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VilaHealth_QualityMetricsTrackingTranscript.pdf
5/8/22, 4:42 PM Vila Health: Quality Metrics Tracking Transcript
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Vila Health ® Activity
Quality Metrics Tracking
Introduction
Challenge Details
Your Of�ce
Sacred Heart Hospital
EHR Meeting
Conclusion
Introduction An accountable care organization (ACO) is a health care organization that follows a model where reimbursements are directly tied to quality metrics and reduced costs. Or, according to the Centers for Medicare and Medicaid Services, "Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients."
Not all health care organizations are ACOs. In order to become
an ACO, health organizations may need to make quality
improvements—and in order to make these improvements, they
may need to track their quality metrics better in order to
document the kinds of changes they need to make. This can be
a challenge at small rural hospitals where quality metrics have
not been tracked well in the past. Because care coordinators
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work closely with patients are aware of barriers to care and
other community issues, they may be asked to assist in the
process of helping to devise a better metrics tracking system so
that the hospital might qualify to become an ACO.
After completing the activity, you will be prepared to:
Investigate strategies for expanding the health information
technology (HIT) at a small rural hospital to better track
quality metrics.
Recommend strategies for improving the tracking of quality
metrics at a small rural hospital so that this hospital can
qualify to become an ACO.
Challenge Details You continue your work as a newly hired case manager at
Sacred Heart Hospital, located in Valley City, North Dakota. As
you know, SHH was recently acquired by Vila Health, a large
health care system that operates hospitals and clinics in
several Midwestern states.
Vila Health wants all of its hospitals to be Accountable Care
Organizations. However, as a small rural hospital, SHH will
have to make many improvements in order to qualify for ACO
status. In order to develop a strategy for making these
improvements, the �rst step will be to track quality metrics
better so that the hospital will have data to work with to
measure problems and to track improvements. You, the new
case manager, will be asked to develop a strategy for tracking
quality metrics to help facilitate the hospital's quali�cation for
ACO status.
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Your Of�ce It looks like you have email from Karen Dellington, Admissions
and Discharge Director. Read the message, then review the
documents below.
Email From: Karen Dellington, Admissions and Discharge Director
Subject: Quality Metrics Tracking
Hello! Thank you so much for all your hard work in helping SHH
to develop a strategy for achieving Triple Aim Outcomes. The
hospital has another, similar project, and we need your help to
complete it.
As you know, SHH was recently acquired by Vila Health. Vila
Health wants all of its hospitals to become Accountable Care
Organizations (ACOs). However, in order to qualify to become
an ACO, SHH will have to make a number of quality
improvements.The Center for Medicaid and Medicare Services
says that an organization has to show quality improvements in
the following areas in order to become an ACO:
1. Patient experience.
2. Care coordination/patient safety.
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3. Preventative health.
4. At-risk population health.
For more information on ACOs, please read the Accountable
Care Organizations: What Providers Need to Know document,
which I will be sending to you.
After reading through the Barnes County Community Health
pro�le, and after interviewing various stakeholders at the
hospital and in the community, I know you're already aware of
some of these needed improvements. For example,
preventative care is an issue in this region. Patients are not
seeing their primary physicians often enough—or they don't
have primary physicians—and they aren't getting diagnostic
tests like mammograms or colonoscopies at a satisfactory rate.
Here's where we need your help. In order to make the
improvements we need to qualify as an ACO, we need to
improve our Health Information Technology (HIT) system so
that we are tracking quality metrics data better. We are not
doing a good job with this. Our EHR is out of date, and we're
not gathering nearly enough data from patients. We need you
to give us recommendations for how to improve our HIT so that
we track the information we need to understand fully how to
make the improvements we need to become an ACO.
So, here's what I'd like for you to do:
1. First, I'd like for you to meet with a patient named Caroline
McGlade, who has recently been diagnosed with breast
cancer. Mrs. McGlade is a typical example of one of our
patients who hasn't gotten enough preventative care. I'd
also like for you to look at her EHR—which, as you'll see,
isn't very thorough. As you think about this case, ask
yourself this: how could we be tracking data in cases like
this one better to help us to make the improvements we
need to qualify for ACO status?
