1. PEBB Board Presentation Kaiser 2006 Quality Initiatives

2. 2 3/21/06 Northwest Region Quality Vision  Our vision is to provide the highest quality care in the world  We will measure success by achieving 90 th percentile on HEDIS effectiveness of care (EOC) quality measures

3. 3 3/21/06 Quality Populations/Measures for 2006 (2005 HEDIS Rank)  Adult Women  Breast Cancer Screening (50th)  Cervical Cancer Screening (10th)  Diabetic Members  Lipid screening (25th)  Lipid control < 130 (90th)  Lipid control < 100 (75th)  HgbA1c screening (50th)  Poor Hgba1c control (75th)

4. 4 3/21/06 Quality Population/Measures for 2006 (continued)  Patients with CV conditions (new measure— no rankings)  Lipid screening  Lipid control <130  Lipid control <100

5. 5 3/21/06 JCAHO AMI Measures  ACE Inhibitor for LVSD(89%)*  Smoking cessation advice/counseling(74)*  Aspirin at arrival(100)*  Aspirin at discharge(98)*  Beta blocker at arrival(99)*  Beta blocker at discharge(99)*  (Thrombolytics) * KSMC 2004 results

6. 6 3/21/06 Quality Populations/Measures for 2006 (continued)  Children/ Adolescents  Immunizations children (90th)  Immunizations adolescent (75th)  Appropriate asthma meds  Age 5-9 (50th)  Age 10-17 (10th)

7. 7 3/21/06 Quality Populations/Measures for 2006 (continued)  Patients with depression  Practitioner contact (25th)  Acute phase treatment (90th)  Chronic phase treatment (75th)

8. 8 3/21/06 ICP Service Quality Targets Measure 2006 Threshold 2006 Target 2006 Stretch Recommend KP to friend46.5%47%48% Saw own PCP71%73%75% Time to Appt – Primary Care71%72%74% Time to Appt – Specialty Care65.7%66.7%68.7% MD Listened – Primary Care82%83%84.5% MD Listened – Specialty Care84%85%86.5% MD in work unit support me in providing quality service 76%78%80%

9. 9 3/21/06 Quality Improvement Opportunities PEBB  Beta blocker post-MI  Diabetes nephropathy screening

10. 10 3/21/06 Beta Blockers Post-MI  For 2006 one of our quality goals regionally is improvement in all the JCAHO AMI measures, including beta blocker use post-MI  At KSMC this is a primary quality initiative for 2006  All plan hospitals—St. Vincent’s, SWWMC, St. Johns, Salem are participating in IHI 100,000 lives campaign with AMI bundle as a core strategy  Six month adherence to beta blocker use is a new HEDIS measure, we are currently considering strategies to ensure compliance

11. 11 3/21/06 Diabetic Nephropathy Monitoring  Those patients at risk for diabetic nephropathy can be identified with newer urinalysis tests— microalbuminuria testing  HEDIS adopted microalbuminuria testing as a standard annual test for all diabetics  Kaiser had microalbuminuria as a standard test on our “panel diabetes” lab ordering process

12. 12 3/21/06 Diabetes Nephropathy Monitoring (continued)  Context: Diabetics develop macrovascular (large vessel) and microvascular (small vessel) atherosclerosis  Macrovascular disease causes heart attacks and strokes and is the leading cause of death in diabetes  Microvascular disease causes diabetic retinopathy leading to blindness; and diabetic nephropathy leading to end stage renal disease (ESRD) resulting in dialysis or kidney transplant

13. 13 3/21/06 Historical Perspective  Research on microvascular disease, specifically diabetic nephropathy, has shown that early detection of those diabetics at risk of renal disease and specific treatments can slow the progression and prevent ESRD/dialysis  The main treatments are: Improved blood pressure control—goal bp < 130/80, and use of specific medications—ACE-I and/or ARB

14. 14 3/21/06 Macrovascular Disease Research  Research on macrovascular disease has demonstrated that all diabetics given ACE-I (or ARB’s) had lower rates of macrovascular disease (heart attacks/strokes)  Based on this information Kaiser Northwest and nationally felt microalbuminuria screening was unnecessary and removed it from the “panel diabetes” order  As a result our HEDIS nephropathy scores have fallen

15. 15 3/21/06 Current Consensus  HEDIS has proposed changing the nephropathy screening measure for 2007 such that any patient on ACE-I or ARB will count as having had nephropathy monitoring  Kaiser Northwest region has decided to add microalbumin testing back to our “panel diabetes” order  By the end of 2007 our nephropathy screening rate will be significantly higher

16. 16 3/21/06 Tools to Achieve Improved Diabetes Quality Goals  Health maintenance alerts for any diabetic who has not had diabetic labs in past 9 months  Health maintenance alerts when last recorded blood pressure is not at goal  Promotion of ALL= Aspirin, Lovastatin, Lisinopril use in all members  Monthly rosters for health care teams listing diabetics with LDL > 100, or no LDL in past 9 months, hgba1c > 9 or no hgba1c in past 9 months, no microalbuminuria testing in past 9 months, bp not at goal