25th Anniversary NNOHA Conference, 2016

‘Establishment of a Quality Improvement Culture at a Large FQHC Dental Practice in Rural Wisconsin’

November 7, 2016

Amit Acharya, BDS, MS, PhDChief Dental Informatics Officer, Family Health Center of Marshfield Inc.

Harshad Hegde, MSInformatics Architect, Institute for Oral and Systemic Health

Marshfield Clinic

Disclosure

I, Amit Acharya, BDS,MS, PhD do have a relevant financial interest or other relationship(s) with a commercial entity producing

health-care related product and/or services:I, Harshad Hegde, MS, do have a relevant financial interest or

other relationship(s) with a commercial entity producing health-care related product and/or services:

Affiliation/Financial Interest Name of Corporate Organization(s)

Grant/Research Support Delta Dental of Wisconsin

Grant/Research Support Family Health Center of Marshfield, Inc.

Presentation Objectives

Objective 1: Discuss the need for a focus on quality in dentistry;

Objective 2: Discuss the opportunities involved with visualizing key dental measures and performance for improving the quality of care in dental practices;

Objective 3: Share the design, development and implementation approach of a dental quality improvement dashboard that supports a large dental FQHC practice in central Wisconsin;

• As the healthcare in US enter the era of accountability and move towards achieving the “Triple Aim”, dental care should not be dismissed;

Reducing the per capita cost of health care.

Improving the health of populations; and

Improving the patient experience of care (including quality and satisfaction);

Triple Aim

Health Care Cost

• Back in 1960, the United States spent 5.1% of its gross domestic product (GDP) on health. By 2014, this had more than tripled, to 17.5%.[*]

• Although, the pace of growth in U.S. per capita health expenditures declined steadily over the past decade, from a rise of 8.4% between 2001 and 2002 to a rise of 5.3% between 2013 and 2014 [*], the cost of treating dental care is a growing concern.

[*] Center for Medicare and Medicaid Services. National Health Expenditures 2014 Highlights https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

Healthcare Expenditure

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

Source: http://www.pewtrusts.org/~/media/assets/2012/01/16/a-costly-dental-destination.pdf

http://www.pewtrusts.org/%7E/media/assets/2012/01/16/a-costly-dental-destination.pdf

• Based on a projection from the Centers for Medicare and Medicaid Services the total national expenditures for dental care will almost triple between 2000 and 2020 (from $62.0 billion in 2000 to $167.9 billion in 2020, a 271% increase);

• Spending for dental services in 2014 is $113.5 billion [*];

[*] Center for Medicare and Medicaid Services. National Health Expenditures 2014 Highlights https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

Dental Care Expenditure

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

Population Health

Improving Population Health

• Partnership with Medical providers• Screening;• Provide Maintenance Care;• Member of the Proactive Practice Team*;

• Oral Health as “non-medical” determinant:• Diabetes Care and Periodontal health;• HIV status diagnosed as oral condition;• Immunosuppressive diseases reflected in oral status;

*Wagner’s chronic care model, the Group Health Research Institute and McColl Center for Health Care Innovation

High Quality of Care can only be delivered by being

‘Diagnostic Centric’

•10 FQHC providing dental services to people from all of Wisconsin's 72 counties

•46,815 unique dental patients [2012]

•47,206 unique dental patients [2013]•49,708 unique dental patients [2014]•50,924 unique dental patients [2015]

Mr. Greg NyczExecutive DirectorFamily Health Center of Marshfield, Inc. Marshfield Clinic Health System

Integrated Medical-Dental EHR Environment

• One of the very unique Medical-Dental EHR Environment to support Comprehensive Patient Care, Research and Education

• Supports well over 110,000 unique patients;

Where is the dental diagnosis??

Much better on the eyes!!!

CattailsDental

CattailsDental User Interface: Procedure Code (CDT) & Diagnostic Code (ICD-9) Linkage

CattailsMD : Medical Provider’s EHR Dashboard

QI vs QA

Quality Improvement• Positive change • Designing a process to be safer, more efficient,

more patient centered.

