245609 Improving HEDIS results for selected measures using the Chronic Care Model as a framework

Sunday, October 30, 2011

Stacey C. Shapiro, MPH, RD , Population Care Management, Kaiser Permanente of the Mid-Atlantic States, Rockville, MD
Kirsten Gibson, MS , Population Care Management, Kaiser Permanente, Rockville, MD
Nancy N. Ortiz, MPH , Population Care Management, Kaiser Permanente of the Mid-Atlantic States, Rockville, MD
At Kaiser Permanente of the Mid-Atlantic States (KPMAS), a health plan caring for approximately 500,000 members, the goal for HEDIS performance is the 90th percentile for all clinical effectiveness measures. The plan's HEDIS 2010 results for selected measures were not only below the 90th percentile, but more importantly, reflected performance that was inconsistent with the plan's standard to provide evidence-based care. HEDIS results demonstrated that members were getting either too much or not enough of care that was well documented in peer-reviewed journals as appropriate. After analyzing past results and the number of events required to improve results to the 90th percentile, quality leaders chose three measures to address first. The measures selected: Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB), Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR), and Use of Imaging Studies for Low Back Pain (LBP). Measurement year 2009 performance on each of the selected measures was at or below the 25th percentile as reported in NCQA's Quality Compass.

The Chronic Care Model guides KPMAS' direction for interventions. Therefore, approaches to change included physician partnership; ‘best practice alerts,' standardized clinical order sets, and changes in preference lists built into the EMR; patient instructions included on office visit summaries given during >95% of visits (also available online); patient education materials; physician performance feedback; academic detailing with physician outliers; member level lists used for outreach; coding review and support; and contacts with patients needing care via phone, letter or secure online messaging.

After 6 months, preliminary results demonstrate a marked improvement in the AAB measure (trend towards a 30 percentage point improvement) and moderate improvements in the LBP and SPR measures. Final 2010 results and comparison to KPMAS previous performance will be available in June 2011 and comparison against the Quality Compass percentiles will be available in September 2011. KPMAS chose to implement multiple interventions simultaneously to maximize improvement in 6 months, understanding that interventions couldn't be evaluated for their individual impact on overall change. With a goal of improved patient care, methodology was less important. Based on this information, KPMAS will continue to innovate and apply successful practices learned within and external to the organization.

KPMAS interventions were created to support patient care on NCQA metrics. However, the learnings can be applied to clinical quality improvement for any population or regulatory/accreditation agency.

Learning Areas:
Administer health education strategies, interventions and programs
Administration, management, leadership
Communication and informatics
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. List at least 3 interventions that can improve performance on clinical quality metrics, such as HEDIS. 2. Describe how a multi-faceted approach to quality improvement, such as one based on the Chronic Care Model, can be more effective than single interventions. 3. Describe the barriers and benefits to using a multi-faceted approach, rather than staggered interventions, to quality improvement.

Keywords: HEDIS, Health Care Managed Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee the population care quality improvement programs for a health plan serving approximately 500,000 members and have been in this role for over 6 years. My MPH in health behavior and health education provides the foundation for program planing, interventions, and evaluation and the focus of my 16 year career, including my time as a clinical dietitian, has been on disease prevention and management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.