IC3 Program A year in review'an evolving initiative

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IC3 ProgramA year in review.an evolving
initiative

• Ralph Brindis, MD MPH FACC FSCAI
• Vice President , American College of Cardiology
• John Spertus, MD MPH FACC
• Member, IC3 Program

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Timeline and growth
National Cardiovascular Data Registry
Imaging Registry
ICD Long
EP Registry
IMPACT Registry
PAD Registry
IC3-Office
ACTION Registry
HF Registry
CARE Registry
CathPCI Registry
ICD Registry
1998.. 2004 2005 2006 2007 2008 beyond
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Bill Weintraub NCDR Founding Father and
Outcomes Thought Leader
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Science tells us what we can do Guidelines
what we should do Registries and their
associated Programs what we are actually
doing.
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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the Benefits to Health Plans
• How Can you Help Achieve these Goals?

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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the Benefits to Health Plans
• How Can you Help Achieve these Goals?

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IC3 Program

• The goal of the IC3 Program is
• To help medical practices fully transition to an
  era of performance measurement by demonstrating
  quality of care.

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IC3 Program Objectives

• Support quality improvement and change process
• Provide guidance in utilization of health
  information technology to advance quality
• Support facilitation of performance assessment,
  including
• external reporting capability for pay for
  performance
• maintenance of certification.
• Facilitate care coordination

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The Big Picture..in the Near Term
PHYSICIAN
PRACTICE
PATIENT
IC3 Online Community
Community
CardioSmart
Quality First
Team-based Care
Learning Portfolio
CardioSmart
Education
Paper Form Web-based Tool EMR
Personal Health Record
Data Collection
THE QUALITY JOURNEY
Performance Measurement
My Best Health Plan
P4P
PQRI/ABIM
Worksite Wellness
Recognition
CVRP
NCQA, BTE
Research
Practice-Based Research Networks
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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the potential benefits to Health Plans?
• How Can you Help Achieve these Goals?

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Timeline
IC3 Program Launch 10/19
Capital City Pilot
Pilot Study
Build
Pilot Study
Med Axiom Partnership
EMR Vendor Relationships
JAN FEB MAR
SEPT OCT NOV
DEC
2008
2007
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Timeline
Selected PQRI Alternative Solution
Launch
Clinical Decision Support Logic Built
Paper Tool-Pilot
Paper Tool Launch
Med Axiom Partnership
EMR Vendor Relationships
APR MAY JUN
JULY
AUG SEPT OCT
2008
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IC3 Program Enrolled Sites- October 28 Over 200
offices across the country 40 states
Contracted Sites 66 practices, 224 office
locations MedAxiom Practices 19, 95 office
locations
Intend to Enroll Sites 142 practices, 353 office
locations MedAxiom Practices 24 practices, 103
office locations
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EMR Vendors Updates

• AllScripts Working on incorporating IC3 Data
  Elements. Creating the custom data export. Alpha
  Testing to start soon.
• GE-Centricity Certified for CAD data collection
  at CENTRA (Lynchburg, VA). Working on
  modifications for other disease processes.
• GEMMS Modifying CAD data collection form to
  include other disease processes.
• NextGen Modifying CAD data collection form to
  include other disease processes. Working on
  custom data export.

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IC3 Program .Pilot Programs

• PQRI
• CMS selected the NCDR as a registry option for
  the 2008 PQRI reporting period.
• Limited to physician participation in the IC3
  Program.
• NCDR will submit aggregate performance rates and
  reporting rates to CMS.
• Includes new alternate partial year reporting
  period (July 1, 2008 and December 31, 2008)
• Eligible for full 1.5 bonus payment

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IC3 Program. Pilot Programs

• State of Virginia/Centra Pilot
• 18 Months/funded by VA HIT Grant
• Primary focus on automating IC3 Program data
  collection
• Evaluates HIT to enhance Continuity of Care in
  2-phase approach
• Centra Health creating a secure central data
  repository to support IC3 Program functionality
• Includes Lynchburg General inpatient/outpatient
  data and clinical data from GE Centricity EMR)
• IC3 Program functionality to provide Centra
  providers and practice sites access to current,
  nationally recognized best practices for cardiac
  care and provider benchmark performance reporting
• Stakeholders Centra Health, GE Healthcare, ACC
  NCDR

