Call for Applications – KY Performance Measures Alignment Committee

Recently, KHC announced the creation of a public-private partnership to create a common measures set in Kentucky, the Kentucky Performance Measures Alignment Committee (PMAC), led by KHC and KY Department for Medicaid Services. The 12-month initiative will produce a common set of measures related to five key areas of healthcare focus, with the ultimate expectation that the measure set be adopted by public and private organizations to better focus improvement efforts toward shared areas.

To support that effort, we are now taking applications to participate on the PMAC committee, which will be chosen jointly by KHC and KDMS. Kentucky PMAC will oversee the measurement alignment work and determine the final core measurement set. We are looking for individuals and organizations with a passion for quality healthcare measurement from various types of stakeholders, including plans, providers, purchasers, consumers, academia, and government.

Committee members will attend an estimated six meetings in-person or virtually from November 2017 to July 2018. For more information about the project, an invitation to apply for a subcommittee, list of roles and responsibilities of committee members, and an application, click here.

Submissions will be due by Wednesday, October 25. Any questions, please contact sclouser@khcollaborative.org.

The Rising Cost of Healthcare: Message from the National Affordability Summit

Healthcare leaders and policy experts gathered in Washington, D.C., at the National Affordability Summit hosted by the Network for Regional Healthcare Improvement (NRHI) to discuss the rising cost of healthcare and its growing threat for patients, employers, government, and the U.S. economy. Themes that emerged from the Affordability Summit were that the healthcare payment system is a problem, necessary services are not covered, fee-for-service fosters unnecessary and wasteful care, and over/avoidable spending on healthcare is the biggest driver of cost.

Scholarship funding awarded to the Kentuckiana Health Collaborative by the Robert Wood Johnson Foundation allowed us to assemble a team of regional champions from various stakeholder perspectives for attendance at this summit. The KHC team consisted of KHC co-executive director Teresa Couts, employer representative Amanda Elder (LG&E-KU), health system representative Shelley Gast (Norton Healthcare), and health plan representative Michael Lorch (Anthem).

National thought leaders Arnold Milstein, Harold Miller, Elizabeth Mitchell, David Lansky and others shared their views about the problems plaguing healthcare, alternative solutions to improve quality and reduce cost, how employers can shape the healthcare landscape, and actions that we can take in our communities to promote affordability.

Harold Miller speaks to attendees about healthcare payment redesign strategies.

Harold Miller, President and CEO, Center for Healthcare Quality and Payment Reform (CHQPR) spoke on redesigning healthcare delivery and payment for higher value. He shared that the biggest driver of healthcare cost is hospitals, followed by insurance administration/profits. The Institute of Medicine estimates that 30 percent of spending is avoidable and 25 percent of avoidable spending is excess administrative costs. By focusing on spending that is unnecessary and avoidable, you can get to better care at lower cost. Barriers in the present payment systems create a win-lose for providers. Barriers small or non-existent spending for high-value services. The system won’t pay for office services delivered outside of face-to-face visits with clinicians, e.g. phone calls, e-mails, etc., but will pay for an ambulance or hospital stay. Harold’s path to affordability is redesigning health care from the bottom up instead of from the top down to achieve better care at lower costs through patient-centered payment. Bottom up payment reform asks physicians and hospitals to identify ways to improve care for patients and eliminate avoidable costs. Then Payers provide adequate payment for quality care and providers take accountability for quality and efficiency. This translates into patients receiving good care at an affordable cost and independent providers remain financially viable. Harold provided examples of healthcare leaders who have successfully implemented this approach for Crohn’s disease, joint replacement, cancer, and emergency room patients.

The Affordability Summit was enlightening and a call to action. There is an urgency to reduce healthcare spending and make healthcare affordable. The KHC will work with our members and partners to improve healthcare cost. One action the KHC has taken is launching an initiative to develop a common measurement set across all payers.

The KHC team that attended the summit thought the conversation was interesting. Lorch is looking forward to further discussions on affordability. Elder said she was pleased to see that transparency is making headway within the industry.

“Healthcare can be overwhelming and confusing, even to those who work in the field.” Elder said. “However, I think the industry and all players are making strides in this area. A common theme I heard throughout the entire summit was there are various ways to achieve improvements in cost and outcomes”.

