The Public Release of MHQP

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• The Public Release of MHQPs Physician Network
  Quality Report
• Barbra Rabson, MHQP Executive Director
• Janice Singer, MHQP Director of Operations
• February 8, 2005

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Massachusetts Health Quality Partners (MHQP)
Established in 1995

• MHQP is an independent, non-profit quality
  collaborative of health care leaders in
  Massachusetts
• health plans
• hospitals
• physician groups
• public agencies
• employers
• consumers

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MHQP Mission and Vision

• Mission to improve the quality of health care
  services delivered to the residents of
  Massachusetts through broad based collaboration
  among health care stakeholders
• Vision to be the premier health care quality
  collaborative in Massachusetts, including the
  most trusted and influential source for
  comparative health care quality performance
  information

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MHQP Roadmap for the Collection and Reporting of
Massachusetts Health Care Quality Information
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The Path Leading to the MHQP Roadmap

• MHQPs success at securing research grants to
  pioneer aggregate measurement of physician
  quality measures
• MHQPs emerging track record as reliable source
  of comparative physician quality performance data
• MHQPs 2004 Quality Conference focused commitment
  to develop roadmap for meaningful release of
  performance data in MA
• An opportunity to rationalize the national
  landscape for providers and consumers in MA

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MHQP Roadmap

• Includes both ambulatory and inpatient measures
• MHQP aggregates and captures ambulatory measures
• MHQP posts existing national inpatient measures
• Uses/develops nationally recognized measures,
  adopt nationally collected data where appropriate
• Broad-based collaborative approach
• Aggregate data across plans
• Involve those being measured in the measurement
  process
• Crystallizes thinking about MHQP strategic focus
  and stakes out important milestones for next 5
  years

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Cornerstones of MHQP Roadmap

• Release of primary care clinical HEDIS
  performance results
• Physician Network level (Q1 2005)
• Medical Group level (Q1 2006)
• Release of patient experience survey results
• site level adult and pediatric PCPs (Q1 2006)
• site level selected specialists (Q1 2007)

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MHQP Roadmap The Next 3 Years

• Adoption of clinical specialty care measures
• Adoption of efficiency measures for primary and
  specialty care
• Addition of Medicare and/or Medicaid populations

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MHQP Roadmap Looking Toward 2010

• Adoption of measures for all six IOM dimensions
  of care effectiveness, efficiency, timeliness,
  patient safety, patient centeredness, equity
• Addition of more payer data, moving towards the
  creation of an all-payer database
• Release of data at increasingly more granular
  level down to the individual physician level when
  methodologically appropriate, statistically
  significant and appropriately funded

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The MHQP Physician Network Quality Report

• The Public Release of Clinical Quality
  Performance Information

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The MHQP Rewarding Results Program Objectives

• Create the infrastructure to sustain reliable,
  consolidated reporting at the physician group
  level
• Support physician groups in improving their
  performance
• Evaluate the impact of financial and
  non-financial incentives on provider performance

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HEDIS Quality Measures

• Breast Cancer Screening
• Cervical Cancer Screening
• Chlamydia Screening
• Diabetic Eye Exams
• Diabetes HbA1c Screening
• Diabetes LDL Screening
• Monitoring Diabetic Nephropathy
• Appropriate Asthma Med. Use
• (5-17 18-64)

• Antidepressant Medication Management
• (Contacts Acute Phase Rx Continuation Phase
  Rx)
• CAD LDL-C Screening
• Well Infant and Well Adolescent Visits
• Measures where 2001 MA mean was below National
  or Regional Mean OR less than 50

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Reports Developed

• Physician and Health Plans
• SCCQR - Statewide Comparative Clinical Quality
  Report at all 3 levels Physician Network
  Medical Groups Practice Sites
• First reports distributed in 2003 with 2 years of
  performance data
• Employers and Consumers
• Physician Network Quality report

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Challenges of Developing Comparative Reports

• Defining Medical Groups and Practices
• Achieving consensus on benchmarks and scoring
• Identifying appropriate contacts for distribution

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Timeline of Performance Reports

• Winter 2004 - Dry run of clinical performance
  data for medical groups and physician networks
  (PNs) based on 2001 and 2002 performance
• Winter 2005 - Reports to medical groups and PNs
  on 2003 performance Public release of large PN
  performance profiles
• Winter 2006 - Reports to medical groups and PNs
  on 2004 performance Public release of medical
  group performance profiles

