GR-8d21 overview.pres.051711tc
Diabetes Group Visit Project
Overview Presentation
1
Outline
• Diabetes as a Primary Health Concern
• Diabetes Group Visits
• GFHC Diabetes Group Visit Project
• Accomplishments to Date
• Future Activities and Physician
Resources
2
DIABETES GROUP VISIT PROJECT
Diabetes as a Primary Health Concern
Diabetes Prevalence
• 10.7% in Genesee County
• Only 8.3% nationally and 9.0% statewide
12.0%
10.7%
9.0%
10.0%
8.3%
8.0%
6.0%
4.0%
2.0%
0.0%
Genesee
County
Michigan
United States
NOTE: Diabetes prevalence rates include estimates of both diagnosed and undiagnosed
individuals with diabetes. In 2007 the U.S. DHHS estimated that there are 18,900
Genesee County adults with undiagnosed diabetes.
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DIABETES GROUP VISIT PROJECT
Diabetes as a Primary Health Concern
60000
Total Diabetic Patients and Poorly Controlled
Diabetic Patients in Genesee County
50000
40000
35% of All
Diabetes
Patients
are Poorly
Controlled
30000
GHP
Medicaid
Medicare
Commercially Insured
20000
10000
0
Diabetic Patients in
Genesee County
Poorly Controlled Diabetic
Patients (estimated)
NOTE: HEDIS (Healthcare Effectiveness Data and Information Set) defines “poor disease
control” for diabetes as an HbA1c level above 9%; Poor control rates for diabetic patients
are 29.6% for Commercially insured, 27.3% for Medicare, and 48.7% for Medicaid
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DIABETES GROUP VISIT PROJECT
Overview of GFHC
Diabetes Group Visit Project
• Began in 2008
• Vision:
To reduce the morbidity related to diabetes and diabetes related
illnesses by improving the quality of life of individuals with diabetes.
Special emphasis will be placed on patient/support system interaction,
adherence to drug therapies, patient education, and improved selfmanagement and understanding of the disease and its long-term
complications.
• Diabetes Group Visit Project is guided by Workgroup
Collaboration
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DIABETES GROUP VISIT PROJECT
Overview of GFHC
Diabetes Group Visit Project
Goals & Activities
•
•
•
To support the continuation/expansion of Diabetes Group Visits within
McLaren Regional Medical Center‟s Family Medicine Residency Program
Develop strategies for the expansion of the Diabetes Group Visit
concept to Genesee County physicians
Support patient education, self-management of disease, improved health
outcomes, lower costs of care, improved patient access, and improved
physician productivity
Impact on GFHC Focus Areas
• Addresses areas of quality, cost, health improvement, and access
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DIABETES GROUP VISIT PROJECT
Overview of GFHC
Diabetes Group Visit Project
Workgroup Membership
•
•
•
•
•
•
•
•
•
Blue Cross Blue Shield of Michigan
Genesee County Medical Society
Genesee Health Plan
Genesys Health System / Genesys PHO
Hamilton Community Health Network
HealthPlus of Michigan
Hurley Medical Center
McLaren Regional Medical Center
United Auto Workers
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DIABETES GROUP VISIT PROJECT
DIABETES GROUP VISITS
&
HOW THEY CAN
IMPROVE YOUR PRACTICE
Paul Dake, M.D.
Chair, GFHC Diabetes Group
Visit Project Workgroup
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
What are Diabetes Group Visits?
• Physician led innovative Clinical Model of Care to improve
treatment, care, and outcomes of diabetic patients
• Utilize patient interaction in the group setting to improve
disease management rather than traditional one-on-one
patient / physician interaction
• Also known as “Shared Medical Appointments”
• Physician acts to answer questions and facilitate
“best practice” sharing by patients
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
What are Diabetes Group Visits?
