Presentation Overview

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Presentation Overview

• Review of Task 1D2 (revised)
• Task 1D2 tools and website update
• Recruitment Strategies
• UQIOSC assistance

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Task 1D2 Goals

• To reduce healthcare disparities
• To increase the adoption of CLAS standards in
  physician office practices
• To provide cultural competency training to
  individual physicians
• To increase the adoption of IT among physicians
  treating diverse populations (under Task 1D1)

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Percent Underserved Population by state, FFS
Medicare beneficiaries alive as of
3/31/04(Source 2004 EDB file)
States Excluded from 1D2
ID ND IA WV ME NH VT VI PR MT WY
lt 3 lt 4 lt 5 5-9.99 10
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1. Statewide Requirements

• QIO must demonstrate improvement in the clinical
  measure summary of gt 4 (absolute)
• QIO must focus on ALL underserved populations
  combined
• QIO must improve all ambulatory(Physician
  Office) measures

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Statewide Assessment

• Task 1D2 baseline/remeasurement formula
• DM1 DM2 DM3 BC1 Imm1 Imm2 6
• 7th SOW Task 1D formula
• (DM1DM2DM3) BC1 Imm1Imm2
• 3 2

Note Data are claims based for all underserved
populations
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The 7th SOW Task 1E formula was based on the
calculated rate of a single indicator for a
single underserved population relative to a white
or white, non-dual population comparison group
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8th SOW Task 1D2 Specifications For Task 1d2,
the QIO shall create two IPGs that may
overlapOne IPG shall work on 1d1 activities
under 1d1 task requirements For the Task 1d1
Underserved IPG, the QIO shall select an IPG of
practice sites equivalent to the underserved
population in the state/jurisdiction
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8th SOW Task 1D2 Specifications The
CLAS/Provider Cultural Competency IPG shall be
composed of 5 of the total practice sites within
the state/jurisdiction, with a minimum of 20
practice sites and a maximum of 50 practice
sites In addition, the QIO shall work with the
IPG practice sites to promote the adoption of
CLAS standards through a practice site self
assessment At the practice level with this IPG,
the QIO shall promote the adoption of CLAS
standardsthrough having at least one
practitioner/clinic manager complete Theme 3 of
the OMHtool
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8th SOW Task 1D2 Specifications For
CLAS/Provider Cultural Competency IPG, at the
practitioner level, the QIO shall select at least
10 of the practitioners from the CLAS IPG
practices sites with a minimum of 20
practitioners and a maximum of 100 practitioners,
who will be required to complete Themes 1 and 2
of the OMH tool
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• Task 1d1 Underserved (IPG1) Requirement
• The same Task 1D1 DOQ-IT requirements
• Underserved representation in 1D1 IPGs
• Ex State working on 200 practices (Task 1D1
  size)
• 10 underserved population in state
• Task 1d1 IPG Selection must include 20 practices
  serving minority population. The 20 clinics are a
  sub-set of the 200 Total 1D1 selection.

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• Questions
• How do I select the ID1 Underserved practices?
• Can this group overlap with the other 1D2 IPG
  (CLAS/CC)?
• When do I report this group and where?
• How is this IPG evaluated?

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• CLAS/CC (IPG2) Practice Site Requirements
• Target 5 of office practices (Min 20, Max 50)
• QIO must administer CLAS assessment tool Pre- and
  Post- Theme completion
• 80 of practices must have at least one MD or
  Senior Administrator complete Theme 3 of the OMH
  web based tool.
• QIOs must use the CMS provided the 5 estimate
  found in SDPS Memo 05-247-PO

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CLAS/CC (IPG2) Practice Site Requirements QIOs
targeting the minimum of 20 Practice sites (3)
AK, RI, SD QIOs targeting the maximum of 50
Practice sites (26) AL, AR, AZ, CA, CO, FL, GA,
IL, IN, KY, LA, MA, MD, MI, MO, NC, NE, NJ, NY,
OH, PA, SC, TN, TX, VA, WA
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• CLAS/CC (IPG2) Practitioner Requirements
• Target 10 of practitioners within the CLAS/CC
  IPG practices sites (Min 20, Max 100)
• 80 of practitioners in the CLAS/CC IPG must
  complete Theme 1 and Theme 2.
• Practitioners can be Physician Assistants,
  Nurse Practitioners, MDs or any other allied
  health professional who bills Medicare FFS under
  a unique identifier (UPIN or NPI)

