PRE-CONFERENCE WORKSHOP PPRNet 101

1. PRE-CONFERENCE WORKSHOPPPRNet 101

2. introductions • Who you are • Why you are here • What you hope to learn

3. Workshop Goals • To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?” • Introduce (or reintroduce) PPRNet and its mission • Provide an overview of PPRNet reports • Share examples of how practices use PPRNet reports to achieve recognition and/or incentives • Allow time for participants to use reports and network with one another

4. agenda

5. Revise agenda?

6. What is pprnet? “A practice-based learning and research organization designed to improve health care in its member practices and elsewhere in the United States.”

7. What is pprnet? • Primary (care) Practices Research Network • A virtual network of primary care practice teams and researchers that aims to: • Turn EHR data into actionable information for clinicians and practice staff • Empirically test theoretically sound primary care quality improvement interventions • Disseminate interventions that improve primary health care

8. PPRNet Aims to… “Blur the distinction between quality improvement and research”

9. PPRNet: Primary Care Practice-Based Research and learning Network

10. PPRNet Agency for Healthcare Research and Quality Center for Primary Care Practice-Based Research and Learning • Answer questions relevant to practice • Disseminate findings

11. Pprnet research • Primary Care-Relevant Questions • “Preventive Services Delivery in Patients With Chronic Ilnesses: Parallel Opportunities Rather Than Competing Obligations” • “Learning from Primary Care Meaningful Use Exemplars” • Translating Research into Practice (TRIP) Interventions • Impact studied across a variety of clinical areas • Prevention, chronic disease management, acute care and medication safety • A-TRIP, C-TRIP, SO-TRIP, MS-TRIP, AM-TRIP, CKD-TRIP…

12. Practice spotlight: NEW London Family Medicine

13. Disseminating “lessons learned” • Ongoing PPRNet Activities • Annual meetings • Monthly webinars • Listserv • Social media • Publications • Presentations

14. PPRNET PERFORMANCE REPORTS • Patient & Provider- Level Report Practice-Level Performance Report

15. Clinical Practice Quality Measures TOTAL: 67

16. Practice Performance Report • 67Quality Indicators • 3 Summary Measures • SPC Methodology • Time trends – Monthly over 2 years • Comparison with PPRNet benchmark (ABC) • Comparison with national benchmarks (when available)

17. Patient-Level Report (PLR) • Excel Spreadsheet with 78tabs: • PPRNet Switchboard • Practice Performance on Individual Measures • Provider Performance on Individual Measures • Patient Registry • PPRNet Measure Groupings (8 tabs) • Patient Lists of those not meeting criteria for each of 67 Individual Measures • Same indicator criteria as practice report • All “active” patients ≥ 3months age

18. PPRNet Switchboard

19. PRACTICE PERFORMANCE ON Individual Measures

20. Provider Performance on Individual Measures

21. Patient Registry

22. CMS MU CQM

23. CMS ACO CQM

24. USPSTF Recommendations(Grade A and B)

25. CDC Advisory Committee on Immunization Practices Recommendations

26. NIAAA Alcohol Screening and Intervention Recommendations

27. CDC Get Smart Treatment Guidelines for URI’s

28. CMS PQRS CQM Groupings

29. PQRS DM TAB All Pts 18-75 with DM

30. PQRS DM LIST

31. ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction

32. ACC/AHA Cholesterol Guidelines for ASCVD Risk ReductionHierarchical Statin Benefit Groups • ADULTS >=21 years old • Diagnosis of ASCVD (CHD or Atherosclerosis) • Highest LDL-C >=190 mg/dL • Diagnosis of Diabetes Mellitus; age 40-75 yr • Estimated 10-yr ASCVD Risk >=7.5% age 40-75 yrs

33. ACC/AHA Cholesterol Guidelines for ASCVD Risk ReductionEstimated 10-yr ASCVD Risk Equations • Dx Smoking Status • Systolic BP • Hypertension Dx • Diabetes Mellitus Dx • Smoking Status • Age • Sex • Race • Total Cholesterol • HDL-CSystolic BP • Hypertension Dx • Diabetes Mellitus

