# Presentation: 499866

## MaineHealth

***Working together so our communities are the healthiest in America***

- Lisa M. Letourneau MD, MPH
- September 2007

- ®

## MaineHealth 

- Hospital Members & Affiliates

**1.**** **Miles Healthcare
- 2. St. Andrews Hospital & Healthcare
- 3. Maine Medical Center
- 4. Spring Harbor Hospital
- 5. Western Maine Healthcare
*6. **Southern Maine Medical Center*
*7.** Mid Coast Hospital*
*8.** MaineGeneral Health*
*9.** Sisters of Charity Heath System*

*Affiliates noted in italics*

## MaineHealth

- Board Of Corporators

- Board Of Trustees

**MaineHealth**

- Intellicare

- Occupational
- Health &
- Rehabilitation
- Services

- Maine
- Medical
- Center

- Saint
- Andrews
- Hospital

- Western
- Maine
- Health
- Care
- (Stephens Hosp)

- Maine Medical Center Partners

- Spring
- Harbor
- Hospital

- Maine
- General
- Health
- (Augusta, Waterville)

- Southern
- Maine
- Medical
- Center

- Denotes Joint Venture
- Denotes Affiliate

- Sisters Of
- Charity Health
- System
- (St. Mary’s Hosp)

- Nordx
- Labs

- Miles
- Health
- Care

- HomeHealth & Visiting Nurses Of Southern Maine

- Synernet

- Maine PHO

- MMC PHO
- SMMC PHO
- KRHA
- Covenant PHO
-  (St Mary’s)

- Healthsouth/
-  NE Rehab

- Maine
-  Molecular
- Imaging

- Mid Coast Health Services
- (Midcoast Hosp)

## MaineHealth Areas of Focus

**MaineHealth** **Areas of Focus**

- Health Status
- Improvement

- Clinical
- Integration

- Administrative
- Integration

-  Asthma
-  Tobacco/ CTI
-  Care Partners
-  Raising Readers
-  Health education/LRC’s
-  Healthy Weight

-  Asthma
-  Cardiovasc Health
-  HF
-  IHD
-  AMI
-  Stroke
-  Diabetes
-  Depression
-  Preventive Health Svc’s

-  HR
-  Finance
-  Legal
-  Audit & Compliance

- Community Health
- Improvement Comm

- Clinical Integration
- Steering Comm

- Admin Councils

## The MaineHealth Story...

- 2000 - 2002: Development of MH Clinical Integration Program, tools
- 2002: Adoption of Chronic Care Model
- 2002 - 2005: Use of learning “Collaboratives” to support practice change

## 2004 - 2005:  Partnership with MMC PHO on development of CIR, technical assistance, nurse care management, & “Quality Rewards” program
2006 - 2007: Introduction of MH Learning Community

- 2006 - 2007: Introduction of MH Learning Community

**The MaineHealth Story...**

## 1. Developed the “Toolbox”

## 2. Adopted the “Care Model”

**Informed,**
**Activated**
**Patient**

**Productive**
**Interactions**

**Prepared,**
**Proactive**
**Practice Team**

**Improved Outcomes**

**Delivery****System**
**Design**

**Decision**
**Support**** **

** ****Clinical****Information****Systems**

**Self-****Management ****Support**

**Health System**

**Resources and Policies**

**Community **

**Health Care Organization**

- (**Chronic) ****Care**** Model**

**2. Adopted the “Care Model”**

## Clinical Integration Programs

- Set of health care improvement programs seeking to improve care and outcomes for patients across the MaineHealth system
- Programs built on framework of Chronic Care Model
- Nationally-recognized model identifying key elements needed to  to improve care and outcomes

## Slide 10

## 3. Partnered with MMC PHO –     Dev’d Clinical Improvement Plan

- Goal: improve chronic illness care in PCP community
- Initial focus on diabetes (adults), asthma (children)
- Provided direct supports to PCP practices:
- Technical assistance to implement CIR
- Practice-based nurse care managers
- Established “Quality Care Rewards” program (financial incentives for PCP’s)

## MMC PHO Clinical Improvement Plan

- Sequential focus (and rewards!) on...
**Year 1 (2003): Structure **
- = establishing registry (CIR) in PCP practices
**Year 2 (2004): Process**
- = using registry to improve care _processes_
**Year 3 (2005): Outcomes**
- = using registry, care management, tools to improve _outcomes_ of care

