1. Reporting Approaches and Best Practices Jennifer Benjamin NCQA
February 2008

2. This Presentation Reporting Performance Data Lessons Learned
Reporting Strategy
Methodology
Reporting in a P4P Environment
Lessons Learned

3. IOM Report: Rewarding Provider Performance Recommendations
IOM. Rewarding Provider Performance. September. 2006/p6/c1/lines 1-4; p7/c1/lines ; p8/c1/lines 23-27; p9/c1/lines 23-24
Implement pay for performance in Medicare (w/recommendations on funding)
Reward high clinical quality, patient-centered, and efficient care: coordination of care, chronic conditions
Providers should publicly report and participate as soon as possible (reporting, then improvement and excellence)
Assist providers w/electronic data collection and implement a monitoring and evaluation system
IOM. Rewarding Provider Performance. September. 2006/p9/c1/lines 32-35; /p10/c1/lines 31-35; p11/c1/lines 1-2; p12/c1/lines 24-41
IOM. Rewarding Provider Performance. September. 2006/p13/c1/lines 9-17; p14/c1/lines 1-6 and 15-24
Some of these recommendations have already been incorporated into demonstration and pilot projects. Others are a preview for what the Medicare program will incorporate over the coming years
Review summary of the IOM’s 10 recommendations
Institute of Medicine. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: National Academies Press; 2006.

4. Public Reporting = Improved Performance
IOM. Rewarding Provider Performance. September. 2006/p6/c1/lines 1-4; p7/c1/lines ; p8/c1/lines 23-27; p9/c1/lines 23-24
“ Hospitals engaged in both public reporting
and pay for performance achieved
modestly greater improvements in quality
than did hospitals engaged only in public
reporting.”
NEJM, “Public Reporting and Pay for Performance in Hospital Quality Improvement”, Feb 2007
IOM. Rewarding Provider Performance. September. 2006/p9/c1/lines 32-35; /p10/c1/lines 31-35; p11/c1/lines 1-2; p12/c1/lines 24-41
IOM. Rewarding Provider Performance. September. 2006/p13/c1/lines 9-17; p14/c1/lines 1-6 and 15-24
Some of these recommendations have already been incorporated into demonstration and pilot projects. Others are a preview for what the Medicare program will incorporate over the coming years
Review summary of the IOM’s 10 recommendations
Institute of Medicine. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: National Academies Press; 2006.

5. Reporting Strategy
AQA. Data Sharing and Aggregation Principles for Performance Measurement and Reporting p1/lines 10-25
Is the information meaningful for the target audience?
Will the target audience understand what to do with the information?
Are the words or concepts presented at a level that the target audience is likely to understand?
Does the information contain an appropriate level of detail?
These principles were published by AQA in April To support performance measurement and reporting, an effective data sharing and aggregation model requires the following:
Transparency
Standardized metrics and data collection protocols that can be compared with national, regional, or other suitable benchmarks
Useful data for physicians to improve the quality and cost of care they provide to their patients
Public reporting to consumers of user-friendly, meaningful, and actionable information
The collection of both public and private data
Association for Quality Assurance. Data Sharing and Aggregation Principles for Performance Measurement and Reporting. January 2006;v1:1.

6. Reporting Strategy – General Principles
AQA. Data Sharing and Aggregation Principles for Performance Measurement and Reporting p1/lines 10-25
Group measures into reporting categories that are meaningful to consumers.
Display comparative information in a format that is easy to read and understand.
Use a rating scale that incorporates measures that are salient to the target audience.
Focus Groups, Sample Report Cards
These principles were published by AQA in April To support performance measurement and reporting, an effective data sharing and aggregation model requires the following:
Transparency
Standardized metrics and data collection protocols that can be compared with national, regional, or other suitable benchmarks
Useful data for physicians to improve the quality and cost of care they provide to their patients
Public reporting to consumers of user-friendly, meaningful, and actionable information
The collection of both public and private data
Association for Quality Assurance. Data Sharing and Aggregation Principles for Performance Measurement and Reporting. January 2006;v1:1.

