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Love You to the Moon and Back

Women Walking

On Jan. 12 of this year, my mother Donna celebrated her 80th birthday. Frankly, she didn’t think she was going to make it. Not because she suffers from a chronic disease or because she has been ill recently. Her mother, Helen, passed away at 79 after falling and breaking her hip. Grandma Helen was hospitalized after her fall and, well, she never left that hospital bed, until she left that hospital bed. My mother just assumed she would suffer a similar fate.

So, when it came time to schedule her six-month check-up in January with her primary care physician, she put it off. After all, what was the point?

When asked about when her next visit with her doctor was, her story always changed: “Oh, they called and rescheduled it for next month.” “Your aunt and uncle are visiting from Colorado that day, so I moved it.” “Oh, your Dad and I forgot about it, so we had to reschedule again.”

Three months passed, and still no appointment. Only now, she wasn’t feeling so hot. She and my dad had both had their flu shots, but over a period of about four weeks, she battled a chronic cough, stomach viruses and sleepless nights. She spent days on end in her pajamas wrapped up in the blanket I got her for her birthday, adorned with the photographs of her 14 great-grandchildren in the shape of a crescent moon with the phrase “love you to the moon and back” scrawled next to it. (“Guess How Much I Love You,” from which that line came, was the story I asked her to read to me over and over again.)

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New Mexico Medicaid is changing: are you ready?

Doctors

Here at HealthInsight, no matter what our titles may be, we each have a role in helping those in our community to understand changes in health care. This came to mind recently in my “off-hours” while I was getting my nails done. The manicurist asked me what I did for a living, and my answer opened up an interesting conversation about her mom.

She explained that although her mom works, she would like to qualify for Medicaid so she can have access to health care. I was glad to provide her with some ideas and resources for additional information. I also let her know that Medicaid in New Mexico is changing.

The current program is called Centennial Care and two of the four Medicaid managed care organizations (MCOs) that contract with the State to provide health care coverage for New Mexico Medicaid beneficiaries are changing. The new MCOs will be:

  • Blue Cross and Blue Shield of New Mexico (BCBS)
  • Presbyterian Health Plan, Inc. (PHP)
  • Western Sky (Centene)
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Connecting

Doctors

I recently returned from two energizing days with 60 senior leaders of HealthInsight and Qualis Health in Seattle. It reminded me of cousin camps in our family -- the cousins would get together from across the country to play and have fun. You would think they lived just down the street from each other all year round. They picked up where they left off even if it had been several years since they last saw each other.

We liked each other. And we liked our work. One of my table mates was an experienced internal medicine physician and information technology expert who enjoys teaching clinicians how to apply Lean improvement methods to simplify workflow and restore joy in work. Another was a social worker who loves her work helping her colleagues comply with contracts. I loved her loud whistles that brought our rowdy crowd to attention after breaks. And she gladly offered to teach me how she does it.

We can forget what it’s like for those who are not so connected. Burned out clinicians who have become estranged from their patients because they are overwhelmed with non-clinical administrative tasks that fill their days. Lonely, socially isolated patients who have lost their will to live. Colleagues swamped with deliverables or reporting deadlines who get distracted from the purpose of the work we do.

Like our customers, we need to keep the trains running on time while we plan where to lay new tracks. The caring professionals we serve need to keep their businesses complying with ever-changing expectations while developing relationships with their patients that build loyalty and trust, which will help them meet their patients’ future needs.

Work monetization, self-absorption and distancing technologies are replacing human relationships with electronic health records, text messages and ever more screen time. As our society expects more immediate gratification from increasing social media connections to strangers, we get less.

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Free Help to Perform Unpaid Labor?

Nurse taking blood pressure

Like most in the improvement science field, I’m constantly on the lookout for new insights – either from projects or initiatives I’m working on or from reports and analysis of other initiatives. So, I was interested to see a recent special supplement to the Annals of Family Medicine1 describing early findings from the Agency for Healthcare Research and Quality’s (AHRQ) program – EvidenceNOW: Advancing Heart Health in Primary Care.

Briefly, EvidenceNOW targets key practices for heart disease management, the ABCS – aspirin use in high-risk individuals, blood pressure control, cholesterol management and smoking cessation. Beyond the clinical focus, EvidenceNOW seeks to understand how best to build and support the capacity of primary care practices to receive and incorporate new evidence and models of care. EvidenceNOW is a $112 million effort, the largest single initiative in AHRQ’s history.