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MHQP Physician Network Quality Report Website

• Introduction How to Choose Quality Health Care
• Letters MHQP Physician Council and MMS
• QA
•  16 Quality Measure Pages - compare 9 PNs
• Describes the measure and its importance
• Presents the patients role and the doctors role
• Lists relevant web resources
• Network Pages all measures for a network
• Technical Appendix
• Quality Resources

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FORMAT Decision Points

• Content and organizing framework
• Performance measures
• Scoring performance of groups
• Representation of group scores
• Messages
• Reporting Medium/Format
• Sequencing of information/flexible formats
• Appearance
• Dissemination strategy Distribution channel(s)

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Scoring/Benchmarks

• Scores will be compared to
• statewide performance (e.g. Above the State Rate,
  Similar to the State Rate, Below the State Rate)
• to national benchmarks NCQA 50th and 90th
  percentile
• Use 5 level of significance to determine above
  and below state rate performance
• No Ranking or Percentile information
• Use success rates 80 received test rather than
  205 did not
• Used stars for each benchmark passed

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Key Messages

• First time in MA that theres been a statewide
  public release of certain medical group
  comparative clinical quality information
  aggregated across health plans.
• Report provides best available information to
  consumers about how physician networks perform on
  certain aspects of quality in MA.
• Report provides physicians throughout state with
  the best available data showing how their
  performance on certain quality measures compares
  with that of their peers, in an effort to promote
  improvement across networks.

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Key Messages (continued)

• Emphasize use of report as a tool for improvement
• MA physician networks perform better than the
  national average on this set of clinical
  performance measures for chronic diseases and
  preventive care.
• Performance varies among medical groups and
  within groups, suggesting that there is further
  room for improvement even in groups that are
  doing well compared to their peers.
• Focus on achievement and improvement positive
  messages

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Some Statewide Results for All MA PCPs

• Massachusetts Physicians Do Very Well Compared to
  the Nation

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STATE RATES Significantly above the National
90th Percentile for 7 of 16 Measures

• Antidepressant Medical ManagementOptimal
  Practitioner Contacts
• Breast Cancer Screen
• Cervical Cancer Screen
• Diabetic Eye Exams
• Well Child Visits (1st 15 months, 3-6 years,
  adolescents)
• Commercial HMO POS members of MHQP member
  plans only

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STATE RATES at or above National 90th but not
statistically significant for 4 Measures

• Chlamydia Screening (ages 16-20, 21-26)
• Cholesterol Screening after Acute Cardiac Event
• HbA1c Testing
• Commercial HMO POS members of MHQP member
  plans only

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STATE RATES Significantly above the National
50th Percentile for 4 Measures

• Appropriate Asthma Medications (Ages 5-17)
• Antidepressant Medical Management
• - Acute Phase
• - Continuation Phase
• Diabetes
• - LDL-C Screening
• Commercial HMO POS members of MHQP member
  plans only

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STATE RATE Significantly below the National 50th
Percentile for 1 Measure

• Appropriate Asthma Medication (18 - 56)
• MA rate 72
• National 50th 74
• National 90th 79
• Commercial HMO POS members of MHQP member
  plans only

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Next Steps

• In 2006 MHQP is planning two more public releases
  of physician quality reports
• Repeat of the 2005 clinical performance at the
  medical group level for 160 groups across the
  Commonwealth
• A first in the nation statewide release of survey
  of patient experiences with their primary care
  physician at the practice site level

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Challenges

• Increasing acceptance and usefulness of the
  reports for the physician community
• Making reports increasingly useful to consumers
• Developing market driven funding model to
  support MHQPs quality data reporting

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MHQP Rewarding Results Research Partners

• Kathryn Coltin, M.P.H.
• Independent Consultant
• Brian Patrolia
• Independent Consultant
• Steven Pearson, M.D.
• Harvard Medical School
• Eric Schneider, M.D., M.Sc.
• Harvard School of Public Health

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For more information about MHQP.

• Barbra Rabson, Executive Director
• Rabson_at_mhqp.org
• Janice Singer, Director of Operations
• Singer_at_mhqp.org
• www.MHQP.org