Quality During a Pandemic

© 2020 All Rights Reserved

Quality During a Pandemic

Virtual Heart Attack and Stroke Free Zone Summit

June 14, 2021

Jerry Penso, M.D., M.B.A.

President and CEO, AMGA

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Congratulations on 10 Years!

University of Best Practices

• Jerry Penso, MD, MBA

• February 7, 2011

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Early Days of Be There

Inspiring Vision

Community-Wide Effort

Sharing Best Practices

Data SharingAddressing

Health Equity

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Todays Agenda

1. AMGA’s Quality Programs

2. What Happened to Medical Groups During the Pandemic

3. How was Quality Affected by Pandemic

4. How Do we move forward with Quality?

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Where Health Care’s Best Get Better

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Collaborative Best Practices

OpioidsAdult

ImmunizationObesity

Rheumatoid Arthritis

Chronic Obstructive

Pulmonary DiseaseDiabetes Care Hypertension HPV

MIPSPatients with

Multiple Chronic Conditions

Medicare Advantage

Osteoporosis

7©2021 All Rights Reserved





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Rise to Immunize™ Overview

AMGA Foundation’s third national health campaign

Four-year campaign focused on improving rates of four types of

adult immunizations

Launching at the 2021 Innovation, Quality, and Leadership (IQL)

Conference

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Rise to Immunize™ Goal

25 million vaccines documented or

administered by 2025

©2021 All Rights Reserved

What Happened to Medical Groups During Pandemic

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Financial Crunch –April 2020


Physician Compensation – April 2020


Staffing – May 2020


PPE Shortages – May 2020


Elective Services– July 2020


Racism and Health Equity – July 2020


Testing – August 2020

Copyright © 2020 AMGA Analytics LLC and OptumInsight Inc. All rights reserved.22

Telemedicine Utilization By Month 2020

E-Visit

CMS Virtual Communication

Phone E/M

Face-to-Face

Video

Visit Modality


Telemedicine Utilization 2020

CPX Participant Organizations

E-Visit


Phone E/M

Face-to-Face

Video

Visit Modality


Telemedicine Utilization by Specialty 2020

E-Visit


Phone E/M

Face-to-Face

Video

Visit Modality


Telemedicine Utilization by Patient Age 2020

E-Visit


Phone E/M

Face-to-Face

Video

Visit Modality

Age Group

26Pharmacist services:Test and Immunize

The PREP Act (Public Readiness and Emergency

Preparedness Act)

• Temporary until end of public health emergency

• Pharmacists:

• Order and administer COVID-19

tests/vaccines and childhood vaccines

• Pharmacy technicians and student

pharmacists:

• Administer COVID-19 tests/vaccines and

childhood vaccines under supervision of

licensed pharmacist

• Provides liability protection if follow specific

guardrails and restrictions

• Preempts state law

• Direct supervision using real-time audio and video technology for pharmacists providing evaluation and management services via telehealth under incident to arrangements

• DSMT (Diabetes self-management training) – accredited pharmacies enrolled in Medicare can deliver services via telehealth

• Virtual Medicare Diabetes Prevention Program (MDPP) delivery

• Expanded chronic care remote physiologic monitoring services (RPM) under supervision

• Pharmacist provided coordination of care and point of care testing in pharmacies and hospital outpatient clinics to complement telehealth visits

27Pharmacist services:Telehealth

• Refills

• Substitution

• Controlled substances

• Alternative/satellite locations

• Signature logs

• Delivery

• Hours

28Pharmacy operations:Dispensing flexibilities

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Leadership Council Virtual Discussions


COVID-19: Impact on Management of Type 2 Diabetes

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Copyright © 2017 AMGA Analytics LLC and OptumInsight Inc. All rights reserved.Copyright © 2021 AMGA Analytics LLC and OptumInsight Inc. All rights reserved.31

● 21 healthcare organizations (HCOs)

● 422K patients age 18 to 99 with type 2 diabetes and ≥1 ambulatory visit in CY 2019 with a PC, endocrinology, cardiology or nephrology provider

● No evidence of pregnancy, polycystic ovary syndrome, gestational or steroid-induced diabetes, palliative care, hospice, or death(2019 or 2020).

Study Population

Size reflects number of FTE physician at

HCO


● Change in visit volume (relative to Jan 2020) for 422K patients age 18 to 99 with type 2 diabetes and ≥1 visit in 2019 across 21 health care organizations (HCOs). Visits adjusted for variation in weekdays/month.

● Black line shows average for 21 HCOs. Each colored line represents an individual organization’s visit volume relative to their volume in Jan 2020.

● In April, average of 40% fewer visits relative to Jan 2020 (range 32% to 52%).

● By September, average visit volume recovered to nearly 12% fewer visits relative to Jan 2020 (range 4% to 29%).

Impact on Visit Volume (Jan–Sept 2020)

Percent difference relative to January

2020

Black line is average across all HCOs


Percent difference relative to January

2020

Visit Volume Relative to Jan 2020

Age Race/Ethnicity Median Household Income18-44 45-64 65-75 > 75 Black

(NH)Hispanic Asian

(NH)Other(NH)

White(NH) <50K 50-75K 75-100K > 100K


● Black line is average for all 21 HCOs. Each colored line represents an individual organization.

● Telehealth represented less than 1% of all visits in Jan and Feb (range 0% to 3%).

● In April, the peak use of telehealth (as a proportion of total visits) averaged 63% (range 13% to 90% across organizations).

● Proportion of visits provided via telehealth fell sharply for all groups, pattern of decline varied and where organizations settled in Sep ranged from 2% to 28% of total visits (average 10%).

