Saturday, May 25, 2002 Pursuing Perfect Healht Care in Whatcom County, WA This is a high level view of our project plan. Details will be forthcoming in various media and arenas. The project officially begins June 1 though much work has been going on at many levels in the participating organizations. Leadership Board Oversight Use of Simulation Model to advocate for reimbursement changes Complete Initial Staffing for Project Staff Training Creation of Curriculum and Documentation of Training provided all staff Measurement Information Technology Work on Infrastructure Medication Hand-offs Work Communication and Transparency (extraordinary openness) Infrastructure Complete Diabetes Pilot Work Plan Integrate Care Managers into the Clinics and Virtual Care Team Congestive Heart Failure Pilot Work Plan Hospital Related Changes to Support Chronic Care Model Living With Chronic Illness Program Expansion Idealized Design of Clinical Office Practice Completed for Pilots Develop Evidence Based Medicine strategy and approach Develop an approach for early adopters outside the grant 9:11:17 PM     comment [] Communication and Transparency Infrastructure The Pursuing Perfection grant encourages, develops and requires Transparency. Extraordinary openness. In order to accomplish this level of openness we have the following project goals in front of us. Several are underway, even before the grant begins, June 1. Communication Plan Developed Establish Communication Team Identify current technology to support internal/external communication on Project Activities Test Technology with this Workplan Attempt to connect all sites participating across the country and in Europe with simple userfriendly web tools for communication. More later. Quarterly Community Forums Planned Extranet Web Site for Pursuing Perfection Started. More soon. Videos Developed Speakers Bureau Developed Experiment with RadioLand as long term communication solution Quarterly Community Forums 9:03:11 PM     comment [] We will soon Complete the Initial Staffing for Project For this project to truly be succefful, these typse of staff positions will need sustainable funding. A daunting thought for a cottege industry. It's a system. The only question is whether the stakeholders can create infrastructure to support a system. Recruitment and Hiring of Project Staff (Data Analyst, Project Manager, Project Coordinator) Hire Grant Writer Recruitment and Hiring of information technology staff (Web Content/patient Education; Programmers) Recruitment and Hiring of Team and Process Improvement Facilitator and Organizational Development (OD) Recruitment and Hiring of Care Managers Consultants and Contractors may be hired 8:55:35 PM     comment [] We will use Simulation and System Models to understand and advocate for reimbursement alignment        Our task list includes the following: Engage the other grantees in system dynamics effort, sharing knowledge with them as it accumulates Follow up on HBOC Offer Develop a contract with System Dynamics folks Scoping Meeting in June. Identify community business participation Week long SYS Dynam meeting with the local Systems Team Conduct community data analysis and costing for diabetes and CHF Identification and contact with employers and community resources for support Identification and contact with payors, national representatives for support in change in reimbursement model 8:48:28 PM     comment [] Leadership to Change Healthcare Pursing Perfection (PP) Leadership Board Oversight Recruitment of Additional Members We started with the leaders of the provider groups, added the leaders of the payer groups (Group Health and Regence. CHPW (Community Healht Plans of Washington) plans to join soon. We plan to invite WA State Medicare (DSHS) and Medicare (CMS) to join in the ldiscussions and modeling for alignment of payment with improved care processes. This work begins in July and shold conclude by January. Ongoing Measurement of Team work The Institute of Health Care Improvement is leading all of the grantees to find measures that are common between the participants across the nation. The goal is for us to benchmark ourselves and raise the bar on quality of healht care we deliver. Locally we have experience in measuing patient-centered satisfaction with healthcare, healthcare functional status outcomes, and "teamness", a proxy for cooperation. We will share that knowledge and experience with the others. Assessment of development needs We are hiring staff with skills in organizational development, education, and human relations. These folks will help us determine where we will want to increase our knowledge and skills, to make patient-centered care a reality by the end of this pilot project in less than two years. Develop Strategy to engage CMS and Medicaid As noted above, we have a plan and strategy to collaboratively develop a deep understanding of the local health care situation including the patients' and payers' concerns. We plan to get all the key skakeholders at the table late summer and fall to model ideal health care for thoses with diabetes and congestive heart failure in Whatcom County. We sincerely hope that a coherent demonstration project can be crafted between