1. NC AHEC’s Role in Healthcare Quality, Technology and Reform
Ann Lefebvre MSW, CPHQ

2. NC AHEC
The mission of the NC AHEC Program is to meet the state’s health and health workforce needs by providing educational programs in partnership with academic institutions, health care agencies, and other organizations committed to improving the health of the people of North Carolina.

3. NC AHEC Statewide Map Mountain Area L Greensboro Charlotte South East
Northwest
Southern Regional
Area L
Charlotte
Wake
Eastern
Source: NC AHEC Program

4. NC AHEC’s Core Services
1. Community-Based Student Training.
Each year over 10,000 student months of student training
2. Primary Care Residency Programs.
Over 1,500 physicians in NC graduated from an AHEC residency program.
3. Continuing Education.
Served nearly 200,000 health professionals in 2009
4. Library Services.
Last year over 7,000 individual health professionals used the AHEC Digital Library
5. Health Careers and Workforce Diversity.
Over 35,000 young people were served by health careers programs in 2009

5. North Carolina’s Improving Performance in Practice
Mission:
To provide primary care practices with the
systems and support to provide
high quality care to improve patient health.
Emphasize is that its support system for primary care and can include all initiatives and align with what practices want/need to do (meaningful use)

6. Lean Techniques Act Plan Study Do Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
Plan
Study Do
Name each model. With lean mention workflows.
Lean
Techniques

7. Examples of Practice Results
Need 3 things…. Data, full engagement and continual tests of change – With those.. We succeed almost every time!

8. Challenges of QI in Primary Care
Practices are overworked and don’t have time to do redundant systems to collect data to evaluate care.
EHRs are good for documentation and improving some efficiencies, but are not currently built to produce data on clinical systems.
The only way to know if we are providing the “right” care is to use data.
Obtaining the data becomes the focus of the QI process instead of improving office systems.

9. American Recovery and Reinvestment Act
$787 billion.
The Act includes
federal tax cuts
expansion of unemployment benefits &social welfare provisions
domestic spending in education, health care, and infrastructure, including the energy sector.
The Act also includes numerous non-economic recovery related items that were either part of longer-term plans or desired by Congress

10. Health Information Technology for Economic and Clinic Health (HITECH) Act
Funds will be distributed through Medicare and Medicaid incentive payments to eligible professionals “EPs”, who are “meaningful EHR users.”
The Recovery Act establishes financial incentives beginning in January 2011 for eligible professionals (EPs) who are meaningful EHR users.  Beginning in 2015, payment adjustments will be imposed on EPs who are not meaningful EHR users.

11. HITECH Act Continued Payments for Certified EHR use from 2011 – 2015
Medicaid Providers (up to $63,750 per provider)
Based on Medicaid Patient Volume
MD, DO, DDS, NP, CNM & PAs with exceptions OR
Medicare Providers (up to $44,000 per provider)
Based on % of allowable charges
MD, DO

12. Meaningful Use in a Nutshell
Successful Meaningful Use in Stage One:
Qualify for Incentive program under Medicare or Medicaid
Use of an ARRA Certified EHR system
Attesting to the successful completion and use of 15 Core Elements
Attesting to the successful completion and use of 5 of the 10 Additional Items

13. US Department of Health and Human Services (DHHS)
Centers for Medicare & Medicaid Services
Medicaid and Medicare incentive structure
Meaningful use definitions
Office of the National Coordinator for HIT
Health Information Exchange (1 per state)
Regional Extension Centers (per undefined region)
Work force training (Community Colleges) 10 state region
EHR certification

14. State and Regional Levels
NC Health Information Exchange (HIE)
Strategic plan submitted
Operational plan submitted 8/30/10
12.9 million dollars + Medicaid support
NC Regional Extension Centers (REC)
Preliminary application accepted 9/29/09
Full application submitted 11/03/09
Awarded 2/12/10
13.6 million dollars

15. NC REC Program Requirements and Goals
Entire state of NC (100 counties)
No charge for services for now
Priority Primary Care Providers
Small practices (less than 10 providers), or
Rural, or
Underserved or Medically underserved, or
FQHC, or RHC, or CAH
3465 providers (estimated practices)
The REC helps us to support the work of QI. –Primary care only

16. Specialized Practice-based services at AHEC
EHR Specialists QI
Consultants
Technical Assistance Specialist

17. Levels of Support NC Medical Society Foundation State HIE Board
Associate Director, Statewide QI
IPH
Carolinas Center for Medical Excellence
HIT Manager
QI Manager
Community Care of NC
Others
Others… NCHICA, NCCHCA, NC DPH, NCAFP, NCPS

18. Practices will transition through AHEC Services
Application received
Practices will transition
through AHEC Services
Do they have an EHR? No
EHR Implementation Specialist works with practice
Successful EHR Implementation
Yes
Meaningful use gap analysis and data pull
All services lead to
improving clinical outcomes
QIC works on IPIP and PCMH

19. On-site consulting with Paper Practices
Financial Assessments
Readiness Assessments
Computer skill Assessments
Hardware Assessments
Environmental Scan
Workflow Assessments
Establishing realistic goals for the EHR
RFP for Vendors
Vendor Demos
Vendor references
Vendor Selection
Vendor Contracting
Template building
Interface building
Vendor set up
Vendor training
Data loading
System testing – back up training
Go-live
Post live evaluation
Touch upon process of implementation

20. On site consulting with Electronic Practices
Meaningful use gap analysis
Guidance/assistance with template building to ensure that data is entered “meaningfully”
Evaluation of interfaces
Evaluating mapping/coding where needed
Training checklists/security and back ups
Trouble shoot post go live evaluation issues
Assistance with Query and Report building
Assistance with or evaluation of eRx
Assistance with HIE connection

21. On site consulting to Improve Quality with Technology
Improvement in outcomes, meaningful use and Patient Centered Medical Home Recognition
Maintenance of Board Certification Part IV
CME for practice-based QI work for providers
Model for Improvement
Care Model
Rapid Cycle Tests of Change
Template tweaking
Implementation of guideline based protocols for care delivery
Implementation of self management support techniques

22. Where does healthcare reform fit?
Patient Centered Medical Home
Improved Clinical Outcomes
Meaningful use of HIT
Electronic Health Records
Paper
Charts
Learn how to:
Meet the requirements of the NCQA Recognition program for PCMH
Approach the PCMH application process with improvement techniques
Learn how to:
Produce population –based reporting to test the efficacy of your care
Use proven methods and techniques to improve the outcomes of your patients
Learn how to:
Use your EHR to meet the federal requirements for the HITECH Act Meaningful Use Incentive Payments from Medicare or Medicaid
Learn how to:
Select a certified EHR that meets your needs
Implement an EHR for optimal use in your practice
Learn how to:
Assess the needs of your practice in an EHR system.
Redesign your paper practice to ready for an EHR.

23. TRHCA Physician Quality Reporting Initiative
The 2006 Tax Relief and Health Care Act (TRHCA) (P.L ) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period).

24. Accountable Care Act Physician reporting (PQRI)to a compare website
LTC, inpt rehab, and inpt psych hospitals, and hospice pgms all to report quality data
Pay for performance incentives (Value-based payment modifier for physician fee schedule: measures)
Health Benefits exchange to include quality ratings for health plans
Demonstration program to integrate quality improvement and patient safety training in to clinical education of health professionals
Patient-centered outcomes research

25. Discussion?
Contact Information