ncqa diabetes presentation
TRANSCRIPT
1
Geisinger Health Plan: A Comprehensive Diabetes
Strategy
2
HEDIS 2009 Results
Comprehensive Diabetes Care:Commerci
al
National 90th
Percentile
HbA1c tested 93.61% 93.67%
HbA1c Poor control (>9.0%) - LOWER IS BETTER 19.71% 18.73%
HbA1c <8.0% 68.25% N/A
HbA1c <7.0% 49.64% N/A
Lipid Profile performed 89.23% 89.78%
Lipids controlled <100 mg/dL 47.81% 53.86%
Diabetic Retinal Eye Exams 66.69% 73.72%
Kidney Disease monitored 87.96% 88.95%
Blood Pressure <140/90 68.07% 73.68%
Blood Pressure <130/80 36.31% 41.83%
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HEDIS 2009 Results
Comprehensive Diabetes Care:Medicare
Advantage
National 90th
Percentile
HbA1c tested 94.40% 94.89%
HbA1c Poor control (>9.0%) - LOWER IS BETTER 11.92% 11.92%
HbA1c <8.0% 77.62% 79.80%
HbA1c <7.0% N/R N/R
Lipid Profile performed 92.46% 92.58%
Lipids controlled <100 mg/dL 63.26% 63.99%
Diabetic Retinal Eye Exams 85.89% 78.06%
Kidney Disease monitored 94.16% 93.40%
Blood Pressure <140/90 57.91% 72.02%
Blood Pressure <130/80 32.85% 42.35%
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Geisinger Providers Perform Well
Comprehensive Diabetes Care: Clinic Panel
HbA1c tested 96.83% 90.15%
HbA1c Poor control (>9.0%) - LOWER IS BETTER 14.08% 25.76%
HbA1c <8.0% 71.13% 65.15%
HbA1c <7.0% 50.93% 48.26%
Lipid Profile performed 92.96% 85.23%
Lipids controlled <100 mg/dL 54.58% 40.53%
Diabetic Retinal Eye Exams 80.28% 50.00%
Kidney Disease monitored 94.01% 81.44%
Blood Pressure <140/90 66.90% 69.32%
Blood Pressure <130/80 39.44% 32.95%
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Current Status
Almost 9,000 members with Diabetes Member barriers:
Don’t know tests were needed Too busy or forgot Co-payment issues Other health issues Services conducted at the VA Previously well controlled Socio-economic issues (e.g.
transportation)
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Health Services Strategy
Health Management Nurses Case Management Nurses at Medical Home
sites (ProvenHealth(SM) Navigator) Open communication lines
On-site nurse Able to pend orders Electronic reminders to providers
Sweet-spot with Geisinger System EMR “Bundles” with monthly provider reporting SNF Care Model Transitions of Care
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Quality Improvement Strategy
Diabetic eye exam member mailing Included retinal exam forms for
ophthalmologist/optometrist Led to 10% increase in data collection Facilitated appointment scheduling
3,259 QI Nurse telephonic outreach calls 7% of members unaware of diagnosis
Secured lab data from large contracted laboratories Currently 7 labs
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2009 Outreach Strategies
Diabetes Health Passport QI nurse outreach Outcomes Outreach
Provider initiative for control measures
Diabetic Eye vendor pilot Targeted interventions through
Provider Network Management MA Focus Groups/Advisory Panel
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Data Strategies
Pay-for-Performance Publicly available Physician Quality
Summaries (PQS) Member Health Alerts
Provider specific non-compliant lists
Monthly Proactive reports Number Needed to Treat
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Physician Quality Summary
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Member Health Alerts
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Proactive HEDIS Graph
93
.61
%
31
.21
%
84
.47
% 89
.84
%
30.5
0%
49.1
8%
61.0
2%
69.7
0%
76.9
7% 80.4
8%
90
.02
%
91
.48
%8
9.7
8%
49
.39
%
61
.32
%
69
.23
% 75
.51
%
78
.86
%
81
.32
% 86
.86
%
88
.74
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Final HEDISResults
February March April May June July August September October November December
HEDIS 2006HEDIS 2007HEDIS 2008HEDIS 2009HEDIS 2010
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Number Needed to Treat
Diabetes Care - LDL-C Screening
Denominator Numerator Rate
HEDIS 2009 548 489 89.23%
PAH 6/09 4607 3045 66.10%
2009 Nat'l PercentileUSNWR Stars
Records needed to
meet percentiles:
Number of additional GHP
members to achieve:
90th 89.78% 5 4136 1091
75th 87.41% 4 4027 982
50th 85.07% 3 3919 874
25th 82.48% 2 3800 755
10th 79.32% 1 3654 609
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Takeaways
Leadership support necessary Multi-team approach is most effective Collaboration with provider groups improves
communication and aligns incentives Control measures require special focus Data analysis and reporting is key There are no ‘silver bullets’
Questions?
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Contacts
• David L. Evans [email protected] 570-271-5108
• Jennifer Brudnicki [email protected] 570-271-5339