Dr. Dreger of Prime PLC talks about the DPC doctors opportunity to incisively analyze their patient panels and use data to improve health outcomes rather than using it to justify reimbursement (like they would in an insurance-driven system). See the full session at: http://video.hint.com/dr-kathryn-dreger-to-measure-or-not

1. Dr. Kathryn Dreger
Prime PLC
To Measure or
Not to
Measure?
That is the
Question...

2. What exactly is
Primary Care?
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3. ● Neurology
● Cardiology
● Pulmonology
● Gastroenterology/Hepatology
● Hematology
● Oncology
● Rheumatology
● Orthopedics
● Endocrinology
● Allergy/ Immunology
● Nephrology
● Urology
● Psychiatry
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A Day in the Life #1
Trigeminal Neuralgia
Chest pain -- new diagnosis of angina
New diagnosis of Leukemia
Hepatitis B, Fatty liver and newly
elevated liver enzymes
Thyroid nodules
Anxiety
Lumbar radiculopathy
Diabetes
Hypertension

4. A Day in the Life #2
Migraines
Osteoporosis
Shingles
Memory loss and anxiety
Recent discharge from alcohol rehab
Muscle pain
Carpal Tunnel
Neuralgia Paresthetica
Disability form, request for opiods
Pernicious anemia
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Malnourished with possible malabsorption
Rectal Bleeding
Chest pain to left arm with normal EKG
Hyperhydrosis
Depression
Hypertension (2)
Pre-diabetes
High cholesterol (2)
Chronic back pain (2)

5. A Day in the Life #3
Rotator cuff injury
Inflammatory arthropathy
Vitamin D deficiency
Ataxia (discussed pros and cons of lumbar
puncture)
COPD Exacerbation
Hypothyroidism
Profound unintentional weight loss
Allergic Rhinitis (2)
Aortic stenosis
B12 Deficiency
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Intractable migraines
Overactive bladder
Tennis elbow
Alzheimer’s (3)
Depression
Osteoporosis
Cervical spine stenosis with shoulder pain
High blood pressure
High cholesterol
Diabetes (2)

6. What do all these days
have in common?
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7. More than 50 measurements to capture primary care
● Controlling high blood pressure
● Controlling diabetes
● Screening for kidney disease in diabetic patients
● Retinal eye exam in diabetics
● Statin therapy for patients with cardiovascular disease
● Statin therapy for patients with diabetes
(AKA -- HEDIS, MIPS, Meaningful Use…)
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8. What we do most often is
not what we spend most of
our time doing.
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9. PPRNet
● EMR Since 2002
● Quality metrics every quarter
● Began changing the workflow in
our office
● Population Health at its best
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10. Angela
● 110 pounds overweight
● Diabetes
● Hypertension
● Elevated cholesterol
● Arthritis
● Kidney damage
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11. Medicare gets
involved… ● Meaningful Use
● Documentation requirements
● Billing & Coding
● Less and less time for patients
● Much less time for population
health
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12. Fractions can hurt...
● 30 Diabetic patients in the practice, 70% had Hemoglobin A1C <7
● For Meaningful Use, 10 had to be Medicare
● Only Medicare patients between ages 65 to 74 count
● Only ten fit that mold
● One was Angela, three more equally “challenging”
● To Medicare’s eye, I was dreadful at taking care of diabetics
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13. Direct Primary Care Changes
Everything
● Practice transformation October
2016
● Opened with 450 patients
● Currently 578 patients
● Population Health in focus once
more
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14. Solo Practice can be Lonely..
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15. Science Marches On..
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16. Member based network of Family Medicine Docs, Pediatricians and
Internists focused on the science behind changing minds, changing care
and changing lives
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17. Population Health: DPC & The PPRNet Foundation
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18. The PPRNet Foundation (pprnet.org)
● “How can my practice improve our preventive care?”
○ Standing orders for Hepatitis C, Alcoholics everywhere!
● “What do I do now?”
○ Sharing questions and knowledge in an accessible form
● “LAMA/LABA? What happened to albuterol!”
○ On-call personal pharmacist for those drug questions
● “What happens if we….?”
○ Scientific study within primary care practices
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19. Digital Health in Primary Care Practices
The PPRNet Conference
November 7-10, 2019 Charleston, SC
● Using EHR-based clinical quality reports as tools to improve care.
● Adopting a remote blood pressure monitoring solution to improve the diagnosis and
treatment of hypertension.
● Hardware and software solutions to improve oral medication adherence.
● Remote spirometry and inhaler adherence for patients with COPD/asthma.
● Patient facing apps to enhance obesity/overweight management.
● Organizing the primary care practice to adopt digital health tools.
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20. “
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Not everything that matters can be measured,
and not everything that can be measured matters.
Albert Einstein

21. We Can Change the Future
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