Healthcare Transformation Learning Session December 5, 2014

Regional partners sharing lessons learned in Greater Columbus

Featured Learning: Primary care organizations sharing quality data Break-Out Session Topics • Patient-Centered Medical Home

Transformation

• Integrating Healthcare

• Choosing Wisely

Upcoming Regional Learning Sessions

Please save these dates from 8:30-11:30am: May 15, 2015

August 21, 2015

December 4, 2015

Healthcare Transformation Learning Session December 5, 2014

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The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. We serve as a catalyst, convener, and coordinator of healthcare transformation & learning in Greater Columbus.

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Topic: Regional partners sharing lessons learned in Greater Columbus Agenda 8:30-8:45 Welcome & framing

• Jeff Biehl, Healthcare Collaborative of Greater Columbus • Krista Stock, Healthcare Collaborative of Greater Columbus

8:45-9:15 Primary care organizations sharing quality data

• Mike Anthony, Mount Carmel Medical Group • Larry Blosser, MD, Central Ohio Primary Care • Rob Strohl, Central Ohio Primary Care • Randy Wexler, MD, The Ohio State University Wexner Medical Center

9:30-10:25 Break-out session – Round 1 10:35-11:30 Break-out session – Round 2

Agenda

Employers Consumers

Providers Health Plans

payment incentives based on value

partner with providers on care coordination

streamline administrative processes

clinical integration care coordination population health

management cultural, language

& health literacy health information

technology

health literacy assistance

engagement in how to use cost and quality information

promote positive behavior change

value-based insurance design

health and wellness programs

partner with providers on care coordination

Transforming to Value-Based Healthcare…

Medicine is in for a radical change as we shift to

performance-driven teams

All members of performance-driven teams will need to function at

“the top of their license”

Measure value: achieving good outcomes as efficiently as possible

Integrating care to be patient-centered

Transforming culture of healthcare organizations…

Source: Catalyst for Payment Reform www.catalyzepaymentreform.org

Public & Private: Payment Reform Framework

Employers are rapidly increasing their participation in regional health improvement collaboratives

Employers are demanding more value from health care delivery systems

Employers are shifting from “payors” to “purchasers” of high value health services

Employers are beginning to change benefits to provide incentives for use of high-value health services and disincentives for lower value services

Public and Private Sector Purchasers (employers, government)

Primary Care Transformation Comprehensive Primary Care Initiative

Federally Qualified Health Center

Advanced Primary Care Practice

Multi-payer Advanced Primary Care Practice

Accountable Care – Payment Reform Bundled Payment for Care

Improvement

Accountable Care Organization (ACO)

State Demonstrations to Integrate Care for Medicare-Medicaid (dual) Enrollees

Financial Alignment Model Demonstrations

Medicare & Medicaid Innovation Center Initiatives

Modernize Medicaid Reform nursing facility reimbursement Integrate Medicare and Medicaid benefits Rebalance spending on long-term services and supports Create health homes for people with mental illness Restructure behavioral health system financing Improve Medicaid managed care plan performance Streamline Health and Human Services Consolidate mental health and addiction services Create a cabinet-level Medicaid department Modernize eligibility determination systems Integrate HHS information capabilities Coordinate programs for children Share services across local jurisdictions Improve Overall Health System Performance Pay for health care based on value instead of volume Encourage Patient-Centered Medical Homes Accelerate electronic Health Information Exchange

Ohio: Current Initiatives

Our Regional Strategic Areas of Focus

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…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers

PATIENT ENGAGEMENT PATIENT-CENTERED MEDICAL NEIGHBORHOOD

COLLABORATIVE LEARNING QUALITY TRANSPARENCY

…improve engagement between patients and providers

…improve care coordination between providers & social services

…improve the use of quality data

…improve the application of learning in Greater Columbus

Collaborative activity with Patient-Centered Medical Homes in

Greater Columbus

Quality Reporting Pilot

PCMH Public Reporting (emerging)

Quality Transparency… improve the use of quality data

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Quality Reporting Pilot

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Pilot Purpose: Based on nationally endorsed measures for managing chronic conditions: • Compile all-payer data every six

months from electronic medical records (EMRs) at participating primary care practice sites.

• Share comparable quality data across participating providers and regional purchasers.

