1. www.mhmc.info & www.mehmc.org 1 MHMC - PTE Objectives  Objective: To get providers and patients/consumers (and secondarily purchasers, policy makers, etc. and others) the information they need when they need it to assume the accountabilities and responsibilities we are asking them to.  Rationale: With the onset of healthcare and payment reform, and initiatives like Patient Centered Medical Homes and Accountable Care Organizations, providers are assuming responsibility for the cost, quality, and patient experience (i.e. Triple Aim) of some sort of people/populations in their areas. However, we almost universally hear from providers they don’t have the information they need when they need it to assume this responsibility.

4. www.mhmc.info & www.mehmc.org 4 Proposed Core Measures - I  Cancer Screening Breast Cervix  Diabetes Annual A1c test Annual LDL test  Heart Disease Annual LDL test Persistence of BB use  Safety Monitoring of pts with persistent medications  Asthma Appropriate use of meds  Overuse Imaging for LBP Approp. Testing for pharyngitis Antibiotics for bronchitis Appropriate tx for children with URI  Readmissions  Utilization of services Could be computed through claims only

5. www.mhmc.info & www.mehmc.org 5 Proposed Core Measures - II  Diabetes BP value (e.g. 130/80) A1c value (e.g., < 8.0) LDL value (e.g., < 100) Annual eye exam Nephropathy screen Foot exam  Heart Disease LDL value (e.g., < 100) Persistence of BB use  Hypertension BP value (e.g. 140/00)  Prenatal/Postpartum Care Visits  Population Health Flu shots (chronic dx patients, older adults) Childhood immunization Pneumovax Colorectal cancer screen BMI (adult, child) Tobacco Use (ID, Advice, Medication) Could be computed through claims + some clinical data

6. www.mhmc.info & www.mehmc.org 6 Proposed Core Measures - III  Measures of care experience  Key themes Quality of MD-Patient Interaction Health Promotion Helpful Office Staff Access to needed Care Care Coordination/Chronic Care  Functional Health Status  Risk Assessment Could be computed through patient survey

7. www.mhmc.info & www.mehmc.org 7 7 3-© 1996 Dartmouth Medical School and Lahey Hitchcock Clinic Function & Risk Health Care Delivery Perceived Health Benefit Disease Costs Direct Medical Indirect Social To Measure Health Status & Outcomes … Need Patient Reported Data Physical Mental Social/Role Behaviors Experience Mortality Morbidity Symptoms

8. www.mhmc.info & www.mehmc.org 8 Risk Assessment

9. www.mhmc.info & www.mehmc.org 9 9 Implications for Measurement: to improve health care value we need patient-focused feed forward information  Need to measure changes in health status, quality & costs using feed forward and feedback principles  Need to include patient-reported data to measure health outcomes and value  Need to design and implement new HIT systems to accomplish this -- good news technology is (almost) ready  Demonstrations have shown the utility and feasibility of this approach

10. www.mhmc.info & www.mehmc.org 10 Touch Pad or Web Technology Patient provides self-report data when visiting provider or at home using web-enabled system

11. www.mhmc.info & www.mehmc.org 11 Patient Summary Report: Dartmouth Spine Center Used to develop/revise care plan & monitor impact of care for individual patients Function Disease Experience

12. www.mhmc.info & www.mehmc.org 12 Managing Patients & Providers (HDA)