1. AHRQ and the Science of Public Reporting Presentation to National Advisory Council Irene Fraser and Carol Sniegoski July 22, 2011

2. Public Reporting One Potential Strategy to Improve Quality Two Theories of Impact Two Theories of Impact – Consumer pathway u Consumers use info. to choose providers u Market shares shift, providers respond – Provider pathway u Providers value their reputations and/or market shares so strive to improve scores – More evidence on second pathway – But science is nascent Transparency also an end in itself Transparency also an end in itself Growing comparative reporting by CMS, states, communities, others Growing comparative reporting by CMS, states, communities, others Role grows under the ACA Role grows under the ACA

3. Goals for Discussion Summarize AHRQ role in public reporting Summarize AHRQ role in public reporting Present one new tool: MONAHRQ Present one new tool: MONAHRQ – Your ideas on priorities for enhancement? Discuss new multi-year initiative on the Science of Public Reporting Discuss new multi-year initiative on the Science of Public Reporting – Your ideas on strategies, themes, issues?

4. AHRQ Has a Significant Role in Public Reporting 1. Does NOT do provider-level reporting, but 2. Develops measures – CAHPS – Quality Indicators – Readmissions measures – CHIPRA and Adult Medicaid Measures 3. Reports national and state data – National Healthcare Quality and Disparities Reports – State Snapshots 4. Provides tools for CMS, states, others to use

5. CMS, States, Others Use AHRQ Measures for Public Reporting CMS – Uses H- CAHPS, Quality Indicators for Hospital Compare and Value-Based Purchasing CMS – Uses H- CAHPS, Quality Indicators for Hospital Compare and Value-Based Purchasing States – also use H-CAHPS and Quality Indicators for Public Reporting States – also use H-CAHPS and Quality Indicators for Public Reporting 25 states use Quality Indicators for public reporting 25 states use Quality Indicators for public reporting

6. AHRQ Has a Significant Role in Public Reporting (cont’d) 5. Provides clearinghouse, inventories – National Quality Measures Clearinghouse 6. Improves data for public reporting 7. Conducts (some) research on public reporting 8. Provides TA, learning networks for users of public reports – Example: 24 Chartered Value Exchanges Multi-stakeholder Multi-stakeholder Represent over 124 million lives Represent over 124 million lives Major activity is public reporting Major activity is public reporting AHRQ leads learning network AHRQ leads learning network

7. Learning Network Example: 24 Chartered Value Exchanges 1 5 2 3 4 18 6 7 8 9 1011 12 13 14 19 24 23 17 16 15 22 21 20 1 5 2 3 4 18 6 7 8 9 1011 12 13 14 19 24 23 17 16 15 22 21 20

8. AHRQ Role in Measures Reporting: An Example from HCUP and the Quality Indicators Statewide Orgs (government or private) Set rules on data collection and use Collect all-payer data from hospitals Process data Create claims databases Manage use of data AHRQ Standardizes data across states Develops national and regional statistics, benchmarks Funds data improvements Develops, validates, maintains, improves measures Seeks NQF endorsement Creates software tools Creates downloadable website-builder States, Communities, CMS, others Decide whether to do public reporting Establish structure and governance structure Select measures to report Display data

9. Goals for Discussion Summarize AHRQ role in public reporting Summarize AHRQ role in public reporting Present one new tool: MONAHRQ Present one new tool: MONAHRQ – Your ideas on priorities for enhancement? Discuss new multi-year initiative on the Science of Public Reporting Discuss new multi-year initiative on the Science of Public Reporting – Your ideas on strategies, themes, issues?