Quality Control/Assurance• Tasks that are done locally by each department

to ensure that standard work is done consistently;

Quality Improvement Steering Committee

to oversees the dental quality improvement and assurance program at all of the eight dental centers within the system

to evaluate the quality and appropriateness of care delivered to patients and to ensure a safe and compliant environment for patient care

intended to identify and improve any deficiencies in care, thus enforcing consistent standards of care and treatment across the institution

Source: http://www.tankonyvtar.hu/en/tartalom/tamop425/0032_kornyezetiranyitas_es_minosegbiztositas/ch01s02.html

http://www.tankonyvtar.hu/en/tartalom/tamop425/0032_kornyezetiranyitas_es_minosegbiztositas/ch01s02.html

Real-time Analytics: Quality of Care • Marshfield Clinic was 1 of 10 large Physician Group

Practice invited by CMS prove that providing high quality coordinated health care could also save $

• In the last year of the PGP Demo, Marshfield Clinic last year exceeded 98 percent of the quality measures;

• Saved > $118 million over the 5 performance years reported to Medicare program;

Quality Improvement in Medicine

Quality Improvement

Steering Committee

Clinician Champions

Administrative Champions

Quality Improvement Work

Group

Dental Informatics Team

HIT Team

IQIPS Team

Dental Centers

Chairs

Center Managers

Dental Quality Improvement Initiative

Road Map

Summary Tab

• Summary tab displays the demographic information of the population being serviced at the dental clinics;

Dental Caries

•Tooth decay is the single most common childhood disease, five times more common than asthma;

•15,000 six year-olds are sitting in the classrooms in the State of WI with active dental decay and painful mouths;

• CDC estimates that in US approximately:

• 40% of the children have caries by the time they enter kindergarten;

• More than 50% have caries by second grade;

• 80% have caries by the time they graduate from high school;

Sealants for 6 – 9 Year Olds (HRSA)

• Goal: This measure shows if dentists are taking preventive measures to prevent caries.

• Measure Description: Percentage of elevated risk children in the age category of 6-9 years who were seen by a dentist and received a sealant (D1351), or have an existing sealant on one or more first permanent molar tooth (tooth #3, 14, 19, 30).

• Denominator: Unduplicated number of elevated risk children between 6-9 years who were seen by a Dentist in the reporting period.

• Numerator: Elevated risk children aged 6-9 at elevated risk who were seen by a dentist and received a sealant, or have an existing sealant on one or more first permanent molar tooth in the reporting period.

• Timeframe: Reporting period is 12 months. • Benchmark: 85% • Exclusion criteria: Disqualifying patients with non-erupted teeth applied

from the reporting month of July 2016 onwards.

Timely Treatment Completion Rate

• Goal: This measure shows if providers are taking steps to complete dental treatment within an appropriate time frame.

• Measure Description: Percentage of dental treatment plans completed within 6 months of comprehensive (D0150).

• Denominator: Number of comprehensive oral examinations (D0150) in the 12 month period beginning 6 months before the reporting period.

• Numerator: Number of dental treatment plans completed (TxComplete) within 6 months of comprehensive oral examination in the reporting period (12 months).

• Timeframe: Reporting period is 12 months. • Benchmark: 75%

Measures Tab

• Measures tab displays the percentage score of various dental measures and evaluates centers/dental providers performance with regards to meeting a pre-determined organizational benchmark;

Source: http://www.sas.com/en_us/insights/big-data/data-visualization.html

•Data visualization is a quick and easy way to convey information;

•Using charts or graphs to visualize large amounts of complex data is easier than poring over spreadsheets or reports;

•Providing performance feedback to the users in a visual manner is more effective than sharing spreadsheets and reports;

Data Visualization

http://www.sas.com/en_us/insights/big-data/data-visualization.html

Trends Tab• Trends tab displays the performance of a chosen measures trending over a

monthly interval;

Healthy Competition and Transparency

Source: http://sciencenewsjournal.com/increase-teams-success-financial-incentive-friendly-competition/

http://sciencenewsjournal.com/increase-teams-success-financial-incentive-friendly-competition/

Comparison Tab

• Comparison tab is similar to the Trends tab but offers the flexibility of comparing every provider/center to every other provider/center system-wide

Acknowledgements

Amit Acharya, B.D.S., M.S., Ph.D.Director, Institute for Oral and Systemic HealthTenured Research Scientist, Institute for Oral and Systemic HealthMarshfield Clinic Research Foundation | Marshfield ClinicChief Dental Informatics OfficerFamily Health Center of Marshfield, Inc. | Marshfield ClinicEmail: acharya.amit@mcrf.mfldclin.edu

Harshad Hegde, M.S.Informatics Research ArchitectInstitute for Oral and Systemic HealthMarshfield Clinic Research Foundation | Marshfield ClinicEmail: hegde.harshad@marshfieldclinic.org

mailto:acharya.amit@mcrf.mfldclin.edu

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