Embed Size (px)
Citation preview
Session 14: Performance Improvement Tools: Gathering the Evidence
R.S. Crawford, III, MD, [email protected]
April 2012
Disclosure
Presenter(s) has no financial interest to disclose.
This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with the MedXellence Program. PESG, and MedXellence Staff, and accrediting organization do not support or endorse any product or service mentioned in this activity.
PESG and MedXellence Program staff have no financial interest to disclose.
Objectives
• Describe MHS performance tools that facilitate delivering population health.
• Use the MHS Population Health Portal to describe a population and forecast the demand for services.
• Use the Tricare Operation Center (TOC) and the Template Analysis Tool (TAT) to assess & manage capacity.
Setting the Stage
Analyst Goal with Dr Crawford
• Establish a working relationship, trust and listen What insight does he already have?
• Assist in decreasing his level of uncertainty This isn’t a research study
• Provide useful information for decision support
• Demonstrate actionable information tools for all staff Executives
Managers
Front-end Staff
Proposed Strategy and Management Questions
Core Measures and Driver Measures
Improving Population Health (Big Picture)
PreventionPopulation at Risk
Incidence of Disability or Disease
Case Management Level 1
Prevalence of Disability or Disease
Level 2Level 3Level 4Level 5
Death
Recovery
Population Health Management
https://carepoint.afms.mil
• Population Identification• Preventive Service Needs• Condition Management• Demand Forecasting • Metrics (HEDIS/PCMH)• Merged with Appointments
MHSPHP Data Sources
DEERS M2 CHCS
Direct CareInpt and Outpt
Purchased Care/NetworkInpt and Outpt
PDTS
TRICARE Enrollment
AdHocs
MammographyPap Smears
Clinical ChemistryEnrollment
MHS Population Health Portal
Population Identification / Overview
Drill Down Reporting Options
• Select one or many DMISs one at a time for a rolled up metric
• Or Select only one provider group
• Choose the metrics you want to view/export
• All HEDIS vs AD
Graphically Displayed Metrics with Benchmarks
Multiple Options for Reporting
•Ability to filter and rank• Ability to save report filtering•DMIS based filters
MHSPHP Action List with Options
MHSPHP Patient Detail (Quick View)
MHSPHP Patient Detail (Extended View)
MHSPHP Patient Detail (Chart View)
MHSPHP Diabetes Detail Pop-up
• Shows diabetes list details and how patient met criteria to be on list:
• Shows most recent 2 outpatient encounters*
• Most recent Hospitalization*• Most recent ER visit*• Most recent 3 dates of diabetic
med dispensing
• *with any ICD9 diagnosis code of diabetes in the claim or encounter; it does NOT have to be primary diagnosis
MHSPHP Local Exclusions
•Exclusions automatically expire after 1 year•Exclusions follow pt (new facility can validate or delete)•30 day flag before they expire•Different icon if exclusion was at other facility•Apply to Medical Home and Action Lists, not HEDIS
MHSPHP Action List Exclusion Report
The exclusion will disappear one year from this date. Renew exclusion prior to this date by re-opening exclusion and clicking save
MHSPHP Data Merged With Appointments
MHSPHP Timelines
• Metrics are run monthly• Patient lists other than appointments are updated monthly• Most data sources are received monthly• Data takes ~ 6 wks to process: anticipate update release
between 15-20 of each month • Nightly test data received from CHCS:
• Certified final results for Paps, mammos, colorectal screens, Hgb A1Cs, cholesterols
• These tests should be on list within 3 days of completion• TSWF MHSPHP AIM form data typically updates 2-3 wks after
entry• Appointment list updated every 10-15 minutes: click refresh to
receive updates
Tri-Service Workflow Team (TSWT) Form
• The form assists MTFs to capture HEDIS-related test results from sources which are not already captured by the MTF
• Use the form only for cancer screenings (breast, cervical, and colorectal cancer screenings), HgbA1c results, and LDL results
• Results properly entered will be automatically added to the numerator as your MTF’s HEDIS metrics are updated monthly
MHSPHP
Putting Care Point to Work:Demand Forecasting
Demand Forecasting
• Daily Demand Forecasting: Team huddles with integrated care team Same reasons as inpatient report
• Planning, Coordination, Safety
• Demand Forecasting and Planning: Increase Primary Care enrollment.
• Effects our ability to deliver preventive services in a timely manner (example: pap smears, mammography). What’s the demand for services with our increases in empanelment?