7. Adapting Reporting Principles to P4P
Collaberation: Involve key stakeholders in the overall process
Transparent methods: Data specifications; results shared with physicians/physician organizations first
Portrayal of performance differences: Results should be displayed relative to peers
AQA. Principles for Reporting to Clinicians and Hospitals p1/lines 20 – 40; p2/lines 1-43
Content of reports
Reports should focus on areas that have the greatest opportunities to improve quality by making care safe, timely, effective, efficient, equitable, and patient centered
Reports should rely on standard-performance and patient-experience measures that meet the AQA Principles for Performance Measurement (eg, measures should be evidence based, relevant to patient outcomes, and statistically valid and reliable)
Transparent methods
Data specifications for reported performance data, such as sample size and methods of data collection and analysis, should be explicit and disclosed to physicians and hospitals
Clinicians whose performance is reported should be able to review and comment on the methodology for data collection and analysis (including risk adjustment). Clinicians and hospitals should be notified in writing in a timely manner of any changes in program requirements and evaluation methods
Portrayal of performance differences
Results of individual clinician or group performance should be displayed relative to peers. Any reported differences between individual providers or groups should include the clinical relevancy of the findings
Report design and testing for usability
Practicing physicians should be actively involved in the design of performance reports.
Report formats should be designed to be user-friendly and easily understood, and should be pilot-tested before implementation.
Collaboration
Clinicians and hospitals should collaborate to share pertinent information in a timely manner that promotes patient safety and quality improvement.
Association for Quality Assurance. Principles for Reporting to Clinicians and Hospitals. April 2006;v1:1-2.
Source: AQA.

8. IHA P4P Public Reporting: 2006 Data Reported in 2007
IHA. Online Report Card. [website] 2006
This is an example of how results from the IHA program are publicly reported to consumers and policy makers
Consumers can go to and search by county to find specific group information on quality
Integrated Healthcare Association. Online report card, Alameda County Available at:
Accessed February 16, 2007.

9. IHA P4P Public Reporting: 2006 Data Reported in 2007
IHA. Online Report Card. [website] 2006
This is an example of how results from the IHA program are publicly reported to consumers and policy makers
Consumers can go to and search by county to find specific group information on quality
Integrated Healthcare Association. Online report card, Alameda County Available at:
Accessed February 16, 2007.

10. IHA P4P Public Reporting: 2006 Data Reported in 2007
IHA. Online Report Card. [website] 2006
This is an example of how results from the IHA program are publicly reported to consumers and policy makers
Consumers can go to and search by county to find specific group information on quality
Integrated Healthcare Association. Online report card, Alameda County Available at:
Accessed February 16, 2007.

11. MN Community Measurement Public Reporting
Medical groups receive an advance copy of the Health Care Quality Report
Report includes results of aggregate data by measure for each group and measure statistics
Numerators, denominators, and patient lists by measure available on request
Report also available on public Web site
Also conduct provider Web cast and medical group meetings
Keeping physicians engaged and feeling as though they are contributing to the process is important, especially when sharing initial results (prior to public reporting)
According to a slide from Greg Pawlson, MD, Executive Vice President, NCQA, in association with Jim Chase, Executive Director, Minnesota Community Measurement Program, March 2007.

12. MN Community Measurement Provider Group Profile
Chase,Jim. MN Community Measurement 2006 State of Health Care Quality Report Presentation. [Website] slide 38
This is an example of how Minnesota Community Measurement results are reported to the public
This report card is at
Chase J, Magnan S. Minnesota Community Measurement Available at: Accessed March 12, 2007.
Reprinted with permission from MNCM.

13. Important Considerations
Lessons learned from two state report cards
efforts:
Content of report cards should be driven by the needs of the target audience.
Report cards should use consumer-friendly reporting categories and measure descriptions.
Consumers are more familiar with survey than clinical quality information
Report cards should have clear and easy to understand tables/charts.

14. Conclusions
Reporting data in a clear, concise manner that is meaningful to consumers is important
Agree on methodology that makes sense to the target audience
Stakeholder participation in the review process is key