October 30, 2009

Primary Care Group lands quality award

Primary Care Group lands quality award

Vanderbilt's Adult Primary Care Group has won one of three 2009 Leadership Awards from the Disease Management Association of America.

The award, for “Outstanding Provider Engagement Initiative,” came in recognition of the group's innovative handling of incoming clinical guidance generated from health insurance claims data.

Insurance claims may yield the date of a patient's last mammogram, what medications she is taking, whether she has diabetes or congestive heart failure, etc. Many large employers, Vanderbilt among them, engage disease management companies to scan beneficiaries' claims data using care guidelines software. As computers flag apparent opportunities to apply guidelines, doctors and patients receive appropriate updates through letters and phone calls.

Such prompts can be hit-and-miss: the patient has moved away or switched providers; the drug being recommended happens to be contraindicated; the potential drug-drug interaction is already being monitored. Clinicians have learned to associate the prompts with information noise. Useful prompts can get lost among the misfires.

Approximately 9,000 of Vanderbilt's 26,000 Health Plan beneficiaries are followed by the Adult Primary Care Group.

When ActiveHealth, Vanderbilt's claims-based disease management vendor, generates a prompt for one of these 9,000 patients, it arrives electronically at Vanderbilt's Center for Health Promotion and Disease Management. Working under partial funding from the Vanderbilt Health Plan, nurses at the center check each prompt against the electronic medical record. They typically reject 45 percent of the prompts as noise, passing along the remainder to clinicians and patients.

The prompts go to clinician's electronic mailboxes in StarPanel, Vanderbilt's innovative electronic medical record application. StarPanel also reminds the clinician about the prompt at the time of the next encounter with the patient.

According to ActiveHealth, claims data show that their prompts are 20 percent more likely to be resolved when the Vanderbilt beneficiary is followed by the Adult Primary Care Group rather than by a community physician. ActiveHealth's calculations say this compliance edge is saving Vanderbilt $9.90 per year in health benefits costs for each of these 9,000 beneficiaries, or about $89,000.

Traveling to the DMAA's annual meeting in September in San Diego to pick up the award on behalf of the APCC was Bill Gregg, M.D., M.S., assistant professor of Biomedical Informatics.

“I see the award as confirmation of the value and importance of provider engagement in any quality improvement initiative. Evidence-based care guidelines aren't something you can implement from a cubicle a thousand miles away.

“You've got to have provider engagement. And we do that with technology,” Gregg said.

“What helps make this work is that we're not inundating our clinicians. They know that the electronic prompts they receive have been vetted in-house,” said Dexter Shurney, M.D., M.B.A., M.P.H., medical director of the Vanderbilt Health Plan.

“This type of innovation and collaboration bodes well for applying disease management across more sizeable populations,” said Robert Dittus, M.D., M.P.H., chief of the division of General Internal Medicine and assistant vice chancellor for Public Health.

“As clinicians we don't have a way of getting at pharmacy and billing data. And without us, payers don't have a way of closing gaps in care. This type of partnership has potential to produce significant benefits for patients,” said Jim Jirjis, M.D., M.B.A., chief medical information officer and medical director of Adult Primary Care.