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Total office practices in the State
DOQ-IT office practices (Task 1D1)
1D1 Underserved IPG Size based on states
underserved pop.
Task 1D2 CLAS/CC IPG 20 Min, 50 Max Based on
5 of Practices
Task 1D2 Cultural Competency Module 10 of
practitioners from 1D2 CLAS/CC IPG Min 20, Max 100
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A note on the Task 1D1 Care Mgmt/CC Option
Cultural Competency is an option for Task 1D1
for those practice sites who have progressed in
this task to a point where they may opt between
care management and CC. If they chose CC then
30 (no-ECI) or 75 (ECI) of the practitioners in
the practice site must complete at least Theme 3
of the Office of Minority Health on-line
program. It is not possible to have a
practitioner complete Theme 3 within a practice
site and have it count towards Task 1D2.
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An example please
200 practices in State, 10 Underserved Population
80 Recruited for DOQ-IT
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8 of 80 (10) IDd for 1D2 DOQ-IT
5 of 200 practices - Min 20 applied 20
practices IDd for CLAS/CC IPG With a total of
250 MDs
10 (20lt25lt100) MDs Targeted for CC
training Expect that 20 (80) will complete
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• Questions
• How do I select Physicians for the CLAS/CC IPG?
• When do I report the CLAS/CC IPG and where?
• When and how do I collect the CLAS pre-assessment
  baseline information?
• How does the CLAS Pre- and Post-assessment impact
  my QIOs evaluation?

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• Questions
• Where to I get the OMH CLAS assessment Tool?
• Where to I get the OMH A Family Physicians
  Guide to Culturally Competent Care?
• Who do I contact for more information about these
  tools?
• Can MDs use the paper-based tool to complete the
  OMH CC training if they dont have internet
  access?

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Evaluation Criteria

• Core Expected Result Weight.
• CLAS IPG 80 .25
• (Theme 3 completion)
• Practitioner CC 80 .40
• (Theme 1 and Theme 2 completion)
• Provider/Stakeholder 80 .10satisfaction
  survey
• Non-Core
• Statewide 4 .25
• The Task 1d2 Underserved Component of 1d1 is
  not part of 1d2 Evaluation

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Registered Users by State December 6, 2004
September 8, 2005
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Registered Users by State August 1, 2005
September 8, 2005
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Users Completing at least one Theme December 6,
2004 September 8, 2005
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Users Completing at least one Theme August 1,
2005 September 8, 2005
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OMH Tool Results to Date
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Physician Recruitment Strategies

• Community Practice Groups serving underserved
  communities through
• Commercial care providers
• Medical University clinics
• FFS Community Health Centers
• Hospital Network physicians
• Task 1d1 Practices

Recognize that if the physician practices
cantbe linked to claims data they cannot be
utilized.
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• Stakeholder Recruitment Strategies
• State Malpractice carrier
• Commercial Health Plans
• Hospital Affiliated Medical Practices
• Local Chapters of Physician Organizations
• AMA, AAFP, ACP, NMA, NHMA, A/PIMA
• Legislators

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Create Selling Points for CLAS/CC

• Changing Demographics means changein office
  practice
• Decreased incidence of medical errors
• Makes care more effective and efficient, i.e
• Providers may order fewer diagnostic tests for
  patients of different cultural backgrounds as
  they may not understand/believe patients
  description of symptoms. Alternatively, providers
  may order more tests to compensate for not
  understanding what patients are saying.
• Patients may not adhere to medical advice because
  they do not understand or trust provider

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Create Selling Points for CLAS/CC

• May help manage risk
• Can assist with patient recruitment
• Meets Regulatory (CLAS) requirements
• Cross-walk CLASS/CC efforts with NCQA, URAC and
  JCAHO requirements

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Provide Examples of Diversity Growth
Minorities will account for 90 total growth
in US population from 1995-2050.
Percent Increase in Population 1995 to 2050
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Provide Examples of Miscommunication Issues
Source Physician Perspectives on Communication
Barriers, RWJF, March 2004
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• UQIOSC Support
• National and Regional calls beginning in October
• Recruitment Strategies, tools, and resources
  posted to MedQIC
• Promotion of QIO disparities efforts at a local,
  statewide and national level
• Respond to QIO inquiries via Quest, Listserv,
  e-mail, telephone

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Questions? Slides and speakers notes available
at www.qsource.org/uqiosc OMH Tool
www.thinkculturalhealth.org Contact
dfitzgerald_at_tnqio.sdps.org
sbrittman_at_tnqio.sdps.org
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Thank You!
This material was prepared by QSource, the
Medicare Quality Improvement Organization for
Tennessee, under contract with the Centers for
Medicare Medicaid Services, an agency of the
U.S. Department of Health and Human
Service.TN-8SOW-TASK1D2-2005-02