1. Community Partnerships in Quality-Based Purchasing
Roy Plaeger-Brockway, MPA
Senior Program Manager
Health Services Analysis
Washington State Labor & Industries
Olympia, Washington

2. Objectives Describe two Washington State pilots
Explain how pilots encourage community based quality improvement
Share results of pilots based on a University of Washington evaluation
Discuss lessons learned

3. Background L&I is a state workers’ compensation insurer
Purchase $500 million of health care a year
Quality of care is a top priority
To improve care we engaged our customers in designing two community-based quality improvement pilots
Centers of Occupational Health & Education
700 participating doctors
20,000 patients a year

4. What was the problem? Difficult for purchaser to influence quality
Doctors with imperfect knowledge about work related conditions
No incentives for physicians to adopt occupational health best practices
No infrastructure for community-wide disability prevention
Delivery system not organized to prevent disability
Lack of care coordination
No education or feedback for doctors
No information systems to track clinical data
Not using data for health care quality improvement

5. What was the solution? Develop a community-based infrastructure
Local centers and experts to provide education and support to community physicians
Health services coordinators
Align payment incentives to support quality
Enhanced payment linked to quality indicators to encourage use of occupational health best practices
Improved work force training
Free CME and individualized physician training and support
More effective use of information technology
Patient tracking tool with reminders and alerts

6. Two providers chosen with RFP
Inland Northwest Health Services
St. Luke’s Rehab Institute
Valley Medical Center

7. Community-based model supports use of best practices
State Insurer
Customer
Advisors
Education & reminders
Patient tracking tools
Health services coordinators
Health System
Pilot
Community
Payment linked to quality indicators
Community
Physicians

8. Design of quality measures
Review evidence
Develop seed measures (best practices)
Share with practicing physicians
Rank with physician leaders
Establish payment levels and billing codes
Develop quarterly reporting to track progress on measures based on billing codes

9. Best practices with incentives
Submit accident report within 2 days
Document worker’s physical status and limitations at each visit
Contact the worker’s employer about return to work options
Assess barriers to return to work at 4 weeks of lost time

10. Example of a best practice
“Activity Prescription”
Use at patient visit
Script best practices
Document employment issues
Work status
Employer contact
Light duty accommodation
Set patient expectations

11. Increased adoption of best practice
Percent of Claims Where Doctors Used Best Practice (Physical Status Form)

12. Evaluation of Western WA COHE
Disability outcomes
Incidence was 17.8% vs. 23.7% for control
Workers on time loss at 6 months was 15.1% vs. 18.9%
Workers on time loss at 12 months was 7.4% vs. 9.4%
Costs
Medical costs were $1,785 per claim vs. $2,167
Disability costs were $711 per claim vs. $1,209
Satisfaction
Patient satisfaction was equal to control group
Physicians reported greater willingness to work with injured workers
Based on 10,000 claims

13. Evaluation of Eastern WA COHE
Disability outcomes
Incidence was 15.1% vs. 21.5% for control
Workers on time loss at 6 months was 20.5% vs. 20.4%
Workers on time loss at 12 months was 10.2% vs. 9.7%
Costs
Medical costs were $1,643 per claim vs. $2,138
Disability costs were $610 per claim vs. $930
Satisfaction
Patient satisfaction was equal to control group
Physicians reported greater willingness to work with injured workers
Based on 10,000 claims

14. Overall results University of Washington evaluation shows:
Reduced incidence of disability
Improved patient outcomes
Lower medical and disability costs
High patient satisfaction
Improved physician satisfaction
Overall savings
$441 per claim Western WA
$359 per claim Eastern WA

15. Lessons Learned
Community-based partnerships between purchaser and health care leaders help:
Create infrastructure needed to improve quality and outcomes
Foster physician support for solutions by involving local leaders in program design and development
Place responsibility for quality improvement within the local marketplace, which increases adoption

16. Lessons Learned
Physicians are willing and able to adopt best practices and improve quality when they have:
Local institutional support from clinical leaders
Incentives for use of best practices
Health services coordinators
Better information tools and education
Reduced administrative burden
Reminders and academic detailing

17. 2001 IOM Report: Crossing the Quality Chasm - Similarities
Institute of Medicine
Washington State Pilot
Design more effective organizational support
Local centers and experts to provide education and support
Create infrastructure to support evidence-based practice
Free CME for doctors and assistance from health services coordinators
More effective use of information technology
Patient tracking tool with reminders and alerts
Alignment of payment incentives to support quality
Enhanced payment linked to quality indicators
Improved work force training
Individualized physician training