1. health and fitness

Alliance Town Hall
Webinar
October 24, 2014
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Today’s Topics
• Alliance Quality Symposium/
QIE Roadmap Update – Destry Sulkes
• Updates on Alliance Staffing:
Executive Director Search and AMC –
Destry Sulkes
• Alliance Committees/How to Get Involved –
Jacob Coverstone & SarahAnn Whitbeck
• 2015 Annual Conference – Mary Ales
Alliance QIE Initiative
ACEhp’s Quality Improvement Education Initiative
Destry Sulkes, MD, MBA
President, ACEhp Board of Directors
http://www.ahaphysicianforum.org/team-based-care/CME/index.shtml
The QIE Initiative
Alignment with ACEhp Strategy?
– Expand beyond CME to all CE providers
– Build bridges to a broader set of stakeholders
– Create resources for members to measure &
communicate impact of education
– Increase the relevance of education in “learning
healthcare organizations”
Alliance QIE Initiative:
A Transformation Shift
QIE
CPD
medicine
CME
nursing
Physicians
Knowledge
Knowledge
Competence
Healthcare
Team
Competence
Healthcare
Institutions
Systems
Change
Health
Informatics
Cost
Effectiveness
Payors
Health
Outcomes
Practice
pharmacy
others
The QIE Initiative
What do ACEhp members say*?
Increasing QI Activity, Yet a Lack of Educators' Involvement in QI
Though 73% of members see QI activities occurring in their organizations, only 26%
are actively involved in the planning / delivery of these QI activities
Increasing Need for QI Expertise, Yet Educators Have Limited Access
Though 84% of members see professional development in QI as important to their
career, only 26% have an advanced level of QI expertise.
* QIE Survey of >1,700 members, >500 responses for a >30% response rate. ~30% hospital-based, ~20% medical
specialty societies, ~20% inter-professional education companies, <10% each of: pharma/device companies,
medical schools, & federal healthcare educators
The QIE Initiative
What is the vision?
 Education will be integrated more consistently
and successfully in QI as part of an ongoing
paradigm shift from volume of care delivered, to
quality outcomes achieved
 The value of education & educators will be more
universally appreciated, starting with QI
stakeholders, and then going more broadly
The QIE Initiative
Who is funding this?
1. Today: QIE-oriented grantors from life
science companies and a leading healthcare
education portal
2. Tomorrow: Payors, Healthcare Systems,
Foundations, Federal and State Government
Institutions like CMMS, AHRQ
The QIE Initiative
What’s the game plan?
Start a sustained process to integrate education into healthcare systems’ “DNA”
• Map US health care stakeholder areas for listening,
collaboration and engagement
• Assemble stakeholders, identify QIE value propositions
• Organize “Building Blocks” needed to achieve QIE
• Build tools to design, deliver and measure QIE
Pt Engagement Webinar
QIE Webinar
QIE Initiative Timeline
AQS
Apr
May
June
July
Aug
Sept
Ann. Conf.
Oct
Nov
Dec
Jan
QIE Advisory Panel
The Advisory Panel “brings the outside in” with
healthcare leader authors from key organizations
necessary to provide insights and context to QIE:
ABMS, ACPE, AANC, Patient Advocacy, AHA, IHI,
HIMSS, Academic Centers & Inter-professional
Education Companies.
QIE Roadmap Advisory Panel
Christine Bechtel, MA
President, Bechtel Health Advisory Group
Carolyn M. Clancy, MD
Interim Under Secretary for Health,
Department of Veterans Affairs
Kathleen Moreo, RN-BC, BSN, BHSA, CCM,
Cm, CDMS
President and CEO, PRIME Education Inc.
Lloyd Myers, RPh
President, CECity.com Inc.