2. Second, I'd like for you to interview a series of stakeholders
who can provide you with information about changes that
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need to be made in our HIT.
3. After completing these tasks, I need you to write
recommendations for how we can expand our HIT to better
include quality metrics—with the ultimate goal of qualifying
for ACO status.
This is a challenging assignment, but I know that you're up to
it! Best of luck.
Thanks,
Karen
Accountable Care Organizations: What Providers Need to Know The Centers for Medicare & Medicaid Services (CMS), an
agency within the Department of Health & Human Services
(HHS), �nalized regulations under the Affordable Care Act to
help doctors, hospitals, and other health care providers better
coordinate care for Medicare patients through Accountable
Care Organizations (ACOs). ACOs create incentives for health
care providers to work together to treat an individual patient
across care settings – including doctor's of�ces, hospitals, and
long-term care facilities. The Medicare Shared Savings
Program (Shared Savings Program) will reward ACOs that
lower their growth in health care costs while meeting
performance standards on quality of care and putting patients
�rst. Provider participation in an ACO is purely voluntary.
In developing the program regulations, CMS worked closely
with agencies across the Federal government to ensure a
coordinated and aligned inter- and intra-agency effort to
facilitate implementation of the Shared Savings Program.
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CMS encourages all interested providers and suppliers to
review this program's regulations and consider participating in
the Shared Savings Program.
This fact sheet provides an overview of ACOs.
Please download the PDF
(downloads/aco_providers_factsheet.pdf) for more information
from The Centers for Medicare & Medicaid Services (CMS).
Caroline McGlade-EHR Patient Information - 04/24/19
Patient Name: Caroline McGlade
Patient ID:
DOB:
Gender:
Phone:
Address:
Insurance:
Primary Care Provider: Dr. Brown
Contact Permissions: Mike McGlade, husband
History - 04/24/19 H&P: Mrs. McGlade is a 61-year-old woman with a PMH of
breast cancer.
Family Hx Mother:
Father: Alive.
Sister:
Meds on Adm:
Neuro:
Cardio: EKG Normal.
Respiratory:
GU: Menses have ceased.
GI:
POC:
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Allergies & Medication - 04/24/19 Allergies: NA.
Medication: Estrogen
Lab - 04/23/19 CBC:
RBC: 5.1
HCT: 38.8
HGB: 14.7
WBC: 11.1
MCV: 81
MCH: 31
PLT: 301
BMP:
Glucose: 399
BUN: 15
CR: 1.1
Sodium: 138
Potassium: 4.2Chloride: 106
Chloride: 106
Co2: 23
Calcium: 11
Protein: 7.9
CA-125-1700 U
Primary Care Notes - 04/24/19 04/21/19: Mrs. McGlade is a 61-year-old woman with a lump
that may be breast cancer. DX: Dr. McCall, suspected breast
cancer
Called Dr. Brown-GYN ONC. Consult expected for tomorrow.
Suggested CA-124, HCG, AFP prior to consult.
04/23/19:
04/24/19: MRI negative for spinal cord or brain lesions.
Plan of care: Breast oncology consult.
CBC, BMP, CA-125, HCG, AFP, Paracentesis, in am. PT, SW, CM
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consult.
GYN/ONC Note - 04/24/19 61-year-old woman with a possible PMH of breast cancer.
Her initial exam revealed an enlarged mass in right breast.
GYN/ONC physical exam. Based on physical presentation,
blood work and radiology studies, breast cancer is con�rmed.
Discuss with pt. treatment options such as surgery and/or
chemotherapy and radiation.
