New Developments in Funding of CME

1. New Developments in Funding of CME OSMACME Providers Update July 12 and 13, 2006

2. Current Situation of OSMA’s accredited CME Providers • Decreased funding from pharmaceutical companies • Increased scrutiny of funding • Increased emphasis on centralization of grant requests • Decrease in number of CME offerings

3. Proposal of Block Grant • Alliance for CME meeting in January 2006 • Idea originated with Medical Association of Georgia (MAG) • Block grant to State Medical Societies • CME providers apply to SMS • Grants awarded by SMS

4. Steering Committee • Five states: Georgia, Florida, Massachusetts, Oklahoma, Colorado • Will set criteria for grant requests/review • Local grant committee will award the grants

5. Initial Pharmaceutical Company • Topics: depression, mood disorders, anxiety, PTSD • Emphasis on Outcomes Measurements • Dream CME programs • Final approval—soon!

6. Additional Pharmaceutical Companies • One other company with very strong interest • Second block grant request to be submitted soon!

7. Future • Other pharmaceutical companies will buy in to “outsourcing” concept • Line item on annual budget of pharmaceutical industry for SMS

8. CME Outcomes Measurements OSMA CME Providers Update July 12 and 13, 2006

9. Levels of Educational Outcomes Derek Dietze A-CME January 2006

10. Participation Satisfaction Learning Performance Patient Health Population Health The number of people who registered and/or participated The degree to which participants’ expectations about the setting/delivery of CME activity were met Changes in self-reported knowledge of participants; development of competence Changes in observed practice performance; the application of learning; the application of competence Changes in the health status of patients due to changes in participant practice behavior Changes in the health status of a population of patients due to changes in widespread practice behavior

11. Forces driving CME Outcomes Measurement • Accountability for effectiveness, impact, and use of resources • Performance improvement movement • MOC and MOL requirements/initiatives • Pay for Performance movement • Increasingly a requirement of commercial support • ACCME is “raising the bar” for providers • CME community’s desire for continuous improvement

12. Practical Strategies for Better Outcomes Carol Havens, A-CME January 2006 and MAG’s CME Outcomes Institute, June 2006

13. good outcomes start with good needs assessment • If you don’t know where you’re going…how do you know when you’ve arrived? • If you don’t know where you started…how will you know if you’ve gone anywhere?

14. the cme process… • Needs link to objectives which link to outcomes • Effective education utilizes multiple interventions • Outcomes, measured in multiple ways over time, document change in clinician practice and patient health status • Outcomes identify future needs

15. Linking CME Needs to Objectives & Outcomes Needs Assessment CME Objectives CME Program or Activity Multiple Interventions Outcome Levels 1-2 Intermediate Outcomes Change in skills, knowledge, or attitude; intent to change Outcome Levels 3-5 Long-Term Outcomes Change in clinician practice or pt. health status

16. why measure cme outcomes? • CME can help move the “Big Dots” • Quality & utilization • Functional outcomes • Mortality rates • Patient safety • Adverse drug events • Patient satisfaction • Screening, diagnostic, treatment, prescribing, immunization rates • HEDIS. JCAHO, NCQA • Healthcare costs

17. why measure cme outcomes? • Leads to more effective, better-targeted education • Demonstrates value to internal & external clients in a climate of shifting funding • Provides a road map to future education • ACCME mandates outcomes measurement

18. the cme paradigm shift

19. five-level outcomes model Level 1Participant satisfaction (the smile sheet) Level 2Change in knowledge, skills or attitude; intent to change Level 3 Self-reported change in clinician behavior or practice Level 4Objectively-measured change in clinician behavior or practice Level 5 Objectively-measured change in patient health status

20. Rates the quality, usefulness, objectives, presentation, faculty, or learning experience Provides feedback on overall quality, faculty, and instructional design Provides limited value in describing the impact of the learning activity level 1participant satisfaction

21. Includes pre-tests/posttests, skill observation, and commitment to change measures Documents learning (knowledge, attitudes, skills) Intent to change has high correlation with actual behavior change Learning may or may not lead to actual behavior change level 2change in knowledge, attitudes, or skills; intent to change

22. Follow-up assessment of implemented practice change Measures are simple and practical and document impact on practice behavior Provides rich information about intended and unintended consequences of CME Tends to be subjective level 3 self-reported behavior change

23. Assesses change in practice data such as quality and utilization measures Objective data are very useful in assessing needs and charting post-activity progress May not capture the breadth or complexity of new behaviors May be difficult to distinguish learners’ data in the context of a large practice group level 4 objectively-measured change in practice

24. Assesses progress toward ultimate goal of improved patient health Tracks net effect of practice change on patients and target populations May take long time periods to reflect change in health status Change may be hard to measure or obscured by co-morbidity level 5 objectively-measured change in treatment outcomes or health status

25. typical timeframes for measuring cme outcomes

26. monitoring overall cme program effectiveness • Track outcomes level by program or intervention • Compare annual trends • Examine value of CME with higher-level outcomes (levels 4-5) • Target high-value programs with low outcomes for improvement

27. better outcomes result from… • Clear measures of gaps in practice • Needs-based objectives • Multiple educational interventions • Multiple high-level evaluation methods(qualitative and quantitative) • Time, thoughtfulness, & patience