Michigan Quality Improvement Network HCCN Grant - A Clinical Perspective January 14, 2020 2020 Great Plains Health Data Network Summit & Strategic Planning Rushmore Plaza Civic Center Rapid City, South Dakota
Overview 1. Michigan Primary Care Association 2. Challenges and Barriers Of member Health Centers 3. Health Center Clinical Leadership and Staff Engagement 4. Michigan Quality Improvement Network- HCCN Grant Highlights 5. PCA-HCCN-CIN Collaboration 6. Lessons Learnt and Successes/Outcomes
MPCA History 1978 - Organization formed as the Michigan • Association of Rural Health Care (MARHC), Networking organization of health centers and • stakeholders interested in fostering primary care in rural underserved communities across the state. Realization that urban communities also had great • health care needs, the association broadened its scope 1981 - to better reflect this broadened scope, • MARHC changed its name to Michigan Primary Care Association (MPCA).
Michigan Health Centers 45 Health Centers across MI provide care for more than 700 ,000 * residents at over 270 delivery sites across Michigan *UDS 2018
Health Center Challenges Health Information Technology/ EHR Challenges Inability to Integrate Clinical, Financial and Operational Data Lack of Process and Workflow Standardization Regulatory and Reporting Requirements Reimbursement and Payment issues Provider Burnout Primary Care Workforce Shortages Emerging Health Care Issues
MPCA Strategic Goals 1. Delivery System Transformation 2. Importance of Data & Analytics 3. Payment Reform
Potential Solutions Workflow Efficiencies, People Process Care Teams, Waste Reduction, Patient Outreach & PDSA. Engagement, Provider Satisfaction. Technology EHR Optimization, Interoperability, Data and Analytics Tool.
Health Center Collaboration Path • Started with MPCA Clinical Quality Committee - 2010 • Formation of MQIN (HCCN) – December 2012 ➢ Round 1 (2012-2016) – focus on EHR Implementation, Meaningful Use, Quality Improvement-PCMH- 22 Participating Health Centers ➢ Round 2(2016-2019) – focus on Population Health Management, HIE, Data Quality and Reporting – 38 Participating Health Centers ➢ Round 3 (2019-2022) – focus on Provider and Patient Experience enhancement, Interoperability, HIT Optimization, Data Integration – 40 Participating Health Centers
Collaboration Path, Cont. • Value Based Care Readiness ➢ PCMH Recognition (33/40 MQIN Members) ➢ CMS Demonstration Projects (MiPCT 1/2012, MiCare Team 7/2016, SIM 8/2016) ➢ Health Center Readiness Assessment (Curis Consulting 2017) • Integrated Data System selection ➢ May 2016 – Committee Startup ➢ March 2017 – Contract Complete with Azara ➢ December 2017 – 11 Health Centers live ➢ December 2018 – 22 Health Centers live ➢ Today – 29 Health Centers live - 3 more before end of 2020
Health Center Leadership and Staff Engagement • Support & Successes • Dedicated Clinical Quality Staff: CMO, Nurse Care Consultant, Associate Director of Operational Excellence, with PCMH CCE providing PCMH T/TA • Clinical Networks and Listservs: Monthly QI news letter, QI Directors Network, CMO Network, Nurse Care Managers Network, Clinicians Listserv etc., • Outside Consultants: MQIN provided nationally renowned expert consultant services- Candice Chitty (PCMH), CURIS (VBC), Coleman Associates (Clinical Process Improvement) etc., • Provider Trainings: Maximizing the Use of EHR, ICD, Clinical Conferences • CHC Benchmarking: UDS, HealthyPeople 2020 benchmarking of Health Centers shared annually • Best Practices Identification: Identification of Health Center best/promising practices and facilitation of sharing between peers • MQIN specific clinical Quality Measure benchmarking with Azara every quarter
Health Center Controlled Network (HCCN) HRSA’s Health Center Controlled Networks (HCCNs) are networks controlled and acting on behalf of health centers as defined and funded under Section 330(e)(1)(C) of the Public Health Service Act and must consist of at least 10 Health Center organizations.
