Innovations Support Physicians in Delivering Advanced Care? Jennifer King AcademyHealth Annual Research Meeting

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1 Do Health hit and ddelivery System Innovations Support Physicians in Delivering Advanced Care? Jennifer King AcademyHealth Annual Research Meeting June 10, 2014

2 Consensus that improvements in health care delivery are needed U.S. National Quality Strategy Aims Better Care Healthy People & Communities i Affordable Care s Prioritie Patient Safety Patient & Family Engagement Care Coordination Prevention & Treatment of Leading Mortality Causes Healthy Lifestyles in Communities More Affordable Care orting Po olicies Infrastru cture Supp and Health Information Technology Public Reporting Quality Improvement/Technical Assistance Certification, Accreditation, Regulation Consumer Incentives and Benefit Design Payment Measurement of Care Processes and Outcomes Evaluation and Feedback Workforce Training and Capacity Development Innovation and Rapid Cycle Learning

3 Health IT and payment and delivery system innovations are key supporting policies Health Information Technology Payment HITECH Act Medicare and Medicaid EHR Incentive Program EHR Certification Program Affordable Care Act Patient Centered Medical Home Accountable Care Organizations/ Shared Savings Models Technical assistance and infrastructure support Regional Extension Centers State HIE Program

4 Has increasing adoption of health IT and delivery system initiatives led to improved care processes? Study aims: How routinely do physicians perform advanced care processes that are thought to improve care outcomes? Quality measurement -- Patient communication Population management -- Care coordination Do EHR use and PCMH/ACO participation support routinely performing advanced care processes? Is there a greater effect of EHR use with PCMH/ACO participation compared to EHR use alone? What EHR-related factors support EHR adopters in routinely performing advanced care processes with computerized tools?

5 Data and methods 2012 Physician i Workflow Survey Conducted by National Center for Health Statistics with funding from Office of the National Coordinator for Health IT Nationally representative of office-based physicians (N = 2,567) Key measures Whether 14 advanced care processes in 4 domains are performed routinely Whether processes are computerized EHR use PCMH or ACO participation EHR characteristics: Whether EHR meets Meaningful Use criteria Year EHR was installed Whether received assistance with EHR implementation or training staff to use EHRs Adjusted for physician and office characteristics using logistic regression

6 Has increasing adoption of health IT and delivery system initiatives led to improved care processes? Study aims: How routinely do physicians perform advanced care processes that are thought to improve care outcomes? Do EHR use and PCMH/ACO participation support routinely performing advanced care processes? Is there a greater effect of EHR use with PCMH/ACO participation compared to EHR use alone? What EHR-related factors support EHR adopters in routinely performing advanced care processes with computerized tools?

7 Physicians performing advanced care processes at variable rates Create quality reports by patient demographics Submit clinical measures to insurers Quality measurement Create quality reports by chronic conditions Create list of patients t by lab result Create list of patients by vital signs Population management Create list of patients by diagnosis Create list of patients due for tests or preventive care Provide patient reminders for preventive or follow-up care Record patient advanced directive Patient communication Provide patients clinical summary for each visit Provide patients copy of their health information Receive information needed post-hospital discharge Receive patient information from other physicians Share patient clinical information with other providers Care coordination 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of physicians routinely performing process Note: Estimates are unadjusted. Source: CDC/NCHS Physician Workflow Survey, 2012

8 If they are performed, most processes are performed with computerized tools Create quality reports by patient demographics Submit clinical measures to insurers Quality measurement Create quality reports by chronic conditions Create list of patients t by lab result Create list of patients by vital signs Population management Create list of patients by diagnosis Create list of patients due for tests or preventive care Provide patient reminders for preventive or follow-up care Record patient advanced directive Patient communication Provide patients clinical summary for each visit Provide patients copy of their health information Receive information needed post-hospital discharge Receive patient information from other physicians Share patient clinical information with other providers Computerized Not Computerized Care coordination 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of physicians routinely performing process Note: Estimates are unadjusted. Source: CDC/NCHS Physician Workflow Survey, 2012

9 Has increasing adoption of health IT and delivery system initiatives led to improved care processes? Study aims: How routinely do physicians perform advanced care processes that are thought h to improve care outcomes? Do EHR use and PCMH/ACO participation support routinely performing advanced care processes? Is there a greater effect of EHR use with PCMH/ACO participation compared to EHR use alone? What EHR-related factors support EHR adopters in routinely performing advanced care processes with computerized tools?