• Two-hour medical appointment with a physician and rotating
diabetes experts in a group setting
• Composed of 7 – 10 Diabetic Patients
• Diabetes Topics identified by the patients are discussed:
•
•
•
•
•
Nutrition & Diet
Exercise
Hypertension
Foot Care
Lipids
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
Why Diabetes Group Visits are an Effective Diabetes Treatment
• Significant amount of patient to patient and patient to physician
interaction
• Two hour session (versus traditional 15 minute session)
• Patients share “best practices” for diabetes self-management
and become “champions” for one another
• Physicians manage most difficult patients in a single setting via
in-depth discussion and interaction
• Most appropriate for patients who are non-responsive to
traditional one-on-one care
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DIABETES GROUP VISIT PROJECT
Physician Advantages
of Diabetes Group Visits
Documented Improvements through Diabetes Group Visits
(compared to traditional one-on-one care)
• Increased Productivity / Decreased Burden
• Address diabetes care for most difficult patients in a single setting
• Productivity improvement allows for increased reimbursement due to
seeing multiple patients simultaneously
• Improved satisfaction
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DIABETES GROUP VISIT PROJECT
Patient Advantages
of Diabetes Group Visits
Documented Patient Outcomes of Diabetes Group Visits
(compared to traditional one-on-one care)
• Improvements in HbA1c, retinopathy, blood pressure
• Increased monitoring of microalbumin, lipids, foot care
• Improved self-management of disease and satisfaction
• Group visits maximize patient interaction while allowing patients to
visit with physician for 2 hours
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
Documented Outcomes of Diabetes Group Visits
(compared to traditional one-on-one care)
• Healthcare Delivery System
• Reduced hospital admissions / ED utilization rates
• Reduced outpatient hospital and professional services
• Lower overall costs of diabetes
•
Per patient per month total medical cost reductions of $14.79-$41.80
Total Poorly
Controlled
Diabetic Patients
in Genesee
County
If demonstrated
savings were
applicable to 25%
of Poorly
Controlled Patients
Per patient
per month
medical cost
reductions
Annual
Reduction in
Healthcare
Costs
~17,000
4,250
$14.79
$754,290
$41.80
$2,131,800
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
Referring the Right Patient
• Diabetes Group Visits are Most Appropriate for:
• Patients needing routine follow-up care
• Patients who, in spite of your best efforts and
encouragement, have been unable to sustain the lifestyle
changes necessary to control their diabetes
• Stable, chronically ill patients requiring total mind/body care
• Patients who typically require more time with their physician
• Patients who come for frequent return visits
• Patients with extensive emotional, informational, or
psychosocial needs
• The unengaged patient
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DIABETES GROUP VISIT PROJECT
Overview of Diabetes Group Visits
Typical Group Visit
• Scheduling of Patients / Chart Preparation
• Patient Arrival, HIPAA forms signed, Introductions
• Review of topics patients wish to cover at the visit
(agenda setting)
• Group discussion, facilitated by the physician
• Physical Examination
• Documentation of proceedings of the group visit
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DIABETES GROUP VISIT PROJECT
Billing for Diabetes Group Visits
Documentation
• Diabetes Group Visit Questionnaire
• Diabetes Group Visit Template
Billing
• Separate Charge for Each Patient
• Bill using E & M Codes
• 99213 – if all targets are attained and no treatment
changes are made
• 99214 – if any targets not reached and/or any
treatment changes are made or tests ordered
• This is the majority of group visit patients
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DIABETES GROUP VISIT PROJECT
Billing for Diabetes Group Visits
Support of this Billing Practice
•
•
•
•
•
•
Centers for Medicare & Medicaid Services
American Academy of Family Physicians
Blue Cross Blue Shield of Michigan
HealthPlus of Michigan
Genesee Health Plan
Additional Support through peer-reviewed journal articles
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DIABETES GROUP VISIT PROJECT
Comparative Economics
• Traditional 1-on-1 patient visits
– 8 „99213 visits ($73 each) in 2 hours = $584
– 9 „99213‟ visits ($73 each) in 2 hours = $657
• Group visits, 2-hour Visit
– 8 „99214‟ visits ($113 each) = $904
– 7 „99214‟ visits ($113 each) and = $864
1 „99213‟ visit ($73 each)
DIABETES GROUP VISIT PROJECT
Available Resources
Diabetes Group Visit Project Replication Manual
•
