Michigan Quality Improvement Consortium

2005 Activity Highlights

Member Organizations

• Blue Cross Blue Shield of Michigan • Blue Care Network• Care Choices• Community Choice Michigan• Great Lakes Health Plan- New Member• Health Alliance Plan• HealthPlus of Michigan• Health Plan of Michigan• M-CARE• Midwest Health Plan• Michigan Association of Health Plans

Member Organizations (cont’d)

• Michigan Department of Community Health• Michigan Osteopathic Association• Michigan State Medical Society• Molina Health Care of Michigan• Michigan Peer Review Organization• Physicians Health Plan of Mid-Michigan• Physicians Health Plan of South Michigan• Physicians Health Plan of Southwest Michigan• Priority Health• Total Health Care, Inc. – New Member• University of Michigan Health System

Guideline review/updating in 2005

•Medical Management of Adults with Osteoarthritis

•Screening and Management of Substance Use Disorders

•Outpatient Management of Uncomplicated Deep Venous Thrombosis

•Medical Management of Adults with Hypertension

• Screening and Management of Hyperlipidemia

• Tobacco Control •Management of Osteoporosis

Medical Directors’ Activities

New guideline development in 2005

•Identification, Evaluation and Treatment of Overweight and Obesity in the Adult (approved 03/05)

•Adult Preventive Services (approved 07/05)

•Prenatal Care (draft #3)

•Pediatric Preventive Services (draft #1)

Medical Directors’ Activities

Medical Directors’ Activities(Cont’d)

Future Guideline Development Agenda

• Chronic Kidney Disease

• Low Back Pain

• Pediatric Obesity

• Acute Bronchitis

• Medical Management Post Myocardial Infarction

MQIC Measurement Group

• HEDIS® and non-HEDIS® compliance measures and measurement specifications have been developed for the following MQIC guidelines:

• Diabetes• Asthma• Tobacco Control• Depression• Substance Use• Hyperlipidemia• Hypertension• Acute Pharyngitis

MQIC Measurement Group(Cont’d)

• Revised lipid-lowering drug list and AHFS codes for diabetes non-HEDIS® measure (percent members on lipid-lowering drugs)

• Significant work has been done to develop measures and measurement methodologies for the heart failure and osteoporosis guidelines

• Analysis completed on MQIC Diabetes Pilot aggregate physician reports

• MQIC health plans submitted HEDIS® 2005 and non-HEDIS® data for MQIC performance reporting

MQIC Implementation Group

• Instrumental in the distribution and review of MQIC guidelines and collection of feedback

• Promoted MPRO DOQ-IT project• Developed list of potential future collaborative

initiatives, including:• Multi-payer performance reports for diabetes, asthma and

depression using administrative data

• Adoption of Asthma Initiative of Michigan’s Mark Toolkit as supplemental tool for MQIC asthma guideline

MQIC Implementation Group(Cont’d)

• Increase physician recognition and awareness of MQIC guidelines, activities and resources

• Identify supplemental materials/tools that will facilitate guideline usage in the practice setting

• Coordinate and assist Michigan Primary Care Initiative work group in assessing existing tools

Coordination with Other Efforts

GDAHC “Save Lives Save Dollars” Initiative

Primary Care Initiative for a Healthier Michigan

GDAHC “Save Lives Save Dollars”

              

 

PROPRIETARY © Thomas Group, Inc All Rights Reserved

How We Got Here

GDAHC formed Future Directions Initiative Steering Committee Measurement and Reporting Expert Panel Payment Expert Panel Cost Savings Ad Hoc Committee Public Reporting Ad Hoc Committee Out patient / In Patient Ad Hoc Committee Business Case Ad Hoc Committee

Save Lives Save Dollars (SLSD) resulted

Business Plan published

Thomas Group hired to manage

              

 

