1. Achieving National Quality Measurement and Reporting: A Purchaser Perspective David S. P. Hopkins, Ph.D. Pacific Business Group on Health AcademyHealth ARM June 5, 2007

2. © Pacific Business Group on Health, 2007 2 IOM Performance Measurement Principles “A performance measurement system should provide information for multiple uses, including:  Provider-led improvement efforts  Public reporting  Payment and benefit design  Population health initiatives.” -- excerpted from Performance Measurement: Accelerating Improvement, p. 48

3. © Pacific Business Group on Health, 2007 3 Consumer-Purchaser Disclosure Project: Performance Measurement Seen Through Consumers’ & Purchasers’ Eyes  Scope and pace of measure development and implementation too narrow and slow  Pressing sense of urgency  Real consumer/patient choices being made with little real information  Cost pressures leading to benefit designs and purchasing strategies too often “value-blind”  Robust performance dashboard essential  Consumer engagement requires relevant and adequate information  Plan designs, payment systems and networks must recognize quality and efficiency  Performance information must be valid and rapidly available: don’t let perfection be the enemy of the public good.

4. © Pacific Business Group on Health, 2007 4 Consumers and Purchasers Guidance on Measure Development Criteria  Reasonable scientific acceptability  Based on consumer’s perspective, not academic perfection  Feasible  Favor measures that can be populated with currently available electronic data  Relevant to consumers and purchasers  Important and actionable: full “STEEEP” dashboard  Enable consumer choice  Show high variation in performance  Affect large numbers of patients or total health care spending  Shed light on overall, cross-cutting, or condition-specific performance  Provide better understanding of disparities  Capture outcomes  Reflect continuum of care

5. © Pacific Business Group on Health, 2007 5 How well have early standardization efforts delivered a robust measure set (per IOM 6 domains)? (* = minimal measure set; ** = partial measure set; *** = robust measure set)

6. © Pacific Business Group on Health, 2007 6 National Efforts Lagging Local/Regional Initiatives  Leapfrog Hospital Rewards – NQF-endorsed quality measures + resource efficiency measures  Bridges to Excellence – systematic office processes + demonstrated excellence in 3 clinical areas  HealthPartners Optimal Diabetes Care – patient-centered view leads to “all-or-none” measurement  Mass. General Insurance Commission – physician-level clinical quality + cost-efficiency using best in class vendor tools  Hospital Infections Reporting (PA, MO, FL)

7. © Pacific Business Group on Health, 2007 7 Better Quality Information (BQI) Pilots  6 Pilots: CA, AZ, IN, MA, MN, WI  Selected through competitive RFP managed by AQA (formerly Ambulatory Quality Alliance)  Focus is on aggregating Medicare and commercial data to measure and report on physician practice performance  Intended for use by consumers and providers  Contracted with CMS  Limited scope of work: 5 nationally-endorsed quality measures initially, building to 12  3 measurement cycles: 2 in 2007, 1 in 2008

8. © Pacific Business Group on Health, 2007 8 Goals for the BQI Pilots  Demonstrate effective public/private partnership  Combine public and private data to achieve large “n” for measurement  Inform the expansion of consensus measures nationally  Demonstrate feasibility of collection of AQA endorsed performance measures  Test additional measures that are feasible to collect and conform to AQA measure principles  Speed adoption and reporting of valid, robust performance measures for use by:  Physicians and hospitals  Consumers  Purchasers  Payers

9. © Pacific Business Group on Health, 2007 9 BQI Challenges  Measures  Seeking a robust set – quality + cost-efficiency  Many specialties, not just 1° care  Consumers and purchasers want to choose/pay based on outcomes  Data  Chart review not scalable at statewide level (40,000+ practicing physicians)  CPT-II codes good in concept, but lacking a path to implementation  need both CMS and private sector  Limited by what is electronically available today: claims, Rx, some lab

10. © Pacific Business Group on Health, 2007 10 Dynamic Tensions in Physician Performance Measurement  Provider desires for “actionable” measures vs. consumer primary interest in outcomes  Provider demands for precision (p<0.05) vs. consumer tolerance for some misclassification  Milstein, et al., Health System Change, 2007  majority of consumers surveyed willing to accept >5% inaccuracy in physician performance ratings; 20+% willing to accept 20-50% inaccuracy  Feasibility: measures requiring new coding vs. measures driven off available electronic data