GHS Diabetes Healthcare Delivery


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GHS Diabetes Healthcare Delivery

  1. 1. Diabetes Healthcare DeliveryA National Tragedy<br />Angelo Sinopoli, MD<br />Chief Medical Officer<br />Chair, Medicine<br />University Medical Group<br />
  2. 2. Total Health<br />
  3. 3. Percent of Diabetic Medicare Enrollees Receiving Appropriate Management<br />
  4. 4. Diabetes Care in <br />South Carolina<br />
  5. 5. Inpatient Diabetes Management<br />Two Inpatient Diabetes Educators<br />Insulin order sets<br />IV insulin<br />SQ insulin<br />Pregnancy<br />Insulin pump protocols and standardized order sets<br />Multidisciplinary Diabetes team<br />Hypoglycemia initiative<br />
  6. 6. Glucotec<br />
  7. 7.
  8. 8. The Care Continuum andthe Accountable Care Organization<br />8<br />Graphic: Sg2<br />Accountable Care Organization Value Proposition: The programs, people, protocols, and payment that define care delivery and patient movement along the care continuum<br />
  9. 9. Focus on the Medicaid Population in the Medicine Clinic<br />A focus on the big six: Diabetes, CHF, Asthma, COPD, HTN, CAD<br />Initial focus on Diabetes as a pilot<br />Focus on quality measures and utilization<br />Duke Innovation Grant<br />
  10. 10. Developed a process for stratifying patients by ER and Hospital utilization<br />Developed an intake process for initiating patients into the “enhanced care” program for buy-in.<br />Working with e-CW to develop CDSS and standard outcomes reporting<br />Duke Innovation Grant<br />
  11. 11. Added a Nurse practitioner to the clinic for monitoring and increased access for this patient population<br />Added a Care Manager for coordination of care and Care Coordination<br />Developed an Emergency Room Care Management role<br />Worked to change the culture of the clinic<br />Duke Innovation Grant<br />
  12. 12. Restructured the Outpatient Diabetes Self Management Program and connected it to the clinic population<br />Changed the hours of education to make it more patient friendly<br />Streamlined the referral process<br />Implemented central scheduling<br />Refined the billing processes<br />Reorienting around primary care practitioners<br />Duke Innovation Grant<br />
  13. 13. Developed Clinical Advisory Teams (CAT) to develop and agree upon standard quality measures by which we would be measured<br />PQRI measures were used as baseline measures but allowed for a higher standard of performance<br /> Also supports “meaningful use” across the system<br />These were developed for Diabetes, CHF, HTN, COPD, and Asthma<br />Duke Innovation Grant<br />
  14. 14. Physician Quality Reporting System (PQRS – was formerly PQRI)GHS Diabetes Quality Measuresapproved by Clinical Advisory Team in 09 <br />
  15. 15. Diabetes Quality Measures<br />HgbA1C Measurement and Control<br />LDL Measurement and Control<br />BP Measurement and Control<br />BMI Measurement and Plan<br />Annual Urine (protein) exam<br />Annual Foot Exam<br />Annual Dilated eye exam/Retinopathy Severity <br />
  16. 16. Diabetes Quality Measures<br />Antithrombotic Therapy<br />Use of ACE/ARB Therapy<br />Tobacco Use<br />While influenza and pneumococcal immunizations are expected to be addressed for this patient population, GHS will handle them as individual quality measures for all patients according to protocols <br />
  17. 17. No such thing as a simple diabetic<br />All have one or more significant co-morbidities such as CHF, CAD, COPD or HTN<br />Duke Innovation GrantChallenges<br />
  18. 18. No telephone<br />Poor living conditions<br />Ongoing Medicaid eligibility changes<br />Transportation<br />No car<br />Have to get a ride to the clinic or even to the bus stop<br />Long bus ride with multiple stops<br />Easier to call an ambulance or wait until someone is off from work to take them to the ER<br />Duke Innovation GrantChallenges<br />
  19. 19. Defined utilization as being for ALL diagnoses, related and non-related to study conditions<br />Did not exclude outliers<br />Duke Innovation GrantResults<br />
  20. 20. Emergency Room visits down 26%<br />Hospital days down 55%<br />Initial PQRI compliance increased by 70% <br />A significant improvement of HgA1c was noted<br />Duke Innovation GrantResults<br />
  21. 21. Duke Innovation GrantPhase Two<br />Add additional eligible Medicaid patients<br />Add unfunded population<br />Connect to AccessHealth SC Grant<br />
  22. 22. Use the infrastructure and knowledge developed around the Duke Grant to expand to other populations<br />Develop a Diabetes Toolkit<br />Further engage Primary Care around Diabetes<br />Develop IT systems around identifying and tracking patients with particular diseases<br />Obtain front-end disease registry<br />Diabetes Care<br />
  23. 23. Questions?<br />