Post on 11-Aug-2020
April 2015Campaign Updates
May 7: National Day of Action
National Day of Action Toolkit
• Event overview• Participation checklist• Sample action ideas• Reporting details• Promotional and
educational materials• Videos• Fact Sheets• Press Release Template• Social Media Posts• Web Content• And More…
Share Your May 7 Plans!(as of April 14th)
• American Kidney Fund• American Medical Group Foundation• Arch Health Partners• Baptist Medical Group• Carle Physician Group• Esse Health• Ralphs• Watson Clinic
Email your plans to MUPDNationalDayofAction@amga.org!
New Campaign Resources
Washington, DC Health Expo
Q1 2015 Reporting Open
• Q1 2015 data is currently accepted through the campaign portal• To report your data, please visit:
https://members.measureuppressuredown.com/
Q1 2015 Reporting Deadline:
June 30, 2015
EvolveMeasureManageChange
Achieving Breakthrough
HTN Results
Presented To:
AMGA/MUPD
Participants
Bob Matthews
April 16, 2015
EvolveMeasureManageChange
PriMed Physicians
• Greater Dayton, OH
• 20 offices throughout the
region
• Physician owned and led
medical group
• 60+ physicians
• Mostly PCPs plus
Cardiology, Endocrinology,
Neurology
MediSync
• Management side of
PriMed since 1996
• Manage one additional
group in Southwest OH
• Invent new ways for
groups to succeed
• MediSync solutions in
~150 medical groups
nationwide
Introduction
EvolveMeasureManageChange
PriMed’s Motivation
For PriMed,
our work on chronic diseases in general
and our on HTN work in particular
have always been
about value.
IF
The amount your group is paid for
medical services
AND/OR
The number of patients who can gain
access to your care
Depends upon your group’s medical
quality and/or cost effectiveness
IF
The amount your group is paid for
medical services
AND/OR
The number of patients who can gain
access to your care
Depends upon your group’s medical
quality and/or cost effectiveness
VALUE
ValueQuality
• Wellness, Risk
Assessments and
Preventive Care (WRAP)
• High control of major
chronic diseases
– HTN
– LDL
– Diabetes
– Asthma
– COPD
– Renal disease
– Depression
– CHF
Cost Effectiveness
• Admissions and re-
admissions
• Preventable bad events
– MI, stroke, renal damage
• Manage the worse 2%
• Optimal cancer care
• Informed patient
directives
• Unnecessary care
– Diagnostic testing, etc.
• ER visits
• Appropriate generics
LDL
Renal disease
HTN
Diabetes
CHF
EvolveMeasureManageChange
What Physicians Do
1. Treat acute problems
2. Manage chronic disease(s)
3. Provide WRAP (Wellness, Risk
Assessments and Preventive Care)
EvolveMeasureManageChange
Cost of Chronic Disease
“Seventy-five percent of the (monies) spent
on health care in the U.S. is for treatment
of the chronically ill.”
- The Commonwealth Fund
EvolveMeasureManageChange
In Medical Groups There Are ALWAYS Two
Components to Significant, Successful Change
1. Intention and willingness to change
– Starts with leaders
– Leaders develop a plan (could be a good plan or a bad plan)
– For medical groups, change will fail unless physicians adopt the new
2. Method
– Some methods are a lot more powerful than others
Outcomes are driven by BOTH Intention and Method
EvolveMeasureManageChange
How Does It Happen In Your Group Today?
• There are likely various reminders
• Staff may alert the doctor about patient being in/out of control
• Staff may have phoned patient or pre-interviewed patient
• So: patient’s blood pressure is >150/90 in office
• What’s next?
EvolveMeasureManageChange
Physician Will Evaluate & Tx Pt
• How?
• If you have 100 PCPs and 15
cardiologists, how many ways are there to
evaluate and treat HTN?
• Are they all equally effective?
EvolveMeasureManageChange
Physicians, NPs, PAs
• Trained at different times and in different schools
• Read different journals
• Attend different CMEs
• Have different intellectual capabilities
• Understand different amounts of the literature
• Therefore, get different results
EvolveMeasureManageChange
So, what method(s) do we choose?