As I reviewed the research articles in the Annals supplement I was impressed by the thoughtful approach to the design of the initiative. AHRQ implemented EvidenceNOW through funded regional cooperatives. Applicant cooperatives were allowed to propose their own implementation design strategies and to provide evidence supporting those choices.

EvidenceNOW is ongoing. AHRQ reports that seven regional cooperatives have enrolled 1,500 small to medium-sized primary care practices with approximately 5,000 clinicians serving 8 million patients, launched their implementation interventions, and collected baseline ABCS data. The supplement includes research articles reviewing topics such as baseline practice characteristics and the experience of regional cooperatives in recruiting practices. It is too early for reporting on project outcomes.

The Annals supplement also includes two invited commentaries. Both hold important lessons for health care systems improvement.

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Exciting Times for a Growing Company

Two months ago, Qualis Health and HealthInsight announced their intention to merge. We’re thrilled to follow that up by announcing the merger is now in effect. You can read our press release here.

As CEO of the new merged organization, I’m encouraged and excited about the future of our work. Qualis Health and HealthInsight share a rich history of community-based, nonprofit health care quality improvement (QI) work, going back 40 years to when we served as Professional Standards Review Organizations for the Medicare program. Today, in addition to our QI work for Medicare and state Medicaid programs, we maintain a diverse portfolio of public‐ and private‐sector business operations across the U.S., and we employ more than 500 people in office locations across the country.

We’re proud of our past achievements and eager to engage with the challenges ahead. The merger will enable us to leverage our complementary strengths and draw on a deeper well of talent and expertise to achieve greater scale and synergy in improving population health and enhancing the quality and value of health care.

We view this as a true merger of equal partners, building on the successes, strengths and cultures of both organizations. Our new governing board is drawn from Qualis Health and HealthInsight, as is our senior executive team.

The new senior executive team has begun defining strategies to align our operations and position the merged company in the health care QI marketplace. A broader group of staff leaders from across our organizations are working to refine our management plans and build on a core set of shared cultural aspirations. And later this year, we will introduce a new company brand. Until then, we will continue to do business under our current brands and organizational names of Qualis Health and HealthInsight.

Please be assured that we intend to provide uninterrupted service as we progress toward full integration of our operations. While our names may change as a result of the merger, the project teams and contacts you are currently working with will not change.

In the meantime, please don’t hesitate to contact me with any questions or concerns you may have.

I am excited about our future and I hope you will join with me to help us reach our full potential.

 

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One Perspective on the Opioid Crisis

Pills and Syringe

I recently came across a headline in the Health Affairs news feed: “Does Naloxone Availability Increase Opioid Abuse? The Case for Skepticism.” Naloxone is a drug that quickly reverses the effects of opioid overdose. The authors critiqued a recent article in an online journal that is not peer reviewed that put forth the case that naloxone use was actually increasing opioid use and crime.

The article in question, “The Moral Hazard of Life Saving Interventions: Naloxone Access, Opioid Abuse and Crime,” concludes that naloxone availability results in reducing fears, increasing the use of opioids, increasing the number of people using opioids, and increased crime due to people stealing to support their addictions.

I read both the article and the resulting comments with interest and, while I can see both sides of this dilemma, even the authors state that naloxone is an effective harm reduction strategy. In reviewing the articles, I was reminded of a small, red cap that I kept on my desk for over a year. I had collected the cap from a medication vial containing naloxone.

Before joining HealthInsight, I was the director of a regional public health office. One day someone came into the lobby asking for help in the parking lot. A young man was in the back of a car: his lips were blue as the result of arrested breathing due to an overdose. I watched public health staff spring into action and deliver two doses of naloxone to the young man while I assisted with rescue breathing.

I saw this person revived and able to walk to the ambulance when it arrived.

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Solving the Morning Rush and How it Relates to Health Care

Child stretching in the morning

Until a few weeks ago, mornings at my house were quite the circus. Despite several “wake up -- we have to leave in 45 minutes, wake up -- we have to leave in 30 minutes …” calls, my children, ages 9 and 6, would wake up 15 minutes before we had to leave the house for school. Inevitably, this led to breakfast in the car, and spilling half of it, leaving their lunch boxes at home, and of course being late for school.

