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Hello and welcome.
I'm Pat Twomey, Chief Medical Officer and
Chief Medical Quality Officer for Essentia, and I'd like to talk to you today
about living up to higher expectations. It's our Essentia Health FY13 Quality Report.
At Essentia Health, or values of quality, hospitality, respect,
justice, stewardship and teamwork are the foundation of everything we do.
It's no accident that quality appears first on the list of
values. Patients trust us to do everything in our power to deliver the
highest quality care possible.
They expect quality every time they visit an
Essentia Health facility. This map shows
Midwestern health systems like Essentia already leading the nation in quality,
in measurements by the Commonwealth Fund from 2009.
The Commonwealth Fund looks at measures such as
access to care, prevention measures,
medical treatment and health care outcomes to grade states across the
country.
You can see in the upper Midwest in the north eastern portions of the country
we are in the top quartile in healthcare performance.
However we still have some work to do,
particularly when we compare ourselves to our regional and state
cohorts who'd tend to perform quite well in quality.
You can see the circular graphs at the top of the slide showing
our current performance for disease states like diabetes,
depression management and vascular disease management as well as colorectal
cancer screening.
Those are percentage performances in those areas to give you a little bit
better idea of how we
compare to some of our state comparison
cohort. You can see the graph at the bottom showing how we're doing
in our sixty-plus clinics, how many are below
the state average, and you can see that we still have some work to do in areas like
colorectal cancer screening
to get more of our clinics at or above state average.
Essentia is committed to improving quality by delivering more.
Patients, employers and payers want
value and quality in return for their health care dollars. In the past year
Essentia Health physicians, leaders and staff have developed tools and programs
designed to demonstrate our willingness
to improve our quality and become more accountable to our processes,
more transparent with our reporting and more vigilant about monitoring outcomes.
I'd like to talk a little bit about
accountability. Essentia Health is accountable to health care's Triple Aim.
When we talk about the Triple Aim we're talking about a better
patient experience and by better patient experience
we meeting both clinical and service quality, which includes our
patient satisfaction metrics. We're also looking at better health of our overall
population.
At the same time we want to lower overall health care costs for our
patients.
In fiscal year thirteen, essentially the foundation for Aim
performance, we formed an Accountable Care Organization.
We now have contracts with multiple payors.
These contracts cover health care for over 150,000 patients
throughout Essentia. We also earned
ACO certification from the National Committee for quality assurance or NCQA.
At the same time, we established the Essentia system
Quality Management Program and Department. We have come to redefine success
as a focus on value versus volume.
In March, Essentia Health was among the first six
health systems to become a nationally certified accountable care organization.
This certification acts as a blueprint for quality that is recognized by
patients and insurers alike.
We feel that this certification establishes Essentia as a national
leader
in accountable care. It ensures we maintain high standards,
including 25 quality measures in areas ranging from
appointment scheduling to optimal chronic disease management.
This accreditation hard wires the build of our standardized care processes
across Essentia's health system.
FY 13 also saw the establishment of the system
Quality Management Program and Department.
In support of the Essentia's mission of making a healthy difference in people's lives, the
Quality Management Department is charged with
leading efforts to improve performance in all areas of care,
including patient safety, chronic disease management,
preventive care, inpatient care and patient experience.
The department is led by myself and my dyad partner, Barbara Possin,
who is the Vice President of Quality and Strategy.
We have several system quality personnel who I would like to talk a little bit
about
at this time, starting with Joyce Kreski, our system Quality Project Manager.
Joyce has been involved in our meaningful use metrics across Essentia.
She's also project manager for the CMMI bundles of care project,
which looks at care for congestive heart failure,
coronary coronary artery bypass grafting and
total hips and knees throughout the West and East regions.
She also is coordinating system safety alert communication.
Cindy Ferrara, our Primary Care Program Manager,
has for years been involved in Minnesota Community Measures reporting.
She also overseas many of the primary care quality metrics
and processes, including colon cancer screening and the Compass and Diamond
mental health initiatives.
