Michigan Quality Improvement Consortium 2005 Activity Highlights.
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Transcript of Michigan Quality Improvement Consortium 2005 Activity Highlights.
Michigan Quality Improvement Consortium
2005 Activity Highlights
Member Organizations
• Blue Cross Blue Shield of Michigan • Blue Care Network• Care Choices• Community Choice Michigan• Great Lakes Health Plan- New Member• Health Alliance Plan• HealthPlus of Michigan• Health Plan of Michigan• M-CARE• Midwest Health Plan• Michigan Association of Health Plans
Member Organizations (cont’d)
• Michigan Department of Community Health• Michigan Osteopathic Association• Michigan State Medical Society• Molina Health Care of Michigan• Michigan Peer Review Organization• Physicians Health Plan of Mid-Michigan• Physicians Health Plan of South Michigan• Physicians Health Plan of Southwest Michigan• Priority Health• Total Health Care, Inc. – New Member• University of Michigan Health System
Guideline review/updating in 2005
•Medical Management of Adults with Osteoarthritis
•Screening and Management of Substance Use Disorders
•Outpatient Management of Uncomplicated Deep Venous Thrombosis
•Medical Management of Adults with Hypertension
• Screening and Management of Hyperlipidemia
• Tobacco Control •Management of Osteoporosis
Medical Directors’ Activities
New guideline development in 2005
•Identification, Evaluation and Treatment of Overweight and Obesity in the Adult (approved 03/05)
•Adult Preventive Services (approved 07/05)
•Prenatal Care (draft #3)
•Pediatric Preventive Services (draft #1)
Medical Directors’ Activities
Medical Directors’ Activities(Cont’d)
Future Guideline Development Agenda
• Chronic Kidney Disease
• Low Back Pain
• Pediatric Obesity
• Acute Bronchitis
• Medical Management Post Myocardial Infarction
MQIC Measurement Group
• HEDIS® and non-HEDIS® compliance measures and measurement specifications have been developed for the following MQIC guidelines:
• Diabetes• Asthma• Tobacco Control• Depression• Substance Use• Hyperlipidemia• Hypertension• Acute Pharyngitis
MQIC Measurement Group(Cont’d)
• Revised lipid-lowering drug list and AHFS codes for diabetes non-HEDIS® measure (percent members on lipid-lowering drugs)
• Significant work has been done to develop measures and measurement methodologies for the heart failure and osteoporosis guidelines
• Analysis completed on MQIC Diabetes Pilot aggregate physician reports
• MQIC health plans submitted HEDIS® 2005 and non-HEDIS® data for MQIC performance reporting
MQIC Implementation Group
• Instrumental in the distribution and review of MQIC guidelines and collection of feedback
• Promoted MPRO DOQ-IT project• Developed list of potential future collaborative
initiatives, including:• Multi-payer performance reports for diabetes, asthma and
depression using administrative data
• Adoption of Asthma Initiative of Michigan’s Mark Toolkit as supplemental tool for MQIC asthma guideline
MQIC Implementation Group(Cont’d)
• Increase physician recognition and awareness of MQIC guidelines, activities and resources
• Identify supplemental materials/tools that will facilitate guideline usage in the practice setting
• Coordinate and assist Michigan Primary Care Initiative work group in assessing existing tools
Coordination with Other Efforts
GDAHC “Save Lives Save Dollars” Initiative
Primary Care Initiative for a Healthier Michigan
GDAHC “Save Lives Save Dollars”
PROPRIETARY © Thomas Group, Inc All Rights Reserved
How We Got Here
GDAHC formed Future Directions Initiative Steering Committee Measurement and Reporting Expert Panel Payment Expert Panel Cost Savings Ad Hoc Committee Public Reporting Ad Hoc Committee Out patient / In Patient Ad Hoc Committee Business Case Ad Hoc Committee
Save Lives Save Dollars (SLSD) resulted
Business Plan published
Thomas Group hired to manage
PROPRIETARY © Thomas Group, Inc All Rights Reserved
How We Got Here
GDAHC formed Future Directions Initiative Steering Committee Measurement and Reporting Expert Panel Payment Expert Panel Cost Savings Ad Hoc Committee Public Reporting Ad Hoc Committee Out patient / In Patient Ad Hoc Committee Business Case Ad Hoc Committee
Save Lives Save Dollars (SLSD) resulted
Business Plan published
Thomas Group hired to manage
PROPRIETARY © Thomas Group, Inc All Rights Reserved
Organizational Process
GDAHC Board
CFT 4Measurements
5 Members
CFT 3Public Reporting
5 Members
CFT 2Differential Payment
5 Members
CFT 1Evidence Based Practice, Cost Savings & Quality
7 Members
SLSDSteering Committee
Results Improvement TEam(RITE) – 11 Members
Generic Rx
BRT 1 BRT 2 BRT 1 BRT 2 BRT 1 BRT 2Diab.
