Publishing Data to Promote Change Massachusetts General Hospital and Partners Health Care - experience with transparency Elizabeth Mort, MD, MPH Vice President Quality & Safety, MGH Associate Chief Medical Officer, MGH Team Leader for Uniform High Quality, Partners HealthCare Inc.

2 Outline Massachusetts reporting environment System and hospital reporting –Partners HealthCare, Inc. –Massachusetts General Hospital –Case studies

3 Massachusetts environment

4 National data sources US News and World Report HEDIS reports for health plans CMS Hospital Compare CMS Nursing Home Compare The Joint Commission Quality Check Leapfrog Health Grades

5 State-wide data sources MA Health care cost and quality council Massachusetts Health Care Partnership Department of Public Health MHA patients first Group Insurance Commission asks Health plans to tier physicians Planned: SRE (Spring 2009), BSI’s (March MA- wide rates, Hospital in the fall), others

6 MA Health Care Cost and Quality Council (HCCQC) launch November 2008

7 MA HCCQC Quality rankings rating system based on 15/50/85th hospital percentile rankings

8 MA HCCQC “Cost” rankings $ - $$$$ rating system applied to a hospital’s median cost (payment from health plans)

9 MA Health Quality Partnership

10 MHA Patients first

11 MA Dept of HHS

12 Cost & Quality: The GIC Approach “Clinical Performance Improvement initiative” Measure cost efficiency via “ETG” methodology Measure quality via HEDIS, etc. Squeeze quality and cost scores from claims data Incent patient and physician behavior via differentials in co-payments Tiers 1,2 and 3 Implemented in 2006

13 Martha’s Vineyard Hospital Nantucket Cottage Hospital Rehab Hospital of the Cape and Islands Faulkner Hospital Newton-Wellesley Hospital McLean Hospital Massachusetts General Hospital Spaulding Rehabilitation Hospital Shaughnessy-Kaplan Rehabilitation Hospital North Shore Medical Center - Union North Shore Medical Center - Salem Non-Acute Hospital Acute Care Hospital H Brigham and Women’s Hospital Partners HealthCare Hospitals

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15 MGH Current Campus

16 1)Tell our Quality and Safety story MGH/MGPO’s interpretation of quality and safety indicators already publicly available. 2)Highlight aspects of quality and safety that are not publicly reported but that we as the MGH/MGPO community feel should be reported to the public. 3)Educate the public about our internal quality improvement efforts by increasing the visibility of quality/safety data and our stories. 4)Target audience includes informed consumers interested in general information about hospital quality of care, payors, legislators, policy staff. Goals for MGH/MGPO External Site

17 MGH-People, Facilities & Services (structural measures-# of board certified, technologies, Magnet status) Delivering the Right Care (NHQM) Keeping Patients Safe (Infection control measures, Leapfrog safety goals) Listening to Patients (HCAHPS) Providing Equitable Care (HF, AMI and PNA segmented by race/language) Improvement stories Categories of Measures

Click on Performance Reports to see list of categories.

25 1)Hold leadership accountable 2)Identify highest organizational priorities 3)Ongoing tracking 3)Target audience internal leadership 4)Eventually develop better IT connections between point of care, acute care documentation, data bases and measurement and reporting tools – a journey Goals for MGH/MGPO Internal Site

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30 Preservation Layer Curation Layer Real-Time Layer Application Layer Integration Layer IODW Query & Reporting AppDM Query & Reporting QSD Dashboard & Scorecard Quality & Safety Performance Measurement Portal Information Source Hub Clinical Analysts Power Users Senior Management Staff Data Files and Data Feeds from Source Systems (e.g. TSI, PATCOM, NSQIP, etc.) Integrated Outcomes Data Warehouse: building the IT infrastructure

31 MGH Quality & Safety Governance

32 Board engagement in Quality & Safety

33 Analysis of problem Integration of Operations & Improvement Performance reporting Operations design Executive oversight Organizational strategy Performance Measurement (Signal detection) Short term implementation Executive incentives Practitioner influence and incentives Longer term implementation Research enterprise Regular Operations Improvement Efforts Process Improvement Design Improvement cycle Operations cycle Backup MGH/MGPO Culture Immediate Response

34 Analysis of problem Integration of Operations & Improvement Performance reporting Operations design Executive oversight Organizational strategy Performance Measurement (Signal detection) Short term implementation Executive incentives Practitioner influence and incentives Longer term implementation Research enterprise Regular Operations Improvement Efforts Process Improvement Design Improvement cycle Operations cycle Backup MGH/MGPO Culture Immediate Response

