CLINICALLY INTEGRATED NETWORK NEWS - 2019 Q2

Call to Action

Q1 Eye Exam Results

The Clinically Integrated Network (CIN) team is here to support you with capturing eye exam results. For Epic users, use the smartphrase .diabeticeyeexam and for non-Epic users, please have the results faxed to “CIN Clinical Outcomes” at 260-458-5630. Questions? We’re here to help. Please call 260-266-6075.

Q2 Call to Action

As referenced in Quality section, either:

  1. Address Health Maintenance (DM-Statin Therapy)
  2. Order a statin for patients with diabetes 40 years of age or older

We will report results next quarter.

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Success Story

Immunization Report

Based on feedback from providers and staff requesting a way to capture patients’ number of vaccinations received from birth to 23 months, the CIN has worked with Information Security (IS) to create an Immunization Report. This is an extremely resourceful report for offices to use to continuously track these patients and provide proactive outreach accordingly, rather than looking back and hoping the child received the vaccine in the required timeframe.

This new report is live on the scorecards and is located within the “My Panel Report” section. It is labeled “CIN: PCP My 0-24 Month Patients Immunization Report.”

Providers and staff—thank you for your continued suggestions and ideas!

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Diabetes Column

Prediabetes does not have to turn into diabetes  

As of May 2019, Epic records show that we have more than 100,000 patients with prediabetes. This includes those with a most recent Hemoglobin A1C of 5.7-6.4%, and/or a Fasting Blood Glucose of 100-125 mg/dL, and/or an Oral Glucose Tolerate Test of 140-199 mg/dL. 

Great news! We have two locations in Allen County that offer a Diabetes Prevention Program (DPP) designed to equip those with prediabetes the tools, skills and resources needed to prevent diabetes. All facilitators are trained and licensed by the American Medical Association.

  • To refer directly to the YMCA, use the REF239 referral in Epic. Details of the YMCA program can be found by following this link.
  • To refer to our Matthew 25 partner, click this link for reference. 

If bloodwork is not available to screen participants, completion of this quiz can determine diabetes risk. 

Chad Shirar, director, Diabetes Care Strategy, at chad.shirar@parkview.com.

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Provider Relations Highlight

Dr. Lawrence Wuest and team

They have immersed themselves into clinical integration and ensuring that patient care gaps are being addressed, resulting in a 29 percentage point increase to his CIN Score from Q1. Great work!

Dr. William Smith and team

As a team, they utilized the unmet report and diligently worked the flu measure, resulting in 97 patients being vaccinated and meeting the desired measure threshold. Great job!

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FAQ

Did the Well Adolescent Visit measure change?

ANSWER: Yes. The Well-Adolescent Visit measure changed from 12-21 to 12-17, approved by the QPIC in April.
 

With the recent Epic upgrade, how do I run the met/unmet report?

ANSWER: Reference these instructions outlining the 4-step process to run the report; otherwise, please don’t hesitate to reach out to your provider relations specialist.

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Quality

Population Health pharmacist provides information on statin use in persons with diabetes

Diabetes is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Dyslipidemia is common in diabetes, and there is strong evidence that the use of statin therapy improves cardiovascular outcomes, including in patients with apparently unremarkable lipid profiles. 

Recommendations:

  • Statins are the drugs of choice for cardio-protection or LDL cholesterol lowering for primary prevention
  • Moderate-intensity statin therapy is recommended for the following patients with diabetes
    • All patients aged ≥ 40 years
    • Patients aged < 40 years with additional ASCVD risk factors
  • High-intensity statin therapy is recommended for the following patients with diabetes
    • With ASCVD
    • With 10-year ASCVD risk > 20%
  • For patients not tolerating intended intensity, maximally tolerated statin dose should be used
  • With diabetes and ASCVD, if LDL cholesterol is > 70 mg/dL on maximally tolerated statin, consider adding additional therapy after evaluating potential for further ASCVD risk reduction, drug-specific adverse effects, and patient preferences.
  • Moderate intensity
    • Atorvastatin 10-20 mg
    • Rosuvastatin 5-10 mg
    • Pravastatin 40-80 mg
  • High intensity
    • Atorvastatin 40-80 mg
    • Rosuvastatin 20-40 mg

Statin intolerance

Approximately 10% of patients experience muscle-related intolerance to statins, though up to 33% may self-report this. These may include myopathy, myositis or rhabdomyolysis (CK > 10 times ULN and elevated serum creatinine). Presentation of statin-induced myalgias are typically symmetrical, involve large, proximal muscles, begin within six months of statin initiation, and improve within two months of statin discontinuation.

