Achieving National Quality
Measurement and Reporting:
A Purchaser Perspective
David S. P. Hopkins, Ph.D.
Pacific Business Group on Health
AcademyHealth ARM
June 5, 2007
IOM Performance Measurement
Principles
“A performance measurement system should
provide information for multiple uses,
including:




Provider-led improvement efforts
Public reporting
Payment and benefit design
Population health initiatives.”
-- excerpted from Performance Measurement:
Accelerating Improvement, p. 48
2
© Pacific Business Group on Health, 2007
Consumer-Purchaser Disclosure Project:
Performance Measurement Seen Through
Consumers’ & Purchasers’ Eyes
 Scope and pace of measure development and
implementation too narrow and slow
 Pressing sense of urgency
 Real consumer/patient choices being made with little real
information
 Cost pressures leading to benefit designs and purchasing
strategies too often “value-blind”
 Robust performance dashboard essential
 Consumer engagement requires relevant and adequate
information
 Plan designs, payment systems and networks must recognize
quality and efficiency
 Performance information must be valid and rapidly
available: don’t let perfection be the enemy of the
public good.
3
© Pacific Business Group on Health, 2007
Consumers and Purchasers
Guidance on Measure Development
Criteria
 Reasonable scientific acceptability
 Based on consumer’s perspective, not academic perfection
 Feasible
 Favor measures that can be populated with currently available
electronic data
 Relevant to consumers and purchasers
Important and actionable: full “STEEEP” dashboard
Enable consumer choice
Show high variation in performance
Affect large numbers of patients or total health care spending
Shed light on overall, cross-cutting, or condition-specific
performance
 Provide better understanding of disparities
 Capture outcomes





 Reflect continuum of care
4
© Pacific Business Group on Health, 2007
How well have early standardization efforts delivered
a robust measure set (per IOM 6 domains)?
(* = minimal measure set; ** = partial measure set; *** = robust measure set)
Measure Type
Robust Measure Set
Effectiveness/Timeliness
Wide set of conditions
Process
Coordination of care
Effectiveness – Outcomes Mortality/morbidity/
functional health status
Wide set of conditions
Safety
NQF Safe Practices (Leapfrog)
Infections/errors
AHRQ Patient Safety Indicators
Nursing Indicators
Patient Centeredness
C-CAHPS/H-CAHPS + other
important domains
 Shared decision-making
 Coordination of care
 Safety/errors
Equity
Measures for population
subgroups
Cost-Efficiency
Cost to payers
Resource use
Multiple time frames
5
NQF-Endorsed
Measures
(as of 6/1/07)
**
*
*
**
0
0
© Pacific Business Group on Health, 2007
National Efforts Lagging
Local/Regional Initiatives
 Leapfrog Hospital Rewards – NQF-endorsed
quality measures + resource efficiency measures
 Bridges to Excellence – systematic office processes +
demonstrated excellence in 3 clinical areas
 HealthPartners Optimal Diabetes Care –
patient-centered view leads to “all-or-none” measurement
 Mass. General Insurance Commission –
physician-level clinical quality + cost-efficiency using best in
class vendor tools
 Hospital Infections Reporting (PA, MO, FL)
6
© Pacific Business Group on Health, 2007
Better Quality Information
(BQI) Pilots
 6 Pilots: CA, AZ, IN, MA, MN, WI
 Selected through competitive RFP managed by AQA
(formerly Ambulatory Quality Alliance)
 Focus is on aggregating Medicare and commercial
data to measure and report on physician practice
performance
 Intended for use by consumers and providers
 Contracted with CMS
 Limited scope of work: 5 nationally-endorsed quality
measures initially, building to 12
 3 measurement cycles: 2 in 2007, 1 in 2008
7
© Pacific Business Group on Health, 2007
Goals for the BQI Pilots
 Demonstrate effective public/private partnership
 Combine public and private data to achieve large “n”
for measurement
 Inform the expansion of consensus measures
nationally
 Demonstrate feasibility of collection of AQA endorsed
performance measures
 Test additional measures that are feasible to collect and
conform to AQA measure principles
 Speed adoption and reporting of valid, robust
performance measures for use by:




8
Physicians and hospitals
Consumers
Purchasers
Payers
© Pacific Business Group on Health, 2007
BQI Challenges
 Measures
 Seeking a robust set – quality + cost-efficiency
 Many specialties, not just 1° care
 Consumers and purchasers want to choose/pay
based on outcomes
 Data
 Chart review not scalable at statewide level
(40,000+ practicing physicians)
 CPT-II codes good in concept, but lacking a path
to implementation
 need both CMS and private sector
 Limited by what is electronically available today:
claims, Rx, some lab
9
© Pacific Business Group on Health, 2007
Dynamic Tensions in Physician
Performance Measurement
 Provider desires for “actionable” measures vs.
consumer primary interest in outcomes
 Provider demands for precision (p<0.05) vs.
consumer tolerance for some misclassification
 Milstein, et al., Health System Change, 2007
 majority of consumers surveyed willing to accept >5%
inaccuracy in physician performance ratings; 20+% willing
to accept 20-50% inaccuracy
 Feasibility: measures requiring new coding vs.
measures driven off available electronic data
10
© Pacific Business Group on Health, 2007