1. 1 NEW YORK CKD COALITION Enhancing CKD System Changes through Collaboration in New York State November 2008

2. 2 IPRO  Medicare Quality Improvement Organization for New York State (NYS).  End Stage Renal Disease Network for NYS (ESRD Network 2).  One of the 10 states awarded the CMS 9 th SoW Chronic Kidney Disease (CKD) Project – Theme 7.3.

3. 3 Background 9 th leading cause of death in the U.S. For each patient who does not progress to dialysis, Medicare saves $250,000. New York ranks 4th in the incidence of CKD Screening rates for patients with known risk factors for CKD are as low as 20%. Currently 42% in NYS. Nearly 26 million American have CKD, with 1.2 million in NYS estimated additional 20 million undiagnosed CKD beneficiaries are living with CKD and don’t know it.

4. 4 Background  Screening rates for patients with known risk factors for CKD are as low as 20%. NYS currently at 42%.  Hypertensive diabetics, treated with ACEs, the progression of CKD can be slowed.  The fistula rate for NYS is 55.3%. The Fistula First Breakthrough Initiative (FFBI) goals are to increase the rate to 55% (already achieved) by 3/31/09 and 66% by 6/30/09.

5. 5 Mission Statement Encourage the early identification and treatment of CKD and minimize and/or prevent the onset of ESRD in New York State.

6. 6 CMS CKD Quality Improvement Goals  Early detection and decrease the progression of CKD.  Improve statewide rate timely testing for diabetes – annual micro albumin testing.  Improve statewide rate of prescribing ACE/ARBs – slowing progression – hypertensive individuals with diabetes.  PQRI companion measure.  Key collaboration with NYS-CKD Task Force for system changes at state and local level.  Improvement of Fistula placement rate at onset of hemodialysis.

7. 7 Why Support IPRO’s CMS NYS Collaborative???

8. 8 New York State Impact  1.2 Million (est.) New Yorkers affected by CKD.  CDC reports a 116% increase in CKD in NYS over the past decade.  NYS 4th highest state at $2.9 billion.  13.1% of NYSCKD patients are 65 or older.  43% of hospitalized CKD patients are diabetics.  Diabetic CKD prevalence rate increasing from 6.2% to 7.6% (2000-2006) in NYS.  African-American and Hispanic-Americans have higher rates of CKD.  African Americans represent 17.4% of NYS population, yet were 40.3% of prevalent CKD cases in 2006.  7,300 New Yorkers will advance to ESRD annually.  Primary Causes of ESRD  Diabetes 40.5%  Hypertension 24%  23,000 New Yorkers suffer from ESRD with almost 5,000 deaths annually.

9. 9 Challenges

10. 10 Strategy

11. 11 Goal: System-level Change  Considered a change in: ●Practice ●Policy, or ●Procedure  Results in sustained improvement  Influenced by activities

12. 12 High Functioning Coalition Information Sharing Leveraged and contributed resources Focused, common mission with tangible, attainable goals.

13. 13 Goals for IPRO’s NYS-CKD Coalition  Assist in increasing adoption of evidence-based practice standards.  Promote community awareness through education.  Support and promote IPRO’s efforts to effect system level improvement.  Collaboration of Membership for NYS CKD ●Task force to drive public awareness of CKD ●Promote evidence based Chronic Care Model ●Collaboration with other interested entities in the care and treatment of renal disease ●Promote community screening, e.g. NKF KEEP Program ●Support efforts of the ESRD Network, e.g. Fistula First ●PCP education ●Participation in CKD workgroups to affect system level changes

14. 14 Mission of NYS CKD Coalition  To combine the efforts and resources of members and encourage prevention, early detection and appropriate ongoing treatment of CKD;  To communicate Kidney Disease Outcomes Quality Initiative (K/DOQI) standards of care to health care providers, annual micro-albumin test, prescribing ACEs or ARBs, referring patients to nephrologists, and encouraging AV fistula placement and maturation.  Communication and support of American Diabetes Association Standards of Medical Care in Diabetes –2008.

15. 15 Blueprint for Action  A shared vision.  A set of common principles, strategies, and actions for achieving goals.  A broad, collaborative and transparent process led by and involving diverse stakeholders.

16. 16 Blueprint for Action  Key focus areas  Outreach and education  Care delivery  System-level changes  Resources The Blueprint is not the end, but the beginning.

17. 17 NYS CKD Coalition – Action Steps  Promote and support early screening for CKD through existing programs, e.g. NKF KEEP.  Communicate and educate care community- ADA Standards of Medical Care in Diabetes –2008.  Promote and support chronic care model for CKD.  Promote and support continuum of care communication (University Model) where applicable.  Promote and support PCP model.  Promote and support pharmacy model of ACE/ARB improvement.  Promote and support EHR where appropriate.

18. 18 NYS CKD Action Steps  To encourage and facilitate dialogue to:  increase understanding and action of community health priorities (specifically CKD & ESRD)  facilitate removal of barriers to improving the health status of the community;  To disseminate provider and patient educational materials for achieving the CKD coalition objectives.  Support existing activities in the CKD community, e.g. NKF KEEP, North Shore University CKD Program.