Seeking a solution to the chaos, I bought them a Lego Emmet alarm clock that sings the “Everything is Awesome” song from the Lego Movie. The children were thrilled at the prospect of waking up to their favorite song in the morning. That night, we set the alarm for 7:15 a.m., expecting to have our first calm departure for school at 8 a.m. To my dismay, the next morning was no different from the previous mornings. My children were fast asleep while the alarm clock declared the awesomeness of the situation. On the way to school, and yes, we were late again, I asked the children to think about why the alarm clock solution didn’t work. My 6-year-old chimed in from the back to say they couldn’t hear the alarm -- the volume was too low despite being turned up to the maximum. My 9-year-old suggested we buy another alarm clock with a louder alarm. So, I got them a louder alarm clock.

I used this experience as a teaching opportunity and asked them how they will know if their solution is a success. My 9-year-old responded to say it will be a success if they wake up when they hear the alarm ring. After some discussion, and a very simplified explanation of process measures and outcome measures, they decide success would be defined as ‘going to school on time.’ With some help, they tracked the number of times they woke up early, the number of times they got to school on time and the number of times mom didn’t yell at them. I guess this could be considered a balancing measure! They did this for a week and with some effort, I am proud to say mornings at our home are no longer chaotic but calm and peaceful. Well on most days—they are children after all!

Thinking more about why this exercise was a success -- it was because the people who were the most impacted by the problem were the drivers of the change. In health care, there is an increasing realization that to improve outcomes, the health care system must begin to include the patient voice. To do this, we need to be asking patients, the users of the system, the question “What matters to you?” and not “What is the matter with you?”

For those of us working on solutions to better health care, we should ask ourselves what we can do to support a patient-driven revolution in health care.

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Oral Health for Seniors – Take Care of Your Teeth

 
ToothbrushI have been fortunate to have had healthy teeth all of my childhood and adult life, until now. As a child, my parents were diligent in making sure I had an annual oral checkup, and properly brushed my teeth. Cavities were filled and I never had a tooth ache. As an adult, I continued with similar maintenance, adding in semiannual hygienist visits. I never thought about cost because, even when I didn’t have dental insurance, maintenance was relatively inexpensive.

Now that I’m approaching Medicare age, I’m learning teeth don’t necessarily last forever, and I’m experiencing a bit of sticker shock on the cost of dental care for services beyond maintenance. When you start getting into crowns, bridges, implants, etc., even with dental coverage, the out of pocket costs are substantial.

54.7[i] million aged (65 or older) or disabled adults currently receive health insurance through Medicare. That number is expected to increase to over 70 million in the next 25 years as our population ages. Preventive personal care combined with seeing a dentist for annual maintenance are the most practical and least costly methods of preserving teeth and health. By catching early signs of infection or disease before they become more serious, you can avoid unnecessary physical discomfort as well as expenditures.


According to the National Health and Nutrition Examination Survey 2011-2012, of adults 65 and over, nearly

  • 19 percent of adults 65 and over had untreated tooth decay
  • 96 percent of all U.S. adults 65 and over with any permanent teeth had cavities (treated or untreated)
  • 19 percent had lost all of their teeth
Poor oral health can lead to periodontal (gum) disease, caused by bacteria in plaque. Irritated, swollen and/or bleeding gums are all signs of developing gum disease. Untreated, deep pockets can form, where more food particles and plaque can collect. As the disease advances, the supporting gums, bone and ligaments around the teeth can pull apart and result in tooth loss.

Oral health is often an overlooked component that could have impacts on overall health and well-being. Periodontal disease has also been linked with diabetes, heart disease and stroke. In addition, many seniors experience more challenges with oral health due to medication reactions, such as dry mouth, a common cause of cavities in older adults.

Original Medicare currently doesn’t offer dental coverage. However, many Medicare Advantage (MA) plans offer the service. Currently, about 63 percent of beneficiaries are enrolled in original Medicare (and 37 percent in MA). With the evolving health care provisions under the new administration, it will be important to keep a close watch on this coverage for both plans.

