Robert Compton, DDS
Executive Director
Rob.Compton@dentaquestinstitute.org
May 20, 2013
Quality, Standards of Care
and Outcomes –
The Era of Accountability
4 Cornerstones of Value Driven Health Care
Introduced by the Bush Administration HHS Sec Leavitt
1.
Measure & Publish Quality Information
To make confident decisions about their health care providers and treatment options,
consumers need quality of care information
2.
Measure & Publish Price Information
To make confident decisions about their health care providers and treatment options,
consumers need price information
3.
Promote Quality & Efficiency of Care
All parties should participate in arrangements that reward both those who offer and those
who purchase high-quality, competitively-priced health care… including pay-forperformance methods for reimbursement
4.
Interoperable Health Information Technology
Has the potential to create greater efficiency in health care delivery
HHS website: http://archive.hhs.gov/valuedriven/fourcornerstones/index.html
2
Congress Mandates Quality Improvement
• The Children’s Health Insurance Plan Reauthorization Act of 2009
(CHIPRA), mandates that quality assessment programs be implemented
to assess and improve the quality of care for children that receive oral
health care under the Medicaid and CHIPRA programs.
• In 2008 CMS proposed to the American Dental Association (ADA) that a
Dental Quality Alliance be established to develop performance measures
for oral health care and that the ADA take a leadership role in its
formation.
Dental Quality Alliance Members
DENTAL PROFESSIONAL ORGANIZATIONS
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Academy of General Dentistry
American Academy of Oral & Maxillofacial Pathology
American Academy of Oral & Maxillofacial Radiology
American Academy of Pediatric Dentistry
American Academy of Periodontology
American Association of Endodontists
American Association of Oral and Maxillofacial
Surgeons
American Association of Orthodontists
American Association of Public Health Dentistry
American College of Prosthodontists
American Dental Association’s Board of Trustees
American Dental Hygienists’ Association
Council on Access, Prevention, and Interprofessional
Relationships (ADA)
Council on Dental Benefit Programs (ADA)
Council on Dental Practice (ADA)
Council on Government Affairs (ADA)
http://www.ada.org/5105.aspx
GOVERNMENT AGENCIES