Barnes County Community Health Pro�le Barnes County, North Dakota Community Health Pro�le by Age
Group, 2000 Census
Age Group: 0-9
Barnes County:
1288
10.9%
North Dakota:
82,382
12.8%
Age Group: 10-19
Barnes County:
1811
15.4%
North Dakota:
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101,082
15.7%
Age Group: 20-29
Barnes County:
1371
11.6%
North Dakota:
89,295
13.9%
Age Group: 30-39
Barnes County:
1303
11.1%
North Dakota:
85,086
13.2%
Age Group: 40-49
Barnes County:
1803
15.3%
North Dakota:
98,449
15.3%
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Age Group: 50-59
Barnes County:
1327
11.3%
North Dakota:
66,921
10.4%
Age Group: 60-69
Barnes County:
1057
9.0%
North Dakota:
47,649
7.4%
Age Group: 70-79
Barnes County:
998
8.5%
North Dakota:
29,492
4.6%
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Age Group: 80+
Barnes County:
817
6.9%
North Dakota:
29,492
4.6%
Total
Barnes County:
11,775
100%
North Dakota:
642,200
100%
Age Group: 0-17
Barnes County:
2624
22.3%
North Dakota:
160,849
25.0%
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Age Group: 65+
Barnes County:
2332
19.8%
North Dakota:
94,478
14.7%
Barnes County, North Dakota Community Health Pro�le by
Race, 2000 Census
Race: White
Barnes County:
11,775
97.9%
North Dakota:
593,181
92.4%
Race: Black
Barnes County:
53
0.5%
North Dakota:
3916
0.6%
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Race: American Indian
Barnes County:
90
0.8%
North Dakota:
31,329
4.9%
Race: Asian
Barnes County:
22
0.2%
North Dakota:
3606
0.6%
Race: Paci�c Islander
Barnes County:
0
0%
North Dakota:
230
0%
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Race: Other
Barnes County:
14
0.1%
North Dakota:
2540
0.4
Race: Multirace
Barnes County:
67
0.6%
North Dakota:
7398
1.2%
Total
Barnes County:
11,775
100%
North Dakota:
642,200
100%
Marital Status of Persons Age 15 and Older, 2000 Census
Marital Status: Total Age 15+
Barnes County:
9693
100%
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North Dakota:
512,281
100%
Marital Status: Never Married
Barnes County:
2565
26.5%
North Dakota:
141,300
27.6%
Marital Status: Now Married
Barnes County:
5486
56.6%
North Dakota:
290,833
56.8%
Marital Status: Separated
Barnes County:
69
0.7%
North Dakota:
3610
0.7%
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Marital Status: Widowed
Barnes County:
863
8.9%
North Dakota:
36,702
7.2%
Marital Status: Widowed-Female
Barnes County:
716
7.4%
North Dakota:
30,346
5.9%
Marital Status: Divorced
Barnes County:
710
7.3%
North Dakota:
39,836
7.8%
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Marital Status: Divorced-Female
Barnes County:
381
3.9%
North Dakota:
21,235
4.1%
Barnes County Community Health Pro�le (PDF)
(downloads/BarnesCoPro�le-20101208.pdf)
It looks like you have a challenging task! You need to �gure
out how to improve the collection of quality metrics at SHH
so that the hospital can become an ACO.
Sacred Heart Hospital
It's time to meet Caroline McGlade, a 60-year-old patient who
has breast cancer. Remember, you've been asked to talk with
this patient because she's a typical example of someone who
hasn't been getting preventative care—a factor that makes it
dif�cult for the hospital to qualify for ACO status. Be sure to
refer back to her EHR, and think about ways the EHR could be
modi�ed to better collect qualify metrics for patients like this
one.
Caroline McGlade Patient, Sacred Heart Hospital
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Mrs. McGlade, how are you feeling? Caroline: I feel just �ne. A little scared, I guess. But it's hard to
believe I have cancer. I mean, I don't feel sick at all. I guess I'll
start feeling sick once they start giving me that chemo. I'm not
looking forward to that, believe me!
Can you tell me a little bit about yourself? Caroline: I guess you could say I'm a pretty typical lady from
Valley City—not very exciting! I've lived in this county all my life.
I grew up on a farm near Tower City. Then I got married to my
high school sweetheart and we live on a big plot of land about
45 minutes from here. I wouldn't want to live anywhere else.
Sometimes I wish we had more neighbors, but Mike and I like
living in the middle of nowhere! I guess you could say we're
independent spirits? That's how we were raised—we don't like
to be dependent on other people. We have four kids—our son
lives in Valley City and our three girls live in the Fargo-
Moorhead area. Nine grandkids so far.
How did you discover the cancer? Caroline: I felt a lump. It wasn't big and at �rst I didn't think it
was anything to worry about. I don't like running to the doctor
every time something feels weird in my body—I mean, that's
just part of getting old, right? But my daughter �nally
convinced me to get checked. And I guess I'm glad I did. Stage
3 breast cancer—that's pretty serious.