Other affordable options for dental services may be available through Federally Qualified Health Centers, private insurance and discounted rates offered by some dentists which can be accessed through the American Dental Association’s website here.

What can you do now? Follow the Centers for Disease Control and Prevention guidelines for maintaining Oral Health for Older Americans to prevent serious issues.

What will I do next? I’m switching to an in-network dental provider and getting as much work done as I can while I still have coverage!

Take care of your teeth and follow a preventive care schedule diligently to prevent problems that can affect the rest of your body. Think of your body as a beautiful sports car — and, the only car you will have for your entire life. To keep the car running smoothly long-term and to prevent any problems with the vehicle, you would likely follow the manufacturer’s preventive care schedule diligently. Do the same with your teeth – you won’t regret it.



[i] Medicare Enrollment Dashboard and Data File, available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html, accessed 3/17/2018
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Asking the Right Questions About Health Care Costs

Charts and graphs on a computer

In fall 2011, my husband found a skin growth on his neck. It wasn’t overly concerning, but I encouraged him to get it checked out. He went to a dermatologist who agreed it likely was benign, but suggested a biopsy to confirm, which took all of five minutes. We later received a surprise bill for $4,500!

It turned out that while the dermatologist was in network, the lab to which he sent the sample wasn’t. And we were charged a high facility fee because the dermatologist’s office was affiliated with a high-cost hospital, information that was news to us.

Why am I telling you this? Because I’ve worked in health care, with a focus on cost and affordability, for over 15 years. This experience and knowledge still did not save our family from an unforeseen medical expense.

The cost of care is receiving more and more attention. Kaiser Health News and National Public Radio have recently begun a Bill of the Month series in which they scrutinize health care bills in an effort to shed light on costs.

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Relationships Eat Knowledge for Breakfast

people networking

A couple of weeks ago I had the pleasure and opportunity to attend the Centers for Medicare & Medicaid Services (CMS) 2018 Quality Conference in Baltimore. I’m somewhat of a conference veteran and have been attending these annual events for the past several years, and as usual, this year didn’t disappoint.

As I sat in the airport and waited for my flight back home, I reflected on what I had learned and what I would take back to the HealthInsight team. What were my key takeaways? There was much to take in, which to be honest, quickly overwhelmed me and eventually led me to the following conclusion: It was the connections with others that made the most difference. The relationships and reunions are what attendees are most excited about. I hear it time after time. People share their conference experience and almost always speak about the personal connections that made their participation worthwhile. The content and presentations were fascinating and offered a great deal of insight, and in some cases tools to take home, however, what people will remember most is the connection they made with a colleague, leader, partner or friend.

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How’s Your Heart?

Heart and Stethoscope

I just had my birthday … and it’s Heart Month. This has gotten me thinking about what my heart might look like. I’m curious: does it look like that of a 30-year-old or is it more like a 70-year-old’s? I would imagine there would be a lot of variation and many Americans may have hearts that appear older than their actual age. Imagine that!

To assess your heart age, the Centers for Disease Control and Prevention and others offer tools that generate an estimate based on your risk factors. Putting in your weight, cholesterol level, blood pressure, diabetes and smoking history allows the tools to calculate your heart age and perhaps get you thinking about ways to reduce that age and live longer. As the daughter of a man who had his first heart attack at age 53 and who was 14 when he lost his father from a heart attack, I am happy that we now know so much more about how to prevent this from happening.

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Equip Yourself to Thrive During Times of Change

letter tiles

“It’s only after you’ve stepped outside your comfort zone that you begin to change, grow, and transform.” ― Roy T. Bennett

“The only way to make sense out of change is to plunge into it, move with it, and join the dance.” ― Alan W. Watts

“Welcome change.” – Fortune in cookie I opened on January 29, 2018 (no kidding).

Like many others, our organization is undergoing a transformation. There are exciting times ahead, as well as periods of change and uncertainty. But let’s be real – for many of us, we are creatures of habit and change is hard. When attending a multi-day meeting, do you tend to sit in the same area of the room each day? Do you have a typical routine for breakfast or getting ready for work? There is nothing wrong with a certain amount of predictability in life, but change can be an impetus toward excellence, a teacher, an opportunity for growth and a lesson in thriving or resilience.

