Improving Quality Through Systems Change
National Health Policy Conference, Washington, DC
Stephanie Alexander, Sr. VP,
Premier Healthcare Informatics
February 12, 2007
CMS/Premier Demo Pay for Performance
In 2003,CMS partnered with Premier for the first national pay-for-performance
demonstration for hospitals. Over 260 Premier hospitals volunteered.
Hypothesis
Financial Incentives improve hospital quality performance
Findings
 Focus on Quality - The P4P Program financial incentives did focus hospital executive attention
on measuring quality and refining care processes according to the study infrastructure.
 Premier is the Change Agent - The Premier Infrastructure and measurements were actually
the change agents in focusing quality improvement efforts. The more hospitals were monitored,
the better performance improved over time.
2
HQID Year 2 – Final Results
Released January 26, 2007
• Quality improvement across all
hospitals and clinical areas
• HQID raised overall quality by
11.8% in 2 years
• Quality incentive payments of
$8.7 Million paid to 115
hospitals
• AMI improvements saved 1,284
AMI patients
• Patients received ~150,000
add’l treatments
• Premier P4P hospitals quality
scores are higher than national
average – 85% compared to
79%
3
Dramatic Improvement Continues
Composite Quality Score
CMS/Premier HQID Project Participants Composite Quality Score:
Trend of Quarterly Median (5th Decile) by Clinical Focus Area
October 1, 2003 - June 30, 2006 (Year 1 and Year 2 Final Data, and Yr 3 YTD Preliminary)
105%
70.00%
73.06%
75%
70%
65%
60%
AMI
CABG
85.13%
86.69%
88.68%
90.93%
91.63%
93.40%
95.20%
95.92%
96.05%
96.89%
97.50%
73.05%
76.14%
78.22%
81.57%
82.98%
84.38%
86.73%
88.79%
90.00%
80%
63.96%
68.11%
85%
78.07%
80.00%
82.49%
82.72%
84.81%
86.30%
88.54%
89.28%
90.09%
90%
85.14%
85.92%
89.45%
90.57%
93.70%
94.89%
96.16%
97.01%
96.77%
98.28%
98.44%
Composite Quality Score
95%
89.62%
89.95%
91.50%
92.55%
93.50%
93.36%
95.08%
95.77%
95.98%
96.14%
96.84%
100%
Pneumonia
Heart Failure
Hip and Knee
Clinical Focus Area
4Q03
1Q04
2Q04
3Q04
4Q04
1Q05
2Q05
3Q05
4Q05
1Q06
2Q06
4
Example of decile movement (by year)
5
Why such movement in quality?
• Not just “one” reason - a combination
• National alignment of evidence-based quality
measures
• Transparency (public reporting)
• Rewards for improvement
• Leadership
• System-level change
Building a Quality Culture
6
Top Performer Characteristics
• “Quality” core value of institution
• Priority of executive team
• Physician engagement
• Improvement methodology
• Prioritization methodology
• Dedicated resources
• Committed “knowledge transfer”
7
Premier Performance Pays Study
Premier’s Performance Pays study proves that when evidence-based processes are
delivered, quality is higher and costs are lower. First study of its kind over 400,000
patient discharges studied.
8
Increased process reliability results in lower costs
9
Increased process reliability results
in fewer complications
10
Shorter Length of Stay
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Fewer Readmissions
12
Improvement Opportunity
For Pneumonia, Heart Bypass Surgery,
Hip and Knee Surgery, and AMI Patients
in One Year Alone
$1.4 Billion
6,000 Avoidable Deaths
6,000 Complications
10,000 Readmissions
800,000 Days
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Example:
Acute Myocardial Infarction
Heart Failure
Hip and Knee
Pneumonia
Quality a core value, executive priority, physician engagement, improvement methodology,
prioritization methodology, dedicated resources, committed knowledge transfer
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Example: Health System Improvement
• A decision to
participate as a
system
• A proxy for system
connectivity
• A few surprises . .
• And the most
important decision
we’ve made for
cultural
advancement
around quality
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Why such movement in quality?
• Not just “one” reason - a combination
• National alignment of evidence-based quality
measures
• Transparency (public reporting)
• Rewards for improvement
• Leadership
• System-level change
Building a Quality Culture
16