MGH site:

36 Martha’s Vineyard Hospital Nantucket Cottage Hospital Rehab Hospital of the Cape and Islands Faulkner Hospital Newton-Wellesley Hospital McLean Hospital Massachusetts General Hospital Spaulding Rehabilitation Hospital Shaughnessy-Kaplan Rehabilitation Hospital North Shore Medical Center - Union North Shore Medical Center - Salem Non-Acute Hospital Acute Care Hospital H Brigham and Women’s Hospital Partners HealthCare Hospitals

37 Partners is an integrated, academic health system founded in 1994 by Brigham and Women’s Hospital and Massachusetts General Hospital Partners four-part mission is patient care, teaching, research, and community service Partners was formed to preserve academic medicine, create a more rational system of care, and add value in the areas of access, cost, and quality Partners HealthCare, Inc.

38 Patient Care at Partners 1.7 million patients receive care from Partners institutions and physicians 170,000 hospital inpatient discharges annually 4.3 million outpatient and physician visits annually 22% of acute hospital discharges in Eastern Massachusetts are from Partners hospitals

39 PARTNERS CORPORATE ORGANIZATION CHART Dana Farber/PartnersTwo Physicians Cancer Care PARTNERS HEALTHCARE SYSTEM, INC. Appointed by Partners Partners International Medical Services, LLC Brigham and Women’s/The MassachusettsNewton-Wellesley Partners Continuing Partners Community NSMC HealthCare, Inc. Faulkner Hospitals, Inc.General HospitalHospital Care, Inc. HealthCare, Inc. The Spaulding The Brigham and Women’s The General Hospital Rehabilitation Hospital North Shore Medical Newton-Wellesley Hospital, Inc. Corporation Center, Inc. Physician Hospital Corporation Organization, Inc. Brigham and Women’s Rehabilitation Hospital Physicians Organization, Massachusetts General North Shore of the Cape and Inc. Physicians Physicians Group, Islands, Inc. Organization, Inc. Inc. Faulkner Hospital, Inc. Shaughnessy Kaplan McLean HealthCare, Rehabilitation Hospital, Inc. Inc. Partners Home The McLean Hospital Care, Inc. Corporation The MGH Institute ofFRC, Inc. Health Professions, Inc. Martha’s Vineyard Hospital, Inc. Nantucket Cottage Hospital REVISED: 11/12/ v6

40 1)Tell the High Performance Medicine Story: what we’re doing to provide better, safer, more cost effective care 2)Educate the viewer about the importance of a system in making the full spectrum of health care services available and in ensuring uniform care throughout the system 3)Share our performance on key quality and safety indicators 4)Highlight improvement strategies 5)Link to entity (hospitals) sites Goals for external reporting at PHS

41 High performance medicine: Better, Safer, & more Cost- effective care Maximizing the use of Information Technology Making our care as safe as possible, free from harm & errors Ensuring high quality across all sites by making care reliable Taking expert, tailored care of specific high-risk patients Using drugs and imaging technologies cost-effectively The story for the first PHS release

42 The Performance Metrics for the first PHS release Maximizing the use of Information Technology Implementing Computerized Order Entry Adopting of electronic medical record by Primary Care Providers Adopting of electronic medical records by Specialists Prescribing medications electronically Making our care safe, free from harm Implementing Electronic Medication Administration Records Bar coding patients, staff and medications Making transitions in care safer Ensuring uniform, reliable, high quality care Adhering to guidelines for care of patients with Heart attacks, Congestive Heart Failure and Pneumonia Delivering PCI within 90 minutes for eligible heart attack patients Delivering smoking counseling to targeted populations Preventing surgical infections Reducing ICU Bloodstream Infections Reducing Patient Falls with injury Caring for High risk populations Connecting Congestive Heart Failure patients to post-discharge services Using resources cost- effectively Increasing the appropriate use of Generic Drugs

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51 Partners High Performance Medicine Leadership Structure Executive Committee James Mongan, MD, Thomas Lee, MD, Jennifer Daley, MD, Cindy Bero, John Glaser, Robin Jacoby, and Sheridan Kassirer CMO’s/Physicians Executive Council (Advisory on Clinical Priorities) Operating Units (Advisory on Resource Issues Director Thomas H. Lee, MD Chief Operating Officer Sheridan Kassirer Team 1 Cynthia Bero Team 2 Tejal Gandhi, MD Team 3 Elizabeth Mort, MD Team 4 Timothy Ferris, MD Team 5 Jennifer Daley, MD Sheridan Kassirer

PHS site: