1. Sarah Hudson Scholle Assistant Vice President, Research June 7, 2008 Opportunities for Improving Quality Measurement in Women’s Health

2. © 2008 National Committee for Quality Assurance Agenda NCQA Current quality measures of particular interest to women Opportunities for the future

3. © 2008 National Committee for Quality Assurance NCQA: Mission and Vision Mission – To improve the quality of health care Vision – To transform health care through measurement, transparency and accountability

4. © 2008 National Committee for Quality Assurance Over 500 plans report HEDIS data to NCQA (Commercial, Medicaid, Medicare) Over 200 commercial MCO plans are accredited by NCQA Over 75 Medicare Advantage plans are accredited by NCQA (more than any other accrediting body) Over 76.5 million patients are impacted through the plans NCQA accredits Over 10,000 physicians are recognized by NCQA programs Achieving the Mission Impact of Accreditation & Certification Programs

5. © 2008 National Committee for Quality Assurance HEDIS ® - Effectiveness of Care Prevention – Breast cancer screen – Cervical cancer screen – Colon cancer screen – Immunizations for Children and Adults – Chlamydia screen – Glaucoma – Physical Activity – Falls risk management – BMI Chronic disease – Hypertension – Diabetes – Cardiovascular disease – Smoking cessation – Osteoporosis testing – Asthma – Depression – Urinary incontinence – Follow up after mental illness hospitalization – Medication management – High risk medications Overuse/Misuse – Imaging in low back pain – Use of antibiotics Relative Resource Use

6. © 2008 National Committee for Quality Assurance Access & Utilization Frequency of Ongoing Prenatal Care –Reports an unduplicated count of deliveries who had <21 percent, 21– 40 percent, 41–60 percent, 61–80 percent or ≥81 percent of the number of expected visits, adjusted for the month the member enrolled and the MCO and gestational age. Prenatal and Postpartum Care –Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the MCO in the first trimester or within 42 days of enrollment in the MCO. –Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery. Retired –Discharges and ALOS—Maternity Care (including C-section rate) –Births and ALOS, Newborns

7. © 2008 National Committee for Quality Assurance NCQA Physician Recognition Programs Identify physicians who deliver superior care Measure against evidence-based standards Assess for diabetes, heart/stroke and back pain care, and evaluate office systems Publicly report Recognized physicians Encourage purchasers, plans and patients to reward Recognized physicians More than 10,000* physicians Recognized *As of March 21, 2008 5,285* physicians 1,431* physicians 3,456* physicians 273* practices 35* physicians 5* practices

8. © 2008 National Committee for Quality Assurance Physician Practice Connections  (PPC) Developed in Response to a Need – To Err is Human and Crossing the Quality Chasm provide evidence on importance of practice systems – Raise physician awareness of importance of systems in enhancing quality – Link health services research on systems and clinical outcomes to practice Measures – Systematically provide preventive and chronic care management – Actionable at physician practice level – Validated by relating them to performance

9. © 2008 National Committee for Quality Assurance Theoretical Frameworks Informing Physician Practice Connections Chronic Care Model Patient Centered Care Cultural Competence Joint Principles of Medical Home Clinical information Systems Decision Support Patient Self- Management Delivery System Redesign Community Linkages Health Systems Respect Patient Values Accessible Family-Centered Continuous Coordinated Community Linkages Compassionate Culturally Appropriate Emotional Support Information and Education Physical Comfort Quality Improvement Culturally competent interactions Language services Reducing disparities Personal physician Physician directed team Whole person orientation Care is coordinated and integrated Quality and safety Enhanced access

10. © 2008 National Committee for Quality Assurance PPC-PCMH Content and Scoring Standard 1: Access and Communication A.Has written standards for patient access and patient communication** B.Uses data to show it meets its standards for patient access and communication** Pts 4 5 9 Standard 2: Patient Tracking and Registry Functions A.Uses data system for basic patient information (mostly non-clinical data) B.Has clinical data system with clinical data in searchable data fields C.Uses the clinical data system D.Uses paper or electronic-based charting tools to organize clinical information** E.Uses data to identify important diagnoses and conditions in practice ** F.Generates lists of patients and reminds patients and clinicians of services needed (population management) Pts 2 3 6 4 3 21 Standard 3: Care Management A.Adopts and implements evidence-based guidelines for three conditions ** B.Generates reminders about preventive services for clinicians C.Uses non-physician staff to manage patient care D.Conducts care management, including care plans, assessing progress, addressing barriers E.Coordinates care//follow-up for patients who receive care in inpatient and outpatient facilities Pts 3 4 3 5 20 Standard 4: Patient Self-Management Support A.Assesses language preference and other communication barriers B.Actively supports patient self-management** Pts 2 4 6 Standard 5: Electronic Prescribing A.Uses electronic system to write prescriptions B.Has electronic prescription writer with safety checks C.Has electronic prescription writer with cost checks Pts 3 2 8 Standard 6: Test Tracking A.Tracks tests and identifies abnormal results systematically** B.Uses electronic systems to order and retrieve tests and flag duplicate tests Pts 7 6 13 Standard 7: Referral Tracking A.Tracks referrals using paper-based or electronic system** PT 4 4 Standard 8: Performance Reporting and Improvement A.Measures clinical and/or service performance by physician or across the practice** B.Survey of patients’ care experience C.Reports performance across the practice or by physician ** D.Sets goals and takes action to improve performance E.Produces reports using standardized measures F.Transmits reports with standardized measures electronically to external entities Pts 3 2 1 15 Standard 9: Advanced Electronic Communications A.Availability of Interactive Website B.Electronic Patient Identification C.Electronic Care Management Support Pts 1 2 1 4 ** Must Pass Elements

11. © 2008 National Committee for Quality Assurance PCMH Must Pass Elements 1.PPC1A: Written standards for patient access and patient communication 2.PPC1B: Use of data to show meeting this standard 3.PPC2D: Use of paper or electronic-based charting tools to organize clinical information 4.PPC2E: Use of data to identify important diagnoses and conditions in practice 5.PPC3A: Adoption and implementation of evidence-based guidelines for three conditions 6.PPC4B: Active support of patient self-management 7.PPC6A: Tracking system to test and identify abnormal results 8.PPC7A: Tracking referrals with paper-based or electronic system 9.PPC8A: Measurement of clinical and/or service performance 10.PPC8C: Performance reporting by physician or across the practice

12. © 2008 National Committee for Quality Assurance Priorities Composite measures – Prenatal and postpartum care – Child well care Coordination/Continuity – Transitions across settings – Primary and specialty care – Medication reconciliation Overuse Disparities

13. © 2008 National Committee for Quality Assurance Gender Disparities Notably Absent in Blood Pressure, Diabetes Control Measures CVD: Cholesterol Control White Males African-American Males African-American Females White Females Blood Pressure Control White Males White Females African-American Males African-American Females Diabetes: Poor A1c Control (Lower is better) White Males White Females African-American Males African-American Females 10 20 30 40 50 60 70 Unadjusted Rate (%)

14. © 2008 National Committee for Quality Assurance Voluntary Accreditation Standards on Culturally and Linguistically Appropriate Services (CLAS) Project designed to develop consensus-based standards for addressing cultural competence, language needs and disparities for health plans, DMOs and MBHOs Activities include – Analysis of current state and federal rules – Assessment of market opportunities – Development of draft standards with input from stakeholder advisory panel – Testing of standards Goal is to have standards ready for public comment by December 2008 with final standards by April 2009 Supported by The California Endowment