Gast said that most of the alternative solutions that were proposed sounded promising:

“It may not work in all markets but best quality care at an affordable price is reasonable. What wasn’t talked about at all was the payer. It seems to be more around what the providers can do to eliminate waste and reduce cost of care but they really didn’t mention the payers. That surprised me. All-in-all I do believe the Kentucky market wants to work on innovative ideas and provide the best care to our consumers. In order for us, the provider, to continue to provide this, the physicians and systems need to maintain their margin; 2 percent. I think it’s going to take everyone making changes, consumers, employers, providers and payers. That’s not easy nor is it something that can happen overnight. We all have the same goal, now we just all need to work together to get there.”

What is Your Organization Doing to Address the Opioid Crisis?

Last week, KHC announced that we have been selected to be part of a 40-member opioid action team that will identify strategies and tactics for opioid addiction prevention and collaborate to accelerate and amplify current efforts going on across the country. It’s no secret that this is a priority in our state and in Southern Indiana, so we are excited to team up with some of the best minds in the country to produce a playbook that addresses the crisis from many angles, including:

  • Leadership and Culture
  • Patient and Family Engagement and Education
  • Clinical Knowledge and Expertise
  • Organizational Policies and Clinical Practice
  • Tracking, Monitoring, and Reporting
  • Accountability
  • Community Collaboration

Over the next several months, the National Quality Forum Opioid Stewardship Action Team will meet in person and virtually to identify best practices for implementing opioid stewardship and tools and resources related to overcoming barriers.

As we begin this work, I want to ask our community partners and friends – what is your organization (or organizations that you work with) doing to address the opioid crisis in our community? The more information we gather about what is going on in our community, the more productive we can be in our work with NQF.

If your organization has launched, plans to launch, or is even thinking about launching a program or strategy related to this, I want to hear from you. Please send me an email at sclouser@khcollaborative.org.

KHC Joins Forces with Other Healthcare Stakeholders in Measurement Alignment Initiative

KHC representatives join Secretary Vickie Glisson for announcement of PMAC.

At last week’s Kentucky Medical Group Management Association fall conference, the Kentucky Department for Medicaid Services (KDMS) unveiled Medicaid’s newly created set of quality measures with 23 measures that meet the quality reporting standards for MIPS. Secretary of the Kentucky Cabinet for Health and Family Services Vickie Yates Brown Glisson kicked off the presentation and also announced that a private-public partnership to align healthcare quality improvement measures in the Commonwealth had been created as a part of this work (if you missed the announcement, see a replay here).

Kentuckiana Health Collaborative’s Teresa Couts, Randa Deaton, and Stephanie Clouser were onstage with Glisson as she announced this effort. What Glisson introduced – although not by name – is called the Kentucky Performance Measures Alignment Committee (PMAC), a public-private partnership between KDMS and the KHC. Members of PMAC, made up of individuals from all healthcare stakeholder types, will help form recommendations for measure prioritization in one of five key areas of focus:

Pediatrics

Acute Care

Chronic Care

Preventive Health

Behavioral Health

The goals of the core healthcare measurement set are to establish broadly agreed upon priority quality measures that improve the quality and value of care, reduce provider reporting complexity, and align Kentucky’s healthcare organizations. The final measures chosen will be included on a core healthcare measure set. Ultimately, the expectation is for the measure set to be adopted by public and private organizations to better focus improvement efforts toward shared areas.

Measurement alignment work and the reduction of reporting complexity is important. A 2013 National Quality Forum (NQF)-commissioned analysis from Bailit and Associates identified 1,367 quality measures in use across 48 different state and regional programs. Of these measures, 509 were distinct and the remaining 800+ measures overlapped or had similar focus, with one or more variations in the specifications. A common saying is that more information is better information, but that is not necessarily the case in healthcare quality measurement. Too many measures can create noise that hides what the key measures are telling us, measures that are “topped out” don’t provide meaningful information about variation between sources of care, and the cost in time and money for measures that aren’t very helpful are not worth that cost.

A core measure set can be used by providers to align their selection of MIPS measures, by health plans to measure and incent the healthcare quality of providers, and by purchasers to contract with plans and providers. All sectors can use a core measure set to improve adherence to evidence-based medicine and health outcomes.

Kentucky PMAC will oversee the measurement alignment work and determine the final core measurement set. Each of the five subcommittees will identify a recommended set of core measures for their area of focus. Each subcommittee will make their recommendations to the PMAC group for inclusion in the core measure set. Both PMAC and its subcommittees are made up of experts from all stakeholder types.