PROPRIETARY © Thomas Group, Inc All Rights Reserved

How We Got Here

GDAHC formed Future Directions Initiative Steering Committee Measurement and Reporting Expert Panel Payment Expert Panel Cost Savings Ad Hoc Committee Public Reporting Ad Hoc Committee Out patient / In Patient Ad Hoc Committee Business Case Ad Hoc Committee

Save Lives Save Dollars (SLSD) resulted

Business Plan published

Thomas Group hired to manage

              

 

PROPRIETARY © Thomas Group, Inc All Rights Reserved

Organizational Process

GDAHC Board

CFT 4Measurements

5 Members

CFT 3Public Reporting

5 Members

CFT 2Differential Payment

5 Members

CFT 1Evidence Based Practice, Cost Savings & Quality

7 Members

SLSDSteering Committee

Results Improvement TEam(RITE) – 11 Members

Generic Rx

BRT 1 BRT 2 BRT 1 BRT 2 BRT 1 BRT 2Diab.

CFT – Cross Functional TeamBRT – Barrier Removal Team

Sub CFT 3

Sub CFT 4

              

 

PROPRIETARY © Thomas Group, Inc All Rights Reserved

CFT Membership

Industry

M. Manning GM

S. Peters Comerica

K. Kohn-Parrott Daimler Chrysler

R. Lueders DTE

R. Turner-Bailey

Ford

Providers

J. Billi U of MR. Frank Oakland Co Med Soc

D. Muenk MSMS

P. LaCasse Botsford

M. Johnson Beaumont

M. Henoch

Oakwood Health Care

S. Grant United Physicians

T. Lundstrom - DMC

Payor / HP

B. Pai HAP

G. Kipa BCBS

K. Seitz BCN

Z. Geyer-Sylvia MCare

W. Alvin Care Choices

J. Halman MCareE. Tuller Care Choices

Others

M. Abbott Thomas Group

D. Ebers GDAHC

H. Lock Thomas Group

J. Kerr GDAHC

R. Robinson Thomas Group

B. Hurd GDAHC

H. Lock Thomas Group

D. Ebers GDAHC

CFT 1 – Evidence Based Practice, Cost Savings and Quality

CFT 3 – Public Reporting

CFT 4 – Measurements

Chairperson Updated 11/15/05

CFT 2 – Differential Payment

Primary Care Initiative for a Healthier Michigan

Michigan Steps Up:Stakeholder Groups

Business

Healthcare

Schools

Faith-based

Community

Mission The Primary Care Initiative for a Healthier Michigan is a statewide, broad-based group of key stakeholders and other interested parties convened to collaborate to improve the system of delivering prevention services and management of chronic disease and/or other conditions in primary care settings throughout Michigan.

Priority System Barriers •Referral and Access to other Professionals/ Community Resources

•Access to a Comprehensive Patient Data Base (Health Record)

•Payment Structure/Reimbursement

•Multiple Guidelines (Work group co-chair – Marc Keshishian)

•Shift from Episodic Care to Health Promotion

 

    

Goals 1. The Primary Care Initiative (PCI) will endorse Michigan Quality Improvement Consortium (MQIC) as a central source for practice guidelines in Michigan.2. The Primary Care Initiative and partners will facilitate the dissemination and implementation of MQIC guidelines to all primary care providers in Michigan.

1. Obtain MQIC collaboration and agreement to be the central source of practice guidelines in MI.

2. Secure agreement of payers and other stakeholders to support MQIC as the central source of practice guidelines

3. Identify a process for addressing input for and gaps in MQIC guidelines.4. Identify a process for incentives to primary care providers to promote the use of

MQIC guidelines. 5. Develop a single set of performance measures based on MQIC guidelines to be

used for evaluation and reporting.6. Educate primary care health professionals in MI about MQIC guidelines and facilitate

their use.

Objectives

Other Activities

•Interview with Robert Wood Johnson

•National Guideline Clearinghouse

•HAP Quality Expo

•BCBSM Provider Information Fairs

•Southfield, Port Huron, Saginaw