CFT – Cross Functional TeamBRT – Barrier Removal Team
Sub CFT 3
Sub CFT 4
PROPRIETARY © Thomas Group, Inc All Rights Reserved
CFT Membership
Industry
M. Manning GM
S. Peters Comerica
K. Kohn-Parrott Daimler Chrysler
R. Lueders DTE
R. Turner-Bailey
Ford
Providers
J. Billi U of MR. Frank Oakland Co Med Soc
D. Muenk MSMS
P. LaCasse Botsford
M. Johnson Beaumont
M. Henoch
Oakwood Health Care
S. Grant United Physicians
T. Lundstrom - DMC
Payor / HP
B. Pai HAP
G. Kipa BCBS
K. Seitz BCN
Z. Geyer-Sylvia MCare
W. Alvin Care Choices
J. Halman MCareE. Tuller Care Choices
Others
M. Abbott Thomas Group
D. Ebers GDAHC
H. Lock Thomas Group
J. Kerr GDAHC
R. Robinson Thomas Group
B. Hurd GDAHC
H. Lock Thomas Group
D. Ebers GDAHC
CFT 1 – Evidence Based Practice, Cost Savings and Quality
CFT 3 – Public Reporting
CFT 4 – Measurements
Chairperson Updated 11/15/05
CFT 2 – Differential Payment
Primary Care Initiative for a Healthier Michigan
Michigan Steps Up:Stakeholder Groups
Business
Healthcare
Schools
Faith-based
Community
Mission The Primary Care Initiative for a Healthier Michigan is a statewide, broad-based group of key stakeholders and other interested parties convened to collaborate to improve the system of delivering prevention services and management of chronic disease and/or other conditions in primary care settings throughout Michigan.
Priority System Barriers •Referral and Access to other Professionals/ Community Resources
•Access to a Comprehensive Patient Data Base (Health Record)
•Payment Structure/Reimbursement
•Multiple Guidelines (Work group co-chair – Marc Keshishian)
•Shift from Episodic Care to Health Promotion
Goals 1. The Primary Care Initiative (PCI) will endorse Michigan Quality Improvement Consortium (MQIC) as a central source for practice guidelines in Michigan.2. The Primary Care Initiative and partners will facilitate the dissemination and implementation of MQIC guidelines to all primary care providers in Michigan.
1. Obtain MQIC collaboration and agreement to be the central source of practice guidelines in MI.
2. Secure agreement of payers and other stakeholders to support MQIC as the central source of practice guidelines
3. Identify a process for addressing input for and gaps in MQIC guidelines.4. Identify a process for incentives to primary care providers to promote the use of
MQIC guidelines. 5. Develop a single set of performance measures based on MQIC guidelines to be
used for evaluation and reporting.6. Educate primary care health professionals in MI about MQIC guidelines and facilitate
their use.
Objectives
Other Activities
•Interview with Robert Wood Johnson
•National Guideline Clearinghouse
•HAP Quality Expo
•BCBSM Provider Information Fairs
•Southfield, Port Huron, Saginaw