Screen for Life

Ruth D. Stevens MD, MPHChief Quality Officer

HealthLinc

v Objectives

The framework that HealthLinc uses to identify patients needing screening.Evidence based interventions utilized

improve screening rates.Methodologies to ensure that patients

receive the materials (FIT/FOBT) or referralPractices in place to improve the return of

test kits

vScreen for Life Training

Model

v PRODUCTS

Greenway Practice ManagementGreenway Intergy EHRPractice Analytics

vPractice Analytics

PCMH pre-validatedIdentify gaps in care based on diagnoses, lab results,

vitals, visits, risk level, and more.Analyze obscure or non-standard measures.Supports group reporting and all EHR-based

measures.

vMeasure Criteria

CQM 130: Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

NUMERATOR DENOMINATORPatients who met any of the following: • A fecal occult blood test (FOBT) or a fecal

immunochemical test (FIT) during the reporting period.

• A fecal occult blood test (FOBT) can be indicated by a resulted patient order record with a result date that occurred during the reporting period.

• A flexible sigmoidoscopy during the reporting period or the 4 years prior to the reporting period start date.

• A colonoscopy during the reporting period or the 9 years prior to the reporting period start date.

Patients 50-75 years of age with a visit during the measurement period

vCQM Measure Selection

vDASHBOARD

vPerformance by Site

Colorectal Cancer Screening (CQM-130)

12.31.17 2017 GOALService Center Numerator Denominator Percent Percent

2,433 5,504 44.0% 65.00%HealthLinc Valparaiso (1) 728 1,676 46.10% 65.00%HealthLinc Michigan City (10) 560 1,153 50.60% 65.00%Porter Starke Services -OV (151) 28 57 50.00% 65.00%HealthLinc Mishawaka (500) 442 1,156 39.50% 65.00%(-Empty-) 10 18 65.20%HealthLinc East Chicago (300) 292 588 52.10% 65.00%HealthLinc Knox (17) 296 624 46.50% 65.00%HealthLinc Mobile Bus (23) 13 22 65.20% TBDHealthLinc South Bend - Medical (750) 61 194 30.90% 65.00%

vPerformance by Provider

Measure Provider Percent Numerator DenominatorGrand Total 44.0% 3,863 8,119

148 61.1% 121 198198 58.9% 166 28247 58.0% 275 47478 55.0% 172 313136 54.2% 143 264132 53.8% 56 104221 52.4% 11 21201 52.3% 45 86191 51.1% 137 268208 51.0% 134 2633 50.6% 126 249

197 50.3% 74 147144 46.9% 129 275166 46.9% 128 273194 46.4% 77 166122 44.0% 103 234206 43.8% 116 26581 43.7% 136 311205 39.4% 69 175165 38.3% 74 193207 37.6% 68 181181 35.0% 21 60109 33.3% 2 6220 30.8% 8 26

vCompliant and Deficient Patients

vPatient List

Person Last Name First Name Age at Start Qual Visits Recent Cancer Screening Exclusion

8678a 10 COLONOSCOPY on 12/12/2008

HL 2

abc 4 COLONOSCOPY on 06/30/2016

abc 8

abc 1 FOBT on 09/18/2017

abc 11

abc 2

abc 4

abc 1

abc 1

abc 13 FOBT on 06/28/2017

abc 1 COLONOSCOPY on 04/13/2011

abc 9 COLONOSCOPY on 10/29/2009

abc 10 FOBT on 11/06/2017

abc 2

abc 10 FOBT on 03/01/2018

abc 4 COLONOSCOPY on 06/27/2014

abc 3

abc 3 FOBT on 11/21/2017

abc 16 FOBT on 12/11/2017

abc 3

abc 7

abc 3

abc 2

abc 1 COLONOSCOPY on 11/12/2013

vBest-Practice Strategies

https://www.thecommunityguide.org

vStrategies Implemented by HealthLinc:

Increase Community Demand

• One-on-One Education• Client Reminders• Small Media• Mass Media

vStrategies Implemented by HealthLinc:

Increase Community Access

• Interventions to Reduce Client Out-of-Pocket Costs

• Interventions to Reduce Structural Barriers– Providing Appointment Scheduling Assistance– Reducing Administrative Barriers– Providing Translation

vStrategies Implemented by HealthLinc:

Increase Provider Delivery

• Provider Reminders (EHR)• Provider Assessment and Feedback

vTracking Codes for Each Step

in the Decision Tree

• Patient education regarding importance of screening

• Kit distributed• Directions given• Kit returned• Test results• Task to provider • F/U Calls made• Referral for positive results

vBarriers to Success

• Tracking• Staff engagement• Increased MA responsibility• Patient compliance• Limited resources

– Time– Financial

• High false-positive rate

vIt Takes a Village

• Provider Engagement (MOC)• Provider training – Population Health & Documentation• Create a staff training workplan• “Poop” on Demand• Mock prescription pads• Executive decision to provide free FIT testing• Call center scripting• Dummy tracking codes• Marketing• Creating a “Screen for Life” training model

vTimeline of Progress

ISDH ICC Project Implementation: June 2015

v

QUESTIONS