Have you ever gotten a mammogram? Caroline: Yeah. I think twice? Maybe three times? It's been a
long time though. I don't know…I guess they could've caught
the cancer earlier if I went more often. But I've heard that
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mammograms aren't all that important. You can �nd a lump
pretty easy by checking your breasts, right? And I do that once
a month or so.
Do you regularly see a gynecologist? Caroline: Well, I did when I was pregnant—but that was a long
time ago. My youngest daughter is 30 years old. And when I
needed birth control pills—then I used to go. But there's no
reason for me to go at my age, right? It's not like I need birth
control pills anymore—I mean, I �nished with menopause when
I was 47! I don't know—I guess maybe I should have gone
more often. But I really hate ... you know, putting my legs in
those icky metal things? I just don't like having doctors poking
around my private parts. Maybe if there were a woman doctor
around here I might have gone more often, but around here
there's not a lot of choice who you see. All the gynecologists
I've ever been to, they're old guys who are kind of creepy.
Do you regularly see a primary care physician? Caroline: No, not anymore. When Dr. Tucker was alive my
husband and I used to go… but he died about seven, eight
years ago? And we've never bothered �nding a new doctor.
Like I said, there aren't a lot of doctors around here, and we'd
have to drive 45 minutes to get to one. Gas is expensive, so we
don't like to go on trips that aren't necessary. And I don't want
to go to someone I don't know. Dr. Tucker, he was my doctor
since I was a teenager. I guess we ought to �nd a new doctor,
but we just don't get sick very often. A few times we've gone to
Urgent Care, but we don't like to go running to the doctor every
time we have some aches and pains. We can't stand people
who do that.
Have you ever gotten a colonoscopy?
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Caroline: NO! No no no. Nobody's sticking a camera up in there,
or whatever it is they do. My husband's never gotten one
either–I'm pretty sure he'd rather die! Besides, those tests costs
a fortune.
How do you feel about preventative care? Caroline: You mean, like shots and such? We got all the
immunizations for our kids. Oh, do you mean, like preventative
care for adults? Like getting your cholesterol checked and all
that? I don't know. I guess I kind of feel like that's a waste of
time. And it's expensive too. We just try to eat healthy and get
some exercise. Neither one of us is overweight, so it's not like
we're going to get diabetes or anything like that.
Why haven't you gotten more preventative care? Caroline: Well, why would we? Like I said, we're pretty healthy
and we don't like to run to the doctor for every little thing. If
there were a doctor around who I trusted, I guess I would go
more often. Plus going to the doctor is expensive. It didn't used
to be so bad when we were younger, but now going to the
doctor costs a fortune. My husband and I are doing okay, but
we de�nitely don' t have money for extras.
Have you always had health insurance? Caroline: No, we've almost never had health insurance. Just
during this one period when my husband was working in town
for a factory that closed down. But we have health insurance
now, thanks to that Obama! We don't have a choice anymore,
do we? Although much as I hate to admit it, maybe it's a good
thing we have insurance. Otherwise I don't know how we'd
pay for cancer treatments.
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Do you think your views about health care and preventative care are typical for people in this area? Caroline: Yeah. I don't know anyone who goes to the doctor a
lot. Most of the people I know, they have even less money than
we do. And like I said, people are independent around here.
People don't like to ask for help unless we really need it. So
going to the doctor a lot… I guess that's not something people
like to do around here.
Check Your Email
It looks like you have another email from Karen Dellington,
Admissions and Discharge Director.
Read the message below.
Email From: Karen Dellington, Admissions and Discharge Director
Subject: RE: Quality Metrics Tracking
I see you've spoken with Caroline McGlade! I wanted you to
meet with her because her case is typical of so many that we
see around here. We need to address the types of issues you
encountered with this patient—especially regarding
preventative care—if we're going to become an ACO. And
before we can do that, we need to gather data on these issues.
I've arranged for you to meet with a panel of four people at
SHH so you can ask them some questions about the strategies
we need to develop in order to better track quality metrics. The
panel will consist of:
1. Todd Chester, Director of Quality Assurance
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2. Mary Loudsinger, a social worker
3. Pete Wade, Director of Information Technology
4. Trish Walstrom, the Care Coordination Manager
Thanks again for your hard work!