the providers, patients, and payers; especially Medicare--since much of the cost of chronic care is paid by Medicare. Initial Training of Board The existance of a board of professional leaders working together to create a system of care that supports the Institute of Medicine's (IOM) CHROSSING THE QUALITY CHASM report is exciting and represents a paradigm shift in focus and system building. We will try to support this group so that they are the most effective team with the best ideas and models to support such dramatic change in and amoung their organizations. More later. We have engaged Kristin Crosby to orient us to Medicare realities Kristen Crosby is the medical director of Olympic Healthcare, a division of Sterling Insurance. Olympic is the largest provider of Medicare supplemental insurance in the country. Kristen is helping us understand the workings and relationships needed for collaboration with Medicare. Development of strategic community-wide plan For this pilot to meet its aims, it must begin to engage the entire community and provide a sustainable vehicle for the full development of the Six Aims of the IOM report Crossing the Quality Chasm: safe, effective, patient-centered, efficient, timely, equitable care. This level and direction of change will require ongoing system building. This is one of the key responsibilities of this PP Board. 8:23:56 PM     comment [] Monday, May 20, 2002 Pursuing Perfection Evaluation site visits From: Irene.Cramer@med.va.gov [mailto:Irene.Cramer@med.va.gov] Sent: Friday, May 17, 2002 11:57 AM Subject: Pursuing Perfection Evaluation site visits We are looking forward to having the opportunity to meet each of you and the members of your staff involved in the Pursuing Perfection effort. As RWJF's John Fiorillo and Linda Bilheimer described in their memo this week, we will be present at the May 29 IHI meeting to introduce the evaluation aspect of this project. We will also provide you with more specific information next week. The evaluation of the Pursuing Perfection effort has several aspects to it with the first being a visit to each of your facilities, hopefully in June. We will be on site for two full days and would like to meet individually with senior and line staff knowledgeable and involved in the Pursuing Perfection effort. In addition, we will want to become familiar with your system for performance based data collection. Because each site varies, we will need to identify the appropriate people site by site and will look to your counsel as well to help us identify the people and set up the appointment times prior to our visit. At this time we are asking you to choose from the times listed below, the three best time slots for a site visit. Please indicate your first, second and third choices. If possible, we would like to complete the site visits in June. We have three teams available, each with three people. 1st choice 2nd choice 3rd choice June 3 and 4 ________ ________ ________ June 4 and 5 ________ ________ ________ June 5 and 6 ________ ________ ________ June 6 and 7 ________ ________ ________ June 10 and 11 ________ ________ ________ June 11 and 12 ________ ________ ________ June 12 and 13 ________ ________ ________ June 13 and 14 ________ ________ ________ June 17 and 18 ________ ________ ________ June 19 and 20 ________ ________ ________ June 20 and 21 ________ ________ ________ June 26 and 27 ________ ________ ________ If you cannot choose three dates in June, please indicate from among the July dates as well. 1st choice 2nd choice 3rd choice July 9 and 10 ________ ________ ________ July 10 and 11 ________ ________ ________ July 11 and 12 ________ ________ ________ July 15 and 16 ________ ________ ________ July 16 and 17 ________ ________ ________ July 18 and 19 ________ ________ ________ If you have questions, please give me a call or e-mail me. Thank you for your assistance. Irene E. Cramer, Ph.D., Pursuing Perfection Evaluation Project Manager Management Decision and Research Center VA Boston Healthcare System (152-M) 150 South Huntington Avenue Boston, MA 02130 Telephone: (617) 232-9500 ext. 5758 Fax: (617) 278-4438 e-mail: irene.cramer@med.va.gov 1:01:43 AM     comment [] Sunday, May 19, 2002 Site map? We need something akin to a site map for Whatcom PP that show what and who a user can link to. 1:42:45 PM     comment [] Searching strategies Searching appropriately, Our next big challenge is to get a search engine in our implementation of Radio and Manilla so that it does what the customer would expect: search the current author's category, the current author's entire web site, the entire Whatcom Community’s category or all local Radio PP sites, and then the WWPP by the same aggregates. One would also want to be able to search by any combination of organizations, categories, and authors. This represents design perspective as well as a search strategy. 