10 Most physicians in PCMH or ACO are using Meaningful Use EHRs 100% 90% No EHR 80% Not using EHR 70% 60% 50% 40% 30% 20% 10% EHR planned in next 12 months Using other EHR Using MU EHR Using EHR 0% All Physicians Participating in ACO Participating in PCMH Note: Estimates are unadjusted. Source: CDC/NCHS Physician Workflow Survey, 2012

11 Physicians with EHRs more likely to perform advanced care processes routinely Any quality measurement process Any population management process Any patient communication process Any care coordination process Not using EHR (38%) Using EHR (62%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of physicians routinely performing process Significantly different from not using EHR at p<0.01. Estimates adjusted for physician and practice characteristics. Source: CDC/NCHS Physician Workflow Survey, 2012

12 Physicians in PCMH or ACO more likely to perform advanced care processes routinely Any quality measurement process Any population management process Any patient communication process Any care coordination process Not in PCMH or ACO (76%) In PCMH or ACO (24%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of physicians routinely performing process Significantly different from not in ACO or PCMH at p<0.01. Estimates adjusted for physician and practice characteristics. Source: CDC/NCHS Physician Workflow Survey, 2012

13 Highest rates among physicians with both EHR use and PCMH or ACO participation Any quality measurement process Any population management process Any patient communication process Any care coordination process No EHR, no ACO or PCMH (33%) EHR, no ACO or PCMH (43%) EHR, ACO or PCMH (19%) 0% 20% 40% 60% 80% 100% Percent of physicians routinely performing process (*) Significantly different from EHR, no ACO or PCMH at p<0.01(0.05). Estimates adjusted for physician and practice characteristics. Source: CDC/NCHS Physician Workflow Survey, 2012

14 Has increasing adoption of health IT and delivery system initiatives led to improved care processes? Study aims: How routinely do physicians perform advanced care processes that are thought to improve care outcomes? Do EHR use and PCMH/ACO participation support routinely performing advanced care processes? Is there a greater effect of EHR use with PCMH/ACO participation compared to EHR use alone? What EHR-related factors support EHR adopters in routinely performing advanced care processes with computerized tools?

15 Physicians with Meaningful Use EHRs more likely to use computerized tools to deliver advanced care Association between EHR-related characteristics and probability that physician routinely performs process using computerized tools Quality measurement Population management Patient communication Care coordination EHR meets Meaningful Use criteria Years since EHR installed ns Received assistance with EHR implementation ns ns ns ns Received assistance with training ns ns ns ns staff to use EHR ns = no statistically significant association between characteristic and probability of performing process routinely using computerized tools. ++(+) = positive association between characteristic and probability of performing process routinely using computerized tools, significant at p<0.01(0.05). Results adjusted for physician and practice characteristics. Source: CDC/NCHS Physician Workflow Survey, 2012

16 Implications Promising i signs that t HITECH policies i and new payment/delivery initiatives can work in tandem to support improvements in care delivery Room for improvement in overall rates of quality measurement, population management and patient communication i Continued efforts to enhance the sophistication and usability of EHR functionalities for these types of activities iti will be important S t i d t h i l i t b f Sustained technical assistance may be necessary for physicians to optimize EHRs, especially for those later adopters who had yet to adopt EHRs at time of this study

17 Collaborators: VihliPtlEi Vaishali Patel, Eric Jamoom, Cth Catherine DesRoches Thank you