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Innovations in Online CME: Convergence of Clinical Practice Data and CME in “Real Time”

John Donovan, R.Ph. John Donovan, R.Ph. Annette Boyer, R.Ph.Annette Boyer, R.Ph.WellPoint Pharmacy ManagementWellPoint Pharmacy Management CECity.com, Inc.CECity.com, Inc.

Michael Lemon, MBAMichael Lemon, MBA Michael Reilly, MSMichael Reilly, MSPostgraduate Institute for MedicinePostgraduate Institute for Medicine Merck & Co. Inc.Merck & Co. Inc.

Alliance for Continuing Medical EducationAlliance for Continuing Medical Education

January 28, 2006

Discussion Topics

• Overview and Business Need• Program Goals & Business Strategy

• Program Methodology & Design

• Program Outcomes

• Questions

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Growth of eLearning in Medical EducationPhysician Use of Web vs. Growth of

online Medical Education Market1470000

222000

6100011000013,115

365000

652866

995000

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1997 1998 1999 2000 2001 2002 2003 2004

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

% Physician Use of Web ProfessionallyCME Participants-Online

AMA Study: Physicians’ use of internet steadily rising; AMA News Report; ACCME Annual Report 2001-2005;Boston Consulting Group Vital Signs Report

Online Medical Education is the Fastest Growing Segment of ALL

•2002 – 6%•2004 – 14%

AMA News Report-Predicts 50% of all Medical Education online in near future

On-line CME Programs: Do they work?

– 46% of physicians use the Internet for CME at least monthly, if not more frequent

– 55% of physicians agree the Internet improves clinical knowledge which improve upon their practice

– Physicians want more interactivity and a greater variety of online CME options.

*Manhattan Research July 2004

2004 Study results:

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eCME Continues to Gain Validation & Credibility

Physicians who use eCME tend to be high prescribersManhattan Research, “Taking the Pulse, Ver 5.0, June 2005

S.C.O.P.E (Study of Continuing Online Physician Education)Landmark & Award Winning Outcomes Study in eCME; Demonstrated physician knowledge delta (pre vs. post) and

knowledge retention in online formats JCEHP, Vol. 24; 2004

Baylor Study showing eCME more effective than live“Comparison of the Instructional Efficacy of Internet-Based

CME With Live Interactive CME Workshops”; JAMA, September 7, 2005

“Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines”

The “Output” of the CME enterprise is evolving…

SeatTime

Changein

Attitude

Changein

Knowledge

Changein

Behavior

Changein

PracticePatterns

Certificationof

Competency

ImprovedPublicHealth

Stakeholders:ACCME

StateBoardsofLicensure

Specialty/SubspecialtyBoards

ProfessionalSocieties

Payors

Typical CME (Passive Engagement)

Live/EnduringTraditional Programs

Best Practice(Active Engagement)

Quality Improvement, CPD, Dynamic CME

What value do certificates really have?

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Influences of Treatment Behaviors

Underlying Influences– Published literature– Continuing education programs – Pharmaceutical industry contact– Peer Influence– Advertisements

Physician Personal Influences– Fear of malpractice– Societal concerns of cost and outcomes– Patients perceived and real demand– Financial incentives

Kaplan J. The Emerging Managed Care Paradigm, Health Care in Transition. Med Interface Sept 1994: 58-59.Avron J, Soumerai SB. Principles of Educational Outreach to Improve Clinical Decision Making. JAMA. 1990;263:549-556.

Provider Education - What works?Overall

– Concise educational materials– Evidence-based and unbiased – Highlight and repeat essential messages– Specific recommendations or patient profiles for intervention– Positive reinforcement– Multi-faceted approach*– Aligned with financial incentives**

Web-based– Short and concise courses– Level of interactivity– Quality of content– Ease of use

*Linda Casebeer, PhD, et al “Standardizing Evaluation of On-line Continuing Medical Education: Physician Knowledge, Attitudes, and Reflection on Practice” J Contin Educ Health Prof 2004; 24(2):68-75 **Avron J, Soumerai SB. Principles of Educational Outreach to Improve Clinical Decision Making. JAMA. 1990;263:549-556.

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Health Care Industry Needs

Continued Evidence of Non-Compliance with Practice Guidelines*– Even in current educational environment– Lack of educational tools that connect guidelines to practice

Need for High Level CME Outcomes

Need for Unique Provider Based Educational Platform– To reach rural physician– To tie educational message with clinical practice

Phillips LS, Branch WT, Cook BC, et al. Clinical Inertia. Ann Intern Med. 2001;135:825-834.McGlynn EA, Asch SM, Adams J, et al. The Quality of Health Care Delivered to Adults in the United States. N Engl J Med. June 2003;348:2635-45.

Level 1Professional Attendance

at the Meeting

Level 2Meeting

Satisfaction

Level 3Completion

of a Post-test for CME Credit

Level 4Pre & Post-

test Impact on Provider Behavior

Level 5Impact on

Patient Health

Level 6Impact on Population

Health

Progression of CME Outcomes

TraditionalCME

Subjective

Objective

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A Physician Focused Personal Intervention Tool– Synchronizes high quality CME programs with health

plan specific initiatives– Uses state of the art technology available at the

physician’s convenience– Decreases the gap between theory and the physician

practice through the use of “real” claim data – Provides a “teachable” moment for behavior

reinforcement– Gains physician confidence by providing evidence-

based guidelines supported by individual practice pattern data

What is DynamicCME?