-- To improve quality?
-- To reduce costs?
EvolveMeasureManageChange
Before We Talk About HTN…
• Inventory: “stuff we need to change”
• Define the “degree of success” we aspire
to achieve
• Decide how to do ALL of this
EvolveMeasureManageChange
Oh, and don’t forget…
• Running a practice is more challenging
each day:
– Growing overhead
– Flat to reduced compensation in real $
– Rising expectations
EvolveMeasureManageChange
“Big” Chronic Diseases
HTN
Diabetes
Lipids (CAD & Vascular Diseases)
Asthma
Heart Failure
COPD
Depression
Osteoporosis
EvolveMeasureManageChange
“Normal” Quality/Cost Improvement
In Virtually All Medical Groups
1. Remind physicians about evidence based
standards, goals, pathways, etc.
– Put quality “pop ups” in EHR
– Generate a registry with lists of patients
2. Generate metrics and publish – (un)blinded
3. Hire additional staff to support the effort, remind
the patients, remind the doctors (i.e. PCMH)
4. Link outcomes to pay
EvolveMeasureManageChange
WHAT DO THE NORMAL METHODS
GAIN IN IMPROVEMENT?
EvolveMeasureManageChange
Medical Quality Goal:Move One Variable (i.e. BP)
Gro
up M
ean P
erc
ent
to G
oal
10
70
60
50
40
30
20
80
90
100
Time in Months
1st 3rd2nd 5th4th 6th 8th7th 9th 10th11th12th13th14th15th16th
Proportion of Patients with HTN whose Blood
Pressure is in Control (140/90) – AMGA Second
Quarter 2014
LDL Control Success Percentage
0 10 20 30 40 50 60 70
Wheaton Franciscan Medical Group
UW Health
ThedaCare Physicians
ProHealth Care
Primary Care Associates of Appleton
Prevea Health
Monroe Clinic
Meriter Medical Group
Mercy Health System
Mayo-Franciscan Healthcare
Mayo Health System in Eau Claire
Marshfield Clinic
Holy Family Memorial
Gunderson Clinic
Froedtert & Medical College of Wisconsin
Dean Clinic
Columbia St. Mary's Physiciasn
Bellin Medical Group
Aurora UW Medical Group
Aurora Medical Group
Aurora Advanced Healthcare
Aspirus Clinics
Agnesian Healthcare
EvolveMeasureManageChange
How High Do You Want To Go?
What % of patients do you want at goal
for EACH measure?
EvolveMeasureManageChange
Three Goals @ 60% Each
»1st Goal 60%
»2nd Goal 36%
»3rd Goal 21.6%
2010 Diabetes Outcomes(Using Wisconsin Measures)
0 5 10 15 20 25 30 35
Aurora Advanced
Aurora Medical Group
Aurora UW Medical
Bellin Medical
Columbia St. Mary's
Dean Clinic
Froedtert/West Bend
Gundersen Clinic
Marshfield Clinic
Mayo/Franciscan
Mayo/Eau Claire
Medical College
Mercy Health
Monroe Clinic
Prevea Health
ProHealth Care
ThedaCare
UW Health
Wheaton Franciscan
Percentage
The “All or None” Hurdle1 goal @ 90% / 60% each 90% 60%
2 goals @ 90% / 60% each 81% 36%
3 goals @ 90% / 60% each 72.9% 21%
4 goals @ 90% / 60% each 65.6% 12%
5 goals @ 90% / 60% each 59% 7.5%
EvolveMeasureManageChange
How High Do You Want To Go?
What percent of patients do you want at goal
for EACH measure?
+
How many measures?
ValueQuality
• Wellness, Risk
Assessments and
Preventive Care (WRAP)
• High control of major
chronic diseases
– HTN
– LDL
– Diabetes
– Asthma
– COPD
– Renal disease
– Depression
– CHF
Cost Effectiveness
• Admissions and re-
admissions
• Preventable bad events
– MI, stroke, renal damage
• Manage the worse 2%
• Optimal cancer care
• Informed patient
directives
• Unnecessary care
– Diagnostic testing, etc.
• ER visits
• Appropriate generics
LDL
Renal disease
HTN
Diabetes
CHF
EvolveMeasureManageChange
So now what methods do you choose?