• School physical demand what can we expect? Do we need to adjust schedules?
Population Identification / Overview
Demand Forecasting and Planning
• Women 18 and older = 92319231/ @ least one Pap q3 yrs = ~3077/yr
• Women 50 and older2632/ @ least one Mammogram q 2 yrs = ~1316/yr
• Children 5 years old ready to start school256 School Physicals
• 52,000 FMC Annual Appointments
Access to Care&
Templates & Scheduling
75.2
77.5
60
65
70
75
80Au
g-09
Sep-
09
Oct
-09
Nov
-09
Dec-
09
Jan-
10
Feb-
10
Mar
-10
Apr-
10
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Oct
-10
Nov
-10
Dec-
10
Jan-
11
Feb-
11
Mar
-11
Apr-
11
May
-11
Jun-
11
Jul-1
1
Aug-
11
Sep-
11
Oct
-11
Nov
-11
Dec-
11
ER V
isits
/ 1
000
Pt E
mpa
nelle
d
ER Visits / 1000 Pt. Empanelled
UCL 73.9
Mean 68.1
LCL 62.4
70.3 69.8
55
60
65
70
75
Aug-
09
Sep-
09
Oct
-09
Nov
-09
Dec-
09
Jan-
10
Feb-
10
Mar
-10
Apr-
10
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Oct
-10
Nov
-10
Dec-
10
Jan-
11
Feb-
11
Mar
-11
Apr-
11
May
-11
Jun-
11
Jul-1
1
Aug-
11
Sep-
11
Oct
-11
Nov
-11
Dec-
11
%
% ER Visits Between 0800 - 1700
UCL 67.0
Mean 63.8
LCL 60.6
40.2
10
15
20
25
30
35
40
45
Aug-
09
Sep-
09
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb-
10
Mar
-10
Apr-
10
May
-10
Jun-
10
Jul-1
0
Aug-
10
Sep-
10
Oct
-10
Nov
-10
Dec
-10
Jan-
11
Feb-
11
Mar
-11
Apr-
11
May
-11
Jun-
11
Jul-1
1
Aug-
11
Sep-
11
Oct
-11
Nov
-11
Dec
-11
ER V
isits
/ 1
000
Ast
hmat
ics
ER Visits / 1000 Asthmatics
UCL 37.2
Mean 26.8
LCL 16.5
Dec 11
Clinic ER Visits Total Empanelled
ER Visits per 1000 Empanelled
% of Total Visits
Family Practice 1,844 17,500 105.37 79.31%
Internal Med 97 2,500 38.80 4.17%
Peds 384 10,000 38.40 16.52%
Total 2,325 30,000 77.50 100.00%
Dec 10Clinic ER Visits Total
EmpanelledER Visits per 1000
Empanelled% of Total
VisitsFamily Practice 1,498 17,500 85.60 74.94%
Internal Med 103 2,500 41.20 5.15%
Peds 398 10,000 39.80 19.91%
Total 1,999 30,000 66.63 100.00%
Tricare Operations Center (TOC)
http://mytoc.tma.osd.mil
Visits with Assigned PCM(source: Tricare Operations Center)
VALHALLA Family Medicine Clinic 44%
Provider Schedule ReportDetermine Provider Availability: # Providers with Schedules
VALHALLA FMC Provider Availability 50%
Provider Schedule ReportClinic/Provider Specific with # of Appointments
Template Analysis Tool (TAT)Overall Clinic Summary Views
0
200
400
600
800
1000
1200
14004/
1/20
12
4/3/
2012
4/5/
2012
4/7/
2012
4/9/
2012
4/11
/201
2
4/13
/201
2
4/15
/201
2
4/17
/201
2
4/19
/201
2
4/21
/201
2
4/23
/201
2
4/25
/201
2
4/27
/201
2
4/29
/201
2
5/1/
2012
5/3/
2012
5/5/
2012
5/7/
2012
5/9/
2012
5/11
/201
2
5/13
/201
2
5/15
/201
2
5/17
/201
2
5/19
/201
2
5/21
/201
2
5/23
/201
2
5/25
/201
2
5/27
/201
2
5/29
/201
2
5/31
/201
2
(blank) - (blank)
(blank) -
Wellness - OPEN
Wellness - FROZEN
Wellness - CANCELLED
Wellness - BOOKED
Specialty - OPEN
Specialty - FROZEN
Specialty - CANCELLED
Specialty - BOOKED
Routine - OPEN
Routine - FROZEN
Routine - CANCELLED
Routine - BOOKED
Other - OPEN
Other - FROZEN
Other - CANCELLED
Other - BOOKED
Acute - OPEN
Acute - FROZEN
Acute - CANCELLED
ATC Category
Slot Status
Appt Date
Sum of Count
Clinic Location Provider
Template Analysis Tool (TAT)ATC Category and Slot Status Dynamic Templates
0
20
40
60
80
100
120
140
160
4/2/
2012
4/3/
2012
4/4/
2012
4/5/
2012