10. MONAHRQ overview Tour of MONAHRQ MONAHRQ introduction MONAHRQ goals and future directions Report from MONAHRQ users: Keely Cofrin Allen, Utah Department of Health

11. MONAHRQ motivation But … building a reporting site is tough Why does every organization have to reinvent the wheel? Growing need to publicly report healthcare quality and costs at the local level Building an effective reporting site is even tougher

12. Introducing MONAHRQ  Software that quickly generates your own local public reporting website Fast Easy Automatic Free Use your local data or use publicly available measures Designed by AHRQ to follow best practices in reporting – Selected as finalist in the Fall 2010/Winter 2011 HHSinnovates competition –

13. MONAHRQ origins AHRQ Quality Indicators MONAHRQ Hospital Costs and Utilization Project MONAHRQ builds on other AHRQ programs AHRQ QI software tools MONAHRQ benchmarks Online data query (HCUPnet) (HCUP) AHRQ QI R&D (QIs) Community health collaboratives Potential adopters Reporting experience AHRQ QI users (CVEs)

14. Download MONAHRQ from monahrq.ahrq.gov MONAHRQ makes reporting easier MONAHRQ

15. Load your local hospital discharge data Load CMS Hospital Compare measures* MONAHRQ makes reporting easier * Publicly available from Hospital Compare MONAHRQ Download MONAHRQ from monahrq.ahrq.gov

16. MONAHRQ Output a healthcare reporting website You host: internal, password- protected, or public MONAHRQ makes reporting easier Download MONAHRQ from monahrq.ahrq.gov Load your local hospital discharge data MONAHRQ runs on your desktop Load CMS Hospital Compare measures* * Publicly available from Hospital Compare

17. The MONAHRQ reporting website ■ Hospital Quality Ratings ■ Maps of Avoidable Hospital Stays ■ Hospital Utilization ■ County Rates of Hospital Use

18. MONAHRQ adoption First released June 2010 4 live statewide reporting sites, plus 2 expected soon

19. MONAHRQ tour: Hospital Quality Ratings AHRQ Quality Indicators CMS Hospital Compare measures HCAHPS measures

20. Hospital Quality Ratings: Search page Choose hospitals and a health topic

21. [Search page] Hospital Quality Ratings: Search page

22. Hospital Quality Ratings: Classification table * Available from HealthData.gov Compare hospital quality ratings

23. Hospital Quality Ratings: Bar charts Drill down to bar charts with benchmarks – Synthetic data –

24. Hospital Quality Ratings: Detailed statistics tables Drill down to underlying measure statistics – Synthetic data –

25. MONAHRQ tour: Maps of Avoidable Hospital Stays AHRQ area-level Quality Indicators Reflect quality of community care, not hospital care

26. [Search page] Choose a measure Maps of Avoidable Stays: Search page

27. Maps of Avoidable Stays: County maps Compare rates of potentially avoidable hospital stays by county – Synthetic data –

28. Maps of Avoidable Stays: Potential cost savings – Synthetic data – Drill down to estimated cost savings from reducing avoidable stays

29. Visit our new live MONAHRQ demo site monahrq.ahrq.gov/demo/index.html – Synthetic data –

30. Report from MONAHRQ users Keely Cofrin Allen Utah Department of Health

31. MONAHRQ goals Encourage local reporting Encourage use of endorsed measures (without enforcing it) Disseminate best practices in reporting Help to harmonize local reporting Provide options to help tailor local reports to local needs

32. Future plans Add new content – – Additional Compare measures – – Custom measures – – Plans, ACOs, or exchanges – – Cost and quality – – Summaries or composites – – EHR meaningful use – – All-payer claims data Add new features – – Time trends – – Custom benchmarks – – Summary pages – – Targeted reports (e.g., pediatrics) – – More customization options Add best practices – – New initiative on Building the Science of Public Reporting Collaborate, assist and assess – – Stakeholder feedback – – Technical support – – User groups

33. Email us: carol.sniegoski@ahrq.hhs.gov anne.elixhauser@ahrq.hhs.gov carol.sniegoski@ahrq.hhs.gov anne.elixhauser@ahrq.hhs.gov carol.sniegoski@ahrq.hhs.gov anne.elixhauser@ahrq.hhs.gov For assistance or to join the MONAHRQ mailing list: monahrq.ahrq.gov email monahrq@ahrq.gov Contact us For more information or to visit our live demo site: Input Your Data. Output Your Website.

34. Discussion Questions about MONAHRQ? Questions about MONAHRQ? Suggestions for future directions? Suggestions for future directions? How to guide MONAHRQ planning or facilitate MONAHRQ adoption? How to guide MONAHRQ planning or facilitate MONAHRQ adoption? Input Your Data. Output Your Website.

