John Poris has been selected as a "Quality Improvement Coach" for IPIP, a comprehensive approach at improving Health Care.  IPIP is currently soliciting additional volunteers to work in Michigan on Practice Improvement on a Pro Bono basis To volunteer, contact: Rose M. Steiner RN, BSN, MBA State Director - Michigan IPIP AIAG 26200 Lahser, Suite 200 Southfield, MI 48034 Ph:  (248) 213-4656 Fax: (248) 213-4672 (confidential) Cell:  (989) 860-7332 E-mail:  rsteiner@aiag.org   For details about IPIP, see the summary below.  You can also visit IPIP's website:  http://ipip.aiag.org/: Improving Performance In Practice (IPIP) Quality Improvement Coach Informational Presentation Health care focuses on the care of people.  Is it possible to use methods successful in the manufacturing environment to improve the quality in the healthcare environment? I. What is IPIP? IPIP Defined • Began with a grant from the Robert Woods Johnson foundation to the American Board of Medical Specialties • Provided ‘seed money’ to states to initiate a state-wide initiative to help practices improve their patient’s care of chronic illness and improve efficiency of the practice. • Each state to develop their own design, based upon the national change package and the chronic care model, with report of aggregate metrics to national monthly The National Aim of IPIP “To develop a system that enables primary care physicians to assess and improve quality of practice for chronic illness and preventive care in a common uniform approach across specialties.” Dr. Darren DeWalt November 14, 2007 IPIP States • Cohort 1: Prototype; CO and NC • Cohort 2: Re-focus; MI and PA • Cohort 3: Spread; MN, WA and WI • Cohort 4: Associate Partners Michigan IPIP - State Structure Michigan Primary Care Consortium (MPCC) (Michigan IPIP Sponsor) It all started in 2004 with the Michigan Primary Care Initiative… Impetus for the Primary Care Initiative Crisis in American healthcare system • Consumers are not receiving the recommended evidence-based preventive and chronic disease care (NEJM, 2003) • Soaring healthcare costs (relative to chronic disease) Michigan’s Healthcare Landscape •Increasing chronic disease burden due to unhealthy lifestyles and aging population •Shrinking primary care workforce •Primary healthcare system is not designed to provide effective, efficient chronic disease and preventive care Other MPCI Drivers • Public health has traditionally used a “silo” approach - developing independent, parallel, programs for specific chronic disease and prevention areas such as diabetes, heart disease, and cancer • Primary care providers need an integrated chronic disease “package” • Significant benefits occur when public and private sectors work together. Limitations of Past Efforts •Emphasis has been on the physician, not on the primary health care system and its barriers •Duplicative/competing organizational initiatives have provided few opportunities for sharing results and lessons learned regarding what does and does not work. •Minimal integration of quality improvement efforts across care settings Created in 2004 to resolve the major system and practice barriers that impact the quality of healthcare and contribute to ever escalating costs – 200 stakeholders were involved – Workgroups researched five major barriers and a strategic plan was created to resolve them and transform primary care in Michigan            www.MPCI.org The Michigan Primary Care Consortium and its Initiative A collaborative partnership between primary care, public health and the broader healthcare community 2006: A Name Change From: Michigan Primary Care Initiative (MPCI) To : Michigan Primary Care Consortium (MPCC) MPCC Mission To improve the system of delivery of preventive services and the management of chronic disease and other conditions in primary care settings throughout Michigan by aligning quality improvement initiatives, addressing gaps, and engaging in problem solving strategies so as to assure a medical home for everyone. MPCC Vision By 2010, key system-level barriers are resolved and the primary care delivery system is: – -Making effective use of community health resources    – -Incorporating health information technology, including patient registries, to improve the safety and quality of health care services    – -Receiving adequate reimbursement for prevention services and chronic disease management      – Using quality and process improvement methods and tools to redesign the provision of chronic disease and preventive services in primary care practices – Consistently using the evidence-based practice guidelines of the Michigan Quality Improvement Consortium – By 2015, every primary care patient has a medical home and is consistently receiving evidence-based preventive and chronic disease care. – Changes to assure quality care are embedded into primary care practices across the state. MPPC Steering Committee Members represent diverse stakeholders – Primary Care Professional Associations – Health Plans and Insurance Companies – Business/Industry – Public Health – Regional Health Programs – Universities – Consumer Groups – Others Top Obstacles to Office Efficiency (July 07 Needs Assessment Survey) • Problems with support staff (28) • Poor reimbursement for services (21) • Excessive paperwork (17) • Prior authorization requirements (13) • Lack of electronic medical records (13) or difficulties transitioning to EMRs (10) • Patients skipping appointments (10) or arriving with multiple concerns (9) Environmental Scan Website Provides information on organizations, programs and resources for – Patient-centered medical homes – Quality and process improvement – Redesign of practice operations – Electronic tools – Advisors/consultants www.stjohndoctors.org/practicetransformation IPIP/MPCC Synergy with PCMH IPIP states of North Carolina, Colorado, and Pennsylvania are involved in patient - centered medical home pilot programs MI IPIP/MPCC convened a stakeholder meeting April 17,2008 to explore interest in a multipayer, multi- state pilot demonstration (and have had 2 meetings since!) IPIP/MPCC Synergy with PCMH – There is good alignment between the PCMH and IPIP models – Practices wishing to attain NCQA recognition as a PCMH can meet several standard components through participation with IPIP MPCC Planned Activities – MPCC chose 4 PCMH projects as top priorities for 08/09 – Includes • Obtaining stakeholder consensus on PCMH definition and measures • Payment reform • Educational materials for consumers, policy makers and health care professionals MPCC Synergy with PCMH MPCC will advocate for high leverage system improvements e.g. use of – Patient Registries and other IT – Embedded evidence-based Guidelines – Payment Reform – Linkages to Community Resources Michigan IPIP : A Primary Care Quality Improvement Initiative