NC AHEC’s Role in Healthcare Quality,

Technology and Reform

Ann Lefebvre MSW, CPHQ

NC AHEC

The mission of the NC AHEC Program is to meet the state’s health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina.

NC AHEC Statewide Map

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Source: NC AHEC Program

MountainGreensboroSouth EastNorthwest Southern Regional

Area L CharlotteWake Eastern

NC AHEC’s Core Services1. Community-Based Student Training.

Each year over 10,000 student months of student training

2. Primary Care Residency Programs. Over 1,500 physicians in NC graduated from an AHEC

residency program.

3. Continuing Education. Served nearly 200,000 health professionals in 2009

4. Library Services. Last year over 7,000 individual health professionals used

the AHEC Digital Library

5. Health Careers and Workforce Diversity. Over 35,000 young people were served by health careers

programs in 2009

North Carolina’s Improving Performance in Practice

Mission: To provide primary care practices with the

systems and support to provide high quality care to improve patient health.

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What are we trying to

accomplish?

How will we know that achange is an improvement?

What change can we make that

will result in improvement?

Model for Improvement

Act Plan

Study DoLabs

Procedures

InjectionsInfusions

Support Groups/Educational Visits

referrals

consults

follow up/call back

Front End Back End

Ancillary

Prescription refills

Phone triage

Vitals

Review of systemsMedication reconciliation

Diagnosis and treatment

Documentation Patient education

Staff interactions

Billing/record keeping

Human Resources

Practice Management

Insurance

Check in/Check outReception

Compliance

Scheduling

Systems within Ambulatory Care

Restorative Therapies Dietary

PharmacyLean

Techniques

Examples of Practice ResultsJa

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0

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40

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Pct of DM Patients with A1c of <=7

Jan-

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Pct of DM Patients with latest BP <=130/80

0

0.2

0.4

0.6

0.8

1Percent of Asthma Patients with Flu Vaccine

%

Baseline

New flow sheet

Reviewed documentation guidelines/flowsheet

Flu vaccine clinics

Reminders to patients

Practices are overworked and don’t have time to do redundant systems to collect data to evaluate care.

EHRs are good for documentation and improving some efficiencies, but are not currently built to produce data on clinical systems.

The only way to know if we are providing the “right” care is to use data.

Obtaining the data becomes the focus of the QI process instead of improving office systems.

Challenges of QI in Primary Care

$787 billion. The Act includes

federal tax cutsexpansion of unemployment benefits &social

welfare provisionsdomestic spending in education, health care,

and infrastructure, including the energy sector.

The Act also includes numerous non-economic recovery related items that were either part of longer-term plans or desired by Congress

American Recovery and Reinvestment Act

Funds will be distributed through Medicare and Medicaid incentive payments to eligible professionals “EPs”, who are “meaningful EHR users.”

The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users.

Health Information Technology for Economic and Clinic Health (HITECH) Act

Payments for Certified EHR use from 2011 – 2015

Medicaid Providers (up to $63,750 per provider) 1. Based on Medicaid Patient Volume2. MD, DO, DDS, NP, CNM & PAs with exceptions

OR

Medicare Providers (up to $44,000 per provider)1. Based on % of allowable charges2. MD, DO

HITECH Act Continued

Meaningful Use in a Nutshell Successful Meaningful Use in Stage One:

Qualify for Incentive program under Medicare or Medicaid

Use of an ARRA Certified EHR systemAttesting to the successful completion and use

of 15 Core ElementsAttesting to the successful completion and use

of 5 of the 10 Additional Items

Centers for Medicare & Medicaid Services1. Medicaid and Medicare incentive structure2. Meaningful use definitions

Office of the National Coordinator for HIT1. Health Information Exchange (1 per state)2. Regional Extension Centers (per undefined

region)3. Work force training (Community Colleges) 10

state region4. EHR certification

US Department of Health and Human Services (DHHS)

NC Health Information Exchange (HIE)1. Strategic plan submitted2. Operational plan submitted 8/30/103. 12.9 million dollars + Medicaid support

NC Regional Extension Centers (REC)1. Preliminary application accepted 9/29/092. Full application submitted 11/03/093. Awarded 2/12/104. 13.6 million dollars

State and Regional Levels

NC REC Program Requirements and Goals

Entire state of NC (100 counties)

No charge for services for now

Priority Primary Care ProvidersSmall practices (less than 10 providers), orRural, orUnderserved or Medically underserved, orFQHC, or RHC, or CAH

3465 providers (estimated 800 - 1000 practices)

Technical Assistance Specialist

EHR Specialis

ts

QIConsultan

ts

Specialized Practice-

based services at

AHEC

QI Manager

HIT Manager

Carolinas Center for Medical

Excellence

NC Medical Society

Foundation

IPH

State HIE BoardLevels

of Suppor

t

Associate Director,

Statewide QI

Community Care of

NCOther

s

Application received

Do they have an

EHR?

EHR Implementatio

n Specialist works with

practice

Meaningful use gap

analysis and data pull

QIC works on IPIP and PCMH

Successful EHR

Implementation

Yes

No

Practices will transition through AHEC Services

All services lead to improving clinical outcomes

On-site consulting with Paper Practiceso Financial Assessments o Readiness Assessmentso Computer skill

Assessmentso Hardware Assessmentso Environmental Scano Workflow Assessmentso Establishing realistic

goals for the EHRo RFP for Vendorso Vendor Demos

oVendor referencesoVendor SelectionoVendor ContractingoTemplate buildingoInterface buildingoVendor set upoVendor trainingoData loadingoSystem testing – back

up trainingoGo-liveoPost live evaluation

On site consulting with Electronic Practices

Meaningful use gap analysisGuidance/assistance with template building to

ensure that data is entered “meaningfully”Evaluation of interfacesEvaluating mapping/coding where neededTraining checklists/security and back upsTrouble shoot post go live evaluation issuesAssistance with Query and Report buildingAssistance with or evaluation of eRxAssistance with HIE connection

On site consulting toImprove Quality with TechnologyImprovement in outcomes, meaningful use

and Patient Centered Medical Home Recognition

Maintenance of Board Certification Part IVCME for practice-based QI work for providersModel for ImprovementCare ModelRapid Cycle Tests of ChangeTemplate tweaking Implementation of guideline based protocols for

care deliveryImplementation of self management support

techniques

Paper Charts

Electronic Health

Records

Meaningful use of

HIT

Improved Clinical

Outcomes

Patient Centered Medical Home

Learn how to:

• Select a certified EHR that meets your needs

• Implement an EHR for optimal use in your practice

Learn how to:

• Assess the needs of your practice in an EHR system.

• Redesign your paper practice to ready for an EHR.

Learn how to:

• Use your EHR to meet the federal requirements for the HITECH Act Meaningful Use Incentive Payments from Medicare or Medicaid

Learn how to:

Produce population –based reporting to test the efficacy of your care

Use proven methods and techniques to improve the outcomes of your patients

Learn how to:

• Meet the requirements of the NCQA Recognition program for PCMH

• Approach the PCMH application process with improvement techniques

Where does healthcare reform fit?

TRHCAPhysician Quality Reporting Initiative

The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period).

Accountable Care ActPhysician reporting (PQRI)to a compare

websiteLTC, inpt rehab, and inpt psych hospitals, and

hospice pgms all to report quality dataPay for performance incentives (Value-based

payment modifier for physician fee schedule: measures)

Health Benefits exchange to include quality ratings for health plans

Demonstration program to integrate quality improvement and patient safety training in to clinical education of health professionals

Patient-centered outcomes research

Discussion?

Contact InformationAnn_lefebvre@med.unc.

edu