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Strategic Partnerships

• Professional Societies
• American College of Physicians
• American Academy of Family Practitioners
• Alliances
• MedAxiom
• Spirit of Women
• DocSITE
• Building web-based data collection tool
• Leveraging relationship with Bridges to
  Excellence

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Strategic Partnerships

• EMR Vendors
• CVS Caremark
• Centra Healthcare System
• State of Virginia Pilot
• Payers

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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the potential benefits to Health Plans?
• How Can you Help Achieve these Goals?

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Lessons LearnedSo far

• Strategic alliances very powerful
• Interoperability is achievable with adequate
  resources, time
• Committed physician leader is critical to
  successful implementation and adoption
• Office workflow redesign is challenging
• Even with an established EMR and interoperable
  systems between offices and hospitals
• Some current performance measures have
  limitations with regards to the feasibility of
  data collection
• Evolving HIT standards for EMRs still in their
  infancy for supporting goals of registry-based
  initiatives

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Lessons Learned

• Multi-pronged data collection approach is
  optimal
• EMR strategies are not necessarily seamless
• Cost issues associated with paper-based solutions
• Quarterly reporting may not be best
• Sub-optimal to improve physician adherence
• POC decision support tools critical to improve
  adherence to guidelines
• Platform needs to be flexible for future
  applications
• Add new modules quickly to test new PMs
• Facilitate testing appropriateness criteria
• Support research network

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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the potential benefits to Health Plans?
• How Can you Help Achieve these Goals?

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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are potential benefits to Health Plans?
• How Can you Help Achieve these Goals?

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IC3 as a Trusted Agent for Data Collection and
Exchange
Payers
CMS/PQRI
United
WellPoint
Others
ACC NCDR IC3 Program
Annual reports to payers
Outpatient Visit
Ongoing data submission to ACC
Periodic data reports to practice
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Health Plan Benefits

• Better Picture of Practice Performance- Trusted
  Agent
• Clinical data prospectively measured
• More accurate assessment of practice performance
  from larger sample sizes than individual plans
• Capture of complete ACC/AHA performance measures
• Plans need not develop their own

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Presentation Overview

• What is IC3?
• What Progress has occurred in the Past Year?
• What Lessons have been Learned?
• What are the Next Steps in IC3?
• What are the potential benefits to Health Plans?
• How Can you Help Achieve these Goals?

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Next Steps

• Engage Local/Regional Pilot Projects to
• Develop Trust in IC3 Reporting
• Define how to improve accuracy and completeness
• Explore Options for Engaging and Reimbursing
  Practices
• Establish the Business Case for QA/QI
• Join an Advisory Program Committee on how best to
  use IC3 Program Quality Network
• Provide input on how to move forward with program
• Suggest new Directions for IC3
• ICD Longitudinal follow up
• Medication adherence/patient compliance
  initiatives

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Questions?
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Long-Term Vision

• National Tool for Performance Measurement,
  Quality Assessment and Improvement
• A Vehicle for Engaging Providers and Patients to
  Optimize Outcomes
• A Means for Measuring and Quantifying Outcomes

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Current ACC/AHA Performance Measures

• CAD Performance Measures
• BP Measurement
• Symptom Activity Assessment
• Smoking Assessment
• Counseled to quit
• Anti-platelet Therapy
• Lipid Profile
• Use of Lipid Therapy
• ?-blocker post-MI
• ACE/ARB in ?EF DM
• Screening for Diabetes

• CHF Performance Measures
• LVEF Assessment
• Weight Measurements
• BP Measurements
• Clinical Symptom Assessment
• Activity Assessment
• Signs of Volume Overload
• Patient Education
• ?-blocker in ?EF
• ACE/ARB in ?EF
• Warfarin for Afib
• Initial Lab Tests

