Metrics and the Population Health Navigator

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Metrics and thePopulation Health Navigator

• Paul D. Rockswold, MD, MPH
• CDR, MC, USN (UMO)
• Navy Environmental Health Center
• 19 March 2006

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Acknowledgements

• Population Health Navigator
• Developed by LTCOL Chris Phillips
• Metrics dashboard
• NMIMC
• Many slides (406)
• LCDR Von Thun

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Objectives

• Population Health Navigator (45 minutes)
• Tell how to access the PHN
• Describe how to get data from the PHN
• Use the PHN for specific conditions
• Questions (5 minutes)
• Hands-on (20 minutes)

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Population Health Navigator

• Major Index Card Sections
• Demographic Information
• Preventive Services
• Disease and Condition Management
• Administration

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Administration
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Demographics
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Preventive Services
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Topic Selection

• Asthma
• Diabetes Mellitus
• Mammography

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Asthma
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Disease/Condition Management
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HEDIS Metric

• Definition Percentage of patients with
  persistent asthma (5-56yo), continuously
  enrolled (x24 months) to an MTF with at least one
  medication considered as acceptable for primary
  therapy for the long-term control of asthma in
  the last 12 months
• Includes
• Patients diagnosed with Asthma (493) as principal
  dx
• 1 Inpatient Admission OR 1 ER visit OR 4
  outpatient visits (w/ 2 med events)
• Patients with Asthma Meds (x4 events) (MTF,
  network, mail order)
• Both MTF network care
• Action List contains all asthmatics gt 1yo
• Excludes
• Patients with COPD, emphysema
• Benchmark 78.0 (HEDIS 90th percentile)
• Navy Average 70.5 (as of 28Feb 05)

Med Event 30day supply
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HEDIS Metric

• Definition Percentage of patients with
  persistent asthma (5-56yo), continuously
  enrolled (x24 months) to an MTF with at least one
  medication considered as acceptable for primary
  therapy for the long-term control of asthma in
  the last 12 months
• Caveats
• Identification of Patients (denominator)
• The term persistent is based on the previous
  years services and medication use rather than
  the clinical measurement of severity
• Patients are identified 12-24 months ago
• Acceptable meds (numerator)
• ICS, nedocromil, cromolyn sodium,
  methylxanthines, leukotriene modifiers
• Treatment identified in last 12 months

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New BUMED Metric

• For inclusion in FY06 BUMED Business Plan
• Definition Percentage of patients with
  persistent asthma (5-56yo), continuously enrolled
  (x12 months) to an MTF with at least one
  prescription for inhaled corticosteroids for the
  long-term control of asthma in the last 12 months
• Benchmark NAVY 90th percentile

Pending
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• Action List contains
• Patient Info name, SSN, DOB, age, BenCat
• Provider Info PCM name, group
• Patient Contact Info address, phone
• Medication fields HEDIS med, date, Steroid med,
  date
• Utilization data Inpt, ED, Outpatient Visits
• Those w/o meds are highlighted, then sorted by
  date of last med
• Action List contains patients identified in last
  12 months

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Leveraging PHN Data

• Actions that might be considered
• Sort by age, PCM clinic, PCM provider
• Find patients not on appropriate meds
• Contact patients using demographic information
• Assess utilization behavior for intervention
• Lots of ER visits
• ER/inpatient visits without outpatient care or
  meds
• Consider case management for designated patients
• Compare quality of care via HEDIS measure
• Download into Excel or Access for further evaln

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Asthma Conclusion

• Other topics
• Diabetes Mellitus
• Mammography
• Wrap up

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Diabetes Mellitus
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Diabetes Mellitus Conclusion

• Other topics
• Asthma
• Mammography
• Wrap up

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Mammography
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Mammography Conclusion

• Other topics
• Asthma
• Diabetes Mellitus
• Wrap up

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Common Wrap-up

• Initial Discussion
• Specific topic
• Asthma
• Diabetes Mellitus
• Mammography
• Wrap-up

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Leveraging PHN data

• Use your Health Care Team!!!
• WHO is going to identify/contact patients?
• HOW are you going to contact patients?
• WHO is going to pull data and HOW often?
• WHO is going to analyze/distribute the data?
• HOW will data be used for feedback?
• WHAT is your current performance?
• WHAT are your goals/benchmarks?
• WHAT will you do when you reach your goals?

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Other PHN Features that may be of interest

• Quick Look Sheet
• High Utilizer File

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To obtain a PHN account

• Command endorsement
• Request account via PHN website
• POC CDR Peggy Sleichter (BUMED)
• E-mail phn.admin_at_us.med.navy.mil
• Phone [phone]

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Population Health Navigator Dashboard
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PHN Dashboard

• Now that you know
• What is being measured
• How it is being measured
• How do you know youre doing a good job?
• How are you doing compared to everyone else in
  the Navy?

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BUMED Metric Tracking

• BUMED Business Plan states that clinical goal is
  to perform greater than HEDIS 90th percentile.
• Population Health Navigator Dashboard
• Presents 4 BUMED Clinical Quality metrics
• Displayed by command, drill down to clinics
• Compares to other clinics/MTFs, Navy averages,
  HEDIS 50th and 90th percentiles
• Provides denominators, values
• Updated monthly
• https//dataquality.med.navy.mil/reconcile/popheal
  th
• Also available via NEHC webpage, and NMO as a
  resource kit

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Leveraging PHN Data with Excel
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Basic Excel Skills

• Basic Excel Skills can serve you well in
  analyzing PopHealth Navigator data.
• Sort e.g.
  sorting/ranking
• Filter e.g.
  isolate clinic, doc
• Sum SUM(range) e.g.
  utilization metrics
• Average AVERAGE(range) e.g. average A1C
• Count If COUNTIF(range,"lt7") e.g. A1C lt7

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Additional Excel Skills

• Intermediate Excel Skills
• Add-In Analysis ToolPak (under Tools) allows
  Data Analysis capability
• Descriptive Statistics (e.g. min, max, mean, SE,
  SD)
• Rank and Percentile
• Histogram
• Advanced Excel Skills
• Pivot Tables

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Common Wrap-up

• Tell how to access the PHN
• Describe how to get data from the PHN
• Use the PHN for specific conditions