronic Disease Management: Driving Quality Improvement in Primary Care August 1, 2008

Chronic Disease Management: Driving Quality Improvement in Primary Care August 1, 2008. Jan Norman, RD, CDE Washington State Department of Health. Quality Improvement Initiative. Aimed at primary care providers Focus on prevention-based care

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Chronic Disease Management: Driving Quality Improvement in Primary Care August 1, 2008

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  1. Chronic Disease Management:Driving Quality Improvement in Primary CareAugust 1, 2008 Jan Norman, RD, CDE Washington State Department of Health

  2. Quality Improvement Initiative • Aimed at primary care providers • Focus on prevention-based care • Redesigns care delivery to deliver population-based care

  3. The IOM Quality report: A New Health System for the 21st Century http://www4.nas.edu/onpi/webextra.nsf/web/chasm?OpenDocument

  4. The IOM Quality Report:Selected Quotes • “The current care systems cannot do the job.” • “Trying harder will not work.” • “Changing care systems will.”

  5. A Framework for System Change COMMUNICATION EDUCATION COORDINATION CONFIDENTIALITY

  6. Collaborative Methods IHI Breakthrough Process Planned Care Model Model for Improvement

  7. Collaborative Process Participants Select Topic Prework P P Identify Change Concepts P A D A D A D S S S Planning Group Outcomes Congress LS 1 LS 2 LS 3 Supports E-mail Visits Web-site Phone Assessments Senior Leader Reports (13 month time frame)

  8. Chronic Care Model Community Health System Resources and Policies Health Care Organization Informed, Activated Patient Prepared, Proactive Practice Team Productive Interactions Functional and Clinical Outcomes Self-Management Support DeliverySystem Design ClinicalInformationSystems Decision Support

  9. Act Plan Study Do Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. G. Langley, K. Nolan, T. Nolan, C. Norman, L. Provost. Jossey-Bass Publishers., San Francisco, 1996.

  10. History 1999 to 2008

  11. Collaborative vs Non Collaborative (DMI, DMII, Spread vs Non Collab)

  12. Washington State Collaborative 5 Diabetes Results * Percent with average blood sugar < 150

  13. Seattle Tacoma Spokane Large, urban or for profit clinics Community, rural or IHS clinics Washington StateCollaborative Graduates

  14. Adult topics Diabetes Depression Asthma Pediatric topics Asthma Overweight prevention Medical Home Partnership with Medicaid 33 teams $5,000 stipend plus incentive money for achievements Practice coaches Target practice with <5 providers May 2008 – May 2009

  15. Knowledge Resources Will

  16. Policy Changes • Medicaid established code to pay for group visits for diabetes and asthma • Medicaid and BlueShield expanded diabetes education to all MD offices • Uniform waived co-pay for Collaborative patients preventive visits

  17. Key to Sustainability of Collaborative Outcomes • “Quality improvement must be addressed on multiple fronts, just one of which is finding a way to build financial rewards for quality improvement into healthcare financing.”

  18. Key to Sustainability of Collaborative Outcomes • “Many plans and providers indicate a willingness to pursue such changes, but their efforts will depend on the support and commitment of the ultimate financiers of health care – government and private employers.”

  19. 2ESSB 5930 2007Governors Blue Ribbon Commission Bill • Expand Medicaid to implement a medical home for all aged, blind and disabled clients • Direct DOH to provide primary care training in chronic care management • Design a reimbursement plan to reward quality

  20. ESSHB 2549 - 2008 Implement a Collaborative on Medical Home Redesign the funding to pay for the implementation of Medical Home

  21. Support tools for moving ahead • AcademyHealth/Commonwealth Fund State Quality Improvement Institute • Primary Care Coalition • WSC Advisory Committee • National Committee for Quality Assurance Physician Recognition Program • Consensus definition of Medical Home across provider groups

  22. What is a Medical Home? The patient-centered medical home is a model for care provided by Primary Care practices that seeks to strengthen the provider-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship.

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