35. Goals for Discussion Summarize AHRQ role in public reporting Summarize AHRQ role in public reporting Present one new tool: MONAHRQ Present one new tool: MONAHRQ – Your ideas on priorities for enhancement? Discuss new multi-year initiative on the Science of Public Reporting Discuss new multi-year initiative on the Science of Public Reporting – Your ideas on strategies, themes, issues?

36. The Science of Public Reporting Initiative Goals: Forge a coordinated, evidence-based strategy for public reporting at the national and local levels Forge a coordinated, evidence-based strategy for public reporting at the national and local levels Improve science of public reporting Improve science of public reporting Incorporate this science in national and local reports Incorporate this science in national and local reports Improve data for public reporting Improve data for public reporting Assess impact Assess impact

37. First Step: AHRQ Summit on Public Reporting for Consumers March 23, 2011 130 participants: 130 participants: – NAC members – Public and private funders of research – Federal or state policymakers – Consumer organizations – Providers – Purchasers and plans – Report hosts Key questions: How do we advance public reporting of provider performance for consumers? How do we advance public reporting of provider performance for consumers? Where do we want to be tomorrow? Where do we want to be tomorrow? Where do we want to be in 2025? Where do we want to be in 2025? What are the challenges and how do we address them? What are the challenges and how do we address them?

38. Survey to Inform Summit: Do you think the best current public reports of provider performance information to consumers: Meredith Rosenthal, presentation at AHRQ Summit on Public Reporting for Consumers, March 23, 2011, work funded by AHRQ and Commonwealth Fund. 38

39. Science of Public Reporting Initiative: The Structure A partnership among AHRQ, ASPE, CMS A partnership among AHRQ, ASPE, CMS Funded through ACA Section 3014 for 2011-2014 Funded through ACA Section 3014 for 2011-2014 Combination of grants, contracts, FTEs to: Combination of grants, contracts, FTEs to: – Build the science – Create a user’s group – Facilitate use of new evidence Related Activities: Related Activities: – Coordination Group from ASPE, AHRQ, CMS to u Create a national reporting strategy u Coordinate on quality measurement and assessment – DHHS Quality Measures inventory – Inventory of potential data sources for public reporting – Analyses to track changes in provider performance on reported measures

40. #1 Build the Science: Pilots and Evaluations to Fill Evidence Gaps What kinds of data do consumers/patients want, and how do we get it? What kinds of data do consumers/patients want, and how do we get it? What display format is most effective? What display format is most effective? How can we maximize consumer engagement (what timing, what type of medium, etc.) How can we maximize consumer engagement (what timing, what type of medium, etc.) How does the impact of a public report vary depending on other incentives and market forces such as payment strategy, market competitiveness, and payment? How does the impact of a public report vary depending on other incentives and market forces such as payment strategy, market competitiveness, and payment?

41. #2 Form User’s Group: CMS, States, Consumers, CVEs, other Community Initiatives #2 Form User’s Group: CMS, States, Consumers, CVEs, other Community Initiatives Aligning Forces for Quality Other NRHI Members Chartered ValueExchange Beacon Communities Other Collaboratives

42. #3 Facilitate Use of New Evidence Enhance National Quality Measures Clearinghouse Enhance National Quality Measures Clearinghouse Establish a coordinating center to Establish a coordinating center to – Distill and synthesize existing evidence on “what works” in public reporting and under what circumstances. – Identify promising advances in website design and medium of public reporting. – Identify promising advances in the content of websites and other public reporting. – Facilitate collaboration across grant sites and dissemination of early findings. Enhance MONAHRQ Enhance MONAHRQ – Report new measure set – Add or refine reporting features – Enhance use and usability

43. Questions and Discussion: Science of Public Reporting Initiative Building the Science: Building the Science: – What are highest priority key questions, issues? How to balance need for comprehensiveness and speed? User’s Group: User’s Group: – What are most important stakeholders? How to keep the group representative yet manageable in size? Facilitate Use: Facilitate Use: – How to balance tension between need for consistent national measures and need/desire for local innovation?