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Integrating Chronic Care & Business Strategies in the Safety-Net

Integrating Chronic Care & Business Strategies in the Safety-Net. AHRQ Annual Meeting September 9, 2008. Chronic Illness in America. More than 125 million Americans suffer from one or more chronic illnesses and 40 million limited by them.

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Integrating Chronic Care & Business Strategies in the Safety-Net

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  1. Integrating Chronic Care & Business Strategies in the Safety-Net AHRQ Annual Meeting September 9, 2008

  2. Chronic Illness in America • More than 125 million Americans suffer from one or more chronic illnesses and 40 million limited by them. • Despite annual costs of more than $1 trillion and significant advances in care, one-half or more of patients still don’t receive appropriate care. • Gaps in quality care lead to thousands of avoidable deaths each year. • Patients and families increasingly recognize the defects in their care.

  3. Chronic Care Model Community Health System Health Care Organization Resources and Policies ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Improved Outcomes

  4. Experience with Collaboratives • More than 1,500 different health care organizations and various diseases involved to date • HRSA’s Health Disparities Collaboratives-600+ community and migrant health centers, • Academic Medical Centers • State, regional, and organization specific

  5. Evaluation of Chronic Care Collaboratives RANDHealth • Practices can change - organizations made average of 48 changes in 5.8/6 CCM areas • Process measures may improve – CHF, asthma, diabetes • Outcome measures may improve – better glycemic control in Diabetes Chin, et al. & Landon, et al. • May take more than 1 year to see outcome changes • Cost-effective

  6. Lessons Learned from the Teams • Teams spent considerable time searching for/developing tools • Some teams felt intimidated by taking on the whole model – asked for a sequence • Collaboratives were time & resource intensive • Many changes were made in ways that were not sustainable financially

  7. Integrating Chronic Care & Business Strategies in the Safety-Net Reaching beyond early adopters Integrate business & clinical changes Provide high- quality tools Less time- intensive learning

  8. Patient-centered Medical Home CCM A Common Misunderstanding: The CCM is only a small componentof the PCMH. The NCQA PPC-PCMH view: Much of the PCMH is consistent with the CCM. The Patient-Centered Medical Home and the Chronic Care Model? Correct Misperception

  9. The Intervention Practice Coach _________________ STEP-UP Methodology Toolkit ______________ Business & Clinical Tools PLUS

  10. Tasks Assessment Day ½ day presentation on CCM & PDSA On-going meetings by phone, email & in-person Coaching of the leaders & the teams Philosophy Focus on motivation, consultation & education Be mindful of the timing of interventions Fix processes relevant to the task at hand Well-structured & supported groups benefit most Coaching Outline

  11. Preliminary Reflections • Six months is short. • Randomization presents both challenges & opportunities. • There is a trade-off between customization and collaborative learning, but providing structured learning time is key. • Clearly define the coaches role & regularly check expectations.

  12. More Preliminary Reflections • Identify a leader on-site who is accountable, creative, flexible, & empowered. It is the functions of leadership, not the role that matters. • Coaches can identify major infrastructural barriers to improvement. • Coaching is one piece within a multi-level system – must seek out alignment between programs. • Coaching can jump-start spread.

  13. Next Steps • Complete evaluation • Revise toolkit & make available at AHRQ.gov & improvingchroniccare.org • Develop companion Coaching Manual • Pursue additional research questions • What are characteristics of teams that can succeed using this toolkit & coaching intervention? • What kinds of micro- and macro- business changes can we expect to see within 6 months or a year implementing the CCM?

  14. Thank you! www.improvingchroniccare.org

  15. Our Evaluation Uses A Block-Randomized Design with an External Control Group Baseline Measures Forming Team & Choosing Tools Implementing CCM & related Business Processes Improve. Pre-post Changes Post Measures Intervention Arm Tool Kit + Practice coaching Difference in Changes Internal Comparison Arm Baseline Measures Post Measures Pre-post Changes Secular Trends Baseline Measures Post Measures External Comparison Arm Pre-post Changes Secular Trends

  16. Measures Implementation: pre-post qualitative interviews • Organizational context & baseline assessment • Plan for change & organizational support • Improvement strategies & implementation processes • Perceived impact & lessons learned Health process & outcomes: HEDIS & utilization Financial measures: ReDeFin • No show rate • # of patient care encounters per FTE • Charges per patient encounter

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