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Current ACC/AHA Performance Measures

• Afib Performance Measures
• Thromboembolic Risk
• Prior CVA/TIA
• Age 75
• Hypertension
• Diabetes
• Heart failure or ?EF
• Warfarin use in High-risk pts
• Monthly INR in pts on warfarin

• Cardiac Rehabilitation PMs
• Referral to a Rehab Program
• Within 12 months of
• ACS
• PCI
• CABG
• Valve Surgery
• Transplant
• Stable Angina
• Diabetes Performance Measures
• Poor HbA1c (gt9)
• LDL Control (lt100)
• BP Control (lt140/80)

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Sample QI Strategies

• Comparative Benchmark Reports
• National, Practice, Location, Physician, PQRI
• Guideline adherence/decision support
• Reminder Systems
• Visit-based summaries of treatment plans
• Printable versions for patients
• Encourage physician to physician communication

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EMR Vendors Next Steps

• Map Final IC3 Data Dictionary fields to existing
  data fields, identify and fix gaps.
• Demonstrate Data Collection to ACC and get
  certified for Data Collection
• Conduct Alpha, Beta Testing
• Develop and deploy IC3 Data Export
• Demonstrate Data Export to ACC and get certified
  for Data Export
• Nationwide Roll out

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Physician Xs Practice
Payer Perspective of my Performance
United (5)
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BCBS (9)
76
Medicare (26)
100
Medicaid (10)
100
Physician Xs Overall Performance 90
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IC3 Program FirstPQRI Solution

• CMS selected the NCDR as a registry option for
  submitting quality of care data on behalf of
  physicians for the 2008 PQRI reporting period.
• NCDR reporting for PQRI is limited to physician
  participation in the IC3 Program.
• NCDR will submit aggregate performance rates and
  reporting rates to CMS.
• PQRI aggregate reporting includes new alternate
  partial year reporting period (July 1, 2008 and
  December 31, 2008) eligible for full 1.5 bonus
  payment for all Medicare Part B covered payments
  for reporting period.

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IC3 Program FirstPQRI Solution (cont.)

• Aggregate data for at least to six 2008 PQRI
  measures can be submitted to CMS on physicians
  behalf.
• Antiplatelet Therapy (All CAD Patients)
• Beta-blocker Therapy
• ACE/ARB Therapy
• Smoking Cessation (All Patients)
• Smoking Query
• Advance Care Plan (All Patients gt65 yrs)
• Physicians are required to sign a data release
  consent form available from the NCDR accounts
  management team to request PQRI data submission.
• Participation in the IC3 Program and submission
  for PQRI to CMS is free of charge at this time.

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How will CMS assess PQRI reporting

• Review that 80 reporting rate threshold has been
  met
• Since IC3 Program requires all eligible patients
  be submitted, IC3 Program reporting rate for PQRI
  should be 100
• Review that minimum of 3 measures are reported
• IC3 Program has capability to report on at least
  6 PQRI measures
• Calculate 1.5 bonus based on Medicare Part B
  claims for 7/1/08-12/31/08 for NPI/TIN

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IC3 Centra Health Pilot

• Centra Practice and Office Site Infrastructure
• Support NCDR IC3 Program functionality
• Collect and electronically transmit data from TCG
  to IC3 Program
• Improve continuity of care
• Improve tracking of patients Hospital
  readmissions
• Improved patient prescription drug compliance
• Outcomes Report Training
• Clinician Decision Support Training
• Centra central data repository
• link with administrative data to capture
  efficiency (cost) performance measurement

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Online Resources

• Orientation Handbook
• Checklists to get started
• Program summaries
• Profile completion instructions

• Training resources
• Office workflow redesign
• Clinical performance measurement
• Outcomes report interpretation for CQI
• Training formats
• Live web conferences
• Online modules
• Face-to-face meetings

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Health Plan Benefits, cont.

• Enhanced patient adherence
• Reduced in appropriate readmission rates
• Increased coordination of care
• Increased patient satisfaction