As Juliana Preston mentioned in her recent blog, our amount of resilience isn’t fixed. Quoting Sheryl Sandberg, “Resilience is the strength and speed of our response to adversity [or change]—and we can build it. It isn’t about having a backbone. It’s about strengthening the muscles around our backbone.”

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Recommendations for Medicare’s Future Quality Improvement Initiatives

Group meeting

In my last post, I put forward some core “change principles” to guide our communities in working to transform the U.S. health care system. In this installment, I’ll try to apply those principles in recommending ways to enhance the value of the quality improvement work that HealthInsight and similar organizations perform for the Medicare program.

As the nation’s largest single purchaser of health care, the Centers for Medicare & Medicaid Services (CMS) has long been a pacesetter and incubator for change. The Quality Improvement Organization (QIO) program represents the largest sustained investment in large-scale quality improvement in history. HealthInsight has served as a contractor for this program since 1984, and our mission has evolved throughout the decades, at the leading edge of change in this national effort, to address changing goals, changing theories about what drives improvement, and changing models of care and care delivery support.

CMS is now designing its quality improvement initiatives for the Quality Innovation Network-QIOs (QIN-QIOs), spanning the 2019‒2024 contract period. These new initiatives give CMS a crucial opportunity to propel the health care system toward meaningful transformation.

At HealthInsight, we believe that sustainable quality gains and cost reductions will not occur without active participation from every segment of the health care system. Multiple stakeholders need to work together and employ diverse, but aligned, strategies and approaches to drive transformation.

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Change Principles for Health Care Transformation

Doctor, Patient and Family

HealthInsight has worked with providers and patients for more than 40 years to improve health and health care. We feel both proud of and humbled by this experience. Proud, because our services have improved health outcomes and helped transform the care delivered to millions of people. And humbled because experience has taught us that real transformation takes time and sustained commitment—and it is hard. We also know our efforts often fall short of the vision of what is possible. So, in quality improvement terms, we seek to design better models.

In support of our core business of improving health and health care, we seek to be a thought leader, shaping the future of our communities and nationally. We are continually considering and reconsidering the best ways to help our system work better. In that spirit, we’d like to share some of our ideas.

Broadly, we believe that sustainable improvement will happen only when patients, providers, payers and purchasers come together at the community level to promote, demand and support transformation based on the following change principles.

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Look for the Lean Routine

People taking Notes

This past month I was lucky to attend a workshop on Lean Rapid Process Improvement hosted by Qualis Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Washington and Idaho. As our organizations hold similar contracts in Oregon and Washington to perform external quality review of the states’ Medicaid programs, Qualis invited me and three of my HealthInsight colleagues to provide an outside perspective on their efforts to “lean up” their workflow processes, with the goal of providing better value to the State of Washington.

The invitation excited me because I had heard a lot about Lean workshops but had never been able to participate. I knew that Lean manufacturing principles―aimed at minimizing waste in a system without sacrificing productivity―could be applied to non manufacturing settings, but I had not actually experienced it.

Over the course of the three-and-a-half-day workshop, we examined a process map that Qualis had developed for one of its workflow processes, with an eye toward reducing waste. We looked for eight types of waste: defects, overproduction, waiting, non utilized people, transportation, inventory, motion and extra processing.

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Tips for Strengthening the Feedback Loop

Doctor viewing scans on a computer

Very early in my career I worked for an organization that placed a high value on building staff skills to communicate effectively, including training in how to give and receive feedback and how to coach others to do the same. I still think about this a lot, and given the headlines about how 65 percent of employees want more feedback (and the number increases for employees under 30), there is a lot of information out there about the importance of improving this skill.

It seems like such a simple thing, but it turns out most of us are pretty bad at giving feedback. There are a lot of reasons – we prefer to avoid conflict, we don’t want to be unkind, we don’t have time. These feelings are largely rooted in assumptions we have about how people feel about receiving feedback, many of which don’t reflect reality.

Here are a few of my favorite resources on feedback – they are all quick to check out and easy to digest!

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Will Mergers and Acquisitions in Health Care be the Disruptive Force We Need?

