Download Case for Quality in 2006, The

The Case for Quality in 2006
CCNV 2nd Annual Client Conference
October 17, 2006
Colleen Lynch, RN, MSN, CPHQ
Community Care Network of Virginia
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
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
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
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
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
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
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
Key Institute of Medicine
Recommendations

All health care organizations should
pursue six major aims: health care
should be safe, effective, patientcentered, timely, efficient and
equitable
Crossing the Quality Chasm, 2001
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
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
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
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
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

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
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
Improved Quality comes
from Improvement in
Work Processes
Quality = Process Focused
“Each system is designed perfectly to get
the results that it gets.”
-W. Edwards Deming


Eliminate blame
Redesign system
An Important Concept…
From a Toyota Senior Executive:
“We get brilliant results
from average people
managing brilliant processes”
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
Why Pursue Quality?

Payor Quality Programs

CMS DOQ-IT project and Physician
Voluntary Reporting Project


Anthem Performance Extra Program


Medicare Care Management Performance
Demonstration Project
Asthma, Diabetes
United Healthcare

Ambulatory Quality Alliance measures
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
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
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
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
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?
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
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
How CCNV is helping you
meet the challenge:
Medical Management Program
 Updating CCNV Clinical Practice
Guidelines for incorporation into EMR
 Diabetes
 Cholesterol
 Hypertension
 Obesity
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
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
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
But don’t forget…
“If you always do what you’ve always
done…
You’ll always get what you’ve always
gotten”…
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.
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
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
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
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
We can still
improve!
And we can do
more!