Achieving National Quality Measurement and Reporting: A Purchaser Perspective

David S. P. Hopkins, Ph.D.Pacific Business Group on Health

AcademyHealth ARMJune 5, 2007

© Pacific Business Group on Health, 2007 2

IOM Performance Measurement Principles

“A performance measurement system should provide information for multiple uses, including:

Provider-led improvement efforts Public reporting Payment and benefit design Population health initiatives.”

-- excerpted from Performance Measurement:

Accelerating Improvement, p. 48

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Consumer-Purchaser Disclosure Project:

Performance Measurement Seen Through Consumers’ & Purchasers’ Eyes Scope and pace of measure development and

implementation too narrow and slow Pressing sense of urgency

Real consumer/patient choices being made with little real information

Cost pressures leading to benefit designs and purchasing strategies too often “value-blind”

Robust performance dashboard essential Consumer engagement requires relevant and adequate

information Plan designs, payment systems and networks must recognize

quality and efficiency Performance information must be valid and rapidly

available: don’t let perfection be the enemy of the public good.

© Pacific Business Group on Health, 2007 4

Consumers and Purchasers Guidance on Measure Development Criteria

Reasonable scientific acceptability Based on consumer’s perspective, not academic perfection

Feasible Favor measures that can be populated with currently available

electronic data Relevant to consumers and purchasers

Important and actionable: full “STEEEP” dashboard Enable consumer choice Show high variation in performance Affect large numbers of patients or total health care spending Shed light on overall, cross-cutting, or condition-specific

performance Provide better understanding of disparities Capture outcomes

Reflect continuum of care

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How well have early standardization efforts delivered a robust measure set (per IOM 6 domains)? (* = minimal measure set; ** = partial measure set; *** = robust measure set)

Measure Type Robust Measure Set NQF-Endorsed Measures

(as of 6/1/07) Effectiveness/Timeliness Process

Wide set of conditions Coordination of care

* *

Effectiveness – Outcomes Mortality/morbidity/ functional health status Wide set of conditions

*

Safety NQF Safe Practices (Leapfrog) Infections/errors AHRQ Patient Safety Indicators Nursing Indicators

*

Patient Centeredness C-CAHPS/H-CAHPS + other important domains

Shared decision-making Coordination of care Safety/errors

* *

Equity Measures for population subgroups

0

Cost-Efficiency Cost to payers Resource use Multiple time frames

0

© Pacific Business Group on Health, 2007 6

National Efforts Lagging Local/Regional Initiatives Leapfrog Hospital Rewards – NQF-endorsed

quality measures + resource efficiency measures

Bridges to Excellence – systematic office processes + demonstrated excellence in 3 clinical areas

HealthPartners Optimal Diabetes Care – patient-centered view leads to “all-or-none” measurement

Mass. General Insurance Commission – physician-level clinical quality + cost-efficiency using best in class vendor tools

Hospital Infections Reporting (PA, MO, FL)

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Better Quality Information (BQI) Pilots 6 Pilots: CA, AZ, IN, MA, MN, WI Selected through competitive RFP managed by AQA

(formerly Ambulatory Quality Alliance) Focus is on aggregating Medicare and commercial

data to measure and report on physician practice performance Intended for use by consumers and providers

Contracted with CMS Limited scope of work: 5 nationally-endorsed quality

measures initially, building to 12 3 measurement cycles: 2 in 2007, 1 in 2008

© Pacific Business Group on Health, 2007 8

Goals for the BQI Pilots

Demonstrate effective public/private partnership Combine public and private data to achieve large “n”

for measurement Inform the expansion of consensus measures

nationally Demonstrate feasibility of collection of AQA endorsed

performance measures Test additional measures that are feasible to collect and

conform to AQA measure principles Speed adoption and reporting of valid, robust

performance measures for use by: Physicians and hospitals Consumers Purchasers Payers

© Pacific Business Group on Health, 2007 9

BQI Challenges

MeasuresSeeking a robust set – quality + cost-efficiencyMany specialties, not just 1° careConsumers and purchasers want to choose/pay

based on outcomes Data

Chart review not scalable at statewide level (40,000+ practicing physicians)

CPT-II codes good in concept, but lacking a path to implementation need both CMS and private sector

Limited by what is electronically available today: claims, Rx, some lab

© Pacific Business Group on Health, 2007 10

Dynamic Tensions in Physician Performance Measurement Provider desires for “actionable” measures vs.

consumer primary interest in outcomes Provider demands for precision (p<0.05) vs.

consumer tolerance for some misclassificationMilstein, et al., Health System Change, 2007

majority of consumers surveyed willing to accept >5% inaccuracy in physician performance ratings; 20+% willing to accept 20-50% inaccuracy

Feasibility: measures requiring new coding vs. measures driven off available electronic data