4/6/
2012
4/9/
2012
4/10
/201
24/
11/2
012
4/12
/201
24/
13/2
012
4/16
/201
24/
17/2
012
4/18
/201
24/
19/2
012
4/20
/201
24/
23/2
012
4/24
/201
24/
25/2
012
4/26
/201
24/
27/2
012
4/30
/201
25/
1/20
125/
2/20
125/
3/20
125/
4/20
125/
7/20
125/
8/20
125/
9/20
125/
10/2
012
5/11
/201
25/
14/2
012
5/15
/201
25/
16/2
012
5/17
/201
25/
18/2
012
5/21
/201
25/
22/2
012
5/23
/201
25/
24/2
012
5/25
/201
25/
29/2
012
5/30
/201
25/
31/2
012
Acute - OPEN
Acute - FROZEN
Acute - BOOKED
ATC Category
Slot Status
Appt Date
Sum of Count
Clinic Location Provider
Template Analysis Tool (TAT)Provider Specific Templates
0
2
4
6
8
10
12
14
16
18
20
4/2/
2012
4/3/
2012
4/4/
2012
4/5/
2012
4/6/
2012
4/9/
2012
4/10
/201
2
4/11
/201
2
4/12
/201
2
4/13
/201
2
4/16
/201
2
4/23
/201
2
4/24
/201
2
4/25
/201
2
4/26
/201
2
4/27
/201
2
4/30
/201
2
5/1/
2012
5/2/
2012
5/3/
2012
5/4/
2012
5/7/
2012
5/8/
2012
5/9/
2012
5/10
/201
2
5/11
/201
2
5/14
/201
2
5/15
/201
2
5/21
/201
2
5/22
/201
2
5/23
/201
2
5/24
/201
2
5/29
/201
2
5/30
/201
2
5/31
/201
2
Wellness - OPEN
Wellness - BOOKED
Routine - OPEN
Routine - BOOKED
Acute - OPEN
Acute - BOOKED
ATC Category
Slot Status
Appt Date
Sum of Count
Clinic Location Provider
Access Management Report
VALHALLA Family Medicine No Shows 11%
No Show Appointments by Day
# No-Show Appointments by Day (1 Jun 06 - 31 May 07) Family Med
514572858
1659
2117
91%
81%
66%
37%
0
715
1430
2145
2860
3575
4290
5005
5720
Monday Friday Thursday Wednesday Tuesday
Num
ber
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=5720 (11% of 52,000 appts)
# No – Show Appointments by Day CY 2011 Family Med
No Shows by Day and Hr
Monday No-Shows Family Med (1 June 06 - 31 May 07)
42446484105127169212
1270
98%96%93%
89%84%
78%
70%
60%
0
500
1000
1500
2000
0800-0859 0900-0959 1700-1759 1300-1359 1500-1559 1400-1459 1000-1059 1600-1659 1100-1159
Time of Day
Num
ber
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=2117
# Monday No – Show Appointments by Day CY 2011 Family Med
No Shows by Day and Hr
Friday No-Shows Family Med (1 June 06 - 31 May 07)
3134495066100165
500
664
98%96%93%
90%86%
80%
70%
40%
0
500
1000
1500
1700-1759 0800-0859 0900-0959 1300-1359 1400-1459 1000-1059 1100-1159 1600-1659 1500-1559
Time of Day
Num
ber
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
n=1659
# Friday No – Show Appointments by Day CY 2011 Family Med
Tricare Operations Center (TOC)Many More Reports
• Appointment Utilization• Access to Care Reports• 3rd Next Available • Enrollment & Population Reports• Booked Management Report• Length of Stay
Valhalla Findings
• Provider availability ~ 50% last 12 mo• % of Appt with PCM is low (44%)• % of 3rd Next Available Acute Appointments meeting
Access Standards (24hrs) is low in Family Medicine• Decrease in team continuity• Low appointment availability on peak days• Deployment in 6 months• No-show rates of 11%• Training during peak hours
Potential Items Affecting Capacity
• Provider availability / schedules / templates• Team experience and continuity• Provider specialties & manpower issues• No-show rates• Leave, TDY, Holiday’s• Additional duty, provider call• Procedures• Facility layout & Support services• Technology • Service level agreements with referrals • Don’t rely on historic utilization patterns
Evaluation:How did we do?
