New Developments in Funding of CME

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New Developments in Funding of CME

• OSMACME Providers Update
• July 12 and 13, 2006

2
Current Situation of OSMAs accredited CME
Providers

• Decreased funding from pharmaceutical companies
• Increased scrutiny of funding
• Increased emphasis on centralization of grant
  requests
• Decrease in number of CME offerings

3
Proposal of Block Grant

• Alliance for CME meeting in January 2006
• Idea originated with Medical Association of
  Georgia (MAG)
• Block grant to State Medical Societies
• CME providers apply to SMS
• Grants awarded by SMS

4
Steering Committee

• Five states Georgia, Florida, Massachusetts,
  Oklahoma, Colorado
• Will set criteria for grant requests/review
• Local grant committee will award the grants

5
Initial Pharmaceutical Company

• Topics depression, mood disorders, anxiety, PTSD
• Emphasis on Outcomes Measurements
• Dream CME programs
• Final approvalsoon!

6
Additional Pharmaceutical Companies

• One other company with very strong interest
• Second block grant request to be submitted soon!

7
Future

• Other pharmaceutical companies will buy in to
  outsourcing concept
• Line item on annual budget of pharmaceutical
  industry for SMS

8
CME Outcomes Measurements

• OSMA CME Providers Update
• July 12 and 13, 2006

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Levels of Educational Outcomes

• Derek Dietze
• A-CME
• January 2006

10

• Participation
• Satisfaction
• Learning
• Performance
• Patient Health
• Population Health

• The number of people who registered and/or
  participated
• The degree to which participants expectations
  about the setting/delivery of CME activity were
  met
• Changes in self-reported knowledge of
  participants development of competence
• Changes in observed practice performance the
  application of learning the application of
  competence
• Changes in the health status of patients due to
  changes in participant practice behavior
• Changes in the health status of a population of
  patients due to changes in widespread practice
  behavior

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Forces driving CME Outcomes Measurement

• Accountability for effectiveness, impact, and use
  of resources
• Performance improvement movement
• MOC and MOL requirements/initiatives
• Pay for Performance movement
• Increasingly a requirement of commercial support
• ACCME is raising the bar for providers
• CME communitys desire for continuous improvement

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Practical Strategies for Better Outcomes

• Carol Havens, A-CME
• January 2006 and MAGs CME Outcomes Institute,
  June 2006

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good outcomes start with good needs assessment

• If you dont know where youre goinghow do you
  know when youve arrived?
• If you dont know where you startedhow will you
  know if youve gone anywhere?

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the cme process

• Needs link to objectives which link to outcomes
• Effective education utilizes multiple
  interventions
• Outcomes, measured in multiple ways over time,
  document change in clinician practice and patient
  health status
• Outcomes identify future needs

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Linking CME Needs to Objectives Outcomes
Needs Assessment
CME Objectives
CME Program or Activity
Multiple Interventions
Outcome Levels 1-2
Intermediate Outcomes Change in skills,
knowledge, or attitude intent to change
Outcome Levels 3-5
Long-Term Outcomes Change in clinician practice
or pt. health status
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why measure cme outcomes?

• CME can help move the Big Dots
• Quality utilization
• Functional outcomes
• Mortality rates
• Patient safety
• Adverse drug events
• Patient satisfaction
• Screening, diagnostic, treatment, prescribing,
  immunization rates
• HEDIS. JCAHO, NCQA
• Healthcare costs

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why measure cme outcomes?

• Leads to more effective, better-targeted
  education
• Demonstrates value to internal external clients
  in a climate of shifting funding
• Provides a road map to future education
• ACCME mandates outcomes measurement

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the cme paradigm shift
Educator Focus Traditional evaluation model Level 1 outcomes Learner rates the overall quality, speakers, content, resources, location, etc. Learner rates the usefulness, applicability, etc. ? Learner Focus Outcomes-oriented model Level 3-5 outcomes Measures learners intent to change Measures learners actual behavior change Measures learners impact on patient health status
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five-level outcomes model

• Level 1 Participant satisfaction (the smile
  sheet)
• Level 2 Change in knowledge, skills or attitude
  intent to change
• Level 3 Self-reported change in clinician
  behavior or practice
• Level 4 Objectively-measured change in clinician
  behavior or practice
• Level 5 Objectively-measured change in patient
  health status

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level 1 participant satisfaction

• Rates the quality, usefulness, objectives,
  presentation, faculty, or learning experience

• Provides feedback on overall quality, faculty,
  and instructional design
• Provides limited value in describing the impact
  of the learning activity

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level 2 change in knowledge, attitudes, or
skills intent to change

• Includes pre-tests/posttests, skill observation,
  and commitment to change measures

• Documents learning (knowledge, attitudes, skills)
• Intent to change has high correlation with actual
  behavior change
• Learning may or may not lead to actual behavior
  change

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level 3 self-reported behavior change

• Follow-up assessment of implemented practice
  change

• Measures are simple and practical and document
  impact on practice behavior
• Provides rich information about intended and
  unintended consequences of CME
• Tends to be subjective

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level 4 objectively-measured change in practice

• Assesses change in practice data such as quality
  and utilization measures

• Objective data are very useful in assessing needs
  and charting post-activity progress
• May not capture the breadth or complexity of new
  behaviors
• May be difficult to distinguish learners data in
  the context of a large practice group

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level 5 objectively-measured change in treatment
outcomes or health status

• Assesses progress toward ultimate goal of
  improved patient health

• Tracks net effect of practice change on patients
  and target populations
• May take long time periods to reflect change in
  health status
• Change may be hard to measure or obscured by
  co-morbidity

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typical timeframes for measuring cme outcomes
Post-Program Evaluation (immediate) Follow-up Assessment (1-3 months) Long-Term Measurements(6-12 months)
Levels 1-2 ? Level 3 ? Levels 4-5
Satisfaction Usefulness Knowledge, attitudes, skills Intent to change Self-reported change in practice Objectively- measured change in practice or patient status
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monitoring overall cme program effectiveness

• Track outcomes level by program or intervention
• Compare annual trends
• Examine value of CME with higher-level outcomes
  (levels 4-5)
• Target high-value programs with low outcomes for
  improvement

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better outcomes result from

• Clear measures of gaps in practice
• Needs-based objectives
• Multiple educational interventions
• Multiple high-level evaluation methods(qualitativ
  e and quantitative)
• Time, thoughtfulness, patience