Panel on Measuring Quality and Value

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Panel on MeasuringQuality and Value
Carolyn M. Clancy, MD Director Agency for
Healthcare Research and Quality IOM Committee
Meeting on Geographic Variation in Healthcare
Spending and Promotion of High Value
Care Washington, DC November 10, 2010
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Not Just for Policy Wonks

• Up to 30 percent of health care spending goes
  toward useless treatments that we dont need
• Overtreatment costs the U.S. system 700 billion
  a year
• Unnecessary treatment and tests arent just
  expensive they also can harm patients.

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Measuring Quality and Value

• What the Measures Tell Us Today
• Variation
• In care delivery
• In spending
• Across populations
• Across geographic regions
• Need to Document, Rigorously
• Recent Legislation

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Improving ValueThree Necessary Ingredients

• Good measures and data
• Evidence-based payment and incentives
• Evidence-based strategies for improvement

• Leading to three paths
• Transparency and public reporting
• Pay-for-performance and payment reform
• Provider-based redesign and quality improvement

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Good Measures, Good Data Will Bridge the Gap
AHRQs Role Supplying the Data

• Healthcare Cost and Utilization Project (HCUP)
• Quality Indicators
• Medical Expenditure Panel Survey (MEPS)
• CAHPS
• National Healthcare Quality Disparities Reports

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AHRQ Prevention Quality Indicators (PQIs)
Potentially Avoidable Hospitalizations

• National hospital costs for potentially avoidable
  hospitalizations (adjusted for inflation)
• decreased from 31.9 billion in 2003 to 30.1
  billion in 2006 Changes are largely attributable
  to avoidable hospitalizations involving chronic
  conditions
• These hospitalizations can be the result of
  inadequate self-management as well as
  inefficiency in the health care system

AHRQ 2009 National Healthcare Quality Report
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Geographic Variation

• While there is wide variation in care quality
  across states
• Those in the upper Midwest and New England tend
  to achieve the highest overall quality
• States in the southwest and south central tend to
  have the lowest care quality

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Disparities Report Key Findings

• Disparities are common
• Lack of insurance is an important contributor
• Many disparities are not decreasing
• These variations indicate that a basic IOM tenet
  of quality carethat care should be equitableis
  not being met

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How Do They Do That?
Multi-stakeholder effort examining
high-performing regions

• Lowest region in state (actual-expected)
• La Crosse, WI
• Portland, ME (one of only two HRRs in Maine)
• Asheville, NC
• Actual cost lt expected
• Temple, TX (second lowest after Lubbock)
• Everett, WA (second lowest after Spokane)
• Four are problematic
• Richmond, VA (highest actual-expected in state)
• Sacramento, CA (actual gt expected)
• Cedar Rapids, IA (actual gt expected, but in a
  low-cost state)
• Tallahassee, FL (actual gt expected)

Source Calculations from HCUP data using
Dartmouth Atlas regions http//www.ihi.org/IHI/Pro
grams/StrategicInitiatives/HowDoTheyDoThat.htm?Tab
Id0
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Important Provisions

• National Strategy to Improve Health Care Quality
• Interagency Working Group on Health Care Quality
• Quality Measure Development
• Data, Collection, Analysis and Public Reporting
• Health Care Quality Improvement (CQuIPS)
• Patient-Centered Outcomes Research Institute

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Payment Based on Quality, Safety and Value

• National Pilot Program on Payment Bundling
• HHS to work with AHRQ and a contract entity to
  develop episode of care and post-acute quality
  measures
• Health Care Quality Improvement
• AHRQs Center for Quality Improvement and Patient
  Safety (CQuIPS) will identify, evaluate,
  disseminate, and provide training on best
  practices on quality, safety and value
• CQuIPS will award grants or contacts to provide
  technical support or implements models and
  practices identified in research
• Technical grants also provided for organizations
  without infrastructure or resources

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Whats Next? National Health Care Quality
Strategy

• Part of Affordable Care Act
• Builds on work of federal, state, local and
  private initiatives identifies what works and
  what needs improvement
• Move from provider-level transparency to a
  patient-focused approach

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Evidence Still Weak on Critical Design
Components

• What to reward?
• structure, process, or outcomes
• Improvement or achievement
• How structure reward?
• Market factors affecting rewards
• How much market share do you need?
• How much of what kind of a payment scheme is
  needed to correct perverse incentives?

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Coming Soon The Evidence We Need?

• Payment Reform Evidence on How Payment Can
  Improve Quality and Value (December)
• AHRQ-sponsored Health Services Research
  issue on payment reform follow-on to 2009
  special issue, Improving Efficiency and Value in
  Health Care
• Analyses assessing impact of efforts to improve
  care by changing the way its paid for
• Value-Based Insurance Design
• Models/simulations related to payment models for
  the future

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Thank You
AHRQ Mission To improve the quality, safety,
efficiency, and effectiveness of health care for
all Americans AHRQ Vision As a result of AHRQ's
efforts, American health care will provide
services of the highest quality, with the best
possible outcomes, at the lowest cost
www.ahrq.gov