John R. Combes, MD
Senior Vice President, American Hospital
Association
Mellie V. Pouwels
VP, Academic Programs & Services,
American Board of Medical Specialties
Rita M. Gallagher, PhD, RN
Nursing and Healthcare Consultant
Joan Straumanis, PhD
Higher Education Consultant
Tom Granatir
SVP, Health Policy and External Relations,
American Board of Medical Specialties
Chitra Subramaniam, PhD
Assistant Dean & Director, Duke Continuing
Medical Education
Jack Kues PhD, CCMEP
Associate Dean for CPD University of
Cincinnati
Jane A. Taylor, EdD
Improvement Advisor
Institute for Healthcare Improvement
QIE Domain Leaders
The Domain Leaders, as ACEhp member
volunteers, edit the QIE Roadmap Report as
drafted by the Advisory Panel, incorporating
Domain Descriptions, Recommendations and
References, with Case Studies*.
* SQUIRE Methodology: http://www.squirestatement.org/
QIE Domain Leaders
Taxonomy, Definitions, & Interventions
Sandra Haas Binford, MA Ed
CME Outfitters
Kathleen Geissel, PharmD, CCMEP
Medscape
Environmental Scanning & Information
Dissemination
Jan Pringle, PhD
University of Pittsburgh School of Medicine
Professional Competencies
Laura Lee Hall, PhD
American College of Physicians
Professional Development
Lois Colburn
University of Nebraska Medical Center
Quality Metrics
Marianna Shershneva, MD, PhD
University of Wisconsin School of Medicine
Health IT
Julie White, MS
Boston University School of Medicine
Regulatory Requirements
Todd Dorman, MD
Johns Hopkins University School of Medicine
Business Models of Support & Reimbursement
Chris Goeschel, ScD, MPA, MPS, RN
MedStar Health
Policy & Ethics
Bob Birnbaum, MD, PhD
Harvard Medicine/Mass General
Building and Using the Evidence Base
Curt Olson, PhD
Geisel School of Medicine at Dartmouth
QIE Commentator Group
The Commentary Group further “brings the outside in”
via structured interviews with a broader group:
Health Affairs, CMMS (Medicare), Veterans Health
Administration, The Joint Commission, Federation of American
Hospitals, NQF, NCQA, Payors, ACOs, AMA, AAMC, CMSS,
Academic Medical Quality Groups, Not-for-profit Hospital
Provider Groups, Health Innovation Initiative, eHealth Initiative,
& The Macy Foundation.
QIE Roadmap with 10 Domains to
Guide Education when Integrated in QI
Triple Aim
6 National Quality
Priorities
National Quality Strategy
Environmental
Scanning and
Information
Dissemination
Taxonomy, Terms
and Interventions
Building and
using the
evidence base
Professional
Competencies
x
QI
Policy and Ethics
Professional
Evaluation
Business Models
of Support and
Reimbursement
Quality Metrics
Regulatory
Requirements
Health IT
Recommendations
• Overarching Recommendations
– Foster collaboration and organizational partnerships
– Use the SQUIRE guidelines to frame all QIE activities;
teach educators to use SQUIRE within their institutions
– Support educational activities for patients and families
focused on quality improvement and the QIE initiative
• Recommendations then Mapped to 10 Building Blocks
Inclusion of Case Studies and SQUIRE
Guidelines in the QIE Initiative
Designed to:
• Provide a tool for planning QIE projects
• Establish a standard set of education formats and
quality metrics data elements
• Create case studies for broad scale data collection
with a standard format for meta-analyses
Inclusion of Case Studies and SQUIRE
Guidelines in the QIE Initiative
Three phase initiative:
• Phase 1: A pilot effort to test the reporting tool
• Details in tomorrow’s session
• Phase 2: Revise/adapt the reporting tool
• Educate membership on how to use
• Phase 3: Widespread integration
• Assemble aggregate data sets from the tool,
to conduct meta-analyses
What’s Next?
Today: Concurrent workshops beginning at 4:15 today, Sept 23rd
– Seeking insight from ACEhp membership related to current
recommendations, additional considerations, and professional needs
November thru end of December 2014:
– “Call for Comments” on ACEhp website
– Solicit comments from Domain leaders, advisory panel and
commentary group
January 2015:
– Final QIE Roadmap Report at ACEhp Annual Conference in Dallas,
January 14-17th, 2015
– Peer-review publication submission(s)
– Establish “living document” parameters for ongoing input
What’s Next?