EvolveMeasureManageChange
What EVERY High Performance Organization
Outside of Healthcare Does:
1. Commitment to quality theory and practice
– Six Sigma, Lean, TQM, Deming, CQI, etc.
2. Must use processes
– Process is the foundation of every quality theory and
practice, the common thread the unites all approaches
3. Over time processes make organizations and work
more and more manageable
– Complexity is the core challenge of all modern
organizations and businesses
EvolveMeasureManageChange
MediSync/PriMed “Special Sauce”
– High levels of improvement/performance is
impossible without process
– Improvement in multiple areas is impossible without
process
Processes
EvolveMeasureManageChange
Definition of Process
A process is a series of steps that are
collectively designed to get you
to your desired goal or outcome.
EvolveMeasureManageChange
Creating the HTN Process
1. Use Six Sigma
2. Establish baseline performance – 41 and 42%
3. Start with an “Ishikawa” or “Fishbone”
4. Create a true process that
• Addresses every HTN patient, every visit
• Includes Impedance Cardiography
• Guides drug selection and dosing
5. Solve controversy with statistics (i.e. ICG)
EvolveMeasureManageChange
In Medical Groups ALWAYS Two Components
to Significant, Successful Change
1. Intention and willingness to change, especially from physicians
– Answers the “Why change?” and the “What kind of change?”
– Tends to build over time
– Start with nidus of doctors and then expand to entire group
– All the normal rules of change management apply
– Managers must be developed along with physicians
2. Method
– Answers the “How to change?” and the “Who/when of change?”
– Some methods are a lot more powerful than others
Outcomes are driven by BOTH Intention and Method
EvolveMeasureManageChange
EvolveMeasureManageChange
Creating the HTN Process
5. Measure use of HTN Process and outcomes
6. Unblinded publication of data
• What do you do with doctors who do not use
HTN Process?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Dr. A Dr. B Dr. C Dr. D Dr. E Dr. F Dr. G Dr. H Dr. I Dr. J
PriMed % HTN to Goal vs. % Copy of Algorithm vs. % Algorithm Followed
August 2005
% BP at Goal
% Copy of Algorithm
% Algorithm Followed
Average:
% HTN to Goal = 83%
% Algorithm Followed = 66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Dr. K Dr. L Dr. M Dr. N Dr. O Dr. P Dr. Q Dr. R Dr. S Dr. T
PriMed % HTN to Goal vs. % Copy of Algorithm vs. % Algorithm Followed
August 2005
% BP at Goal
% Copy of Algorithm
% Algorithm Followed
Average:
% HTN to Goal = 70%
% Algorithm Followed = 49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PriMed % HTN to Goal vs. % Copy of Algorithm vs. % Algorithm Followed
August 2005
% BP at Goal
% Copy of Algorithm
% Algorithm Followed
Average:
% HTN to Goal = 61%
% Algorithm Followed = 66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PriMed % HTN to Goal vs. % Copy of Algorithm vs. % Algorithm Followed
August 2005
% BP at Goal
% Copy of Algorithm
% Algorithm Followed
Average:
% HTN to Goal=49%
% Algorithm Followed=37%
EvolveMeasureManageChange
Creating the HTN Process
5. Measure: HTN Process use and outcomes
6. Publish results
• What do you do with doctors who do not use the HTN Process?
