Digital Diabetes Tools

Recorded on November 1, 2018

Summary of Medical Director Advisory Council (MDAC) on Demand call

Objectives of the call

Provide resource for coalitions to pose questions to an experienced group of medical directors about any issues broadly related to clinical topics or services
Foster discussion with input from multiple perspectives
Encourage use of the medical director group as a valued National Alliance resource – either via these monthly calls or more directly involved/contracted engagement

Topics:

The Alliance: We’re implementing a direct primary care model with contracted vendor staffing, and we’re looking for medical director support to meaningfully evaluate the clinical effectiveness of the offering. Is there an opportunity for an ad hoc role for data analysis and clinical oversight?

Discussion points:

Important to note scope of clinical input, which may include both a clinical role as well as primary care business operations role. The MDAC has expertise in both areas.
Ensure that staffing for the clinic recognizes the role of The Alliance in guiding clinical focus, rather than exerting control over clinical services. This will ensure that The Alliance has ownership to maximize impact and value of provided services.
Define metrics and target clinical and engagement goals to best align services with clinical priorities. This can ultimately lead to opportunities for risk-based contracting.
MDAC can also provide support for contract review from a clinical perspective.
Recommended involvement with initial metrics development, with at least quarterly data collection to start. Once approach is formalized, can likely shift to involvement on more of an as needed basis.
Important to also use such clinics as a hub for referral to other employer benefits offerings, including chronic condition management, for example.
Resources:
- National Association of Worksite Health Centers (Larry Boress) has a white paper related to measurement of worksite clinic value – may be of use in identifying priorities.

Sherman/Fabius paper about quantifying the value of worksite clinics (available on request from Bruce Sherman – bws@case.edu)
Sherman/Parry paper about metrics for assessing patient-centered medical home value. https://www.pcpcc.org/sites/default/files/media/metrics_guide_2011_0.pdf

Wyoming Business Coalition on Health: Healthcare costs in Wyoming are 40-50% more expensive than in Montana; data suggest that substantially lower use of primary care may be contributory. What can employers do to increase primary care use?

Discussion points:

Need to clarify reasons for low primary care use – is it a question of primary care clinician supply, after-hours access for hourly workers, or benefit design that limits primary care access? The claims data should provide evidence for the first question, and may be helpful for the third; it may be worth pursuing additional data sources (PCP office hours) to determine after-hours access is an issue.
May also be worth evaluating avoidable/preventable hospitalizations, using the associated AHRQ metrics: https://www.ahrq.gov/downloads/pub/ahrqqi/pqiguide.pdf
Potential solutions:
1. Telehealth as a potential consideration for primary care services
2. On-site/near-site clinics staffed by either primary care physicians or nurse practitioners
Contact high-quality, popular primary care physicians and partner with employers to expand primary care office hours

Promote use of retail clinics if available for primary care services
Expand communications regarding importance of primary care for helping to control out-of-pocket healthcare costs

Mike Thompson: Why haven’t we made more of an impact on controlling waste in healthcare?

Discussion points:

Multiple contributors to waste, including fraud and abuse (typically seen in Medicare and Medicaid), as well as rapid evolution in evidence-based healthcare – physician habits often not keeping up
Need “big data” to help with identification of issues
Unnecessary care a significant contributor to waste, as evidenced by Choosing Wisely data
Need to activate healthcare consumers, increase access to price transparency
Coalitions can help to improve care coordination and promote safety (via Leapfrog)
Coalitions can also engage in regional quality improvement activities to drive more appropriate healthcare utilization
Practical steps – considerations
1. Choose 1-3 areas where waste exists, work with data aggregators to generate physician report cards and share data. Physicians will respond by improving their scores.
2. Look specifically at unnecessary services or services done at costly locations without added value (e.g., hospital MRI vs. free-standing MRI facility). Since unit cost has been the predominant driver of healthcare cost increases, drive use of services where lower cost is available.
Consider claims review to identify inaccuracies – many vendors offer this service with payment as a percentage of recovered dollars. Most employers expect plans to provide, but effectiveness of plan services may not be sufficient.