Industry/Health Care Collaboration Michigan IPIP features a unique collaboration between industry and primary health care • MPCC is the program’s sponsor. • AIAG is the fiduciary agent AIAG What is the AIAG? – Automotive Industry Action Group • Has worked with Quality, and been involved in crafting the quality documents for the automotive industry for years. • Co-authored the current QS/ISO document for healthcare titled the “Business Operation System” (BOS) • Has Health Steering Committee dedicated to improving the health care environment, with employer members and others on the group. How does the AIAG help? IPIP staff/consultants reside at the AIAG facility in Southfield, and will be IPIP contacts for practices – Dave Lalain – Director of Life Sciences      • Responsible for the IPIP budget, as well as quality consultant – Rose Steiner – State Director – IPIP – Nancy Malo – Program Manager for Life Sciences – Mark Mroz – Project Assistant – Becky Snyder – Six Sigma Master Black Belt      • On loan from Ford Motor Company      • Is our quality expert in residence, helps with education of coaches, curriculum development and consultant for practices related to process improvement AIAG provides administrative assistance, as well as performs the financial governance of the program – AIAG Web site with E-communities for the various communities – IPIP web site housed on their server • www.ipip.aiag.org – All meetings are scheduled through the AIAG administrative assistance, and all records of meetings viewable on the respective e-community – Physical facility for meetings and educational sessions at AIAG How does the AIAG help? II. Where do the coaches fit in? Industry/Health Care Collaboration Industry trained quality and process improvement experts will coach primary care practices – Coaches will be interviewed, and selected based upon their capabilities to do this work – Coaches will be trained in the Medical Culture, but certainly rely on the practice medical experts for that side of the practice improvement equation. – This work is done by the coaches on a Pro Bono basis, with most coaches volunteering to use their skills to improve “their” health system. Selecting Coaches Coaches are recruited from various industries using contacts in the American Society for Quality, as well as personal referral from other coaches who have gone through our training. Coaches have the following expertise: – Quality Improvement – Lean – Quality System Management (QS/ISO/TS) – System Integration Quality Improvement Coach Selection Process Quality Expert (Lean/Six Sigma/QMS/Other) applies for volunteer position as a practice coach for IPIP; completes application and skills list Applicant interviewed by panel consisting of State Director, Practice Manager and Quality Expert Final acceptance as coach based upon skill set in quality, communication skills, availability to perform role, commitment to coach practice for one year minimum All selected applicants must complete QIC training (all segments), sign QIC agreement, and provide availability (geographic, days and times) Coaches paired with practice, and improvement process begins. All activity monitored by state program director Desired Outcomes are: • Improved office efficiency • Improved clinical outcomes • Established planned care processes • Increased number of practices in Michigan participating (spread) How Can Coaches Help? • Improved office efficiency – Using Lean/Six Sigma methods, the coaches will evaluate current office processes and work with you to make them more efficient • Improved clinical outcomes – Coaches help the team implement ‘standardized work’ to improve clinical outcomes. These are based upon evidencedbased guidelines. • Established planned care processes – The use of templates for care, with standardized work, will help achieve this outcome • Increased number of practices in Michigan participating (spread) – As practices begin to improve with the coaching and education, other practices will want the same benefit Education of Coaches All coaches are required to attend the 1 ½ day training session, and complete all homework. In addition, they are to attend a 1 ½ hour session on the first Monday of the month, which also includes educational content. Education of Coaches The agenda of coach training is: • Introduction to IPIP • Medical Practice 101: The Basics • IPIP Change Package/Systems Diagram • Overview of the Chronic Care Model • Introduction to the Patient Centered Medical Home • Diabetic care using the Chronic Care Model • The IPIP measurement and reporting plan • The Model for Improvement and AIM • BTS Collaborative in conjunction with coaching Education of Coaches In addition, topics presented at the monthly session include: – Asthma overview and care using the CCM – Physician Organizations and their role – The role of payers in medical practices – Value Stream Mapping in the practice setting – Practice Transformation Other topics are planned for the future as well.  The key is to introduce industry coaches to the medical culture so that they can identify with the practice staff as they work with them. The Role of the Coach The main work of IPIP is done by the Practice Improvement Team (discussed later). The coach is a part of that team, and are there to: – guide the practice improvement activity – share Lean/Six Sigma/QMS tools that will enhance the process – educate on the use of process improvement tools – help move the team’s activities toward their goal Matching Process MATCH •Location •Time of Meeting •Fill out •Time of work Application •Attend training *Usually Lunch Time is sweet spot Pool of Quality Improvement Coaches orientated to IPIP Doctor’s Practices that have applied & completed the Initial assessment & been accepted for the initiative Practice Selection Criteria Each Practice MUST have a Quality Champion (can be one of individuals below) • Lead Physician • Lead Clinical Professional • Lead Practice Manager (likely person for Quality Champion) This is the Practice Improvement Team What Practices are to expect… III. What’s in it for the Practice? Primary Care: An impossible job? “Across the globe doctors are miserable because they feel like hamsters on a treadmill.  They must run faster just to stand still… The result of the wheel going faster is not only a reduction in the quality of care but also a reduction in professional satisfaction and in increase in burnout among doctors.” SOURCE: Morrison & Smith. BMJ 2000: 321: 1541. Reality Check • Practice redesign brings resource savings, but takes time, effort and resolve • Enhanced payment must be adequate to cover more than just the costs of practice redesign and enhancement • Practice redesign must also return professional joy and security to primary care so that increasing numbers of students will enter the field