Agency for Healthcare Research and Quality

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

Health Resources and Services
Administration

Medicaid and SCHIP Dental Association
DENTAL PLAN ASSOCIATIONS

America’s Health Insurance Plans

Delta Dental Plan Association

National Association of Dental Plans
OTHER MEMBERS

American Dental Education Association

American Medical Association

The Joint Commission

National Network for Oral Health Access

Public Member

DentaQuest
DQA Organizational Chart
DQA Board of Member
Organizations
Executive Committee
Advisory Committee on
Governance & Finance
Advisory Committee on
Research & Development
of Performance Measures
Advisory Committee on
Implementation &
Outcomes Assessment
Advisory Committee on
Education &
Communication
http://www.ada.org/5105.aspx
5
6
Quality of Care
• The degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent
with current professional knowledge
• This prescript contains just two concepts: measurement and knowledge.
Medicare: A Strategy for Quality Assurance. IOM, 1990, p.21
7
Metrics
Domains
Outcome of
Patient
Outcome of Care
Care
Experience
is a health state of a patient resulting
from health
care
AND is supported by
evidence that the measure has been
Clinical
used to detect the impact
more clinical Process
Qualityof one orStructure
interventions.
Measures
Process of Care
Access
HEALTH
Is a health
CARE care-related activity performed for, on behalf of, or by a
patient
AND is supported by evidence that the clinical process led
SYSTEM
to improved outcomes
Use of
Cost of Care
Services
Use of Services
Related
Measures
The provision of a service
to, on behalf of, or by a group of persons
Health Status
Management
identified by enrollment in a health plan or through use of clinical
of Patient
of Care
services.
Use of service measures can assess encounters, tests, or
Units
of Care of the
interventions that are Efficiency
not supported by
evidence
Resource
appropriateness of the service for the per
specified
individuals.
Source for Slides: http://www.qualitymeasures.ahrq.gov/index.aspx
Aims
Safe
Effective
Patient
Centered
Timely
Equitable
Efficient
8
Programmatic Measures
• Initially measures will be reported at the benefit plan level.
• Similar to HEDIS
• Rolls up performance of providers
• In order for benefit plan administrator to improve its score it will have to
work with providers to improve their performance
Where will these measures likely be reported to the public?
• CMS for Medicare and Medicaid Programs
• Healthcare Exchanges
• State-based All Payers Claims Databases
9
All-Payer Claims Database
The definition developed by NAHDO and RAPHIC—is:
• databases, created by state mandate, that typically include
data derived from medical claims, pharmacy claims,
eligibility files, provider files, and dental claims from private
and public payers.
• In states without a legislative mandate, there may be
voluntary reporting of these data.
http://www.apcdcouncil.org/
10
http://www.apcdcouncil.org/sites/apcdcouncil.org/files/APCD%20
Fact%20Sheet_FINAL_2.pdf
12
CO Center for Improving Value in Healthcare
http://www.civhc.org/CIVHC-Initiatives/Data-and-Transparency/All-Payer-ClaimsDatabase/APCD-Frequently-Asked-Questions.aspx/
13
14
Presentation Test | March 14, 2012
Hours before HHS Announced Website
“The Washington Post, which received the
information in advance, already created some
interactive tools online that might be more useful
to patients than the CMS spreadsheets.”
http://www.washingtonpost.com/wp-srv/special/national/actual-cost-of-medical-care/
MA All Payers Claims Database
BCBS - CY 2010 Physician Group Relative Price and Payment
Distribution
2.50
0.18
0.16
0.14
0.12
Relative Price
1.50
1.00
0.1
0.08
0.06
0.50
0.04
0.02
0.00
0
Percent of Total Payments
2.00
Relative Price
2.00
HPHC - CY 2010 Physician Group Relative Price and Payment
30%
Distribution
25%
20%
1.50
15%
1.00
10%
0.50
0.00
5%
0%
Percent of Total Payments
2.50
What Are Dental Plans Doing to
Prepare for the Change?
Presentation
24
Test | March 14, 2012
Fluoride Recommendation
Professional applied topical fluoride: Evidence-based clinical recommendations. ADA Council on
Scientific Affairs. JADA 2006;137;1151-1159
25
Frequency for Periodontal Maintenance
• Many patients presenting with recurrent gingivitis without additional
attachment loss after definitive periodontal therapy may be adequately
maintained with PM performed semiannually. However, for most
patients with a history of periodontitis, numerous clinical studies suggest
that PM should be performed at intervals of less than 6 months.
• In general, data suggest that most patients with a previous history of
periodontitis should obtain PM at least four times per year, since that
interval will result in a decreased likelihood of progressive disease,
compared to patients receiving PM on a less frequent basis
Periodontal Maintenance (2003) J Periodontol 2003;74:1395-1401
26
27
28
PROGRAM Performance for Fluoride and Perio
Maintenance
70%
59.9% 61.0%
60%
50%
61.8%
63.6%
49.1%
46.3%
40%
Jan-Jun 2011
Jul-Dec 2011
30%
Jan-Jun 2012
20%
10%
0%
Fluoride
Perio Maintenance
29
Provider Performance for Fluoride on Higher Risk
Children
Jan-Jun 2011
Jul-Dec11
Jan-Jun 2012
110%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Names of Providers on X Axis
30
Provider Performance for Perio Maintenance
Jan-Jun11
Jul-Dec11
Jan-Jun12
110%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Names of Providers on X Axis
31
Results
• Around 60% of dentist achieve the fluoride goal
• Around 75% of dentists achieve the perio goal
• Around 85% of dentists receive a financial bonus
• Improved quality of care
• Improved our Program Quality Score
• Reimbursed for quality not just quantity (P4P)
32
Our World Is A Changing
• We know how it is changing
• Very transparent process
• All the major professional association and trade
groups are at the DQA and other tables
• There will be an orderly, timely transition
• Medical plans and physician’s will be first
• Dental Plans will be next
• Dental providers will follow
• But we need to begin preparing for the change
33
Questions?
Robert Compton, DDS
Executive Director
May 20, 2013