Collaborators
Collaborators
National
National Study
Study of
of Physician
Physician Organizations
Organizations
and
and the
the Care
Care of
of Chronic
Chronic Illness
Illness (NSPO)
(NSPO) II
II
AcademyHealth
2007 Annual Research Meeting
Diane R. Rittenhouse, MD, MPH
Stephen Shortell, PhD (Principal Investigator)
Lawrence Casalino, MD, PhD
James Robinson, PhD
Robin Gillies, PhD
Sara FernandesFernandes-Taylor, Doctoral Student
Rodney McCurdy, Doctoral Student
University of California, San Francisco
National
National Study
Study of
of Physician
Physician Organizations
Organizations
and
the
Care
of
Chronic
and the Care of Chronic Illness
Illness (NSPO)
(NSPO) II
II
Funded by:
Robert Wood Johnson Foundation
The Commonwealth Fund
California HealthCare Foundation
Care
Care Management
Management for
for Chronic
Chronic Illness
Illness
³ Quality Chasm
³ Particularly concerning for chronic illness care
³ Substantial disease burden and cost:
³Diabetes, Asthma, CHF, Depression
Care
Care Management
Management for
for Chronic
Chronic Illness
Illness
³ New models of care delivery are needed
³ Physician organizations (large medical groups
and IPAs)
IPAs) well positioned to improve care
Physician
Physician Organizations’
Organizations’ Role
Role in
in
Improving
Improving Chronic
Chronic Illness
Illness Care
Care
Internal
Capabilities
External
Incentives
Care Management
Processes
Improved
Outcomes
Physician
Physician Organizations
Organizations ––
Improving
Chronic
Improving Chronic Illness
Illness Care
Care
National
National Study
Study of
of Physician
Physician Organizations
Organizations
and
and the
the Care
Care of
of Chronic
Chronic Illness
Illness (NSPO)
(NSPO) II
II
³ Comprehensive list of all U.S. physician groups
(medical groups and IPAs)
IPAs) with 20 or more
physicians n=1063
³ 35 minute phone survey with Medical Director
or CEO
³ 1/1/06 - 3/31/07
³ 52% response rate; n=551 physician groups
Care
Care Management
Management
for
for Asthma
Asthma and
and Diabetes
Diabetes
Electronic registry
Guideline based reminders at point of care
Performance feedback to physicians
Send reminders to patients
Specially trained patient educators
Provide nurse case managers
Mean number of CMPs (out of 6)
Internal
Capabilities
External
Incentives
Care Management
Processes
Improved
Outcomes
Care
Care Management
Management
for
for CHF
CHF and
and Depression
Depression
Diabetes
Asthma
51.0 %
50.8 %
65.6 %
51.6 %
73.6 %
54.6 %
38.1 %
36.0 %
56.5 %
35.6 %
53.1 %
42.6 %
3.66
2.86
Care
Care Management
Management for
for 44 Diseases
Diseases
³ On average, physician organizations used
11.1 (out of 24) care management processes
for all 4 chronic diseases.
Electronic registry
Guideline based reminders at point of care
Performance feedback to physicians
Send reminders to patients
Specially trained patient educators
Provide nurse case managers
Mean number of CMPs (out of 6)
CHF
Depression
38.4 %
32.8 %
51.1 %
35.4 %
53.4 %
47.6 %
23.6 %
22.8 %
33.2 %
20.0 %
35.4 %
25.3 %
2.79
1.78
“Practice
“Practice Re-design”
Re-design”
³ Advanced Access scheduling: 59.7%
³ Group visits for chronic illness: 24.7%
³ Primary care teams: 30.3%
Physician
Physician Organizations’
Organizations’ Role
Role in
in
Improving
Chronic
Illness
Improving Chronic Illness Care
Care
³ Does good job of assessing patient needs
Internal
Capabilities
External
Incentives
Patient
Patient Centered
Centered Culture
Culture
³ Staff promptly resolve patient complaints
Care Management
Processes
Improved
Outcomes
³ Patient complaints are studied to identify
patterns
³ Patient data are used to improve care
³ Patient satisfaction data are used in developing
new services
Health
Health Plan
Plan Activities
Activities
Participation
Participation in
in Quality
Quality Initiatives
Initiatives
³ To what extent do physician organizations
³ Does your group participate in any quality
report that health plans are providing CMP
services to their physicians/patients?
improvement demonstration programs?
³ (Eg:
Eg: Bridges to Excellence, IHI, Pursuing
Perfection, Improving Chronic Illness Care)
³ Are health plan and P.O. efforts
³ Does your group use the rapid cycle quality
complements or substitutes?
improvement strategy (PDSA)?
External
External Incentives
Incentives for
for Quality
Quality
% yes
Evaluated -- on patient satisfaction
-- on quality
-- on IT use
Receive extra income -- for pt satisfaction
-- for quality
-- for IT use
Receive better contracts for quality/pt sat
Receive extra income for efficiency
80.6
82.8
53.4
46.5
55.4
32.8
28.7
33.9
Emerging
Emerging Story
Story
³
Internal Capabilities
³ Culture plays an important role
³ Health plan care management activities are
complementary to physician organization efforts
³ Participation in quality improvement programs
³
External incentives
³ Prevalent and associated with increased care
management