It is estimated that this work will take about 12 months. Currently, subcommittee members are being finalized and between November 2017 to March 2018, each subcommittee is expected to meet four to five times. They will then give their recommendations to the large committee, which will make final decisions and have a public comment period. The measure set is expected to be finalized in July 2018.

Anyone interested in the project can keep up with updates on the KHC website.

Movie Screening Illustrates Need for Mental Health Resources

KHC representatives at GE Appliances, a Haier company, holding Morgan Meltton’s students’  art, expressing feelings about mental health.

I was recently touched by a story about a high school football player who struggled with mental illness and lost his way in life. KHC was honored to attend and be a part of a screening of the award-winning true story narrative feature Holden On. As the mom of a senior in high school, I could see this boy as my son’s friend, my nephew, my neighbor, or worst yet, even my own son. Tears flowed, and although I laughed about the tissues given to us, they were necessary to get through the screening. I couldn’t wait to share this story with everyone I knew. I want to fix this issue. I want to help heal the world. I can’t stop thinking about this story and what can be done do to help kids that are “holden on.” My son and I have talked every day about this issue. He’s starting to avoid me now when he hears, “Hey Hunter, I was thinking about Holden On and…” I would encourage everyone make time to watch this movie. It tells a powerful story that has created an incredible movement for teens.

An example of art done through the IAMHOLDENON High School Art Initiative.

Holden On shares the true story of 17-year old Holden Layfield, who fought to keep his mental illness a secret. We follow his traumatic story, which ultimately led to him to take his own life. The story has created a lot of talk and now a following, IAMHOLDENON, which is a movie and art initiative for teens to help discuss mental health through art. The screening included an art show, which was an incredible display of art created by high school students across the country who used the medium to express their feelings about mental illness.

The KHC Fourth Annual Conference in March 2018 will focus on integrating mental and physical health. If Holden’s story has interested you, I would encourage you to look into attending the conference.

 

KHC Selected for National Opioid Stewardship Action Team

It’s no secret that opioid addiction is a problem in Kentucky and Southern Indiana. Kentucky is third in drug overdose deaths and writes the fourth most prescriptions for opioids in the nation. Nearly half of all Kentuckians who enter treatment for substance abuse do so for opioid misuse – the eighth highest proportion in the U.S. Earlier this year, Louisville made national headlines when a shocking 151 overdoses occurred in just four days.

Addressing addiction is such a priority for the KHC that our annual conference in March will focus on connecting behavioral and physical health, including addiction treatment strategies. We have recently added Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) to our yearly reports to reflect that focus. As a multi-stakeholder coalition, our members’ time and time again have identified mental health and opioid abuse as priorities for their organizations. Public health professionals, employers, providers, plans, and citizens are all reeling from this opioid epidemic and are anxious to work together to find solutions.

As another effort to address Kentucky’s – and the nation’s – opioid use crisis, I am pleased to share that the KHC has been selected to be part of a 40-member opioid action team that will identify strategies and tactics for opioid addiction prevention and collaborate to accelerate and amplify current efforts going on across the country.

National Quality Partners (NQP) Opioid Stewardship Action Team, a program by the National Quality Forum, will ultimately publish a playbook that focuses on improving prescribing practices and identifying strategies and tactics for managing care of individuals who are at high risk of becoming dependent on opioids, while building on current public- and private-sector efforts to address the opioid epidemic. The playbook will be released in March 2018. NQP will model the Playbook after other successful efforts to tackle national healthcare priorities, including National Quality Partner’s Playbook: Antibiotic Stewardship in Acute Care, which has become an essential resource to help physicians, pharmacists, and healthcare organizations implement strategies to promote the appropriate and safe use of antibiotics. That playbook has been downloaded more than 30,000 times.

I will represent KHC on this Action Team, and I will join individuals from organizations across the country, many of which have launched innovative programs to address the opioid crisis. The Action Team is chaired by Christina Mikosz, MD, MPH, Medical Officer at Centers for Disease Control and Prevention, and Paul Conlon, PharmD, JD, Senior Vice President, Chief Quality and Patient Safety, Trinity Health.

For more information on the NQP Opioid Stewardship Action Team, click here. The following organizations have representatives on the Action Team:

Aetna

Agency for Healthcare Research and Quality

American Academy of Orthopaedic Surgeons

American Academy of Physical Medicine and Rehabilitation

American Nurses Association

American Physical Therapy Association

American Society of Health-System Pharmacists

Appriss Health

BlueCross BlueShield Association

Centers for Disease Control and Prevention

Centers for Medicare & Medicaid Services

Council of Medical Specialty Societies

Dental Quality Alliance

Elevating Home

GeisingerHealth System

Harborview Medical Center

Health Resources and Services Administration

HealthPartners

Henry Ford Hospital

Heron Therapeutics

Hospice and Palliative Nurses Association

Hospital Corporation of America

IBM Watson Health

Institute for Behavioral Healthcare Improvement

Institute for Healthcare Improvement

Kaiser Permanente

Kentuckiana Health Collaborative

Magellan Health, Inc.

