The Three Phases of Collaboration: Chronic Disease Management, Cancer Prevention, and Capacity

1. The Three Phases of Collaboration: Chronic Disease Management, Cancer Prevention, and Capacity Kim Salamone, Ph.D. Vice President, Health Information Technology

2. Health Services Advisory Group • Quality Improvement Organization for Arizona, California, and Florida • Subrecipient for Arizona Regional Extension Center (REC) • Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance • Partners with physicians, health plans, nursing homes, hospitals

3. Agenda • Overview of 3 Phases • Goals • Outcomes • Lessons Learned • Barriers to reporting • Motivation to overcome barriers

4. National Strategy for Quality Improvement in Healthcare

5. Phase 1: Chronic Disease Management • Use Electronic Health Records (EHRs) to manage patients with chronic diseases => increased quality of healthcare • Baseline of Stage 1 core meaningful use (MU) and core clinical quality measures (CQMs) • Mammography screening, colorectal cancer screening, cervical cancer screening, and chlamydia screening • Administered the ASHLine Tobacco Cessation Assessment Tool to each site

6. Phase 1 Outcomes • No CHCs had actually reached MU. • Medicaid Adopt/Implement/Update (AIU) • Out of the 8 community health centers (CHCs) that purchased NextGen, only Chiricauhua and Adelantehad received the necessary health quality measures (HQM) module. • The HQM was proven problematic • Some interfaces didn’t work • Calculations were wrong on CQMs

7. Phase 1: Lessons Learned • Thresholds were difficult to meet for MU: • Clinical summaries • Providing patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication lists, medication allergies) upon request • Reminders to patients, per patient preference, for preventive/follow up care • Diabetes measures were difficult to calculate for NextGen users. • Users struggled with documentation.

8. Phase 2: Cancer Screening Measures • Limited budget and scope • AdelenteHealthcare • Mountain Park • Maricopa County Health Care for the Homeless (MCHCH) • Wesley • Providers had met Stage 1, year 1 MU • Adelente could not produce the CQMs • MCHCH was the only one where baseline measures were generated for diabetes measures • Every CHC improved • Breast cancer screening • Diabetes LDL management control • Diabetes A1C control

9. Phase 2: Lessons Learned • Healthcare reform requires implementing change systemically • Using an EHR in a meaningful way • Improving quality measures • Implementing quality improvement projects • Emphasizing preventive medicine • Barriers that remain: • Data entry of labs, cancer screening reports, and other scanned-in reports • Changes in EHRs • Users still struggle with documentation

10. Phase 3: Capacity Building • EHRs • 2 Next Gens • 1 eCW • Aligned with Arizona Department of Health Services (ADHS) and Centers for Disease Control and Prevention (CDC) measure interests • Five distinct elements • Assessment • Baseline determinations • Workflow review • Capacity development • Identify best practices

11. Phase 3: Assessment • Current utilization of the EHR to maintain current and complete information related to multiple measures • MU-focused • Measure specifications different • 90 days • EHRs restricted outside of MU requirements • Issue with 2014 versions

12. Phase 3: Capacity Building • Currently generating measures: • Current baseline screening rates for breast, cervical and colorectal cancers • Percent of the diabetes population within range for HbA1C • Percent of population with smoking assessed, and a referral to ASHlinerecorded for smokers • Percent of population with BMI assessed and recorded • Percent of population with complete HPV immunizations • Percent of population with alcohol use assessed • Percent of population with physical activity assessed, addressed

13. Phase 3: Current Status and Next Steps • Current Status • Have baseline measures for Adelente • Feedback reports generated for each site • Started workflow analyses at each site • Next Steps • Obtain baseline from the other 2 CHCs • Produce feedback reports and conduct workflow analyses • Capacity development • Train the trainer on generating care management reports • Implement preventive, patient-centered procedures • Share best practices with ADHS, Arizona Alliance for Community Health Centers (AACHC), and others for dissemination

14. Barriers to Reporting • Physician buy-in • Takes away from direct patient care • Adds work time • Less efficient than paper • EHRs • Some have multiple ways to input the same measure, example: BP • Confusion regarding requirements • Standards • Interoperability

15. Motivating providers • Must align with National Strategy • Must demonstrate level of care • Must demonstrate quality of care • The U. S. Department of Health and Human Services (HHS) beginning to align measures and payment mechanisms • MU • PCMH • ACA • PQRS

16. Additional Questions? Kim Harris-Salamone, PhD, MPA Vice President, Health Information Technology Health Services Advisory Group KSalamone@hsag.com