Prevea Health

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Prevea Health May 20, 2009 Ashok Rai,
MDPresident and CEO
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About Prevea Health

• Founded in 1996
• Multi-Specialty Medical Group
• Over 200 physicians
• 1000 employees servicing Northeast Wisconsin
• 16 health centers, including nine in the Green
  Bay metro area and regional locations
• 50 specialties

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Our Values

• Mission
• To take care of people with passion, pride and
  respect.
• Vision
• The best place to get care The best place to
  give care

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Patients Are Not Receiving Recommended Care
New England Journal found only 45 of patients
are compliant following their physicians care
guidelines
RAND researchers found that patients received 55
of the recommended care
Kaiser Foundation found that 27 of patients put
off or postponed getting needed health care and
23 skipped a recommended medical test or
treatment
McGlynn et al The Quality of Health Care
Delivered to Adults in the United States NEJM
June 2003 RAND Health study - supported by the
Robert Wood Johnson Foundation and the Veterans
Affairs Health Administration, Issued November
2006 Kaiser Family Foundation Health Tracking
Poll October 2008
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Improving Chronic Care
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Modeling The Joint Principles of the Patient
Centered Medical Home (PCMH)

• Personal physician
• Physician directed medical practice
• Whole person orientation
• Care is coordinated and/or integrated
• Enhanced access to care
• Documentation of Quality Care
• Patient Safety Culture
• Payment Reform

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Embracing the PCMH Impact on Care
Todays Care
Medical Home Care
Our patients are those who are registered in our
medical home
My patients are those who make appointments to
see me
Care is determined by todays problem and time
available today
Care is determined by a proactive plan to meet
health needs, with or without visits
Care varies by scheduled time and memory or skill
of the doctor
Care is standardized according to evidence-based
guidelines
I know I deliver high quality care because Im
well trained
We measure our quality and make rapid changes to
improve it
A prepared team of professionals coordinates all
patients care
Patients are responsible for coordinating their
own care
Its up to the patient to tell us what happened
to them
We track tests and consultations, and follow-up
after ED and hospital
Clinic operations center on meeting the doctors
needs
An interdisciplinary team works at the top of our
licenses to serve patients
Source Adapted with permission with IBM from
Daniel F. Duffy, M.D.
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PatientPhysician Connectedness is Key to the
Quality of Primary Care
Those patients with the strongest relationships
to specific primary care physicians were more
likely to receive recommended tests and
preventive care.
PatientPhysician Connectedness and Quality of
Primary Care Steven J. Atlas, MD, MPH Richard
W. Grant, MD, MPH Timothy G. Ferris, MD
Yuchiao Chang, PhD and Michael J. Barry, MD 3
March 2009 Volume 150 Issue 5 Pages 325-335
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Preveas Approach to the Medical Home

• Four Key Initiatives
• Expand the concept of multi specialty integration
• Education/Medical Management
• Staff Model Re-design
• Patient Outreach

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Branding Our Belief
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What We Found

• Despite on going staff and physician education
  our internal and external benchmarked quality
  scores were not moving
• Internal audits showed our physicians were doing
  the right thing when the patient was in front
  of them
• Our challenge was the patient we werent seeing

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Preparing for the Future
No longer can clinicians, practice managers, and
clinical coordinators limit their concern to the
patient in front of them. They need to pay
attention to the patients who should have called,
should have presented to the office, or should
know they have been prescribed a recently
recalled medication. Michael Sheinberg,
M.D. Associate Medical Director, Medical
QualityLehigh Valley Physician Group
MaryAnne Peifer, M.D., M.S.I.S., Associate
Medical Director, Informatics Michael Sheinberg,
M.D., Associate Medical Director, Medical
Quality and Pamela Marcks, Senior Project
Manager, Performance Improvement, Lehigh Valley
Physician GroupPresenting during AMGA Session -
http//www.amga.org/Education/AC/TSessions/it_tSes
sions.asp
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Targeting Non-Compliance through Automated
Outreach
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Outreach Program Overview

• Live on July 15, 2008
• 85 providers live on Outreach
• 2 Chronic Disease protocols
• 6 Preventive Care protocols
• Average Active Patients in Registry 134,901
• Outreach calls sent 152,006

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Patients Non-Compliant by Protocol
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Chronic Compliance Improvement (6 months)
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Chronic and Preventive Compliance Improvement
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Results Discussion

• The results were positively strong, suggesting
  that Automated Outreach had a significant impact.
• As with any control group study, possible
  differences in the two groups of patients
  including physician and patient characteristics
  may have contributed to the results.
• For both the Diabetes and Hypertension groups,
  the results were statistically significant with
  p-values of less 0.00001.

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Our Results
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Next Clinical Focus Areas

• Heart Failure
• Prostate Cancer Follow Up
• Valve Clinic Follow Up

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Questions