Doctors

There is still uncertainty about federal funding for the upcoming fiscal year, at least until March 31, the next pending deadline on the federal budget. At the end of December, Congress provided the Children’s Health Insurance Plan (CHIP) with $2.85 billion to keep it funded through March. Will they fully fund CHIP to cover the program for the year or leave it to the states to cover the gap? They have also provided community health centers with $550 million. Will they provide full funding or again leave it to those providers and states to figure it out? Will there be any activity from Congress on reducing drug pricing? Likely not, but the FDA is working to bring lower cost generics to the market in attempts to promote competition. There is also discussion regarding congressional work on entitlements such as welfare, Medicaid and food stamps, but there is not a strong consensus between the House and Senate nor along party lines―particularly with 2018 being an election year. So, we will have to watch congressional activity and await outcomes.

So, with the stalemate we see right now on the policy side at the national level, many private sector players are taking things into their own hands. They have not seen the health care sector transforming as quickly as it needs to, so many private sector players are positioning themselves as intentional disruptors in health care and particularly in the health care delivery system. In the last quarter of 2017 we saw horizontal, vertical, regional, national, large and small scale mergers and acquisitions take place. Many of these mergers appear positioned to shift care away from hospitals in order to reduce medical spending. Will that tactic be the magic bullet? We’ll have to wait and see.

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Radical Resolutions

New Years Resolution

As I reflect on this past year and prepare for new challenges in 2018, I have been inspired by the Institute for Healthcare Improvement (IHI) Leadership Alliance’s 10 guiding principles or simple rules for radical health care redesign. As we move into a new year, it seems appropriate to revisit this simple, yet thought provoking, guidance for quality improvement in health care.

  1. Change the balance of power. Co-produce health and well-being in partnership with patients, families and communities.
  1. Standardize what makes sense. Standardize what is possible to reduce unnecessary variation and increase the time available for individualized care.
  1. Customize to the individual. Contextualize care to an individual’s needs, values and preferences, guided by an understanding of what matters to the person in addition to “What’s the matter?”
  1. Promote well-being. Focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.
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The ABCs of Diabetes Education

Students

My father died at age 58 from complications of Type 2 diabetes when I was still in high school. Following his diagnosis, he developed chronic kidney disease, lost two toes to amputation and faced heart challenges that ultimately led to his passing. Because of my family history, my doctor is concerned about my own diabetes lab values and talks to me regularly about the disease.

In my work life, I interact with groups of dedicated Utahns trying to support and help patients with diabetes. The Larry H. & Gail Miller Family Foundation donated $5.3 million to the University of Utah health care system last year on World Diabetes Day to help prevent the growth of diabetes in our state. Larry H. Miller, former owner of the Utah Jazz, died in 2009 from complications related to Type 2 diabetes. A few years ago, HealthInsight worked with the Miller family and the Utah Department of Health to produce a heartfelt TV commercial that aired for six months.

Type 2 diabetes is a difficult and costly disease to treat. Though it typically develops after age 40, it has recently begun to appear with more frequency in the younger population. Those with a Type 2 diabetes diagnosis manage their disease through a combination of treatments, including diet, exercise, self-monitoring of blood glucose, and in some cases, medication. Most health problems resulting from the condition can be lessened or avoided altogether, which is why education is key to prevention, reduction and improvement in quality of life.

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Quality Improvement Fundamentals and MIPS

Stethoscope and money

Connecting basic quality improvement (QI) work to new government programs can be a bit of work. A case in point is the Merit-based Incentive Payment System (MIPS), one of two payment tracks for Medicare Part B clinicians under the Quality Payment Program.

If your practice takes part in an Advanced Alternative Payment Model (AAPM), you don’t necessarily need to participate in MIPS unless your AAPM requires it. Most AAPMs do require participation in the same requirements of the MIPS program. So, in most cases you’ll need to participate in MIPS (or prescribed components of it for your AAPM) in 2018 to avoid a negative payment adjustment. And starting in 2020, the cost of care you provide will affect the way you get paid for Medicare services, based on your MIPS performance in 2018.

The four variables of MIPS―Costs, Quality Reporting, Advancing Care Information and Improvement Activities―will all count toward a performance score that can swing your payment as much as 5 percent downward or upward, depending on your performance. Costs will account for only 10 percent of your overall performance score in 2018 (for 2020 implementation), but will increase to 30 percent of your score in 2019 (for 2021 implementation), as it affects your payment fee schedule from Medicare.

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