34. Q: What data are used for calculating performance?

35. A (part 1): Report guide details data source for each measure

36. A (part 2): PPRNet measures are now aligned with Meaningful Use Clinical Quality Measures • Applies to some new measures (ie, eye exam in patients with diabetes) and new categories (ie, ACO CQMs) • Identifiers (ie, CMS id, NQF # or PQRS id) cited in reports

37. How do I UPLOAD MY DATA EXRACT AND access my reports? https://pprnetportal.musc.edu/

38. New DATA Extract • PP users will be migrating to a new extract process for October reports • McKesson support for prxtract ends in October • The MUSC OCIO has worked with us to develop a “vendor neutral” extraction process • New reports will include patient identifiers!

39. Summary: PPRNet Reports in Practice • Evaluate performance over time • Identify patients overdue for care • Engage, motivate, and incentivize practice team • Demonstrate quality of care for quality recognition and incentive programs

40. questions • To (begin to) answer the question: “How can I maximize the benefit of PPRNet in my practice?” • Introduce (or reintroduce) PPRNet and its mission • Provide an overview of PPRNet reports • Share examples of how practices use PPRNet reports to achieve recognition and/or incentives • Allow time for participants to use reports and network with one another

41. USING REPORTS FOR RECOGNITION AND INCENTIVE PROGRAMS

42. Recognition and incentive programs • PPRNet practices use reports for a variety of local and national quality recognition and pay for performance programs • During this session, we will highlight: • NCQA Patient-Centered Medical Home • CMS Physician Quality Reporting System

43. Pprnet 101: glossary • NCQA • PCMH • CMS • PQRS • ABFM • PLR • SQUID What is your experience with these recognition programs? How has your practice benefited from recognition?

44. NCQA PCMH 2014 Standards • Published in March 2014 (must be used by March 2015) • Revisions to align with MU Stage 2, reflect PCMH evidence base and from stakeholder input • Major edits in the areas of: • Care management of high-need populations • Team-based care • Focus on triple aim domains (patient experience, cost, clinical quality) • Sustaining transformation • Integration of behavioral health

45. NCQA PCMH 2014 Content and Scoring(6 standards/27 elements) Scoring Levels Level 1: 35-59points. Level 2: 60-84 points. Level 3: 85-100 points. *Must Pass Elements

46. PCMH 2: Team-based care • Element 2D: The Practice Team • The practice uses a team to provide a range of patient care services by: • Defining roles for clinical and nonclinical team members • Identifying practice organizational structure and staff leading and sustaining team based care • Having regular patient care team meetings or a structured communication process focused on individual patient care* • Using standing orders for services • Training and assigning members of the care team to coordinate care for individual patients (continued)

47. PCMH 2: Team-based care • Training and assigning members of the care team to support patients/families/caregivers in self-management, self-efficacy and behavior change • Training and assigning members of the care team to manage the patient population • Holding regular team meetings addressing practice functioning • Involving care team staff in the practice’s performance evaluation and quality improvement activities • Involving patients/families/caregivers in quality improvement activities or on the practice’s advisory council

48. PPRNet Tools • PPRNet Improvement Model as background • Build team meeting agendas based on PPRNet reports, webinars or network meeting topics • Use plans for Element 3D (Population Management) or 4A (Care Management and Support) to document responsibilities for team-based care

49. PCMH 3: Plan and Manage Care • Element 3D: Use Data for Population Management (MUST PASS) • At least two different preventive care services • At least two different immunizations • At least three different chronic or acute care services • Patients not recently seen by the practice • Medication monitoring or alert

50. PCMH 3: PLAN AND MANAGE CARE PPRNet Patient-level Report (PLR) includes lists of patients: With specific diagnoses Needing preventive services, including immunizations Requiring clinician review or action Taking specific medications