KAISER PERMANENTE 21 st ANNUAL DIABETES SYMPOSIUM December 1, 2015

Transcription

1 KAISER PERMANENTE 21 st ANNUAL DIABETES SYMPOSIUM December 1, 2015 Integrating Endocrinology and Primary Care for a Cost Effective Model for Ethnic Diabetic Control Agenda Downey Diabetes Reality Developing a Diabetes Culture Educating the Medical Center on Diabetes Piloting Innovation Models Presenter One :: Manuel Fernandez, MD Presenter Two :: Wendell Osborne, MD Downey Medical Center Creating Activated Patients, Activated Doctors, and Activated Modules Endocrinology s Role in Supporting Diabetes Care 1 2 HgA1c by % Hispanic Population Correlation r = <9 hispanic Downey Medical Center 2009 Correlation between A1c<9 control, Hispanic demographic, education and income Hispanics A1c<9 Control Downey Demographics & Diabetes Staffing Team of Providers # of Providers Primary Care Providers 113 Care Managers Pharmacists 11 Endocrinology Providers (4 MD / 2 RNP / 3 RN) 9 Population Demographics 9.6% of population is diabetic 45.9% of DM population is Hispanic Highest obesity rate Lowest high school graduation rate Lowest area income Education Income 5 6 1

2 Where we are now 2014Q4 KP SCAL Equitable Care Report Diabetic control in Hispanic population consistently 10% lower than Asians or Whites 7 8 Leading in Hispanic A1c Control Largest Hispanic Population 9 10 Equitable Care Outcomes March 2015 Potential Success if model is adopted by all Medical Centers

3 Diabetic Patients per PCP June 2015 Care Managers per 600 diabetic patients 8 June 2015 Some DMC physicians even have up to 350+ DM patients Current Diabetics 8 per Care Manager Staffing 1 Care Manager per 600 Diabetics 8 Need for 1:600 AV BPK Down Fon Kern LAMC OC PC Riv SD SB WLA WH Total Developing a Diabetes Culture Leadership Involvement Buy in from Area Senior Leadership and Department Leadership Establishing oversight committee to set goals, establish tools Front Line Conversations Communicate the problem Financial impact on organization Reducing pain and suffering Improving Quality of Life Improved clinical quality and outcomes Change Begins Physician realizes the breadth of the problem Supporting systems are implemented Physician begins to take ownership of panel Physician begins to integrate resources into their practice Innovation begins Engaging Leadership and Driving Quality Create a Quality Care Committee comprised of: Medical Group Administration AMGAs, AAMD, PIC Complete Care, DM Champion Endocrinologist, HTN/Lipid Champion, Pharmacy Lead, Primary Care Leadership Committee responsibilities: Set goals and expectations Review DM Guidelines/Treatment algorithms Set Directives for: CME/Education agenda Monthly Reports Central role for PCP, Specialty Departments, and Supporting Staff Primary Care Leader Performance Reviews Creating Activated Physicians Continued Support of Primary Care Physicians Provide tools and reports Composite CSG Reports Lists CME Consults Technology Un-blind physician data to encourage healthy competition Continual communication with Complete Care team to fill gaps and avoid duplication of work Create a process to have those with the greatest improvement in scores to share successful practices with others Incentivize good performance Creating Action Plans for Physicians who are not engaged

4 Educating the Medical Center on Diabetes 1. Physician Education Offsite presentations Department specific presentations Module specific presentations CME program Distribute Treatment Guidelines Review Medications and Insulin Metformin/Glipizide Communicating which low cost meds have better results Review MRAR and pharmacy records Motivational Interviewing and Shared Decision Making and BM Complete Care Drives Improved Patient Outcomes Integrated Complete Care Program for Panel Management Effective Care Management Teams Pharmacist Care Managers Medical Assistants Support Coordinators Teams are embedded in respective modules Engenders team ownership and collaboration 2. Support staff education (RN, LVN, MA) 3. Complete Care education, training, and support Med Center Roll-out of Successful Innovation Pilot: Glucometer Download and SMBG Pattern Recognition All Primary Care modules follow Glucometer Download Workflow Every Primary Care workstation and physician office has OneTouch Pro software installed and MA/PCP has cables Patients bring medications to every visit 14 N + 6 R before breakfast 6 8 R before dinner 48 N bedtime 10 pm Consistency and Repetition are key for patients to adhere to bringing medications and performing blood checks Consistency: Regular patient SMBG Technique: Emphasize patients MUST BRING glucometer and medications to clinic Repetition: Patients are seen at TWO WEEK intervals 21 Creating Activated Physicians Physician Collaboration via Ideabook 24 4

5 Innovation Pilot Rosecrans Glucometer Download All Primary Care modules follow Glucometer Download Workflow Every Primary Care workstation and physician office has OneTouch Pro software installed and MA/PCP has cables Consistency and Repetition are key for patients to adhere to bringing medications and performing blood checks Consistency: Regular patient SMBG Technique: Emphasize patients MUST BRING glucometer and medications to clinic Repetition: Patients are seen at TWO WEEK intervals Spreading Innovation Family Medicine Module roll out of Innovation Pilot showed improved control rates Cudahy Improvement Video: <Creating Activated Modules> VIDEO BY: Dr. Manolo & Lucy Endocrinology Leads the Medical Center Endocrinology department leads DM insulin regimen Set example for treatment protocol Endo leads using NPH Endo Case Managers (RNPs/RNs) Seeing 6% of A1c>8 population within one month Performing patient directed DM education Providing Cost Effective Care Formulary is effective and cost efficient Downey had the second lowest antidiabetic Rx cost per DM patient in 2015 in the SCAL region Area DM C$PMPM Membership % Change DM Patient Pop. % A1c < 9.0 % A1c < Fontana 20% 518,267 44,588 80% 68% 11. Kern County 17% 102,596 9,325 NA NA 10. Riverside 14% 427,142 31,556 81% 68% 9. South Bay 10% 224,675 23,498 81% 71% 8. Panorama City (incl. Antelope Valley) 0.3% 353,036 30,519 81% 70% 7. Woodland Hills 2% 230,109 19,484 83% 72% 6. Baldwin Park 3% 243,743 27,061 81% 68% 5. San Diego 5% 585,339 46,661 83% 72% 4. Orange County 8% 506,180 39,822 82% 70% 3. West LA 10% 223,666 18,622 81% 70% 2. Downey 12% 332,742 31,998 81% 69% 1. Los Angeles 20% 293,097 28,764 80% 67%

6 Type 2 Diabetes Management Basal Insulins Higher is Better Potential Success if model is adopted by all Medical Centers Q MRN Counts Key Takeaways 1. Calculating the ethnic disparities into A1c control is essential in determining A1c control between medical centers and probably nationally when comparing different health plans. It also allows us to identify best practice correctly. 2. Engaging leadership to support the importance of A1c control is vital when developing healthcare strategies and incentives which influence our workflows and healthcare providers to improve A1c control. 3. Primary care providers play a pivotal role in diabetic care and need to be educated as diabetes experts and given the correct workflows to improve diabetic care. 4. Diabetes is a data based disease. Glucometer readings and medicine reconciliation are essential in determining the correct treatment plan for individual patients. 5. Endocrinology departments need to support primary care and participate in the care of patients on complicated insulin regimens. 6. Innovation needs to be supported and rewarded. Most innovation starts at the module level. 33 6