The National Movement Towards Disclosure of Performance for Providers and Treatment Options

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The National Movement Towards Disclosure of
Performance forProviders and Treatment Options

• Consumer-Purchaser Disclosure Project

Randy Johnson Arnie Milstein MD, MPH May 28, 2003
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Why Performance Disclosure is a Priority

• If you cant measure it, you cant reward it
• If you dont reward it, you wont improve it

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Through Purchasers Eyes

• IOM highlighted our fiduciary responsibility for
  quality
• We need performance measures now for providers
  and treatments
• Consumer-centric models require it
• Medicare reform
• Tort malpractice reform

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Through Consumers Eyes

• Status quo is unacceptably hazardous
• Caregiver selection is a life or death decision
• Greater consumer responsibility requires
  adequate information

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Leading Edge Efforts IOM Describes the Chasm

• To Err is Human
• Crossing the Quality Chasm
• Leadership by Example Governments Role
• Unequal Treatment Confronting Disparities
• Priority Areas for National Action

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Leading Edge Efforts National Quality Forum

• Created in response to the Presidents Commission
  on Health Care Quality
• Multi-stakeholder, membership organization,
  consensus-based process to refine standardized,
  publicly-reported performance
• Board plus 4 Councils
• Activities to date
• Safe Practices Diabetes care
• Nursing homes Cancer treatment
• Hospitals

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Leading Edge Efforts Accreditors and Government

• JCAHO
• Hospital ORYX core measures
• NCQA
• Health plans (HEDIS)
• Physicians
• CMS
• Measure development and pilots
• Nursing Homes
• Hospitals
• Doctor Office Quality

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Leading Edge Efforts Purchasers

• Local/regional business coalitions projects on
  the ground
• PBGH (California) BHCAG (Minnesota)
• The Alliance (Wisconsin) HealthCare 21 (TN)
• Central Florida Coalition (FL) Many more
• The Leapfrog Group
• 3 hospital safety standards
• 130 large public and private purchasers
• 17 local regional rollouts

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Leapfrog Progress and Impact

• Leapfrog as of December 31, 2002
• 18 Roll-Out Regions reporting
• 952 urban hospitals invited to submit results
  voluntarily
• More than half, 543 hospitals (57), submitted
  responses
• 4 Regions had 100 participation from invited
  hospitals, 12 had greater than 60 participation
• 53 percent of hospitals cleared at least one of
  Leapfrogs high bar settings for safe practices

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Leapfrog Safe Practices

• Three hospital leaps
• CPOE
• ICU staffing
• Volume-based referral
• What are they worth annually in urban hospitals?
• 522,000 serious medication errors
• 58,300 preventable deaths
• 58,300 X disabilities
• 9.6 billion

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Evidence of Impact 18 Regions

• CPOE
• 5 of the responding hospitals have fully
  implemented CPOE
• An additional 24 say they have specific plans to
  implement such systems by 2004
• IPS
• 20 of respondents have fully implemented IPS
• Another 16 of responding hospitals indicate
  plans to enlist intensivists by 2004

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Lots of New Measurement Happening, But
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The Unintended Tower of Babel
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National Standards Essential

• Comparability across markets
• Credibility
• Reporting burden
• Economies of scale and leverage

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Consumer/Purchaser Disclosure ProjectUniting the
Buy Side of the Market

• Common consumer, purchaser and labor agenda to
• Define standardize valid measures
• Develop institutionalize measurement systems
• Accelerate public reporting

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Disclosure Project Support

• RWJF Project Sponsor
• Participating Organizations
• 3M March of Dimes
• AARP Midwest Business Group on Health
• AFL-CIO Motorola
• American Benefits Council National Association
  of Manufacturers
• Buyers Health Care Action Group National Black
  Womens Health Project
• Carlson Companies National Business Coalition on
  Health
• California Healthcare Foundation National
  Citizens Coalition for Nursing Home Reform
• Consumer Coalition for Quality
  Healthcare National Partnership for Women and
  Families
• Employee Benefits Research Institute National
  Breast Cancer Coalition
• Employer Health Care Alliance Coop. Niagara
  Health Care Quality Coalition
• ERISA Industry Committee Pacific Business Group
  on Health
• Ford Motor Company The Robert Wood Johnson
  Foundation
• General Motors State Medicaid Directors
  Association
• The Leapfrog Group Union Pacific Railroad
• National Coalition for Cancer Survivorship U.S.
  Chamber of Commerce
• Washington Business Group on Health (founding)

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Disclosure Goal

• By January 1, 2007, Americans will be able to
  select hospitals, physicians, integrated delivery
  systems, and treatments based on public reporting
  of nationally standardized measures for clinical
  quality safe, timely and effective care
  patient experience, equity and efficiency.