–Karen
EHR Meeting
It looks like you'll be listening in on the SHH panel meeting.
Read the discussion around each question below.
Panel Participants:
Todd Chester: Sacred Heart Hospital Director of Quality Assurance
Trish Walstrom: Care Coordination Manager
Mary Loudsinger: Sacred Heart Hospital Social Worker
Pete Wade: Director of Information Technology
What is your opinion of the hospital's EHR? Trish: Um, well…
Pete: It's okay, Trish. You don't have to hold your tongue around
me. I know the hospital's EHR has a lot of problems.
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Todd: In all fairness, Pete, it's not worse than EHRs you'd �nd
at many small-town rural hospitals. We simply haven't had the
budget to improve it.
Pete: That's for sure. I don't have the budget to do much of
anything.
Todd: We just haven't made the EHR much of a priority. The
wish list of things we need at this hospital is pretty large, and
that's always lower on the list than things like new equipment.
But now that there's this push to become an ACO, we're going
to have to �nd the funds to upgrade the EHR. Otherwise, we're
never going to be able to track the metrics we need to make
improvements.
Trish: And that's the problem with the EHR, in my opinion. It's
not set up to track much of anything. Patients come in here
multiple times, and we have to ask them the same questions
over and over again because the EHR just isn't comprehensive
enough. And if the EHR isn't comprehensive enough to help
patients on an everyday basis, it sure isn't comprehensive
enough to be used for data collection purposes.
How would you recommend updating the hospital's EHR? Mary: Well, in my opinion, one of the biggest problems is that
there simply aren't enough categories to enter information. I
wish there was a social work tab so that I could keep track of
visits with patients. If we had that tab, we could record things
like patient barriers to care, and other important information
that might impact their treatment.
Trish: Oh, I totally agree, Mary. There's just not a lot of places to
add non-medical information.
Pete: I'm not sure what to do about that. it would be great if we
could add more categories, but that's not easy. We'd have to
work with the vendor, and that could be expensive.
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Todd: Oh, I know, Pete. But if we're ever going to become an
ACO, we might need to �nd a way to make this investment.
Trish: So, here's a suggestion for you, since you're the one
coming up with a strategy for tracking metrics. Why don't you
take a good look at our EHR and think about places where we
could add more categories? And other updates too.
Are there changes that need to be made in how the EHR is used? Trish: I'll say! The system takes a long time to navigate. It's not
the least bit intuitive. And that means that nurses and case
managers sometimes don't enter information as thoroughly as
they need to.
Pete: Aren't they required to �ll it out in detail?
Trish: Well, yes. But this hospital is understaffed. Sometimes
the EHR isn't �lled out as completely as it ought to be.
Pete: What? Now that sounds like a serious problem. How are
we ever going to use the EHR to track quality metrics if people
aren't even using it correctly?
Todd: I'm really glad you brought that up, Trish. We should
discuss this further. I know that part of the problem is technical;
we're going to need to spend some money to make the system
more user-friendly. But it sounds like we're going to need a
change management strategy as well. We need it to be the
norm for people to use the system correctly.
Trish: I'm �ne with that. But are you going to address the
reasons why people aren't �lling the EHR out completely? It's
not because anyone is lazy. It's because they're busy.
Todd: I understand that. And we do need to be cognizant of
people's schedules as we develop our change management
strategy.
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How can we better track issues related to preventative care? Todd: Well, like we've already discussed, we need to include
more �elds on the EHR so we can track more kinds of
information. Other than that, well, that's something we're really
going to need to discuss. I don't have all the answers. But I
can't emphasize enough what an important issue this is.
People are not getting the preventative care they need in this
county, and that's driving up costs and driving down quality of
care.
Pete: But how do we measure that?
Todd: Well, we do have data from Barnes County that
measures some statistics. For example, the data shows that
women aren't getting Pap smears and mammograms, and that
people aren't getting enough colonoscopies. That's a start. But
I think we need more nuanced data.