Mayo Clinic

Memorial Sloan-Kettering Cancer Center

Partners Behavioral Health Management

Patient & Family Centered Care Partners, Inc.

Pharmacy Quality Alliance

Premier Healthcare Alliance

Press Ganey Associates

Substance Abuse and Mental Health Services Administration

Trinity Health

U.S. Pharmacopeial Convention

Veterans Health Administration

Vizient, Inc.

Mental Health Integration: the Focus of 2018 Annual KHC Conference

In planning our 2018 annual conference, the KHC Executive Committee quickly identified mental and physical health integration as the focus, a clear indication that mental health has become the priority for many our key healthcare stakeholders.

We know that our community is facing alarming rates of mental health issues, including substance use disorders. Kentucky has three times as many deaths to suicide as homicide, and overdose deaths are rising at unprecedented rates. Nearly a third of Kentucky high school students report they feel sad or hopeless, according to the U.S. Department of Health and Human Services. Kentucky leads the nation in many of the risk factors linked to poor mental health such as poor physical health, sedentary lifestyle, poor diet, smoking, and poverty. Stress, trauma, and negative coping skills are also significant risk factors for developing depression, anxiety, and substance use disorders.

Despite these statistics, persons with mental illness are under-identified and under-treated. Primary care providers are the backbone of the healthcare delivery system and are seeing a greater volume of patients with mental health issues than even mental health providers. They “prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States,” according to researchers. Patients dying by suicide see primary care more than twice as often as mental health providers and 45 percent saw a primary care clinician in the month before their death (see research).

The World Health Organization has called integrating mental health services into primary care as the most viable way of closing the treatment gap for untreated mental illnesses. Integrated models of care are seeing success in communities across the country, including the Collaborative Care Model developed jointly by the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM). The Collaborative Care Model and other integrated care models work to better meet the whole health needs of people with mental health conditions.

The barriers individuals face in getting mental health services are many and go well beyond the healthcare delivery system. One of the biggest barriers to individuals seeking treatment is the stigma associated with mental illness. The KHC conference will feature keynote speaker Mike Veny, who will discuss his personal journey and how mental health stigma can be transformed (see keynote highlights here).

The KHC annual conference will be held on March 14, 2018. Registration will open in October. The conference will feature evidenced-based approaches, best practices, and successful models of addressing mental health and integrating care. Topics for the day include:

  • Mental Health Stigma
  • StAMINA – Student Alliance for Mental Health Innovation and Action
  • Collaborative Care Model
  • Integrated Care Models
  • Addiction Treatment Models
  • Mental Health Co-Morbidities, Hepatitis C
  • Mental Health Innovation and Technology
  • Successful Employer Models of Improving Mental Health

Having a mentally healthy community means that each of us are better able to function during stressful situations, form good interpersonal relationships, set and achieve realistic goals, seek help during difficult times, and enjoy life to the fullest.  To improve the mental health of our community, key healthcare stakeholders will need to collaborate to make systemic cultural and organizational changes. The KHC is currently investigating how to best support efforts to increase effective mental health prevention and treatment services for Kentuckiana youth and adults and will be announcing its plans at the 2018 KHC conference.

The Rise and Evolution of Onsite and Near-site Clinics

A few decades ago, I remember sitting in a meeting with our company doctor planning new hire orientation, feeling miserable, and wishing I could just have him see if my cold needed to run its course or required a prescription. Instead, I took a half day off of work for a doctor appointment, but I longed for easy and hassle free access to a healthcare provider at or near work. Today, more and more companies are adopting onsite or near-site clinics, also known as worksite health centers, as a way to meet the healthcare needs of their employees.

Onsite clinics were at one time only for the largest of corporations, but companies with as few as 500 employees are now adopting a worksite health center model. According to Springbuk, the current market penetration of worksite health centers is 16 percent and is expected to surpass 30 percent by 2020. This means that up to 10 percent of the adult population under the age of 65 will receive their healthcare through a worksite health center.

