Massachusetts Health Quality Partners

1
Massachusetts Health Quality Partners

• Presentation to the
• MA Health Care Quality Cost Councils
  Transparency Committee
• Barbra Rabson, Executive Director
• February 11, 2009

2
MHQP Team Structure

• Lead Contractor MHQP Subcontractor Milliman
• MHQP responsible for overall project management
  strong experience managing large, complex
  projects
• MHQP team responsible for all quality measures
  gt30 yrs experience
• Milliman responsible for development reporting
  of cost/price measures
• MHQP core team
• MHQP key staff
• Barbra Rabson, Jan Singer, Polly Marvin and
  Phakdey Yous
• MHQP consultants
• Kathy Coltin, John Freedman, M.D., Robert
  Rosofsky, Bill Rogers PhD
• Milliman core team
• John Phelan PhD, John Kasey, Andrew Naugle

3
Deliverables and Timeline for FY09

• Task I (due Mid-March 09) A high-level final
  report that includes an assessment of
• the Councils existing website, including any
  recommended changes to the measures and how they
  are displayed
• existing quality and cost measures available in
  publicly reported websites by others
• Task II (due June 09) A three year reporting
  plan for the Council including quality and cost
  measures. For recommended FY10 measures will
  focus on hospital (inpatient and outpatient) and
  ambulatory measures and will supply technical
  specifications.

4
Deliverables by QCC Meetings

• February Transparency/ QCC Meeting
• Introduction of project staff
• March Transparency/ QCC Meeting
• Task 1 deliverables due
• Strategic issues identified
• April Transparency/ QCC Meeting
• Interim reports
• Solicit input
• May Transparency/ QCC Meeting
• Interim reports
• Solicit input
• June Transparency/ QCC Meeting
• Task 2 three year reporting plan due

5
Shared Principles for Cost Measures Reporting

• The Council should publish a comprehensive and
  inclusive set of cost measures that reflect
  sufficient volume and relevance to be useful to
  an intended audience consumers, employers,
  providers, insurers or policy-makers.
• Cost measures should be accurate and reliable,
  and should be as timely as is feasible.
• Cost measures should include the range of costs
  per procedure for an individual provider, as well
  as the most likely cost (median, mean or mode).
• The Council should make efforts to display cost
  measures, to the extent possible, in ways that
  minimize harmful unintended consequences such as
  increased health care costs, collusion,
  introducing barriers to market entry, and other
  anti-competitive behavior.

6
Shared Principles for Cost Measures Reporting
(continued)

• 5. The Council should display
• cost and quality measures that are closely
  aligned on the same page
• cost measures that do not closely align with
  quality measures on separate pages and
• quality measures that do not closely align with
  cost measures on separate pages.
• In situations where either cost or quality
  information is displayed alone, the measures will
  be accompanied by clear, concise text that
  cautions users not to infer quality from cost, or
  vice-versa.

7
Shared Principles for Quality Measures Reporting

• 1. Wherever possible, measures should be drawn
  from nationally accepted standard measure sets.
•  
• 2. The measure must reflect something broadly
  accepted as meaningful to providers or patients.
•  
• 3. There must be empirical evidence that the
  measure provides stable and reliable information,
  and that the data sources and sample sizes are
  sufficient for accurate reporting at the level
  chosen.
•  
• 4. There must be sufficient variability or
  insufficient performance on the measure to merit
  attention.
•  

8
Shared Principles for Quality Measures Reporting
(continued)

• 5.a. There must be empirical evidence that the
  measured entity (clinician, site, group,
  institution) is associated with a significance
  amount of the variance in the measure. The
  measures offered for providers should, in
  totality, be representative of a significant
  proportion of their practices.
• OR
• 5.b. The measure is important for patients or
  communities, even though a clear consensus on
  accountability for performance has not been
  determined.
•  
• 6. Providers should be informed about the
  development and validation of the measures and
  given the opportunity to view their own
  performance, ideally for one measurement cycle,
  before the data are used for public reporting.
  Where feasible, providers should be permitted to
  verify data and offer corrections.

9
Issues for Discussion

• Who is the primary audience for the measures?
• What are the priorities for expanding measurement
  set?
• What are the priorities for focusing resources?
  E.g. updates, expansion, make vs buy decisions
• What is process to review/incorporate measurement
  recommendations from subcommittees?