Sue Henke has been doing significant work with our NCQA
accreditation preparation, practice development
and referrals tracking throughout the system, as well as access and appointments
to our primary care clinics.
Steve Mattson is working with our quality metrics
in collaboration with Information Management and Information Services.
He works on developing new metrics within the quality
warehouse as well as setting metric targets for our ACO metrics,
our value-based purchasing and other quality dashboards.
Mickey Schultz was the project manager for our successful NCQA accreditation
in FY13. She is also responsible for our Balanced Scorecard
metrics and making sure that they are populated
in a timely fashion. Marie Helbach, our newest addition,
oversees our patient experience
database for both H Caps and CG caps
She's also trained on the Truven quality database
and does a lot of our statistical analysis of quality metrics throughout
the system.
Gail Ernst is instrumental in helping with our control charts
as well as our spreadsheets across the system for quality
and does a lot of our event planning, especially in the primary care
arena.
Patty Feiro is our scheduling person and also works
on our PowerPoint presentations for system quality.
Looking regionally at our quality personnel we have a dyad leadership model
within each region. You can see here that we have in the Central Region
Dr. Mark Dray and Kathy Miller,
in the East Region Dr. Jeff Lyon and Cindy Wilson-Nordskog,
and in the West Region
Dr. Michael Briggs and Claudia Volk.
These folks are really your regional points of contact for Quality.
They help oversee such things as core measurement,
performance, patient safety metrics, infection prevention,
med reconciliation, readmissions processes,
they also get involved in many areas in peer review,
event reporting and RCA investigations.
Within the past fiscal year we established quality committees
throughout Essentia Health.
We have an overriding Essentia Health Board of Directors Quality Committee
and we have a system operational Quality Committee.
The Essentia Health Board of Directors Quality Commitee
meets quarterly
and the system Quality Committee meets monthly.
Within the regions, then, we also have regional Quality Committees that
meet either monthly or quarterly, as well as board-level
quality committees in each of those regions.
I'd like to talk a little bit about transparency in our quality metrics.
Until recently patients and insurers assumed clinical quality was given
in health care. Today as more data becomes available
it is clear that quality varies among and even within US hospitals and clinics.
Patients are responding by seeking out this publicly reported quality data
when choosing where they're going to receive their care.
While this data can be found in various public internet sites, Essentia Health is
taking transparency one step further
by posting our key quality measures on the essentiahealth.org
public website.
You may have also seen posters which we have placed in most of our
hospital and clinic lobbies. These posters
are stating our goals in terms of quality, as well as our
focus on transparency for quality, and if you
have a smartphone you can click on the QR code in the lower left hand corner
of these posters
and it will bring you right to our internet quality site.
When you arrive on that quality site you will see
in the lower left hand corner here a box where you can click on any one of the
metrics to get a look at how
Essentia Health is performing, and also how
we're performing as compared to state or national benchmarks.
Looking on high blood pressure you can see how Essentia Health performs
in treatment of patients with hypertension. You can see that our
performance is 78 percent
in this slide compared to a Minnesota state average of 75 percent, so
we're above
the state average. And you can do
likewise a look at any other quality metrics on this site to see how are
performing.
We've made an effort to make sure this site is simple, understandable and
has benchmarks which will give
our patients some kind of context as to how we're doing.
In addition to transparency, we're also more vigilant about
our outcomes than we've ever been. There's a popular saying in health care
that you move what you measure.
Thanks to a significant investment in electronic health records and
our new data warehouse,
Essentia Health is now able to closely monitor key health indicators for every
patient in health system.
This information is being used to improve care for individual patients
and for patients overall. This information drives us to better
customer service and
enhances care for patients with many diseases, like heart disease, diabetes,
hypertension,
and stroke, just to name a few. Over the past year the Quality,
Information Services and Information Management departments have developed
the Quality Dashboard
that shows our performance on key quality measures at the system, region
clinic and physicians levels.