19. 19 NYS CKD Action Steps  To share knowledge and best practices with other organizations to better serve their populations. Ultimately, the coalition’s combined disciplines, strengths and resources will educate, motivate, and improve outcomes for Medicare beneficiaries and other healthcare consumers.

20. 20 NYS CKD Coalition Membership  Broad-based membership with representation from providers, patients, regulators, educators, community health care organizations and the renal communities.  Leadership & Coordination  NYS CKD Task Force  IPRO-CKD Coalition  Meetings  Regular teleconferences monthly  Face-to-face twice per year  Regular workgroup interaction  No fees or membership dues  Voluntary, not mandatory  Shared incentives and commitment to a working consensus model

21. 21 Proposed IPRO-CKD Coalition Members  Albany College of Pharmacy & Health Sciences  Albany County DOH  Albany Dialysis Center  Albany Medical College  Albany Memorial Hospital- Laboratory Director  American Access Care  American College of Clinical Pharmacy – NY Chapter  American Diabetes Association-the Diabetes Resource Coalition  American Nephrology Nurses Association- NY Chapter  Blue Cross/Blue Shield of NY  Catholic Charities-Terrance Cardinal Cooke Center  Columbia University College of Physicians & Surgeons-Internal Medicine Residency Program  Columbia University Nephrology Division  Counsel of Renal Social Workers  ESRD Network 2  ESRD Network 2 Fistula First Steering Committee  Feed the Soul Nutrition  Greater Brooklyn Health Coalition & CAMBA  Glen Falls Hospital dialysis Unit  IPRO C. Bradley, MD  IPRO Consumer Health Collaborative  Dr. Kessel, Montifore Medical Center  Lani Jones, Albany EDU  National Association of Nephrology Technicians  National Kidney Foundation- Dr. Joseph Vassalotti

22. 22 Proposed IPRO-CKD Coalition Members (continued)  National Kidney Foundation Kidney Early Evolution Program  National Kidney Foundation NY Chapters  National Kidney Foundation of NE NY  National Kidney Foundation of Central NY  Nephrology Associates of Syracuse  NY Chapter of the American Society of Consultant Pharmacists  The New York State Council of Health-system Pharmacists  New York Diabetes Coalition  North Shore LIJ Health System - Janet & John Raggio Nephrology Institute  NYS CKD Task Force  NYS DOH Diabetes Prevention and control Program.  NYS clinical Laboratory Association  NYS Senate Health Committee  NYSDOH Clinical Chemistry & Hematology Laboratory Wadsworth Ctr.  NYSDOH Heart Health Program  Olean General Hospital  Quentin Medical Labs  Renal Support Network  Counsel of Renal Nutrition – Long Island Chapter  State University of NY-Eli Friedman, MD  University of Buffalo Jefferson Family Medicine. Chester Fox, MD  University of Buffalo, School of Pharmacy  Wegman’s School of Pharmacy  Chain of Pharmacy Association of NYS  Touro College of Pharmacy

23. 23 NYS CKD Coalition Structure

24. 24 Workgroup Functions Marketing & Communications Workgroup System level changes Workgroup Clinical Practice Workgroup Community Education Workgroup Develop/identify audience appropriate message Identify change opportunities for coalition and their implementation Promote adoption of K/DOQI clinical guidelines with PCP Practices Create a listing of beneficiary education materials Interact with other groups to define target audiences for out reach and distribution of coalition products and marketing packets Options for achieving change Promote positive clinical treatment patterns and best practice through peer- to-peer contact, education and training Evaluate materials using Clinical Champions Develop directory of New York State nephrologists Analyze options for change and there feasibility Promote ADA care guidelines Develop / adopt core messages for patients Coordinate speakers bureau and assist with other marketing activities Outline implementation steps for recommended changes Promotion of Continuum of Care-Chronic Care Model (University Model) Develop dissemination plan for community education PCP recruitmentDevelop statewide policy & regulatory improvement Promotion of Pharmacy Model Develop dissemination plan for provider education Develop data for CKD and its impact in NYS Support CKD research Distribute CMS-CQI results for NYS and national benchmarks Support CKD patients needs and activities Develop list of provider participants.

25. 25 Next Steps  Organizational meeting  ____________, 2008 – Teleconference  Facilitated by IPRO ●IPRO’s role ●Coalition structure ●Volunteer workgroup established ●Meeting dates ●Blueprint for Action ●Next meeting

26. 26 For more information, contact Corporate Headquarters: 1979 Marcus Avenue, Lake Success, NY 11042 ● www.ipro.org William F. Brezsnyak, MHSA Project Director (516) 209-5356 Wbrezsnyak@nyqio.sdps.org Jessica Squeglia, BA Performance Improvement Coordinator (516) 209-5234 jsqueglia@nyqio.sdps.org Chris Scalamandre, BS, RD Performance Improvement Coordinator (516) 209-5248 cscalamandre@nyqio.sdps.org Clare Bradley, MD Medical Director cbradley@nyqio.sdps.org Alan Silver, MD Clinical Director asilver@nyqio.sdps.org Ti-Kuang Lee, ScM Statistician tlee@nyqio.sdps.org Susan Ulmer, BA Administrative Assistant sulmer@nyqio.sdps.org Thomas Hartman, BA Vice President thartman@nyqio.sdps.org