75.2
77.5
64.0
60
65
70
75
80Au
g-09
Sep-
09O
ct-0
9N
ov-0
9De
c-09
Jan-
10Fe
b-10
Mar
-10
Apr-
10M
ay-1
0Ju
n-10
Jul-1
0Au
g-10
Sep-
10O
ct-1
0N
ov-1
0De
c-10
Jan-
11Fe
b-11
Mar
-11
Apr-
11M
ay-1
1Ju
n-11
Jul-1
1Au
g-11
Sep-
11O
ct-1
1N
ov-1
1De
c-11
Jan-
12Fe
b-12
Mar
-12
ER V
isits
/ 1
000
Pt E
mpa
nelle
d
ER Visits / 1000 Pt. Empanelled
UCL 73.9
Mean 68.1
LCL 62.4
UCL 73.9
Mean 68.1
LCL 62.4
Mean 65.3
70.3 69.8
64.1
55
60
65
70
75
Aug-
09Se
p-09
Oct
-09
Nov
-09
Dec-
09Ja
n-10
Feb-
10M
ar-1
0Ap
r-10
May
-10
Jun-
10Ju
l-10
Aug-
10Se
p-10
Oct
-10
Nov
-10
Dec-
10Ja
n-11
Feb-
11M
ar-1
1Ap
r-11
May
-11
Jun-
11Ju
l-11
Aug-
11Se
p-11
Oct
-11
Nov
-11
Dec-
11Ja
n-12
Feb-
12M
ar-1
2
%
% ER Visits Between 0800 - 1700
UCL 67.0
Mean 63.8
LCL 60.6
Mean 62.7
40.2
22.8
10
15
20
25
30
35
40
45
Aug-
09Se
p-09
Oct
-09
Nov
-09
Dec-
09Ja
n-10
Feb-
10M
ar-1
0Ap
r-10
May
-10
Jun-
10Ju
l-10
Aug-
10Se
p-10
Oct
-10
Nov
-10
Dec-
10Ja
n-11
Feb-
11M
ar-1
1Ap
r-11
May
-11
Jun-
11Ju
l-11
Aug-
11Se
p-11
Oct
-11
Nov
-11
Dec-
11Ja
n-12
Feb-
12M
ar-1
2
ER V
isits
/ 1
000
Asth
mat
ics
ER Visits / 1000 Asthmatics
UCL 37.2
Mean 26.8
LCL 16.5
Mean 24.1
Mar 12
Clinic ER Visits Total Empanelled ER Visits per 1000 Empanelled
% of Total Visits
Family Practice 1,450 17,500 82.86 75.40%
Internal Med 100 2,500 40.00 5.20%
Peds 373 10,000 37.30 19.40%
Total 1,923 30,000 64.10 100.00%
Dec 11
Clinic ER Visits Total Empanelled ER Visits per 1000 Empanelled
% of Total Visits
Family Practice 1,844 17,500 105.37 79.31%
Internal Med 97 2,500 38.80 4.17%
Peds 384 10,000 38.40 16.52%
Total 2,325 30,000 77.50 100.00%
Dec 10
Clinic ER Visits Total Empanelled ER Visits per 1000 Empanelled
% of Total Visits
Family Practice 1,498 17,500 85.60 74.94%
Internal Med 103 2,500 41.20 5.15%
Peds 398 10,000 39.80 19.91%
Total 1,999 30,000 66.63 100.00%
Patient Appointments with PCM(Goal 70%)
Valhalla Medical Center (Jan – Mar 2012)Source: Tricare Operations Center
MEPRS Clinic % with PCM
Family Practice Clinic A (BGAB) 70.1
Family Practice Clinic B (BGAC) 67.5
Family Practice Clinic C (BGAD) 68.7
Access to Care 3rd Next Available(Acute) - Goal 80%)
Valhalla Medical Center (Jan – Mar 2012)Source: Tricare Operations Center
MEPRS Clinic % @ Std
Family Practice Clinic A (BGAB) 83.3
Family Practice Clinic B (BGAC) 87.2
Family Practice Clinic C (BGAD) 91.2
Questions
?