DynamicCME Program Goals

Develop Unique Educational Platform that:• Promotes physician best practices• Demonstrates learning• Improves patient outcomes• Demonstrates measureable change in physician behavior

Meet/exceed accreditation and regulatory guidelines

Aligned with ACCME goals and objectives

Provide high quality and interactive CME activities

Obtain high usability

Provide program flexibility

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DynamicCME Program Strategy

Leverage current web base technology to construct new educational platform

Identify and construct strong partnership for program success• Technical Vendor• Accredited provider• Pharmaceutical supporter• Health care provider

Leverage knowledge and process of integrated medical and pharmacy claims database

Construct high quality CME educational platform

Develop process to measure results

Key Step #1: Construct Key Partnerships

Merck– Program supporter

Postgraduate Institute for Medicine– CME certification

WellPoint– Educational design (Gap learning principle)– Integrate database and outcomes analysis

CECity– Technical provider of CME eLearning & Outcome Solutions– Provider for National Health Care Distribution

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Key Step #2:Construct Education Platform and Design

• Based on gap learning principles and eLearning system

• Built within CME technology framework– embedded and post-test questions

• Ensure educational component around physician data validation

• Constructed peer group benchmarking• Developed actionable steps for intervention

Key Step #3: Construct Integrated Database & Profile System

Pharmacy Claims Data

Medical Claims Data (where available)

Eligibility Data

Physician File

Dynamic Database of relevant claims and other data

•Lipid lowering Rx claims

•Diabetes, hypertension, and CHD-related Rx claims

•Physician zip code

•Diagnosis of hyperlipidemia, hypertension, diabetes

Identify Patient Population (Denominator) for each question

1. Patients receiving lipid lowering therapy

2. Patients with CHD, CHD risk equivalent, multiple risk factors

3. Patients with diabetes

4. New start patients taking statintherapy

Identify Target Population (Numerator) for each question

1. Patients with CHD, CHD risk equivalent, or multiple risk factors receiving lipid lowering therapy

2. Calculate % LDL lowering therapy for monotherapy patients

3. Patients with diabetes receiving lipid lowering therapy

4. Calculate PDC for new start patients on statin therapy

Calculate data for chart

•Physician

•Benchmark (i.e., group practice, peers, regional benchmark, clinical data, etc.)

Populate Data Tables and FTP to CECity

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DynamicCME Architecture

Healthplan 1

Healthplan 2

Collect Utilization Data Aggregate Utilization Data Present Utilization Datain DynamicCME

user

user

user

user

user

user

CECity

Healthplan n

users

WellPoint

reports

DynamicCME Pre test

DynamicCME Database

Medical / Rx Claims DynamicCME Post test

0102030405060708090

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

Peer’s Data

Practice Data

DynamicCME Engine Dynamic Post Test Results Box

Educational Content

based evidencebased

evidence

Patient Profiles

DynamicCME Backend Engine

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DynamicCME Behavior

Network Physician Data displayed is the individual physician’s

utilization data compared to the Health Plan, the practice and/or peers.

Health Plan Network Data displayed is

aggregate Health Plan, practice and/or peer

utilization. Not related to an

individual physician.

Physician at LargeNo physician practice

data or Health Plan data.Data displayed is the

responses of those whoparticipated in the eCME

activity.

Health Plan LogoHere

Health Plan Logo Here

DynamicCME in Action

Program Spotlight

Professional Management Tools

Direct access to other featured CME activities

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User is presentedwith an InteractiveCME question

User is shown answer

Evidence-based Resource link provided for further Information(Guidelines, Clinical Trials, etc.)

DynamicCME Interactivity

Physician utilizationdata is displayed withbenchmarksestablished by theHealth Plan

Data provided by Health Plan database

Link is available to send a request for specific patient

information

DynamicCME Reinforcement

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Closes educational loop by providing actual patient data for intervention

DynamicCME Interventions

DynamicCME DistributionDynamicCME Activity is Repurposed Online One Time

DynamicCME Activity is Distributed via a National Professional

Distribution Network

Associations (i.e. AOA, AMCP)

CME Portals(i.e.CE Medicus)

WellPoint Health Plans

Chain Pharmacies (i.e. Eckerd/Brooks, Kmart, etc.)

…and more!

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Measurable Outcomes

• Exceeds Level 1 & 2 Outcomes– Measures beyond # of users and satisfaction

• Understanding of the gaps in knowledge• NCQA and HEDIS measures• Measures outcomes of specific interventions

– Examples:• Change in aggressive lipid lowering prescribing patterns• Change in combination therapy prescribing for high risk patients

• Improvement in tx/rx compliance• Measure influence of Dynamic vs Non-Dynamic• Risk populations• Compliance with national guidelines• Changes in inappropriate prescribing• Ability to analyze geographic variations

The Sphere of Health Care Outcomes

Identification of Health Care

Best Practices

Quality Improvement

Awareness ofClinical Best Practices

& Guidelines

Consistent Education Relevant to Health Care

Appropriate Prescribing & Utilization Management

HEDIS & NCQA

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Dynamic CME"Standard of Excellence"

2005 Web Award Competition

DynamicCME.com Awarded the 2005 "Standard of Excellence" WebAward for Outstanding Achievement in Website Development

QUESTIONS?