1:40:56 PM     comment [] Saturday, May 18, 2002 WA state medical reimbursement   Rewriting WA State medical reimbursement to support new models of care.. From: Anderson, Nancy, Dr. (MAA) [mailto:ANDERNA@dshs.wa.gov] Sent: Monday, May 13, 2002 10:49 AM To: Kevin Little Cc: 'James W. Stout' Subject: RE: [asthma] FW: [btscollege] Re: Asthma group visits Medical Assistance (the Washington State Medicaid Administration) is in the process of writing billing instructions for group clinical visits, led by an MD or ARNP, that are specific for diabetes and asthma. We've written various drafts of the instructions, but all include: 1. review of records/labs/etc by the clinician prior to the visit; 2. Group discussion devoted to a clinical issue; 3. Some question/answer time; 4. Routine review for all (most can be done in a group setting) and short individual visits as necessary We will allow four one hour modules per year, which can be grouped together and billed as more than one module at one time. We will not allow billing for another e/m code the same day for the same diagnosis. We will allow those clients who have both diabetes and asthma to get clinical visits for each diagnosis (ie 8 one-hour visits a year, 4 for each disease). I'm hoping that we'll begin reimbursement June 1 (but with various bureaucratic issues, probably wouldn't make a bet). We also have a separate pilot project for asthma education with one clinical site, which is an individual contract. These visits are let by an asthma educator and are modeled after the diabetes education that we already reimburse. Nancy Anderson MD MPH Medical Epidemiologist PO Box 45506 Olympia WA 98504-5506 360-725-1567 (v) 360-664-3884 8:19:05 AM     comment [] Thursday, May 16, 2002 Great Britian's Clinical Measures Links to the Great Britians National Healht Service (NHS) national performance indicators. 9:35:35 AM     comment [] Wednesday, May 15, 2002 Medication System, measure related to quality    Common Measures: Medication System           1. Adverse Drug Events (ADEs) per 1000 doses (safety)           2. Therapeutic Range (effectiveness)             3. Cycle time to medication for certain medication (timeliness) 8:03:03 PM     comment [] Acute Care Hospital, measures related to quality   Common Measures             1. Adverse Drug Events (ADEs) per 1000 doses (Safety) 2. Mortality rates (Effectiveness) 3. Readmissions (Effectiveness) 4. Time to treatment on presentation (Timeliness) 5. Functional status, Quality of Life (Patient centered) 6. Average cost per case (Efficiency) 7. Average length of stay (Efficiency) 8. Hours of diversion per month (Efficiency) 9. Patient satisfaction (Patient centered) 8:00:32 PM     comment [] Access to Care, Measurements of  Common Measures             1. 3rd next available appointment (effectiveness)       2. Total time for a visit (efficiency)       3. # of patients on a wait list to be assigned a primary care physician (effectiveness)       4. Percent of patients “highly satisfied” with appointment scheduling (patient centered)       5. Percent “no show” (efficiency) 7:55:43 PM     comment [] High Level model of Whatcom Co, Pursuing Perfection approach Key Components of Whatcom Consortium's approach to Pursuing Perfection in Healhtcare. Pursuing Perfection Components in Whatcom County. We will use this or a similar graphic on the home page of the future to guide users to the parts they are interested in. We will also add search capabilities by these categories... in the future, the near future I hope. 6:19:18 PM     comment [] Saturday, May 11, 2002 6 Aims and 10 Simple Rules for more perfect heathcare, Institute of Medicine The key ideas behind this entire Institute of Medicine approach includes six goals: 1. Safe, 2. Effective (evidence based), 3. Patient-centered, 4. Timely, 5. Efficient, and 6. Equitable; and ten simple rules: 1.  Continuous healing relationships 2.  Customization 3.  Patient control 4.  Shared information 5.  Evidence-based decision-making 6.  Safety as a system property 7.  Transparency 8.  Anticipation of needs 9.  Continuous decrease in waste 10.  Cooperation among clinicians   4:08:03 PM     comment [] Patient Centered care, the relationship between measruement and care team behavior. Bill Mahoney begins the open dialogue on Patient Centered care when he posts: Activated patientness is not a trait but a state. The state is created by the care team (in whatever form) providing patient-centered care. The only importance of patient traits is that they (e,g, locus of control, self-esteem, soci-economic status, location in the social structure) specify the probability of x level/type of patient-centered care activity resulting in y level of activation. The biggest barrier (if the focus groups done 2 years ago tell us anything) is not the patient, but the provider. Building patient-centered care (CCM's productive interactions) is identical to building team development (it is team development.....patient as full partner in the care team). The absolutely essential foundation of patient-centered care is the creation of team cohesiveness (see team measure) and this will require that providers redefine their role, the patient's role and the nature of the patient-provider relationship. My hypothesis is that few will be willing to go there and we may easily revert to blaming it on those noncompliant patients...an animal that does not exist. [Bill Mahoney's Radio Weblog]   11:11:22 AM     comment [] © Copyright 2002 Marcus Pierson, MD.

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