Establishing a causal relationship is through statin withdrawal for at least two weeks and until the symptoms have improved, followed by re-challenge and evaluation of the return of symptoms.

Treatment options in statin intolerance:

  1. Change to another agent at a lower dose
  2. If intolerance continues, change to pravastatin
  3. If intolerance continues, change to moderate dose three times weekly (rosuvastatin preferred)
  4. If intolerance continues, non-statin therapy depending on patient comorbidities and risk

CIN and VBC measures

SUPD is a measure for Parkview Care Partners CIN and value-based contracted (VBC) measures. For CIN, the measure is used for benchmarking and is not scored. For VBC, a weighted measure is used with a 5-STAR threshold of ≥ 86% of patients 40-75 years old receiving at least two diabetes medication fills and at least one statin fill. There is room for improvement in Parkview’s current standing with this measure as it is < 80% for all payer contracts resulting in 3-STARS.

Conclusion

In conclusion, moderate- or high-intensity statin therapy in patients with diabetes is recommended to prevent or delay the onset of ASCVD.

References and questions

For references or questions, reach out to Sarah Pfaehler, PharmD, MBA, BCPS, pharmacy specialist, Clinical Integration, Parkview Health.

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Education

Upcoming Collaborative Learning Sessions (CLS):

Date

Topic(s)

June 25 at 7:30 a.m., Noon and 4 p.m.

Diabetes strategy and approach

July 23 at 7:30 a.m., Noon and 4 p.m.

Epic Ops guest speaker: BPA usage


Skype meeting (contact parkviewcarepartners@parkview.com if you are currently not receiving outlook invites for this meeting)

Suggested Attendees:

  • Clinic Managers
  • Directors
  • Quality Leads
  • Clinical staff who support providers in the CIN
  • Physicians (depending on the topic)

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In the Know

Specialty specific scorecards

As many of you know, along with many independent specialist groups, the CIN has eight lines of business within PPG actively engaged in the CIN. We are currently in the process of meeting with the 50+ other PPG specialists to transition them into the CIN. In preparation of these additional specialties, and a significant increase in new measures, the CIN has worked to create specialty specific scorecards which displays only that particular section’s measures. The current eight lines of business will notice these changes now on the scorecard.

New team members

Also, as it relates to the additional PPG specialties in the CIN, we have hired two new provider relations specialists to support those specialties, Mariah Kiefer and Kathie Hoerdt. We warmly welcome them to the team!

Clinically Integrated Network's Governance Structure

Board

Thomas Bond, MD - Chair
Thomas Gutwein, MD - Sectretary
Jeffrey Brookes, MD
Thomas Curfman, MD
Raymond Dusman, MD
Michael Grabowski, MD
Alan McGee, MD
Berry Miller, MD
David Stein, MD
Mitch Stucky, MD
David Jeans
Ben Miles

Quality & Process Improvement (QPIC)

Thomas Bond, MD - Chair
Lemuel Barrido, MD
Fen-Lei Chang, MD
Harin Chhatiawala, MD
Paul Conarty, MD
James Ingram, MD
Greg Johnson, DO
Vijay Kamineni, MD
Joshua Kline, MD
Jeffrey Nickel, MD
Richard Nielsen, MD
Andrew O'Shaughnessy, MD
Jason Row, MD
Ronald Sarrazine, MD
David Stein, MD
Anusha Valluru, MD

Administrative Team

Chief Clinical Integration Officer - Greg Johnson, DO
Vice President Enterprise Management - Joni Hissong
Director Clinically Integrated Network - Nicole Krouse
Supervisor Clinically Integrated Network - Katrina Koehler

Finance Committee

David Stein, MD - Chair
Raymond Dusman, MD
Scott Karr, MD
Jason Row, MD
Mitch Stucky, MD
Greg Johnson, DO
David Jeans

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Contact Us

If you have questions or suggestions about measures, appeals, scorecards, etc., please contact your provider relations specialist or the CIN supervisor:

Katrina Koehler, RN
Phone: 260-266-6530
Email: Katrina.Koehler@parkview.com
 

If you would like to join or have questions about Parkview Care Partners, please contact the CIN director:

Nicole Krouse
Phone: 260-266-3709
Email: Nicole.Krouse@parkview.com

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