## MMC PHO Nurse Care Management 

- Practice-based nurses, integrated into practice team, introduced by patient’s physician (*not *long-distant telephonic stranger)
- Offer personalized, intense, face-to-face approach to patient education and motivation
- PHO hires, supports 14 RN care managers

## MaineHealth CIR

- Web-based clinical improvement (chronic illness) registry
- Allows tracking of outcomes for MH chronic care focus areas
- Diabetes	     - Depression         ** Preventive Health Services **
- Asthma        - CVD
- Supports system need for supporting OP data management & reporting (“bridge” to EMR)

## Slide 15

## Patient Populations Managed using MH CIR

|  | MMC PHO | MaineHealth |
| --- | --- | --- |
| Asthma  | 7729 | 8710 |
| Diabetes  | 11725 | 15599 |
| Depression  | 9324 | 9893 |
| CVD  | 5852 | 6887 |
| HF | 951 | 973 |

## CIR Supports Strategic Initiatives

- CIR as tool to _drive quality improvement_ through...
- Promoting patient-centered, collaborative care
- Providing decision support tools
- Supporting practice and system-level population data reporting

## CIR Tools

- Point of Care
- Patient Self Care
- Population Based Care
- Hierarchical reporting
- Embedded tools

## Slide 19

## Slide 20

## CIR Reporting

- Designed to help practices use data for ACTION to improve care!
- Logician data downloaded to CIR for reporting
- Supports physicians’ ability to participate in public reporting (PTE)

## Hierarchy Reporting

## CIR Practice Participation

- Logician Participation

## CIR Patient Populations

- Logician Participation

## MMC PHO - CIR Adult DiabetesPercent of Patients Receiving Process Care

- Office Visit

- Blood Pressure

- HbA1c**(1)**

- ASA**(3)**

- LDL**(2)**

- Microalbumin**(1)**

**(1)**  NCQA 2005 blended commercial, Medicare & Medicaid rate based on MMC PHO population percentages
**(2)**** **Sperl-Hillen J, O’Connor. Am J Managed Care 2005; 11:S177-S185
**(3)** American College of Preventive Medicine

- 56%

- 48%

- 79%

- 87%

**Nat. Avg.**

**MMC PHO - CIR Adult Diabetes**Percent of Patients Receiving Process Care

## CIR Adult Diabetes Care Processes (excludes care managed patients)

- At Increased Risk: At least 1 of the following
- BP ≥ 140/90, HbA1c ≥ 9, LDL ≥ 130

- Intermediate: All of the following
- BP < 140/90, HbA1c < 9, LDL < 130

- Optimal: All of the following
- BP < 130/80, HbA1c < 7, LDL < 100

**(n=4,660)**

**(n=6,349)**

**(n=6,988)**

_**2005 - 2006**_
**382 additional patients documented**
**at optimal level**

## CIR Adult Diabetes Care Processes (Results for care managed patients)

- At Increased Risk: At least 1 of the following
- BP ≥ 140/90, HbA1c ≥ 9, LDL ≥ 130

- Controlled: All of the following
- BP < 140/90, HbA1c < 9, LDL < 130

- Optimal: All of the following
- BP < 130/80, HbA1c < 7, LDL < 100

**(n=191)**

**(n=738)**

**(n=1,521)**

_**2005 - 2006**_
**182 additional patients documented**
**at optimal level**

**CIR Adult Diabetes Care Processes** (Results for care managed patients)

## 4. Introducing...

- Partnership of MaineHealth and Maine PHO
- Wider, more flexible range of education & outreach options for busy practices
- Alternative approach to traditional single-disease learning collaborative
- Opportunities to reach larger number of practices
- Active effort to foster cross-condition approach improvement

## MH Learning Community

- Tools, resources
- Comparative data feedback
- Quarterly learning sessions
- One-on-one team coaching
- Regional improvement meetings

**Less intensive**

**More intensive**

## From 2000 to 2007, have moved from...

-  Individual improvement  efforts
-  No uniform conceptual model for change
-  Highly variable patient & provider tools
-  Little (no?) ability to track population-based outcomes
-  Little (no?) focus on, rewards for population-based outcomes

-  System leadership for coordinated improvement effort
-  Use of Chronic Care Model as programmatic framework
- Standardized patient & provider tools
-  Web-based CIR and other databases to track population-based outcomes
-  Consistent focus, financial rewards for population-based outcomes

## Lessons Learned

- Professionalism
- Self-respect
- Peer respect

- Motivators for adoption & spread of change

- Needed to sustain change

- Efficiency
- Support
- Recognition/  incentives

- Recognize different motivators – need both the “heart” and the “head”!