There are three primary reasons employers are adopting worksite health centers: 1) improved access to care that enhances productivity and job satisfaction, 2) improved population health management, and 3) better management of healthcare costs. The role of worksite health centers is evolving from the occupational medicine clinic – like the one my company doctor ran – to primary care clinics. We are now seeing an evolution that focuses more on employee well-being by integrating population health, wellness, and evidenced-based medicine into a more holistic approach to employee health.

With the increasing adoption of onsite and near-site clinics, employers considering an investment in a worksite health center now have access to case studies and information about how well these clinics have supported companies’ long-term healthcare goals. On September 12, 2017, the Kentuckiana Health Collaborative and the National Alliance of Worksite Health Centers will host a half-day event to discuss the latest information on worksite health centers. Confirmed speakers for the event include:

  • Diana Han, MD- Global Medical Director, GE Appliances, a Haier company featuring their onsite clinic vendor, Premise Health
  • Larry Boress- Executive Director, National Association of Worksite Health Centers
  • Gregg Potts, MD- Senior Medical Director, Papa John’s International
  • Dexter Shurney, MD- Chief Medical Director/Executive Director Global Health/Wellness, Cummins Inc.

If you are considering a worksite health center or would like to learn more, be sure to join us for The Rise of Worksite Health Centers to Address the Unmet Health Needs of Employees. This event requires registration and is free to current KHC and NAWHC members. This forum will be held at the Jewish Hospital Rudd Heart & Lung Conference Center in Louisville, KY.

 

KHC Member Spotlight: Vicki Welch

 

Vicki Welch
Louisville Metro Council

Vicki Welch is a Metro Councilwoman for Louisville’s District 13, where she serves her constituents and works with legislations involving Louisville Metro ordinances. Councilwoman Welch has been a member of the KHC for more than four years.

 


What are you currently working on that you are most excited about? How do you think it will drive improvements to health and healthcare in the community?

“After months of discussions to incorporate electronic smoking devices and hookah into our current smoking ban, I proudly report that after 3 months of deliberation, the Metro Council voted 15 to 6 in favor. It is my hope that this legislation will bring awareness of hazardous toxins in electronic smoking devices and hookah.”

What do you see as the biggest threat to our community’s health? How do you feel it needs to be addressed?

“I believe heroin usage is the most pressing threat to our community. We need more recovery beds and studies of pharmaceuticals that curb addiction to allow addicts to be rehabilitated. This threat is causing overflow of jails, increased usage of LMPD resources, and increased usage of hospitals and emergency services.”

Why do you and your organization belong to the KHC? What do you find most valuable as a member?

“As a registered nurse 34 years previous to my election to Metro Council, I am interested in how our local organizations are partnering for the greater good of the health of our community. KHC is a great resource for this collaboration to bring awareness and possible solutions to health issues.”

What is your dream vacation spot?

“My dream vacation/retirement location is my little condo in St. Petersburg, Florida where we have 20 Louisville owners and everyday is paradise!”

Improving Colorectal Cancer Screening Rates Saves Lives

About 44 percent of people in Kentuckiana were not properly screened for colorectal cancer in 2015.

Colorectal cancer (CRC) screening isn’t always a relished birthday activity, but it should be if you are turning 50 and even sooner if you are at increased risk for colorectal cancer. This is why screening at the right time is so important. In Kentuckiana, 44 percent of people 50 and older are not getting the recommended screening.

The lack of screening increases CRC incidents and deaths. According to the Colon Cancer Prevention Project, colorectal cancer is 90 percent curable if caught early. Despite the effectiveness of screening, Kentucky leads the nation in CRC prevalence and is fourth in the nation for CRC deaths, according to the Centers for Disease Control (CDC). If more Kentuckians were screened according to recommended guidelines, many of these cases could be avoided.

Kentucky leads the nation in CRC prevalence and is fourth in the nation for CRC deaths, according to the Centers for Disease Control (CDC) data.

As a partner on the Kentucky Department for Public Health’s Organized Approaches to Increase Colorectal Cancer Screening (CRC) grant, the Kentuckiana Health Collaborative distributes annual individual provider and group practice reports throughout the Commonwealth of Kentucky on colorectal cancer screening rates. We are also working with our network of local employers to provide resources for improving CRC screening rates. A new KHC Colorectal Cancer Screening Resource for Employers webpage has been created to provide businesses with tools to improve their CRC screening rates.

Providers and employers are powerful forces for driving improved colorectal screening rates in Kentucky and Kentuckiana!