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Regional Collaboratives as Catalysts for Quality Reporting and Improvement September 15, 2009

Regional Collaboratives as Catalysts for Quality Reporting and Improvement September 15, 2009. Mary McWilliams Executive Director. Health Alliance: A Regional Coalition. Collaborative of purchasers, providers, plans, patients Private, non-partisan, non-profit 501(c)(3)

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Regional Collaboratives as Catalysts for Quality Reporting and Improvement September 15, 2009

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  1. Regional Collaboratives as Catalysts for Quality Reporting and ImprovementSeptember 15, 2009 Mary McWilliams Executive Director

  2. Health Alliance: A Regional Coalition • Collaborative of purchasers, providers, plans, patients • Private, non-partisan, non-profit 501(c)(3) • Created in 2004; hired staff in 2005 • Now ~150 organizations with 2 million lives • Focus: 5 counties in Puget Sound region • Funded by participants and grants • RWJF Aligning Forces for Quality grantee • HHS Chartered Value Exchange

  3. Alaska Airlines The Boeing Company REI Starbucks Coffee Company Puget Sound Energy WA State Health Care Authority County Governments City of Seattle UFCW/Teamsters Group Health Polyclinic Everett Clinic Northwest Physicians Network WA State Medical Association WA State Hospital Association Academy of Family Physicians WA Naturopathic Physicians WA State Nurses Association Virginia Mason Medical Center Swedish Medical Center Providence Health & Services Aetna Health Plans of WA Cigna Premera Blue Cross Regence Blue Shield United Health Care A Sampling of Who We Are . . . .

  4. What We Do • Build local agreement on evidence-based care and standard measures • Report on health care performance in quality and cost • Provide resources to help with decision-making • Encourage incentives to reward value (e.g., medical home payment pilot) Transparency. Value. Consumerism.

  5. Community Checkup: • Signature report & web site http://www.WAcommunitycheckup.org • Quality performance measure results for the community 1st release –January 2008 14 volunteer medical groups; 97 clinics 2nd release – November 2008 47 medical groups; 170 clinics 25 hospitals 3nd release – July 2009 80 medical groups; 270 clinics 25 hospitals

  6. 3rd Community Checkup (July 2009): Ambulatory Quality of Care Measures: • 23 process of care measures including chronic disease management, prevention, and appropriate use of services. • Claims and encounter data for 2 million lives from 18 health plans, self-insured purchasers, union trusts and Medicaid. • Separate results for Commercial and Medicaid • Custom reports for data suppliers’ workforce/dependents Hospital Quality of Care Reports: • Repackaging of publicly available hospital results for Medicare (http://www.hospitalcompare.hhs.gov) including heart attack, heart failure, pneumonia, surgical care, and patient experience eValue8TM Health Plan Results: • Summary level comparison of six health plans through standardized tool of National Business Coalition on Health

  7. Next Steps for Quality Reports: • Additional measures • Additional data suppliers • Expand medical group auditing capabilities • Expand data elements (e.g. cost data, vision data, benefit information, PHI for linking member data) • Incorporate clinical data

  8. The Next Horizon: Cost Transparency • Need cost transparency to complete the value equation • Currently lack pricing data from data suppliers • Interim strategy: report on relative resource use • Alliance developing 4 report ‘tracks’ to capture service intensity across hospitals and medical groups

  9. Resource Measurement Report Plan • Mine public sources for acute care facility information • Dartmouth Atlas service intensity • CHARS (WA hospital data) gross charges and net revenue per case 2. Use Alliance multi-payer data set to analyze selected high cost, high volume hospitalizations • Facility & professional care dyad resource use during hospitalization • Apply APR-DRG (3M) and RVUs (Milliman) 3. Use Alliance multi-payer data set to analyze selected surgical procedures (preference-sensitive conditions) • Procedure frequency by patients’ area of residence 4. Use Alliance multi-payer data set to aggregate episodes of care • Resource use across care continuum: professional, facility, Rx • QASC (Brookings/ABMS) definitions – link to HEDIS measure results

  10. What’s Made the Alliance Successful (to date)? • Personal, sustained leadership of respected purchaser executive • Purchaser driven, multi-stakeholder effort • Quality first; efficiency second • National standards but local stakeholder input • Community-wide report rather than payer-specific • Limitations on first uses of report • Public reporting at the medical group level • Trial run of 14 volunteer clinics for first report • Positioning as “Community Checkup” • Addition of eValue8TM for plans byNBCH for purchasers

  11. What Challenges Lie Ahead? • Expanding the content and uses of the quality report and scope of reporting • Navigating the development and release of resource use reports and subsequent cost measures • Engaging health plans in collaborative projects • Continuing to afford the cost of data aggregation • Demonstrating ROI to stakeholders, especially purchasers • Expanding the use of all-payer data base as community asset • Balancing national standardization and local flexibility

  12. Transparency. Value. Consumerism. http://www.WaCommunityCheckup.org Puget Sound Health Alliance 2003 Western Avenue, Suite 600, Seattle, WA 98121 (206) 448-2570 http://www.pugetsoundhealthalliance.org

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