Governance MQIN Leadership Committee Operate under structure and by-laws of MPCA Leadership representatives: Executive Officer • Financial Officer • • Operations Officer Medical Officer • • Information Systems/Technology Quality Improvement • Transformation Leader • The primary function of the Michigan Quality Improvement Network Leadership Committee is to provide guidance to the Network to support systems and processes that provide optimal organizational results in clinical outcomes, operations, financial sustainability and patient satisfaction MQIN Leadership Committee Leadership 2019 Chair – Velma Hendershott 2019 Vice-chair – Dan McKinnon 2019 Meeting Dates February 12, 2019 Teleconference May 14, 2019 Teleconference August 4, 2019 (MPCA Annual Conference) In-person with teleconference option November 19, 2019 Teleconference
HCCN Spread
HCCN Grant 1.0 : MQIN Implementation Date: August 1, 2012 End of Funding Cycle: July 31, 2015 Membership: 22 Health Centers Grant Amount: $750,000 Grant Focus Areas: 1. EHR Adoption and Implementation 2. Meaningful Use 3. Quality Improvement: PCMH, HealthyPeople 2020
HCCN Grant 2.0 : MQIN Implementation Date: August 1, 2016 End of Funding Cycle: July 31, 2019 Membership: 39 Health Centers Grant Amount: $1.125 Million per year
1. Health IT Implementation and Meaningful Use 2. Data Quality and Reporting 3. Health Information Exchange (HIE) and Population Health Management 4. Quality Improvement
1.Health IT Implementation & Meaningful Use Certified EHR Implementation and Optimization: Support the adoption, use, and optimization of certified EHRs. Advance Meaningful Use Assist with meeting Stages 1, 2, and 3 Meaningful Use requirements. Response/TA Strategies : EHR/EDR User Groups- 3 EHR and 2 EDR user groups Virtual CHC- Group discounts and vendor negotiations MU assistance- Staff expertise and strategic partnerships (M- CEITA, Medicaid EHR Incentive program office), HIPAA training and Security Risk Assessment help.
MQIN CHC's Achieving MU/Promoting Interoperability Column1 Column1 95% 91% 3 36 2 20 6 0 68% 26 2 48% 6 46% 226 368 40% 293 2015= 2016= 2017= 2015= 2016= 2017= 22 CHC 38 CHC 38 CHC 22 CHC 38 CHC 38 CHC CHCs that EP’s achieving PI Attested
EHR Challenges • Non performing or under performing EHRs • Variety (11) of EHRs being used across Michigan • Promoting Interoperability reporting issues • Mergers and Acquisitions of EHR companies • Health Centers in the middle of transitioning EHR systems • 2 Health Centers have transitioned in 2018 to a new EHR • 5 will have to move off SuccessEHS in 2019 due to SuccessEHS end of life.
EHR Support • Continued engagement and discussions with EHR vendors • Financial incentives offered for adopting tools and templates for EHR optimization, such as: • PRAPARE tool • OSIS NextGen EHR toolkits • Offered a no cost Security Risk Assessment (SRA) • using HIPAAOne tool hosted by MetaStar. • EHR trainings and resources • Nextgen Optimization training at MPCA • SuccessEHS Optimization and transition training remote and at MPCA • Assistance with EHR system transitions • Virtual CHC hosting and technical support • Hosting of EHR/EDR user groups
2. Quality Improvement Clinical Quality Improvement Support use of health IT to enhance performance on clinical quality measures Operational Quality Improvement Support use of health IT to support health center operational excellence. Advance PCMH Status Assist health centers in using health IT to advance their respective PCMH recognition and implementation efforts. Response and TA Strategies: CMO Network, Clinician Network, QI Directors Network, Lean and PCMH certified staff- personalized TA Trainings and educations on a regular basis Strategic partnership (GLPTN, Consultants)
Percent of MQIN Members with PCMH Recognition Goal PCMH Nationally: 70% of Health Centers 2016 n=37 86.84% 86.84% 2017 n=39 76.92% 33 33 2018 n=38 67.50% 2019 n=38 30 25 2016 2017 2018 2019
Healthy People 2020 UDS 2018 Number of MQIN Members Meeting HP2020 Goals N=38 26% 10 21% 18% 8 16% 7 11% 6 8% 4 3 Meeting < 4 Goals Meeting 4 Goals Meeting 5 Goals Meeting 6 Goals Meeting 7 Goals Meeting 8 Goals
2018 Clinical Quality Assessment Health Information Technology (HIT) & Promoting Interoperability/Meaningful Use 79 % 27 62 % 21 EHRs 10 33 EDRs 8 (97 2016 (n=32) 2018 (n=34) Patient Portal %) Total Number Patients receive summary Access to Patients of EHR’s & within 48 hours of visit N=34 EDR’s N=34
2018 Clinical Quality Assessment Telehealth 26 % 11 Primary Care 2 22 (45% 5 % ) 7 Psychiatry 9 Specialties 3 2016 (n=32) 2018 (n=34) Telehealth services Telehealth Services Active telehealth integrated in EHR (check all that apply) services N=11 N=11
2018 Clinical Quality Assessment Social Determinants of Health 88 71 % 30 % PRAPARE 9 24 44 SIM SDOH 5 44 % 14 % 14 Home grown 7 tool Other 9 2016 (n=32) 2018 (n=34) 2016 (n=32) 2018 (n=34) SDOH tool SDOH Tracking SDOH Tool integrated N=34 N=30 in EHR N=30
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