Trish: I agree. For example, the county data doesn't track what
percentage of women are seeing gynecologists, or how often
they're going. There's data about how many people don't have
a primary physician, but there's not data about how many
women see a gynecologist. And I'd like to see more nuanced
data in relation to mammograms. The only stat they provide is
how many women over 40 have had a mammogram in the
past two years. I'd like to know how often they get
mammograms, and how many women have never had one.
Mary: And in addition to these numbers, I'd like to know why.
Are women not getting mammograms because of cost? Or
because there aren't enough providers around here? Or
because they just don't think it's important? I mean, based on
my experience, I can tell you why I think women aren't getting
mammograms.
Pete: But we need nuanced data to back that up.
Mary: Exactly!
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Trish:And I think that's true for a lot of the county data. There's
good surface information in there, but we need more nuanced
data on a lot of different things. I recommend that you take the
time to read through the data carefully, and come up with
some ideas for areas where we need to do more nuanced
research.
Are there social factors that the hospital could be tracking better? Mary: Yes! Where do I ever start?
Trish: You could start with barriers to care. As a care
coordinator, I see every day that there are barriers to care that
make it dif�cult for people to get the care they need.
Mary: Absolutely. Poverty, lack of transportation, lack of access
to providers and specialists in this region—those are the big
barriers to care that we see all the time.
Trish: And there are other issues too, like our large population
of vets with PTSD—some of them don't want to go into town
and see a health provider.
Mary: Plus there's just the general attitude of distrust that a lot
of people around here have in regard to the health care system.
Pete: But how do you measure that in terms of quality metrics?
Mary: That's a good question, Pete. I don't know how to
measure that attitude, but I know from experience that it
serves as a very real barrier to care.
Pete: I don't mean to be a downer here, but I'm confused. I
know it's important for you all to track social factors so you can
treat patients better. But what does that have to do with
tracking quality metrics that would help us to become an ACO?
Todd: Good question, Pete. The thing is, we need to track
problems that are making it dif�cult for us to give the best
health care experience we can. And a lot of those problems are
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directly related to social issues, like poverty and other barriers
to care. If we can �gure out how to measure these problems
more effectively as they relate to health care, we could come up
with effective strategies for improving people's health care
experiences.
Are there special population needs we could be tracking better? Mary: We need to track the needs of returning vets. That's
pretty obvious to everyone around here.
Todd: Well, that's the thing, Mary. It's pretty obvious to the
people at this hospital that we need to be serving the needs of
vets better. But an outsider wouldn't know that because we're
not tracking that very well.
Pete: Doesn't that Barnes County Community Health Pro�le
have information about vets?
Trish: No, it actually doesn't, Pete! They have statistics about
suicides. And we know anecdotally that a lot of those suicides
are vets with PTSD, but we don't have stats to back that up.
Mary: And we're not tracking other things either, like home
care needs for disabled vets.
Pete: For starters, we could add a demographic box for
veterans on the EHR.
Mary: Great idea. And I hate to bring this up repeatedly, but if
there were a �eld in the EHR to enter information about social
work concerns, we could enter that information there as well.
Trish: Are there other special populations we need to be
tracking?
Mary: Of course. This county may be over 90 percent white, but
that doesn't mean there aren't people of color around here. We
need to do a better job tracking the needs of everyone in this
county.
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Are there partnerships that the hospital could form with other organizations to track metrics better? Mary: I think teaming up with the public health department
would be a good start, don't you? They're already collecting
data that we can use. Maybe we could work with them to
collect more nuanced data, or different kinds of data.
Todd: That's a very good idea, Mary. In addition, one thing I
think we really need to do is link our EHR with some of the
clinics in the area.
Pete: And like I said, that could be expensive.
Todd: I know. But we have to prioritize this.
Trish: I think we could do more than just linking the EHR. We
could work with clinics in the area to help us collect data about
things like barriers to care and other patient information.
Conclusion You have completed the Vila Health: Quality Metrics Tracking challenge. Based on this information, you should now be able to make recommendations for strategies that Sacred Heart Hospital can use to track quality metrics better—with the ultimate goal for becoming an ACO.
Investigate strategies for expanding the health information
technology (HIT) at a small rural hospital to better track
quality metrics.
Recommend strategies for improving the tracking of quality
metrics at a small rural hospital so that this hospital can
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qualify to become an ACO.
Licensed under a Creative Commons Attribution 3.0 License
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