QIE Updates at each ACEhp live meeting
• ACEhp Annual Conference in January
• Alliance Industry Symposium in Spring
• Alliance Quality Symposium in Fall
QIE Phase 2 Grantor Strategy Sessions
• Monthly updates on Phase 1 for current grantors
• New solicitation for Phase 2 grants to current and new grantors
• Live meetings in parallel with QIE Updates
Alliance Committees
• Updates to the Membership and Education
committee structures have been completed
• Opportunities to volunteer
– Email the Alliance at [email protected]
– Committee members needed
– Mentor/Mentee Program
• Opportunities to engage
– At the Annual Conference
– President’s Panel
– Ongoing information to ACEhp Members
Want to be heard?
– Breakfast with the Board
• Saturday, January 17
• Submit questions to
[email protected]
by Friday, January 16 –
or join us in person.
– Suggestion boxes
• e-idea boxes available
through the conference
app and text message.
• Physical boxes available
at registration and
Member Engagement
Lounge.
Want to be heard?
• President’s Panel
– Monthly, small-group, phone conferences with Ed Dellert
(2015 ACEhp President)
• Discussion will include your ideas, proposed plans for
the ACEhp, etc.
– If interested, please email [email protected]
to make arrangements.
• Where will these responses from the Panels go?
– ACEHP website
– Future Almanac publications
January 14-17, 2015
Register at www.ACEhpAnnual.org
1. Precons
Research
Basics
Leadership
Visualizing
Data
2. Keynotes
Jennifer Golbeck PhD
Laura Adams
3. Celebrate
4. Exhibitors
Foundation
5. Engage
Education
Coalition
Membership
SIGs
6. Tracks
ACCREDITATION&CERTIFICATION
SYSTEMSTHINKING
LEARNINGSTRATEGIES
OUTCOMES&ASSESSMENTS
TECHNOLOGY
PROFESSIONAL ADVANCEMENT
PERFORMANCE/QUALITYIMPROVEMENT
BASICS
RESEARCH
THINKINGOUTSIDETHEBOX
7. Storyboards
• QI
• Research
• Awards for
top posters
SoonerCare Chronic Disease Management
Performance Improvement Ini a ve
Mike Speight, Telligen
Heidi Ness, IPMA
Health Care Problem
Educational Strategy
The state of Oklahoma has a significant need for chronic
disease management as evidenced by high disease burden.
Data from the CDC indicate that Oklahoma ranks 48th for
diabetes deaths, 48th for stroke deaths, and 49th for heart
disease deaths.1 Chronic diseases are among the most
costly of all health problems; treatment of chronic disease
accounts for more than 75 percent of total U.S. health care
spending. Providing care to individuals with chronic
diseases, many of whom meet the federal disability
standard, has placed a significant burden on state Medicaid
budgets.
Telligen deployed a team of registered nurse prac ce facilitators
in Oklahoma to provide one-on-one in-office coaching. Physicians
at each site lead their office staff to improve their efficiency and
quality of care through the following ac vi es:
In 2006, the Oklahoma Medicaid Reform Act mandated the
Oklahoma Health Care Authority (OHCA) to develop and
implement a management program for chronic diseases,
including but not limited to asthma, chronic obstruc ve
pulmonary disease, conges ve heart failure, diabetes and
hypertension. Thus the SoonerCare Health Management
Program (HMP) was established in 2008 to improve pa ent
health status of chronically ill SoonerCare members while
reducing unnecessary medical expenditures at a me of
significant fiscal constraints.
• Reviewing claims and clinical records using a standardized
audit tool to iden fy gaps in care compared to evidencebased clinical guidelines;
• Assessing their exis ng processes for quality improvement;
• Developing and implemen ng educa onal and other
interven ons based on the results of the audit tool and care
process assessment;
• Implement a system for ongoing performance measurement
to assess the quality of care for individual pa ents and the
overall popula on of pa ents seen in the prac ce and to
access the impact of process changes and other
interven ons; and
• Build skills among the prac ce team that supported a selfsustaining performance improvement culture in the prac ce.