Developed as a comprehensive tool for physicians and practices to
support interested physicians in performing diabetes group visits
•
113-page manual clearly outlines necessary steps to implement
diabetes group visits
•
Provides information describing:
•
•
•
•
•
•
Meeting Structure
Tools for Startup
Documentation Tools
Confidentiality and HIPAA Compliance
Billing and Reimbursement
Literature Review detailing Improved Patient and Physician
Outcomes
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DIABETES GROUP VISIT PROJECT
Available Resources
Financial Assistance for Services to Support Group Visits
•
The GFHC can provide financial assistance for diabetes experts
(behaviorists, dieticians, diabetes educators) to present to your patient
group
•
Financial assistance for renting space is also available if your office
does not have enough space to hold a group visit
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DIABETES GROUP VISIT PROJECT
Available Resources
Diabetes Registry
•
The Diabetes Registry tracks the progress of diabetic patients
•
Recorded information includes:
•
•
•
•
•
•
Patient demographics
Body mass index, HbA1c, LDL, blood pressure, tobacco use
GFR, microalbuminaria
Foot exams and retinal exams
Diabetic medication classes and date started
It is expected that the registry will expand to become County-wide
•
•
•
To date, over 75 physicians use the registry
Expected that this will support “best practices” discussions among
Physicians regarding diabetes care and treatment approaches
Support many PCMH guidelines regarding registry and tracking of
patient outcomes
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DIABETES GROUP VISIT PROJECT
Activities & Accomplishments
Physician “Champion” Education Events
•
•
Designed to promote interest and implementation of diabetes group visits
Over 30 physicians, clinicians, and practice managers have attended the events
(In addition to this evening‟s attendees)
Local, Regional, and National Interest
•
Conference and Meeting Presentations
•
•
•
•
Conference on Practice Improvement: Constructing the Medical Home
Patient Centered Medical Home – A New Approach to Care
Diabetes Partners in Action Coalition Meeting
Regional and National Resource Sharing
•
Shared resources with organizations regarding diabetes group visits:
• St. Joseph Mercy Health System, Ypsilanti, Michigan
• Memorial Hospital in McPherson, Kansas
• Diabetes Outreach Network, Newberry, Michigan
• Multiple requests for Diabetes Group Visit Project Replication
Manual, which is available online through GFHC website
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DIABETES GROUP VISIT PROJECT
Activities & Accomplishments
Physician Interest and Engagement
•
Broad Interest and Engagement
•
Broad physician engagement has occurred through physician events and
presentations
•
•
•
•
Physician Champion Events
HealthPlus of Michigan Medical Directors Meeting
Genesee County Medical Society Practice Managers Meeting
Hamilton Community Health Network Professional Staff Meeting
•
With GFHC support, physicians are now implementing diabetes group
visits at Hamilton Community Health Network, McLaren Internal Medicine
Residency Program, and Local Physician Practices
•
Additional physicians are in the planning process
•
Hurley Medical Center‟s Internal Medicine Residency Program
is considering support of the diabetes group visit model
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DIABETES GROUP VISIT PROJECT
Activities & Accomplishments
Expanding Physician Implementation of Diabetes Group Visits
Number of
Physicians
Type of
Practice
Currently
Implementing
Planning to
Implement
Strong Interest,
Considering
Implementation
Moderate
Interest
5
3
9
15
Hospital
Residency
Program
FQHC
(Hamilton
Community
Health
Network)
Small
Physician
Practices
Small and
Group
Physician
Practices,
Hospital
Residency
Programs
Various
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DIABETES GROUP VISIT PROJECT
Future Activities
Expansion of Diabetes Group Visits
•
Expanded implementation within local physician community
•
Engagement of hospital residency programs
Expansion of Data Collection & Analysis
•
Expanding the Diabetes Registry and Data Collection Efforts
•
Increased Analysis and Documentation of Impact on Patients and
Providers
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DIABETES GROUP VISIT PROJECT
Tools and Resources Available
to Genesee County Physicians
• Diabetes Group Visit Project Replication Manual
• Support of the Diabetes Group Visit Project Workgroup and
the Greater Flint Health Coalition
• Resources to support reimbursement for behaviorists,
dieticians, and space/room rental to physician
practices implementing diabetes group visits
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