Quality Improvement Learning Group November 3, 2016 Record of Learning
Coordinated by:
Participants • Alex Meyer, CompDrug • OhioHealth Physicians Group: David Applegate, MD • Concord Counseling: Connie Emerson, Jennifer Sheets • Southeast, Inc.: Charles Huber • Lower Lights Christian Health Center: Melodie Gee • Syntero: Leslie Fritz • Mount Carmel Medical Group: Hannah Carlson • Healthcare Collaborative of Greater Columbus: John Leite, Michelle Missler, Krista Stock • Ohio State University Wexner Medical Center: Susan Butler Session Objectives: • Shape a regional strategy that helps to advance quality improvement and transparency. • Learn about opportunities and challenges to improve healthcare quality measurement and transparency. • Share best practices to improve healthcare quality in Greater Columbus. Share Learning and Best Practices Purpose: Share learning on quality measures What is key learning from the most recent data? ü Tobacco: Huge population of tobacco users. Issue could be data collection; Regional tobacco performance seems low, especially for PCMH practices. Would expect them to be in the 90% range. Possibility that screening is done, but counseling is not. ü Nephropathy: low scores, gaps are patients that are not engaged; surprised at how low the regional performance is; A1C in control/Nephropathy = correlation? ü Not the doctor’s job to find data. ü Some of the results are better than I would have expected (tobacco screening) and some worse. ü Still working on reporting accurately. Incentivizing doctors could improve performance ü FQHCs are at an advantage because they have had to report quality metrics for many years. ü Measures are helping organizations get to the root cause of an issue. ü Participating in this work gives orgs the opportunity to get ahead of the curve of payment reform. May not be perfect, but its helping them prepare. What quality improvement opportunities could we explore in 2017? ü For behavioral health to look at quality measures relating to physical health care. ü Behavioral health providers could be encouraged to report on tobacco screening/cessation one they have mastered the depression measures. ü Primary care providers begin reporting depression measures. ü Important to work changes into workflow; Standardizing processes and striving for less variation; Look at subpopulations; implement PDSAs to streamline screenings ü Closing the communication/referral loop, especially referrals outside our own systems; Specialists in CliniSync; Meaningful use; electronic submission of electronic referrals ü Engage specialists in QI discussions. Will they have the same financial incentives as PCPs ü Readmission/ED visits for established PCP patients ü PCMH: If CPC+ practices, their focus will be on the gaps. This could positively impact regional quality performance. ü How can plans be engaged in QI work? Are plans using AHIPs core measures? ü CG-CAHPS will become transparent to the public, so that is where focus will be ü Patient engagement: test different models, build infrastructure to get patients in ü Social service needs such as transportation
Strategic Discussion Purpose: Shape project work and targets for 2017 What should our targets be for the newest measures? ü There was collaborative discussion around setting regional targets. What are other regions doing? Where can we look for benchmarks? (i.e., AHRQ, state performance) Targets can help orgs aim higher than if there wasn’t a target. ü Why the reluctance to set a target? Targets can be helpful internally, but could send the wrong message to the public about an organizations performance. ü Group will continue to explore benchmarks and other data as possible targets and will revisit, possibly after the second round of data. What should be our focus in 2017? ü See discussion of 2017 QI opportunities ü More integration of the PC and BH measurement data. While their results will have significant differences, it would be interesting to compare the results between the groups. ü More involvement of specialists in closing the referral loop and quality measurement and improvement. ü Need to continue this work. Next Steps 2017 work sessions: All sessions will be hosted at the Nationwide & Ohio Farm Bureau 4H Center. A poll will be sent out with options for meetings based on participant feedback. Results of the value survey administered at the conclusion of the session: Very High High xxxxxxx (7) Medium x (1) Low No Additional comments or reflections: • Canvassing staff from organizations before performing above and under targets may provide insight into process changes that could improve targets. • Good discussion. • Have one organization present a metric and what they are doing to act on it. • I think because of the payment reforms on the horizon there is a great amount of anxiety about performance measures, but we still need to do this! • It would be interesting to hear how places are collecting their data – processes and procedures. • Like the idea to include specialists for input. • Maybe a discussion around PPSA’s or other tools organizations can employ to help move the numbers. • Population health presenters discuss “high level” goals that can be applied in the “roots.” • This isn’t a support group, but it does help! • What data can mean or do for you? • Would like to focus on one measure at each meeting to brainstorm ideas on how to improve that measure. • Would like to spend at least one meeting per year on the different programs we have to pull measures on and what the challenges are with them.