Diabetes Best Practices Symposium Sponsored by AMGA and Merck - PowerPoint PPT Presentation

1 / 25
About This Presentation
Title:

Diabetes Best Practices Symposium Sponsored by AMGA and Merck

Description:

Epic EMR since 2002. What is the APP Clinical Integration Program? ... Data is largely collected from the Epic database, IDX database and with chart ... – PowerPoint PPT presentation

Number of Views:42
Avg rating:3.0/5.0
Slides: 26
Provided by: amga
Category:

less

Transcript and Presenter's Notes

Title: Diabetes Best Practices Symposium Sponsored by AMGA and Merck


1
Diabetes Best Practices SymposiumSponsored by
AMGA and Merck Co., Inc..October 21-22,
2009Detroit, MI
  • Clinical Integration A System Approach

2
Dreyer Medical Clinic
3
Medical Group Profile
  • Established 1922 by John Dreyer
  • Part of Advocate Healthcare
  • 150 docs, 26 specialties, 11 sites
  • 60 allied health professionals
  • 500,000 patient visits a year
  • Epic EMR since 2002

4
What is the APP Clinical Integration Program?
  • Advocate Physician Partners (APP)
  • Collaborative effort by 3,400 physicians in two
    medical groups, nine PHOs and the nine affiliated
    hospitals
  • Drives targeted improvements in health care
    quality and efficiency
  • P4P program

5
What is the APP Clinical Integration Program?
  • 2007 Highlights
  • 6M in generic drug savings
  • 1.9M in asthma savings
  • Smoking initiative saved 7,814 work days
  • CAD and CHF initiatives saved 65 lives and 158
    hospital days
  • Includes a comprehensive set of diabetes
    management metrics

6
Team Composition
  • APP staff
  • Dreyer Medical Clinic
  • Medical Directors
  • PCPs and endocrinologist
  • Quality Director, Manager, RN, RHIT Data
    Analyst
  • Disease Management Director, RN CDE, Dietician
    3 Clinical PharmDs
  • EMR Team / MIS

7
Diabetes Metrics
  • Goals set annually by APP based on improvement of
    current state
  • Applies to group, PCPs Endo

8
Diabetes Metrics
9
Diabetes Goal
  • Our program is about achieving and exceeding
    benchmark care levels
  • This is important for our patients and our very
    Raison d'ĂȘtre
  • Success will look like years of life added to our
    patients lives
  • What we need from you is relentless measuring and
    managing

10
Diabetes Population Baseline
  • True population management for type I and type II
    diabetics identified by billed diagnoses, problem
    lists and drug utilization
  • Demographics 4406 patients, ages 18-75, 21
    Hispanic, 12 Medicare, 56 PPO, 24 HMO, 54
    female
  • Epic diabetes registry created

11
Diabetes Interventions
  • Ambulatory ICU for difficult to control
    patients
  • PharmD run clinic
  • Complete prescribing authority via collaborative
  • Coordination with dietitian and CDE
  • Podiatrist hired

12
Behind the Scenes
  • CI score as senior management team and director
    Key Result Area
  • Selected CI components added to KRA manager
    scorecards
  • Balanced scorecard for PharmD
  • Lean rollout 2.5 years ago
  • Disease Management auto referral agreement with
    PCPs of all patients w/ A1C gt9

13
Workflow
  • Clinical Integration added to visit pre-work
  • Clinical Integration added to rooming standard
    work
  • Clinical Integration added to refills via
    protocols
  • Clinical Integration considered in every Lean VSA
    and RIE

14
HIT Interventions
  • Epic comfortable by 2004
  • Measurement via Epic registry
  • Numerous real time EMR alerts
  • Best Practice Alerts
  • Health Maintenance Alerts
  • Regular physician progress reports
  • Epic smart sets and dot phrases

15
Staff Involved
  • Initially behind the scenes with QI and EMR
    team working the process
  • After LEAN, people doing the work and support
    staff work the process
  • Management buy-in with KRAs

16
Physician Change Methods
  • Moral Raison d'ĂȘtre
  • Social Culture and peer pressure with
    transparent results
  • Financial P4P (but payments early on were
    trivial)

17
Measures/Data Sources
  • Thank you Intermountain for allowing us to use
    your DM practice guideline!
  • APP uses HEDIS, IOM, NAS, NQF, Leapfrog, HHS and
    TJC for setting measures
  • Data is largely collected from the Epic database,
    IDX database and with chart review (minimal) as a
    supplement

18
Challenges or Obstacles
  • Theyre non-compliant vs. measuring and then
    managing by a four box approach
  • Physicians accepting non-physicians as active
    managers
  • Justifying disease management for non-capitated
    patients

19
Success factors
1 VISION
BEHAVIOR
TOP MANAGEMENT
2 STRATEGY
4 DECISION SUPPORT SYSTEM
3 STRUCTURE
6 HUMAN RESOURCE SYSTEMS
5 REWARD SYSTEMS
7 ORGANIZATION CULTURE
PERFORMANCE
20
Outcomes AIC gt9 lt7
21
Outcomes LDL lt100
22
Outcomes BP lt130/80
23
Future Steps
  • Eliminate waste and improve workflows via LEAN
  • Adherence tools
  • Bundle scoring

24
Lessons Learned
25
Questions
  • How do you work with patients to improve
    adherence?
  • How do you see the medical home changing the way
    we address diabetes?
  • What do you suggest shifting from physicians to
    mid-level providers next to improve care?
Write a Comment
User Comments (0)
About PowerShow.com