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The Three Phases of Collaboration: Chronic Disease Management, Cancer

Prevention, and Capacity

Kim Salamone, Ph.D.Vice President, Health Information Technology

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Health Services Advisory Group

Quality Improvement Organization for Arizona, California, and Florida

Subrecipient for Arizona Regional Extension Center (REC)

Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance

Partners with physicians, health plans, nursing homes, hospitals

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Agenda Overview of 3 Phases

–Goals–Outcomes–Lessons Learned

Barriers to reporting Motivation to overcome barriers

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National Strategy for Quality Improvement in Healthcare

Better Care Reduce harm caused by poor-quality care.Increase patient engagement.Improve communication and care coordination.

Better Health for Populations Promote prevention and treatment of leading causes of mortality, starting with cardiovascular disease.Affordable Care Make quality care more affordable by developing and spreading new healthcare delivery models.

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Phase 1: Chronic Disease Management

Use Electronic Health Records (EHRs) to manage patients with chronic diseases => increased quality of healthcare

Baseline of Stage 1 core meaningful use (MU) and core clinical quality measures (CQMs)

Mammography screening, colorectal cancer screening, cervical cancer screening, and chlamydia screening

Administered the ASHLine Tobacco Cessation Assessment Tool to each site

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Phase 1 Outcomes

No CHCs had actually reached MU. Medicaid Adopt/Implement/Update (AIU) Out of the 8 community health centers (CHCs)

that purchased NextGen, only Chiricauhua and Adelante had received the necessary health quality measures (HQM) module.

The HQM was proven problematic– Some interfaces didn’t work– Calculations were wrong on CQMs

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Phase 1: Lessons Learned

Thresholds were difficult to meet for MU:– Clinical summaries– Providing patients with an electronic copy of

their health information (including diagnostic test results, problem lists, medication lists, medication allergies) upon request

– Reminders to patients, per patient preference, for preventive/follow up care

Diabetes measures were difficult to calculate for NextGen users.

Users struggled with documentation.

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Phase 2: Cancer Screening Measures

Limited budget and scope– Adelente Healthcare – Mountain Park – Maricopa County Health Care for the Homeless (MCHCH)– Wesley

Providers had met Stage 1, year 1 MU– Adelente could not produce the CQMs– MCHCH was the only one where baseline measures were

generated for diabetes measures

Every CHC improved– Breast cancer screening– Diabetes LDL management control– Diabetes A1C control

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Phase 2: Lessons Learned

Healthcare reform requires implementing change systemically – Using an EHR in a meaningful way – Improving quality measures – Implementing quality improvement projects – Emphasizing preventive medicine

Barriers that remain:– Data entry of labs, cancer screening reports, and

other scanned-in reports– Changes in EHRs

Users still struggle with documentation

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Phase 3: Capacity Building EHRs

– 2 Next Gens – 1 eCW

Aligned with Arizona Department of Health Services (ADHS) and Centers for Disease Control and Prevention (CDC) measure interests

Five distinct elements– Assessment– Baseline determinations– Workflow review– Capacity development– Identify best practices

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Phase 3: Assessment

Current utilization of the EHR to maintain current and complete information related to multiple measures– MU-focused

• Measure specifications different• 90 days

– EHRs restricted outside of MU requirements– Issue with 2014 versions

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Phase 3: Capacity Building

Currently generating measures:– Current baseline screening rates for breast, cervical and

colorectal cancers– Percent of the diabetes population within range for

HbA1C – Percent of population with smoking assessed, and a

referral to ASHline recorded for smokers– Percent of population with BMI assessed and recorded– Percent of population with complete HPV

immunizations– Percent of population with alcohol use assessed– Percent of population with physical activity assessed,

addressed

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Phase 3: Current Status and Next Steps

Current Status– Have baseline measures for Adelente– Feedback reports generated for each site– Started workflow analyses at each site

Next Steps– Obtain baseline from the other 2 CHCs– Produce feedback reports and conduct workflow analyses– Capacity development

• Train the trainer on generating care management reports• Implement preventive, patient-centered procedures

– Share best practices with ADHS, Arizona Alliance for Community Health Centers (AACHC), and others for dissemination

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Barriers to Reporting

Physician buy-in– Takes away from direct patient care– Adds work time– Less efficient than paper

EHRs– Some have multiple ways to input the same

measure, example: BP– Confusion regarding requirements– Standards– Interoperability

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Motivating providers

Must align with National Strategy Must demonstrate level of care Must demonstrate quality of care The U. S. Department of Health and Human

Services (HHS) beginning to align measures and payment mechanisms– MU– PCMH– ACA– PQRS

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Additional Questions?

Kim Harris-Salamone, PhD, MPAVice President, Health Information Technology

Health Services Advisory GroupKSalamone@hsag.com