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Dr. Robert Gabbay, Chief Medical officer of Joslin Diabetes Center, presents at the 2014 DiabetesMine Innovation Summit at Stanford School of Medicine.
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IMPROVING CARE AND ACCESS
Getting the Care You Want Wherever You
Are!
Robert A. Gabbay, MD, PhD, FACP
Chief Medical Officer & Senior Vice President
Joslin Diabetes Center
Harvard Medical School
HOW DO WE IMPROVE CARE
Current Model- Episodic- Acute Care
System
Primary Care evolving to Patient Centered
medical home
Center of Excellence-How to extend reach
The First Step to Improve Quality
HOW ARE WE DOING IN THE US?
Only 19% of diabetes patients in the US
are currently at goal for ABCs
It’s not because of bad care providers or
bad patients
IT IS THE SYSTEM
Acute Care vs. Chronic Care
4
THIS IS NOT A NEW IDEA?
6
Joslin Clinical Quality Measures
Outcome Quality MeasureADA
BenchmarkJoslin
% A1c <9.0% >79% 84%
% LDL <130 >63% 89%
% LDL <100 >45% 71%*
% BP <140/80 >50% 64%*
7
* = HEDIS 90th
Percentile Goal
Achieved
NOTE: Not all ADA measures
have associated HEDIS measures.EYE CARE
Best Corrected VA, median (Q1, Q3)*
20/20 (20/16,20/25)
Change in BCVA, mean (SD)*† - 0.5 letters
20/20 or better (N) 72% (10,535)
20/40 or better (N) 92% (13,414)
20/200 or worse (N) 1% (153)
SOUNDS GREAT BUT I DON’T LIVE
IN
Exporting Our Care- A Joslin Tradition
Wandering Nurses
– Nurses that instructed the community to
instruct people with diabetes about the use of
insulin and management of the disease
Now known as Certified Diabetes
Educators
9
Centers of Excellence Concept
Organize into integrated practice units (IPUs) or Centers Excellence
Measure outcomes and costs for every patient
Move to bundled payments for care cycles
Integrate care delivery across separate facilitates
Expand excellent services across geography
10
The Strategy That Will Fix Healthcare, Michael Porter, Thomas Lee – Harvard Business Review 2013
Expanding Access to the Best Care
Replicate Centers of Excellence
Spread Exemplar Models of Care
Guiding local providers
Virtual visits
ACCELERATING DIFFUSION
SPREADING BEST PRACTICES
13
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Accelerating the Diffusion of High Value Care Delivery Innovation
Create diffusion innovation collaboratives
– Sharing between early and late adopters
Rapid evaluation systems with the
understanding of how to customize local
circumstances
Known care delivery innovations can lower
healthcare costs 20-35%
Learning Health Networks (IOM)
Berwick JAMA 2003
Joslin Affiliates as an
Innovation Collaborative and Learning
Health System Network
Continuously innovate
Share data to identify positive deviants
Disseminate best practices
Move towards transparency
The Patient-Centered Medical Home
16
PCMH Without a Neighborhood
What does a Good Neighbor
Look Like?
18
Redefining the Role of the Specialists
Leveraging Expertise
Itinerant Embedded Specialists
Project Echo- knowledge multiplier
Tele-screen (i.e. Retinal Camera)
Population management
eConsults
Teleconsult and Virtual Visits
19
WHAT ARE WE DOING NOW
20 Affiliates Nationally
International Activities
Educating all types of providers
Expanding reach digitally
– virtual visits, apps
CAN WE ADVOCATE REFERRALS TO
CENTER OF EXCELLENCE
20
What's the biggest impact change?
REIMBURSE FOR NON-FACE TO
FACE CARE