A Report from the Alliance Clinical Practice Improvement Network January 30, 2013

1. A Report from the AllianceClinical Practice Improvement NetworkJanuary 30, 2013

2. Today • Briefly review highlights from the Alliance’s 2012 Community Checkup • Share results from the Alliance’s 2012 Medical Group Survey Presenting: • Susie Dade, Puget Sound Health Alliance Commentary: • Peter McGough, MD, Chief Medical Officer, UW Neighborhood Clinics • Scott Kronlund, MD Chief Medical Officer, Northwest Physicians Network

3. Community Checkup 2012: Ambulatory Highlights • Sixth Community Checkup • Includes results for: • 81 medical groups with 4 or more clinicians in more than 300 locations • Claims covering 2 million lives • Measurement year: July 2010 - June 2011 • 30+ performance measures • New: Generics reporting @ individual provider level • New: Generic anti-hypertensives measure • Medicaid data back in! • Comparison of results over time www.WAcommunitycheckup.org

4. Aetna The Boeing Company Carpenters’ Trust CIGNA City of Seattle Community Health Plan of Washington First Choice Group Health King County Molina Healthcare of Washington Premera Blue Cross Recreational Equipment Inc. (REI) Regence Blue Shield Sound Health and Wellness Trust Snohomish County UnitedHealthcare Washington State Health Care Authority – Public Employees Washington State Health Care Authority – Medicaid Washington Teamsters Welfare Trust Alliance’s data repository includes approximately 2 million covered lives! Data Suppliers

5. Alliance Vision Physicians, other providers and hospitals will achieve top 10% performance in the nation in the delivery of equitable, high quality, evidence-based care and in the reduction of unwarranted variation, resulting in a significant reduction in the rate of medical cost trend.

6. 2012 Community Checkup Results Progress in Achieving Top 10% Performance At or Above NCQA 90th Percentile, Commercial • Screening for Colon Cancer** (but still only at 61%) • Screening for Cervical Cancer • Antidepressant Medication Adherence (12 weeks) • Diabetes – HbA1c Testing • Diabetes – Kidney Disease Screening • Avoidance of Antibiotics for the Common Cold • Avoidance of Imaging for Low Back Pain • Use of Spirometry – COPD **Measures the newly eligible

7. 2012 Community Checkup Results Progress in Achieving Top 10% Performance Below NCQA 90th Percentile, Commercial • Antidepressant Medication Adherence (6 months) • Diabetes – Cholesterol Testing • Heart Disease – Cholesterol Testing • Heart Disease – Use of Beta Blockers • Avoidance of Antibiotics for Bronchitis • Appropriate Use of Medication – Asthma Way Below NCQA 90th Percentile, Commercial • Adolescent Well Child Visits • Screening for Chlamydia

8. 2012 Community Checkup Results Prevention Opportunity!

9. 2012 Community Checkup Results Appropriate Use of Care Opportunity!

10. There is still a lot of variation among medical groups. 10

11. Generics Prescribing: StatinsTremendous variation withinmedical groups 11

12. Bottom Line . . . • Significant variation persists in our region • Some medical groups perform among the best in the nation on some measures; others have significant room for improvement • No one medical group excels at everything, so opportunities for all to learn • While Medicaid results are generally lower, some clinics do as well as high performing clinics in commercial population • Low rates translate into thousands of people not getting the right care or having a good experience “…the gap between what we know works and what is actually done is substantial enough to warrant attention. These deficits, which pose serious threats to the health and well-being of the U.S. public, persist despite initiatives …” Elizabeth McGlynn, NEJM, 2003

13. Comments from Drs. McGough and Kronlund To see detailed Community Checkup results, go to: www.WAcommunitycheckup.org

14. Adoption of Processes and Tools to Advance Effective Patient Care Medical Group Survey Results October 2012

15. Background and Purpose of the Survey • Collect and share information that describes whether or not activities and tools are being implemented in the practice setting • Survey developed with physician guidance • Focuses on activities and tools that have been shown to positively impact performance and support the delivery of evidence-based care • Provide community-wide scan of progress being made (compared results to 2010) • Share results to (1) provide broad view of overall clinic management and care coordination, and (2) identify opportunities for improvement

16. Survey Overview • Sent to 53 Medical groups • 5-county region, included in Community Checkup • 42 respondents, up from 33 in 2010 (62% response rate to 79%) • 32 medical groups with multiple locations • 10 individual clinics • 7 medical groups declined to respond • 4 medical groups declined to participate • Survey assessed practice activity in several domains: • Understanding Healthcare Disparities • Access and Communication • Chronic Conditions Management • Care Coordination • Data Management • Improving Quality and Patient Experience

17. Access and Communication

18. Access and Communication

19. High Level Results for the Region

20. Management of Chronic Conditions BIG Opportunity !

21. Management of Chronic Conditions

22. Management of Chronic Conditions

23. Care Coordination

24. Care Coordination

25. Use of EHRs to Manage and Improve Care Not surprisingly, EHR adoption is improving in the region and the number of capabilities being used is increasing compared to 2010 (55% to 69%) Strengths: • Patient appointment scheduling • Clinical documentation of each visit • Documentation of current medical list • Lab results reporting Moderate Improvement: • Complete, standardized problem lists • RX ordering w/ability to highlight drug interactions/correct dosing • Lab/radiology order entry • Alerts re: abnormal values

26. Use of EHRs to Manage and Improve Care Uses Lagging Behind: • Point-of-care clinician alerts based on evidence • Decision support tools (easy access to clinical guidelines or protocols) • EHR-linked patient registries • Access to clinical documentation from ED and inpatient stays • Secure patient portal • On line appointment scheduling • Patient reminders for needed tests or follow-up care • Secure email • Access to clinical information (e.g.,lab/radiology/biometric results, medication lists and ordering, visit summaries, immunization records)

27. Community Progress – High Performers • Implemented majority of tools and resources: • Group Health Cooperative • The Everett Clinic • Virginia Mason • Implemented or in the process of implementing majority of tools and resources: • MultiCare Medical Associates • Pacific Medical Centers • Swedish Medical Group • UW Medicine Neighborhood Clinics

28. What’s Ahead? • 2013 Community Checkup • Beginning statewide-expansion, starting at county level first • Fielding 2nd Ambulatory Patient Experience Survey • Updated “Resource Use Report” on Common Hospitalizations, to include utilization/service intensity, quality and pricing • Potentially Avoidable ED Visits by Hospital & Medical Group • 30-day All Cause Readmissions without an MD Visit

29. Comments from Drs. McGough and KronlundQuestions? For more information: Susie Dade Deputy Director Puget Sound Health Alliance sdade@pugetsoundhealthalliance.org Please visit our new website: www.wacommunitycheckup.org