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Architecture of Full Dashboard
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C/P Core Principles

• Assure measures are relevant evaluable
• Use existing measures and build on ongoing
  efforts
• Keep pace with research practice
• Engage provider input
• Encompass all levels of health care
• Assure patient privacy and confidentiality
• Pursue rapid and broad adoption

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Define Standardize Valid Measures

• Encourage identification and disclosure of
  measures that meet Disclosure Group goal and core
  principles
• Identify gaps using consumer and purchaser lens
• Collaborate with measure developers (e.g., CMS,
  NCQA, JCAHO, AHRQ, Academia, etc)
• Advance measures through NQF or other consensus
  process ensuring informed support by
  purchaser/consumers
• Promote testing, refinement and addition of new
  measures

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Develop and Institutionalize Measurement Systems

• Identify and support best measurement
  systems/sponsors
• Promote funding mechanism(s)

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Accelerate Public Reporting

• Market Levers
• Consumer Education and Tools
• Benefit Design
• Provider Payment
• Employers, Public Purchasers, Consultants and
  Plans
• Regulatory Levers

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Two Complementary Tracks

• Voluntary track
• Leverage National Quality Forum and other related
  efforts to facilitate consensus-based adoption
  and implementation of national standards for
  performance reporting
• Regulatory track
• Explore regulatory approaches through work with
  government agencies and accreditation bodies
  (e.g. inclusion in accreditation standards or
  Medicare Conditions of Participation)

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2002 Accomplishments

• Forged partnership among consumer, labor and
  purchaser organizations establishing a gt 100
  million life customer voice for disclosure
• Shaped course and urgency of NQF deliberations
• NQF now committed to all six IOM performance
  domains
• Built alliance with CMS
• Regular dialogue helping chart course for CMS
  and federal disclosure agenda

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2002 Accomplishments

• Accelerated speed of hospital measurement
  reporting
• Expanded NQF hospital measurement set
• Triggered AHRQs fast track development of
  H-CAHPS CMS adoption
• Instigated hospital industry voluntary reporting
  on a limited measure set and commitment to expand
  with purchaser and consumer advice

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Priorities for 2003

• Hospital measures
• Promote reporting of NQF measures
• Fill the gaps (i.e. efficiency)
• Physician measures
• Lay groundwork for future NQF measure setting
• Enable use of CMS data for physician measures
• Expanded Partnerships CMS and beyond
• Shared vision and measurement matrix
• Bake disclosure into Medicare reform

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How Can Employers Help?

• Join Leapfrog commit to purchasing principles
• Sign on as a C/P Disclosure Project participant
• Join National Quality Forum
• Support local efforts to promote disclosure

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How Can Employers Help?

• Make disclosure integral to your purchasing and
  enrollee
• communication efforts
• Build standardized provider measurement into
  health plan contracts
• Give enrollees to tools to make better decisions
  (through health plans, your own site, or in
  collaboration with others)
• Promote higher value consumer selections based on
  provider performance (variable co-insurance,
  tiered networks)
• More

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Performance DisclosureThe Critical Path from
Disclosure to Performance Breakthrough
Americans
High
Q 50 ppts 40 ppts
Chasm Crossing
Clinical re-engineering by MDs, hospitals
Consumerism P4P
Value of Health Benefits
Performance Disclosure
? Market sensitivity to performance
Performance comparisons for hospitals, MDs Tx
Low
2002
2012
Key Evolutionary Steps
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For More Information

• Consumer/Purchaser Disclosure Project
• Steve Wetzell, Strategic Director
• [phone]
• Email swetzell_at_msn.com
• The Leapfrog Group
• Suzanne Delbanco, Executive Director
• Web site leapfroggroup.org
• [phone]
• Email sdelbanco_at_leapfroggroup.org
• The National Quality Forum
• Web site qualityforum.org
• [phone]
• Email info_at_qualityforum.org