Proportion of Total Visits that are Telehealth

13%

90%

63%

2%

28%

10%Black line is average across all HCOs


● Across 9 groups with endocrinology, cardiology and nephrology, the percent of total visits conducted via telehealth at the peak (April) ranged from 65% (PC) to 82% (endo)

● The proportion of total visits conducted via telehealth settled in September at a low of 5% for cardiology visits to 20% among both endocrinology and nephrology visits

Visits by type: In-person vs. Telehealth (percent of total) Jan—Sep 2020

Total Visits (n)

In-person

Telehealth

Percent of total visits


Age Race/Ethnicity Median Household Income

18-44 45-64 65-75 > 75 <50K 50-75K 75-100K > 100KWhite(NH)

Black(NH)

Other(NH)

Asian(NH)

Hispanic

Proportion of visits that are telehealth (Monthly Jan thru Sep 2020)

Percent of patients with at least one visit in month (Jan to Sep 2020)


(1 of 3) Percent of patients with lab, clinical measures, visits (in-person, any)● For 422K patients across 21 HCOs, the change in the percent of patients with at least one A1c, lipid , URAC recorded per calendar month (adjusted

for weekdays/month) relative to Jan 2020. All 3 labs have similar patterns with regard to the fall in April (down 61% to 64% relative to Jan 2020)

● Lab recovery peaks in June before settling in at 6% to 9% below Jan

LabsuACR measured

Lipid measured

A1c measured

Patient with:

Percent difference relative to

January 2020


(2 of 3) Percent of patients with lab, clinical measures, visits (in-person, any)● For 422K patients across 21 HCOs, the change in the percent of patients with at least one A1c, lipid , URAC recorded per calendar month (adjusted

for weekdays/month) relative to Jan 2020. All 3 labs have similar patterns with regard to the fall in April (down 61% to 64% relative to Jan 2020)

● Lab recovery peaks in June before settling in at 6% to 9% below Jan

● Clinical measures fall in April to 67% (BMI) and 72% (BP) and recover to 14% and 15% respectively

Labs

Clinical measures

uACR measured

Lipid measured

A1c measured

BMI recorded

BP recorded

Patient with:


January 2020


uACR measured

Lipid measured

A1c measured

● For 422K patients across 21 HCOs, the change in the percent of patients with at least one A1c, lipid , URAC recorded per calendar month (adjusted for weekdays/month) relative to Jan 2020. All 3 labs have similar patterns with regard to the fall in April (down 61% to 64% relative to Jan 2020)

● Lab recovery peaks in June before settling in at 6% to 9% below Jan.

● Clinical measures fall in April to 67% (BMI) and 72% (BP) and recover to 14% and 15% respectively.

● Over time we see labs begin to track more closely with total visits (as they ramp up lab options to support telehealth visits and catch-up for those that put off labs) creating a steeper recovery, while clinical measures track more closely to in-person visits throughout the year.

In-person visit

Any visit

BMI recorded

BP recorded

In-person visit

Any visit (in-person or TH)

(3 of 3) Percent of patients with lab, clinical measures, visits (in-person, any)


January 2020

Patient with:

Patient with:


What are we seeing for outcomes?

• 800K patients with T2DM at 62 HCOs reporting T2G measures in 2019 Q4 and 2020 Q4

• On average, HCOs saw HbA1c, BP, Nephropathy and Bundle control fall

• Lipid management increased (Pts w/ an Rx for statin)

% change in T2G measure control rates relative to 2019 Q4


Improvements inHealth Care Organizations during COVID-19

41


Together 2 Goal: HbA1c < 8.0

Big push to get HbA1c up to date in 2020Q4 as part of PCMH application

28 HCOs with better than average performance(Δ HbA1c control rate)


Together 2 Goal: BP < 140/90

Involved in health system BP project, which has formalized workflow to record BP readings including those from ‘virtual’ visits.

Missed BP targets in value-based contracts in prior year, so have pushed education and efforts to record BP using best practices and to ensure BP is taken at least twice to remove any white coat syndrome

29 HCOs with better than average performance

(Δ BP control rate)


Together 2 Goal: Attention for Nephropathy

Part of big push at end of 2020 to support PCMH application


(Δ attn to nephropathy rate)


Together 2 Goal: Lipid Management


(Δ lipid management rate)

Participating in several value-based risk contracts (all have lipid management measures). Plans have assisted us (e.g., patient outreach, switching patients to 90-day supply for Rx, etc.). Expanded internal care management team to focus on these measures.


Together 2 Goal: Bundle Control


(Δ bundle rate)

Colorectal Cancer Screening Overall


Colorectal Cancer Screening Improvements: HCO #1

Screened

Not Screened

Hypertension Control Overall


Hypertension Control Improvements: HCO #2

In Control

Out of Control

Missing


Going Forward

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Opportunities

Telehealth

AI

Home Testing

Pharmacy/Pharmacist Role

Health Equity/SDOH

Mental Health

Consumerism

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53

Harness Technology

Drive Change within the

Organization

Engage the Care

Team

High-Performer Trends

Empower Patients

“Own” the Data

Develop External

PartnershipsLeverage Campaign Resources

54

Inspiring Vision

Community-Wide Effort

Sharing Best Practices

Data SharingAddressing

Health Equity

© 2020 All Rights Reserved

Quality During a Pandemic

Virtual Heart Attack and Stroke Free Zone Summit

June 14, 2021

Jerry Penso, M.D., M.B.A.

President and CEO, AMGA

Documents

Quality During a Pandemic