The SETMA Model of Care includes five steps:
- The tracking by each provider on each patient of the provider’s performance on preventive and screening care and on quality standards for acute and chronic care. This occurs simultaneously with care given by the healthcare team, including personal provider, nurse and clerk. Data aggregation occurs automatically at all points-of-care.
- The auditing on the above standards is done for the practice, each clinic, or each provider. The focus of the audit is an individual patient, a unique population of patients, or a panel of patients.
- The statistical analyzing of audit results to measure improvement by practice, by clinic, or by provider. This includes analysis for ethnic disparities, and other discriminators such as age, gender, payer class, socio-economic groupings, education, frequency of visit, frequency of testing, etc. This allows SETMA to look for leverage points through which to improve care and/or to design quality improvement initiatives.
- The public reporting by provider name of performance over 200 quality measures. This helps overcome “clinical inertia,” by pressuring all providers to improve; it also allows providers and patients to know what is expected of them. The disease management tools “plans of care” and the medical-home-coordination document summarize a patient’s care and encourages him/her to ask the provider for any preventive or screening care which has not been provided.
- The design of Quality Assessment and Performance Improvement Initiatives – SETMA’s 2011 initiatives involved the elimination of all ethnic disparities of care for diabetes, hypertension and dyslipidemia, and reducing hospital preventable readmissions.
The key to this Model is the real-time ability of providers to measure their own performance at the point-of-care. This is done with multiple displays of quality metric sets, with real-time aggregation of performance, incidental to excellent care. The following are several examples which are used by SETMA providers.
There are similar tools for all of the quality metrics which SETMA providers track each day. The following is the tool for NQF measures currently tracked and audited by SETMA:
Providers’ compliance with these measures is color coded for quick reference: “Black” means that the measure applies to the patient and has been done; “Red” means the measure applies and has not been done; “Gray” means that the measure does not apply. The “view” button allows the provider to review the content of the metric and the patient’s results. Real-time auditing of performance by providers at the point-of-care provides leverage for performance improvement.
Below are examples of auditing dashboards for provider performance analysis. Note: Columns in gold represent patients treated to goal and those in purple are the patients not treated to goal.
SETMA is able to look at differences between the care of patients who are treated to goal and those who are not. Patients can be compared as to socio-economic characteristics, ethnicity, frequency of evaluation by visits, and by laboratory analysis, numbers of medications, payer class, cultural, financial and other barriers to care, gender and other differences. This analysis can suggest ways in which to modify care in order to get all patients to goal.
SETMA can also compare different providers and different clinics with one another:
SETMA’s provider performance is benchmarked against published, evidence-based, national standards of care. Because SETMA has deployed a robust Business Intelligence (BI) solution for data auditing and analytics, and because we have bought multiple licenses, practice leadership, informatics staff and healthcare providers can review performance ourcomes. SETMA also has monthly peer-review sessions with all providers. The clinic is closed for a morning, and performance on quality metrics, patient satisfaction and gaps in care are discussed openly among all providers.
Collegial relationships and an organizational-cultural commitment to excellence make it possible for SETMA to be specific about needs for improvement in these monthly meetings.
Dashboards are color coded: “white” is to goal, “yellow” needs improvement, and “red” is unacceptable. This display is of NQF Diabetes Metrics on HbA1c and LDL:
Comparing 2007 results with 1/1/2011-12/31/2011, shows that the quality standards are still being met. HbA1c percentages above 9.0% are shown in red as SETMA “standard” is that this value should be zero, but the NCQA benchmark is less than 15% of the patients being treated for diabetes. All but one SETMA provider exceeds that standard.
Special Dashboards – NCQA Diabetes Recognition Program Audit
Specific dashboards, such as the one above, have also been developed for programs such as the NCQA Diabetes Recognition Program. All SETMA clinics and providers qualified for this recognition in 2010-2013. Quarterly and annually, we now measure this standard so as to make sure that we continue to improve. As can be seen below, the dashboard gives the metric, the benchmark, the provider’s performance and the aggregate score required for recognition. This material is given to the provider and it is posted on our website under Public Reporting, NCQA Diabetes Recognition Program Audit. Because all deficiencies in care are displayed in “red,” SETMA providers have developed their own commitment to “get the RED out.”
Medical Home Feedback Report – CMS Study Contracted with RTI International -- 2011
This study compared 312 Medical Home Practices with matched, benchmark practices which did not employ care coordination. It contrasted the practices on “Quality, Coordination & Cost for the years 2007-2008, 2008-2009 and 2009-2010. This result is for the SETMA II Clinic.
SETMA’s results are excellent. Our quality is superior to all. Our coordination results are superior to the benchmarks and comparable with the mean of the 312 Medical Homes. Our costs are superior to the benchmarks. Our total annual medical cost per capita for Fee-for-Service Medicare beneficiaries is 37.5% below the benchmarks. While our goal is always to improve, these CMS-generated results show that our model works.