• Apply learning from quality reports to catalyze quality improvement.

Participating Providers • Central Ohio Primary Care

(34 practice sites) • Mount Carmel Medical Group

(17 practice sites) • The Ohio State University Wexner

Medical Center (13 practice sites)

Participating Purchasers Aetna, Anthem Blue Cross and Blue Shield, Cardinal Health, County Employee Benefits Consortium of Ohio, Employers Health, Franklin County Cooperative, Health Benefits Program, Health Action Council, MediGold, Nationwide Insurance, Ohio Bureau of Workers' Compensation, Ohio Public Employees Retirement System , OSU Health Plan, School Employees Retirement System of Ohio, State Teachers Retirement System of Ohio, The Dispatch Printing Company, The Ohio State University, UnitedHealthcare

A good place

to start!

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Quality Reporting Pilot Overview

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Primary Care Practices

use reports to improve quality of care provided by your organization

share lessons learned to help improve healthcare transparency in Greater Columbus

will not use pilot content to promote or publicize physician practices

Purchaser Learning Group

share lessons learned to help improve healthcare transparency in Greater Columbus

will not use pilot content to promote or publicize physician practices

Healthcare Collaborative of Greater Columbus

provide technical services sufficient to support the pilot maintain safe-space to enable the sharing of learning with pilot

participants apply learning to catalyze best practices to improve healthcare

transparency in Greater Columbus will not use pilot content to promote or publicize physician

practices

Quality Reporting Pilot Overview – Terms of Use

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Quality Reporting Pilot: Q3/2013 – Q2/2014 (data not risk adjusted)

# Patients Lowest Average Highest

Diabetes Patients 18-75, Hemoglobin A1c (HbA1c) Poor Control (>9%) NQF #0059

44,947 35% 11% 3%

Diabetic Patients 18-75, Blood Pressure Management (<140/90) NQF #0061

37,018 50% 73% 92%

Diabetes Patients 18-75, Low Density Lipoprotein (LDL) Management NQF #0064

13,884 40% 56% 79%

Hypertensive Patients 18-85, Blood Pressure Management (<140/90) NQF #0018

79,254 51% 70%

89%

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Today’s Panel Mike Anthony, Mt. Carmel Medical Group Rob Strohl, Central Ohio Primary Care Larry Blosser, MD, Central Ohio Primary Care Randy Wexler, MD, The Ohio State University Wexner Medical Center Discussion What has been your major learning so far from participating in the quality reporting pilot?

Quality Reporting Pilot – Share Learning

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Continue primary care quality reporting pilot with focus on quality improvement • invite current/additional providers to share EMR-based data

aligned with PCMH/CPC measures

• frequency of data submission every six months

• coordinate pilot until such time Ohio’s SIM infrastructure is standardized across the state for measuring PCMH/CPC quality improvement

In 2015 – Public Reporting Phase in collaboration with Robert Wood Johnson Foundation and Consumer Reports • Design and implement a quality data portal via a collaborative process with

participating primary care providers and the Purchaser Learning Group

In 2016 - Regional quality data insert in Consumer Reports Magazine

Quality Transparency – Next Steps

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DOCTOR Project – Public Reporting

Participating Providers • Central Ohio Primary

Care

• Columbus Neighborhood Health Center, Inc.

• Heart of Ohio Family Health Centers

• Lower Lights Christian Health Center

• Mount Carmel Medical Group

• OPEN invitation to others in Greater Columbus

DOCTOR Project Vision Data on Clinicians to Optimize Results

People across the region will have a new way to find and share reliable

information on health care performance resulting in an overall

improvement in health.

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DOCTOR Project – Public Reporting – Learning from other regions

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Lessons Learned • Consumers very receptive to

ratings inserts

• Consumers asked why certain medical groups were not included – useful in medical group recruitment

• Mutual consent needed between providers and reporting organizations

• Listing practices in alpha order better than by rankings

DOCTOR Project – Public Reporting – Learning from other regions

Collaborative activity with Patient-Centered Medical Homes in

Greater Columbus

Quality Reporting Pilot

PCMH Public Reporting (emerging)

Quality Transparency… improve the use of quality data

www.hcgc.org

Please join me in congratulating our panel and the organization’s they represent for leading quality transparency in Greater Columbus!