leveraging data for performance improvement jack millaway, lphi chatrian kanger, ahl
Post on 20-Jan-2018
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Why is it Important?
• Data has always been important in healthcare, but its scale continues to expand– Individual patients– Chart Sampling– Patient Registries– Organization-wide– Whole population (community and beyond)
Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives
In the past few years, data and its impact on payment has expanded drastically:– ACO’s and other shared savings or incentive
contracts with payers– UDS Quality Awards– Patient Centered Medical Home– Meaningful Use
Pay-for-Performance, Alternative Payment Models and Value Based Care Initiatives
• And its impact will only continue to expand!– Medicare payments• 30% of contracts by the end of this year• 50% by the end of 2018• MIPS and MACRA
– Meaningful Use Stage 3– UDS whole population reporting– Grants and other initiatives
Best Practices to adopt today
1. Evaluate your current environmenta) Active payer contractsb) UDS, PCMH, Meaningful Use, and other Quality
Incentive programs2. Make a plan
a) Where does it make sense to target efforts?b) Capacity to implement change
3. Make it a prioritya) Regular monitoringb) Integrate data into all QI projects
Who We Are
• Established as St. Charles CHC in 2002• 27 practice sites (CHCs + SBHCs)• 9 parishes• 92 providers total• 40k patients & ~125k visits / year
Internal Structure:
Care Teams
Support Teams Training Department,
QA/Reporting/ EMR staff, Call Center
Athena
Current Performance / Quality Improvement Process
• Collect and review data from multiple data sources
• Prioritization of Quality Measures• Categorize by roles • Leverage internal structures & technologies
when feasible (e.g. EMR, call center, training team, etc)
Priority Area – Care Coordination
AHL focus: Ensure timely access to follow-up care after a hospital discharge
Issues with Current Flow:
Introducing RISK: – Losing patients to timely f/u care– Increasing likelihood for readmission or
inappropriate ED usage againLosing $$$Ability to document & track:
- Scheduler (appt types)- Pre-built Templates - Pre-built Reports
What’s on the Horizon?• Patient load in GNOHIE is about to increase
once our interface completes with Athena• Additional patient load & awareness of ED /
hospital visits w/ other interfaces + payers
• Reducing ED/ hospital visits• Incentive $$$ focus on ensuring timely access
to f/u care • Care coordination
Emergency Dept / Hospitalizations
GNOHIEScheduling: Add drop down
for appointment reason
Clinical Documentation: Rx reconciliation HPI template –
“Emergency F/U Record”
Reporting Templates: Use “ED Followup
Report” & “Hospitalizations Report”
Other Systems
Considerations:
• Added workload on Nurse Care Managers:– Explore opportunities to reduce inefficiencies• Suggestion: Triage to Medical Records?• Give lookup access to Patient Care CoordinatorsTraining Nurse Care Mgrs on Scheduling?
• Leverage templates within Athena– HPI Template: “Emergency F/U Record”– Report: “ED Followup” & “Hospitalization Report”– Scheduling: Add in drop-down for “appt reason”
RECAP:• “Data” can be quantitative and qualitative• Work backwards• Steps or Tools:– Review data reports to id trends against targets– Workflow mapping of current state & future state– Explore options within our EMR system to automate
functions:• Scheduling• Documentation • Reporting
– Deliver training / update protocols accordingly
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