solomon by k3vXw129

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									California Quality Collaborative
   Accelerating Improvement of the
    Commercial Delivery System


          Neil A. Solomon, MD
          Clinical Director, CQC
                                     1
                   Regional Variation
        Clinical Performance                 Patient Ratings of Care
90
                                     84
85                                   83
80                                   82
75                                   81
70
                                     80
                                     79
65
                                     78
60                                   77
55                                   76
50                                   75

                                          Inland Empire    Los Angeles      Orange County
     MY 2006 P4P Results by Region        Central Valley   Central Coast    San Diego
                                          Bay Area         Sacramento/North Statewide
                                                                                        2
 Courtesy of IHA
    California Quality Collaborative
• Statewide collaboration of purchasers, health plans, physician
  groups, QIO, and their partners
• Identify and accelerate adoption of innovations in ambulatory care to
  achieve the highest attainable value
    – By promoting system changes and care re-design
        • At the practice site
        • At the physician groups
    – For the benefit of all patients cared for by practices affiliated with
      delegated physician groups
    – With other organizational partners in California (e.g. government, public
      health, academic institutions)
    – To achieve the 6 IOM aims
• Started as Diabetes CQI project (7 years), then Breakthroughs in
  Chronic Care Program (2 years): Progressive scope of work.
                                                                             3
Strategy for Changing Practice
                           Lever for Change
          110
        Physician            What groups/IPAs can do that
                             most doctors can’t:
         Groups
          Contract with:
                                •Provide feedback reports
                                from multiple payers
         35,000                 •Invest capital for IT
        Practices               systems (EMR/registries)
            Care for:           • Hire staff to redesign
                                practice
      Est. 13 million
                                • Offer Practice incentives
      HMO and PPO
         Patients               •Coordinate care across
                                settings and offices 4
1. Run Implementation Collaboratives
      Improving Patient Satisfaction Scores (PAS)
      Improving Clinical Results
      Improving Efficiency/Total Cost
2. Coordinate disease management between
   health plans and groups
3. Facilitate Regional Learning Networks
4. Conduct performance Improvement training
   for executives and executive teams


                                                     5
Improving Patient Experience
2007
  – 4 groups participated in first implementation collaborative 2006-
    07, showed improvement across all 2008 P4P measures.
    Rating of all care improved 7.6%, twice state average.
  – Improved patient experience scores an average of 3 points in 9
    months. Improved Staff Satisfaction over same time period
  – Documented key changes in change package published on
    web site www.calquality.org
2008
  – Supported implementation of key changes at 8 more physician
    groups (estimated 1.2 million HMO/PPO enrollees)
  – Analyzed and submitted findings for publication
2009
  – To begin implementation at additional 10 groups
  – Will disseminate best practices through one-day conference     6
        Clinical Improvement
2006-08
     – Improved 7 Diabetes and Cardiovascular process
       measures for practices at 13 physician groups (2 million
       HMO/PPO members)
     – HbA1c < 7 increased 28 percentage points (from 49% to
       77%) over following 12 months while matched controls
       remained unchanged
     – In 2008, working with 23 more groups in Inland Empire
In 2009:
     – Will Support implementation of best practices - reporting
       tools and workflows to improve clinical performance – in
       lower performing physician groups

                                                                   7
                              Example: Diabetes Results in One Group
                                                                                                                             % Diabetes Patients in Control
                                        HbA1C Screening Rates                                                                        (<7.0 HbA1c)

                           100%                                                94%                                    100%
                                                          90%
                           90%          86%                              86%                                          90%
                                  82%              83%
                                                                                                                                                                        77%




                                                                                           % meeting HEDIS Criteria
                           80%                                                                                        80%
% meeting HEDIS Criteria




                           70%                                                                                        70%
                                                                                                                                            57%                   57%
                           60%                                                                                        60%
                                                                                                                               51%                 49%
                           50%                                                                                        50%

                           40%                                                                                        40%

                           30%                                                                                        30%

                           20%                                                                                        20%

                           10%                                                                                        10%
                                                                                                                       0%
                            0%
                                    2004                2005               2006                                              2004                2005               2006

                                              Network    CQC Practices                                                                 Network    CQC Practices



                                                                                                                                                                              8
                                                                               Hill Physicians
                   Efficiency
2008
  – Trained 6 physician groups (est. 1.2M HMO/PPO members) in
    methodology to engage physicians on reducing overuse
  – 4 focus areas: ED use, CAD testing, extremity MRIs, anti-HTN
  – Producing change package for managing ED use
2009
  – Showcase methods to address variation and reduce overuse at
    one-day conference in March
  – Teach 8 new physician groups to address variation and overuse
    (integrating P4P Efficiency metrics)
  – Offer teleconferences on reducing ED use and improving generic
    prescribing


                                                                   9
                   Regional Variation
        Clinical Performance                 Patient Ratings of Care
90
                                     84
85                                   83
80                                   82
75                                   81
70
                                     80
                                     79
65
                                     78
60                                   77
55                                   76
50                                   75

                                          Inland Empire    Los Angeles      Orange County
     MY 2006 P4P Results by Region        Central Valley   Central Coast    San Diego
                                          Bay Area         Sacramento/North Statewide
                                                                                       10
 Courtesy of IHA
           Learning Networks
• Inland Empire:
  – 31 physician groups participated over 12 month
    period
  – Participants improved more than others in the region
    better on P4P Patient Experience ratings (Clinical
    results to come..) 2007 to 2008.
• Los Angeles and Orange County to start in Q4
  20089

                                                           11
                         CQC: Physician Group Engagement

                                                                 7,000,000
                   100
                                                                 6,000,000
Number of Groups




                   80                                            5,000,000




                                                                             Enrollment
                                                                               Total
                   60                                            4,000,000

                                                                 3,000,000
                   40
                                                                 2,000,000
                   20                                            1,000,000

                    0                                            0
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                   Ap 0 6




                   Ap 0 7




                   Ap 0 8
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                   O -06




                   O -07
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                    Ju 6




                    Ju 7




                          8
                   Ja 05




                   Ja 06




                   Ja 07
                      r- 0




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                         # of Groups   Target Group Enrollment
                                                                                          12
      Steering Committee (summer 2008)
Ellen Badley
Department of Managed Health Care                  Lance Lang, MD – Co-Chair
State of California                                Vice President, Senior Medical Director,
                                                   Health Net
Mike Belman, MD, MPH
Staff VP & Medical Director Quality Management,    Nancy Oswald, PhD
Blue Cross of California                           Executive Director,
                                                   Redwood Community Health Coalition
Michael-Anne Brown, MD
Sr. Medical Director of Quality ,                  Susan Payan-Lopez
Blue Shield of California                          California Diabetes Program

Elizabeth Haughton                                 Linda Sawyer, PhD, APRN , BC
Chief Counsel, NAMM                                Chief Operating Officer,
                                                   Lumetra
Halsted Holman, MD
Professor of Medicine, Stanford University         Wells Shoemaker, MD Co-Chair
                                                   Medical Director,
David Hooper, MD                                   California Association of Physician Groups
Chief Operating Officer,
Palo Alto Medical Group
                                                   Michael Van Duren, MD
                                                   Medical Director
David Hopkins, PhD
Director of Quality Management, Pacific Business   Hill Physicians                              13
Group on Health/CCHRI
2007 Funding
 $1.2 Million


                Health Plans
                Pharma
                CHCF
                Fdn-Other
                PBGH
                Fees
                Other




                               14

								
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