# Presentation: 637195

## QIOs & Primary Care:Accelerating HIT Adoption & Use

**Christine Bechtel**
**Director of Government Affairs**
**The American Health Quality Association**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Summary

**AHQA & QIOs **
**QIO Program – 8****th**** Statement of Work**
**What are we trying to do?  Do physicians need support? **
**Role of QIOs in Physician Practice HIT **
**Other Ambulatory Projects**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## The American Health Quality Association (AHQA)

**AHQA is a 501(c)(6) trade association, founded in 1973, which lobbies Congress and executive branch agencies.**
_**Mission:**_** AHQA is an  educational, not‐for‐profit national membership association dedicated to health care quality through community-based, independent quality evaluation and improvement programs.**** **

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

**Notes:**
AHQA Annual Meeting: February 20- 24, 2006Hyatt Regency Miami 

## QIOs:  A National Infrastructure for Quality Improvement

**Private, independent, mostly not for profit organizations, present in every state and territory.**
**Have 3 year contracts with Medicare under federal program created by Congress in 1982. **
**QIOs work with nursing homes, home health agencies, hospitals, physician offices and MA plans to measurably improve care for Medicare beneficiaries**
**QIO quality improvement projects are voluntary, free**
**QIO program represents largest coordinated federal investment in QI -- $6.42 per beneficiary per year ($0.54 PMPM)**
**QIOs have other contracts: Medicaid, DM, IRO, SHIP...**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

**Notes:**
-Because voluntary, QIOs have to be experts at partnership development, collaboration and marketing their services because they are accountable for generating measurable improvements in quality in each state.

## QIO Infrastructure Advantages:

**Bring their own funding (e.g., no cost to providers)**
**Bring expertise to bear on quality issues, including QI experts, epidemiologists, biostatisticians, and physician office redesign and HIT experts who understand quality measurement **
**Interface with stakeholders in all settings**
**Local, independent entities with existing relationships; trusted in their communities **
**Accountable to the culture of medicine**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## QIO Program: 2005-2008

**Focus on achieving major “transformational” change in a small number of providers and practitioners, then spread success.**
**Several new initiatives in the 8****th**** Statement of Work:**
**Organizational Culture in Hospitals, Nursing Homes, Physician Offices, Home Health Care**
**Surgical Complications Improvement Project **
**National patient safety partnership project built on success of QIO SIP project**
**Prescription Drug Quality Improvement**
**Mandated by MMA; Research shows Rx therapy improvement is badly needed**
**Health Information Technology**
**Promising way to achieve dramatic improvement in quality in Rx, chronic disease management, preventive care.**** **

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## What’s the Problem?

**Gap Between Bookshelf & Bedside:**
**Americans receive only 54.9% of the care recommended for their conditions, based on evidence**
**Translation of medical research into practice is slow—average of 17 years **
**Physicians must integrate an amount and complexity of new information that is beyond bounds of human cognition**
**HIT is one tool, along with redesign **

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Do physicians need support?

**“****Unless substantial support is given, physicians will not be able to configure their systems, train for their use, integrate them into their workflow, and support the transition of their staff.  In other words, if left alone, most physicians will fail at CPR [computerized patient record] implementation.”**
**	****	****	****	****	****-David Brailer, MD, PhD**
**	****	****	****	****	****CHcF, 2003.**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## What is the goal of support?

**Increase HIT Adoption**
**Prevent implementation “failures”**
**Address partial use of EHRs to increase quality & show ROI **
**Build Infrastructure****	**
**For Health Information Exchange**
**Improves value proposition, quality and efficiency**
**For Pay-For-Performance **
**Helps align incentives**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Role of QIOs in HIT:

**Work with at least 5% of adult primary care practice sites in 3 domains:**
**Adoption of HIT systems**
- EHR, Registry, e-prescribing, e-labs
**Care Process & Workflow redesign to support care management, patient self-management and efficiency **
**Reporting of clinical quality measures to clinical data warehouse **

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Identified Participant Group (IPG)

**5%-6% of adult primary care practice sites in each state**
**Approximately 6,000 practices nationwide**
**80% will be small and medium size practices**
**25% of IPG can have EHRs or e-Rx plus registry already**
**75% without EHR or Registry**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## HIT Systems Adoption

**Readiness: Help prepare practices **
**Planning for implementation**
**Considerations for vendor selection**
**Guidance on functionality and interoperability considerations**
**Information on contract (key points)**
**Hardware considerations**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Care Process Redesign

**Assessing current processes**
**Mapping workflow**
**Guidance on improving chronic care management and preventive care**
**HIT functionality**
**Alerts and reminders, decision support, etc.**
**Assistance with care process design:****	**
**Group visits, open access scheduling, regular  analysis of quality data, etc.**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Care Management

**Electronic Health Records and Information Technology**

**Decision Support**

**Alert and reminders**
**Guidelines**
**Clinical knowledge**
**Templates**

**Care Management**

**Delivery System Redesign**

**Self Management**

**Set optimal health goals**
**Primary care team**
**Open access**
**Care coordination**

**Personalized care plan**
**Personal health record**
**Online goal setting tools**

**Population Management**

- Slide courtesy of:

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Reporting Data

**From EHR or Registry to Data Warehouse**
**DOQ Measures:**
**CAD, HTN, CHF, DM, Preventive Care**
**QIO provides practice-specific report on measures**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Quality Improvement

**Based on data, implement changes to improve quality:**
**Further care process changes**
**Group Visits**
**Open Access Scheduling**
**Patient-specific care plans**
**Activating additional features of EHR**
**Continue cycle as needed**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## What QIOs Will NOT Do:

**Provide financial support**
**But do provide “consulting” services for free**
**Recommend a specific vendor**
**But will provide considerations to help physicians narrow down their options**
**Offer programming or other technical support, perform the installation, write interfaces, etc.**
**But will consult on planning for implementation, workflow and systems configuration to lay the groundwork for care management and QI **
**Provide “help desk” support to troubleshoot technical problems**
**Will help troubleshoot workflow issues, quality issues, etc.**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Performance Requirements

**Practices **_**without**_** EHR or Registry:**
**75% must have fully implemented HIT**
**30% must have care management functions in place**
**10% must report data to Data Warehouse**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Performance Requirements

**Practices **_**with**_** EHR or Registry:**
**75% must have care management functions in place**
**20% must report data to Data Warehouse**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Timeline

**Contract starts August 1, 2005**
**QIOs working with pilot practices now**
**Total time between contract start and re-measurement of QIOs:  26 months! **
**Level of interest & demand for assistance will drive future availability (funding)**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## Other Ambulatory Performance Requirements

**Promote improvement on diabetes, immunization & mammography measures statewide**
**Work with Medicare Advantage plans to support/create incentive or P4P programs**
**Work with ESRD Networks upon request**
**Improve cultural competency**
**QI projects re: prescription drugs**

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005

## For More Information:

**List of QIOs to contact for state-specific information:  **_**http://www.ahqa.org**_
**Christine Bechtel**
**Director of Government Affairs**
**202-261-7569 direct**
_**cbechtel@ahqa.org**_

- AHRQ PBRN RESEARCH CONFERENCE

- July 22, 2005