Healthcare Quality Data: Consumers, Employers, and Underwriters Professional Liability Underwriting Society Meeting March 15, 2006 Chicago, IL How many people saw a new health care provider in the past year? How did you choose a provider?

“Never go to a doctor whose office plants have died.” - Erma Louise Bombeck

Source: The New Yorker November 29, 2004

High Variability in the Quality of Care

Jacob Bigelow, in a speech to the Massachusetts Medical Society in 1835

Compliance with Evidence Based Medicine Survey by Duke Clinical Research Institute revealed that only 45% of cardiologists and 15% of EM docs had reviewed the latest ACC/AHA guidelines AND most clinicians do NOT have feedback performance data Hospitals that were least compliant (<=65%) with EBM guidelines had an in-hospital mortality rate for eligible patients of ~ 6%. Hospitals that were the most compliant (>=80%) had an all-cause mortality rate of only 3.6%.

Medical mistakes cause as many as 98,000 deaths per year To Err is Human, Institute of Medicine, 1999

Would You Buy A Car Without Doing Research? Between 2002-2004, a typical patient would have, on average, a 65% lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital. A typical patient would have, on average, a 45% lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average HealthGrades 8th Annual Hospital Quality in America Study

A Look at Hospital Quality By State (HealthGrades 6th Annual Hospital Quality in America Study – 2003)

Death in Low Mortality DRGs Failure to Rescue Comparison of Best Hospitals vs. Worst Hospitals Performance vs. Expected on Three patient Safety Measures Death in Low Mortality DRGs Failure to Rescue Accidental Puncture ..or Laceration Worst Hospitals Performance Best Hospitals Performance

How Is Health Care Quality Measured?

Type of Quality Measurement What Does It Measure? Examples Structure Are the right structures and tools in place to facilitiate high quality? Computerized Physician Order Entry (CPOE) Process Is the right thing being done at the right time? Percent of heart attack patients getting aspirin on arrival Outcome What was the clinical outcome? Mortality rates; Complication Rates, e.g., infection rates Outcome - Patient Safety Was the patient free from accidental injury due to medical care, or medical errors? Patient Safety Incident Rates, e.g., foreign body left in patient Patient Satisfaction Was the patient satisfied with their care and the outcome of that care? Patient Satisfaction Scores Volume How many cases are done annually? American College of Cardiology requirement of at least 75 coronary intervention cases/year for maintenance of physician competency

Quality Measurement Pyramid

How Is Health Care Quality Information Being Used? Consumers Employers/Payers Liability Underwriters

The New Health Care Consumer Quality Cost Value = There is no clear answer/consensus on how to measure quality and provide direct incentives to reward quality. CMS: Financial incentives to hospitals that report process measures for heart attack, heart failure, pneumonia. Health Plans: Combination of EBM/process measures, chronic disease management, customer satisfaction, investment in technology, cost-containment, etc. Private market lacks transparency re: what benchmarks are being used – increasing challenges for providers. Many efforts to make a change: CMS - $ incentives Heart Attack Heart Failure Pneumonia Health plans = EBM + Process, etc; starting to drive transparency

Perceived Variations in Quality of Health Care Source: Great-West Healthcare and Harris Interactive

The Most Important Factor in Selecting a Hospital Source: Great-West Healthcare and Harris Interactive

Percent of Americans who say they would prefer a… Information begets the desire for more information. There is no turning back – embrace it! Source: Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health National Survey on Consumers’ Experiences with Patient Safety and Quality Information, November 2004 (Conducted July 7-September 5, 2004).

HealthGrades’ Hospital Consumer Ratings - Mortality

HealthGrades’ Hospital Consumer Ratings - Complications

Pennsylvania Physicians Quality Ratings - Complications Pennsylvania HCC Total Hip + Knee replacements by Surgeon Highlights complications and LOS

Product Case Study – Consumer Google Local (Beta Project Example) LBS, paid search, ecommerce

Employers/Payers Employers and payers are steering employees toward high-quality providers Poor quality care costs employers $1,900 per employee per year (Midwest Business Group on Health)

The State of Health Care

Overview of Consumer-Driven Health

Source: The New Yorker July 15, 1933

Risk Assessment

HealthGrades’ Nursing Home Quality Ratings

Thank You Sarah Loughran sloughran@healthgrades.com (303) 716-6502