This dashboard is located on Essentia's
intranet. You can find it by clicking into the Source.
It contains both inpatient and outpatient measures and is available to
all physicians and employees within Essentia.
When you get to the Source, look under the quick links tabs
over on the right hand side there and you can see the third one down is
Clinical Quality Dashboard. If you click on that
it will bring you right into the warehouse in the Quality Dashboard.
Once you arrive at the Quality Dashboard, can see that our metrics
are categorized into several different buckets and at the top so you can see
its our ambulatory care metrics.
Below that we have our 30-day readmission rates for
several different diseases. At the bottom we have our process of care
measures, which is our
care for inpatients. And then not shown here but also available on that
landing page,
our metrics for infection prevention, mortality,
patient experience and and a without being seen
metric for our ER service.
You can then drill down from the system level and into
regional level performance. You can see here that we've clicked into
Mammography compliance and you can see how each of our
three regions are performing for mammography. On the left hand side
you can see a
Essentia West, Central and East, the performance level they're currently at
under value
and then you can see the red dots next to each one of those showing us that
we're not quite at target yet.
Just the right of that then we have a spark line which shows
our performance over multiple months.
Where you see bars that are green instead of blue that is the
measurement period where we had the highest performance for that particular
metric.
Then to the right of that, under patients, you can see exactly how many
patients qualify in each of our region's for mammography.
Then over to the right we have a a larger graph
showing our system performance with the yellow line
extending from left to right showing the number of patients eligible
for mammography.
You can see that that's been growing progressively over the previous months
and then you can see the red target up in the upper right hand corner.
The red arrow job signifies what our target is for this metric.
Drilling down further then
into just a single region, we've clicked into the
West Region and we're looking actually at clinic level data
in the West region and you can see we've actually gone to the Whapaton Clinic
and you can see that there's
two groups of physicians in the Whapeton Clinic that have mammography data. It's
both the Family Medicine and
Internal Medicine physicians and you can see what their performance is,
as well as what their spark land looks like.
Drilling then one little deeper into just the Family Medicine doctors within
the Whapeton Clinic, you can see by name
how each those physicians is performing currently
and how they performed over the last several months. You can also see that
they're
high-water marks, or the green bars, are very recent, and so they're they're
performance has been increasing
in recent months. And you can also see how many patients
in their patient panel are eligible for mammography. In the coming year,
we're looking at maintaining our focus on quality and we have some highlights
coming forward, beginning with system-wide training on the
Quality Dashboard for physicians and employees.
We're going to be sending out regular email updates on key quality measures
and we'll have stories on on key quality measures featured in the
Daily Dose. We've also expanded our list
of quality metrics for FY14 on the dashboard. This is our list
metrics will be looking at this fiscal year and I'm just gonna highlight
those that have changed or been added compared to last year.
Under patient experience, we have service excellence. We are now measuring the
CG Caps patient experience list of questions which has been mandated by
both
state and federal payors. Under hospital measures, we've
added measures for stroke patients and the care
that they receive, and under ambulatory measures
we've added colorectal cancer screening. Under patient mortality,
we are looking at overall all-cause mortality,
whereas last year we were looking at mortality for just heart failure,
pneumonia or
acute myocardial infarction. But this year we're beginning to look at
all-cause mortality. Our efforts discussed today are about living up to
Essentia's vision.
By 2018, Essentia HEalth will be a national leader in providing
high-quality,
cost-effective, integrated healthcare services.
We are already doing many things right at Essentia Health.
Our next step is to make sure we do the right thing for every patient, every time.
Working together, we can take the quality ever care to a higher level.
We will do more for our patients and we will live up to their higher
expectations by living up to our own.
Please keep our mission, vision and values in mind in all
that you do.
We are fortunate to work in a mission-driven profession.
thank you for your time and attention today. I'm honored to help lead this
focus on quality, but the real improvement efforts come from all of you.
Thanks again, and have a great day.