7. Link HTN Process compliance to physician compensation
• NOT based upon outcomes, based upon participation in the process
8. Constant work on “group culture”
Changing Medical Group Culture:Quality vs. Tradition
• Changing the group culture requires its own process
• LOTS of time discussing– Group meetings
– Section meetings
– Site meetings
– Task Force meetings
– Board meetings
• Some doctors decided to leave due to differences
100% 100% 100% 100% 100% 100% 100%98% 98% 98% 98% 98%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% BP@Goal PriMed
Quartile 1September 2009
% BP @ Goal
%Protocol Followed
Averages:% BP@Goal = 99%% Protocol Followed = 100%
Dr. A Dr. B Dr. C Dr. D Dr. E Dr. F Dr. G Dr. H Dr. I Dr. J Dr. LDr. K
96% 96% 96% 96%94%
92% 92% 92% 92% 92% 92% 92% 92% 92%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% BP@Goal PriMed
Quartile 2 September 2009
% BP @ Goal
%Protocol Followed
Averages:% BP@Goal = 93%% Protocol Followed = 100%
Dr. M Dr. N Dr. O Dr. P Dr. Q Dr. R Dr. S Dr. T Dr. U Dr. V Dr. XDr. W Dr. ZDr. Y
91%
90% 90% 90%
88%
82%
84%
86%
88%
90%
92%
94%
96%
98%
100%
AHMAD SHAH WELLER ADIB PORTER
% BP@Goal PriMed
Quartile 3 September 2009
% BP @ Goal
%Protocol Followed
Averages:% BP@Goal = 90%% Protocol Followed = 99%
Dr. ABDr. AA Dr. ADDr. AC Dr. AE
88% 88% 88%86% 86%
84% 83% 82%
75% 74% 73% 73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% BP@Goal PriMed
Quartile 4 September 2009
% BP @ Goal
%Protocol Followed
Averages:%BP@Goal = 82%% Protocol Followed = 96%
Dr. AGDr. AF Dr. AIDr. AH Dr. AJ Dr. ALDr. AK Dr. ANDr. AM Dr. AO Dr. AP Dr. AQ
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Elite Medical Groups Post Intervention
Average US Performance
Percent of Patients Reaching JNC-7 BP GoalHTN Outcomes With or Without Co-Morbidities
MediSync Groups
ClinicThe
D5
Blood
Pressure
Bad
Cholesterol
Blood
Sugar
Tobacco
Free
Daily Aspirin
Use
My Doctor 66% 86% 93% 85% 93% 100%
PriMed 57% 93% 76% 77% 89% 99%
Internists of
Wyoming52% 93% 65% 83% 87% 99%
TriHealth
Practices43% 85% 66% 78% 88% 99%
TriHealth
Group41% 83% 66% 76% 87% 99%
Queen City 39% 80% 67% 76% 87% 98%
Health First 39% 87% 57% 74% 87% 97%
Summit FP 37% 86% 56% 73% 83% 100%
Overall Rate 35% 80% 60% 72% 84% 97%
Mercy
Health35% 81% 61% 72% 86% 97%
UC Health 32% 74% 58% 73% 85% 99%
St. E East 32% 76% 59% 69% 81% 97%
St. E West 29% 77% 58% 71% 80% 94%
Christ PCP 25% 76% 53% 68% 83% 93%
Crossroad 14% 74% 36% 55% 67% 99%
HC Connect 8% 72% 29% 42% 67% 94%
Group/Clinic Results > Optimal Diabetes Care – 2013 DOS
EvolveMeasureManageChange
What Makes PriMed Different?
It is NOT that:
– Dayton patients are
more eager to
make lifestyle
change or adhere
to Rx therapies
– PriMed doctors are
better educated
EvolveMeasureManageChange
Why Medical Groups Should
Embrace Process and Quality Practices
• Medicine today = too much really complicated stuff
– Medicine is now beyond human memory or mastery
• Process makes you able to outperform others in
region/nation
– Process achieves higher results per measure
– Process allows us to master more “measures” or
goals
• Process and quality offers = solution to PCP ‘burn-
out’
EvolveMeasureManageChange
Process vs. No Process
• You have choices:
– Continue with every doctor
doing every disease
his/her favorite way
or
– Move to use of process*
*Requires “change
management”
Process Competency
• Not every process is
equally effective
– In other words: Some
processes work better
than others
– This is called “Process
Capability”
Two Decision Points:
EvolveMeasureManageChange
Requirements for Success
1. Commitment to both high(er) goals and process as the means
2. Seriously talented “change management”
3. You need to acquire or develop processes– Processes do not grow on trees (especially the good ones)
4. Avoid pitfalls– You can’t boil the ocean. You need to plan larger quest
into phases that show regular progress and build one step of success upon another
– MOMENTUM is critical
EvolveMeasureManageChange
Questions / Comments?
bob.matthews@medisync.com
513-533-6006
www.medisync.com