Dirigo Health Agency’s

Dirigo Health Agency

Research Dissemination on quality, evidence-based medicine and patient safety Adoption of quality measures, coordination of collection and reporting Consumer education Technology assessment Promotion of adoption of electronic technology Recommendations regarding State Health Plan Annual report

Governance DHA Board of Trustees DHA Executive Director MQF Director Funding –Share of DHA “SOP” Funds Guidance –MQF Advisory Council

MQF Advisory Council Physicians (3) RN (1) Hospital (1) Mental Health Provider (1) Nonphysician Provider (1) Consumers (4) –Organized Labor (1) –Health Advocacy (1) –Uninsured/MaineCare (1) –Commercially Insured (1) Employers (4) –State Employees Health Commission (1) –Large Employer (1) –Midsize Employer (1) –Small Employer (1) Private Health Plan (1) MaineCare (1) Maine Health Data Organization (1, ex off.)

MQF PROJECTS  Data Collection and Reporting  Discharge Data and Website  Paid-claims Data and Health Dialog Project  Hospital-reported Performance Indicators (Chpt 270)  Healthcare-Associated Infections  Advanced Medical Home Pilot  In-a-Heartbeat  Voluntary Practice Assessment  Website Development  RWJ Projects: Quality Counts/AF4Q/RQS  Critical Access Hospital Collaborative  CON Assessment

Summary of Key Cost Drivers Utilization –Health Status – Preventable chronic illness complications increase utilization –We use more outpatient and more ED than most other New England states –Supply of technology (e.g. MRI) Inefficiency –20-60% variation in cost to treat same patient for same illness in different hospitals –Significant variation in how patients are treated by different physicians for similar problems

Variation Discharge Data Voluntary Performance Indicator Reporting Paid Claims Database Analysis

Discharge Data

Performance Indicators

MQF-Health Dialog Project Complete: Warehoused the paid-claims data and assessed its quality and capability to support population-based quality measures Conducted pilot provider profiling analysis –Primary care –Cardiology Conducted geographic variation analysis of advanced imaging utilization (CORE)

MQF Regional Variation in Effective Care

Performance Varies Across Providers

USING DATA TO EFFECT CHANGE Research Consensus Guidelines Performance Indicators for Providers Benchmarking Internal QI Public Reporting PHC4 NYHHC Pay for Performance Tiering Steerage Nonreimbursement POLICY

Advanced Medical Home Pilot More effective primary care, better platform for coordinated chronic disease management Collaborators –Maine Quality Forum –Quality Counts –Maine Health Management Coalition and Pathways to Excellence –Martins Point Healthcare –MaineCare –Anthem, other payers

In a Heartbeat Standardization of Best Practices for STEMI Care Community Engagement Publicity and training Emergency Care EMT Systems, Cath Lab Activation from Field Hospitals Data and Metrics

Critical Access Hospital Collaborative Problems with standard metrics; ?”Rural- relevant” indicators Patient Safety issues prominent (not “n- dependent”) Collaborators: MQF USM Muskie School of Public Service MeHAF 14/15 Critical Access Hospitals Medication Safety Project(s)

RWJ: Aligning Forces for Quality, Regional Quality Strategies AF4Q –Performance Measurement –Public Reporting –Consumer Engagement –Quality Improvement RQS –PM/PR of Hospital Quality –Investigation of Racial, Ethnic, Socioeconomic Disparities –Nurse-centered Inpatient Quality Improvement

AF4Q/RQS Collaborating Organizations Maine Quality Forum Maine Health Management Coalition Quality Counts 50 Employer groups (MHMC) 28 Member Organizations (QC)