Educational Strategy, continued
Measures for six chronic condi ons were targeted for
improvement and tracked through a clinical data registry:
•
•
•
•
•
•
Asthma
Chronic Obstruc ve Pulmonary Disease (COPD)
Coronary Artery Disease
Diabetes
Conges ve Heart Failure
Hypertension
A er selected for facilita on services, the prac ce team
works with the assigned facilitator to outline the most
appropriate implementa on schedule of core components.
Core prac ce facilita on components include:
•
•
•
•
Founda onal/infrastructural development;
Full prac ce assessment/evalua on;
Process improvement interven ons; and
Registry implementa on.
Outcomes, continued
Overall improvement on the clinical measures ranged from
a low of 3.75% aggregate improvement on the
hypertension measures to a high of 10.4% aggregate
improvement for the COPD measures. Improvement in the
other clinical topic areas was also seen: asthma measures
improved 3.8%, and diabetes measures improved 4.9%.
Aggregate data compiled during the first three years of
program opera ons revealed a significant cost savings for
the state. The PMPM medical expenditures for all pa ents,
regardless of condi on, were below forecast. Savings
equaled $15 PMPM, or two percent, during the first twelve
months and $90 PMPM, or 13 percent, during the second
twelve months. Overall net savings to the state totaled
over $86 million over this me period.
Outcomes
One component of the program, Prac ce Facilita on, was
designed to build QI skills in the primary care se ng,
implement evidence-based guidelines into the prac ce, and
deploy an ongoing performance measurement system to
assess program impact. These interven ons were designed
to improve clinical outcomes for pa ents and lower costs
for the state Medicaid agency.
Of the 76 prac ces involved in this project, a total of 90
clinicians (including MD, DO, NP, PA and RN) completed the
12 month cycle of the Chronic Disease Management PI CME
project. Results from 74 par cipants have been assessed. A
total of 52 (70%) selected more than one chronic disease for
their PI CME ac vity. Sixty-five percent of par cipants
focused on diabetes management, 52% focused on
hypertension, 15% worked on coronary artery disease and
11% focused on asthma.
Telligen, a na onal quality improvement & medical
management firm specializing in care, quality and
informa on management services was chosen to provide
nurse care management and prac ce facilita on to OHCAdesignated primary care providers in the SoonerCare
network.
IPMA, a physician led 501(c)(3) organiza on, provides
evidence-based educa on that leads to improved
competence, enhances prac ce performance, assurance of
pa ent safety and improved pa ent care collaborated with
Telligen to provide CME/CE and MOC Part IV cer fica on
for this educa on.
Amy Holthusen, IPMA
1CDC
data, 2008, Number of deaths due to disease per 100,000
Program-level impact data documented sta s cally
significant improvement on over 50% of the quality measures
included in the program. Among the 90 clinicians
par cipa ng in the project:
• 90% report making changes in management of pa ents
with chronic condi ons
• 87% credited program with improving care they provide
• 80% are conduc ng performance measurement using a
disease registry
• 93% would recommend program to peers
Administra ve costs for the prac ce facilita on component
of the SoonerCare Health Management Program totaled
$7,406,342 ; the medical savings a ributable to this
component, however, total $49,195,274 (a 564% Return
on Investment).
8.
9. Take Something Home
10. You!
Top 10 Reasons to Attend
1.
2.
3.
4.
5.
Precons
Keynotes
Celebrate
Exhibitors
Engage
6. Tracks
7. 80!
8. Storyboards
9. Take something home
10.You
E
Thank you &
see you in Texas!
You can also email us anytime at [email protected]
Submit your questions and comments!
Thank you!
Contact us at [email protected]
with any questions or comments.
Next Town Hall:
November 14, 2014 1:00 p.m. ET