1. Measuring and Reporting Performance Data Through Health IT AHRQ Annual Meeting Wednesday September 26, 2007 A. John Blair, III, MD President, Taconic IPA

2. Evolution  Process incentives/Claims data  Structure incentives  IT adoption and usage  NCQA/POL  Outcomes incentives/Clinical data

3. Process Incentives/Claims Data 200020042008200620102002 Report Development Transparency Multi-Payer P-4-P Project Single Payer P-4-P Project Physician Feedback and Communication Efforts

4. Physician Reports

5. Single Payer P-4-P

6. Transparency

7. Multi-Payer Reports

9. Physician Feedback & Communication  Medical Council  PCP  Specialty  Clinical leadership  Strong quality focus  Initial report feedback  Individual  Group  Monthly Newsletter  Physician comment period prior to incentive payments

10. Structure Incentives 200020042008200620102002 NCQA/PPC eRx Community Viewer Clinical Messaging Physician Feedback and Communication EHR THINC RHIO, Quality Committee

11. NCQA Physician Practice Connections  Access / Communication  Patient tracking / Registries  Care management  Self management support  Electronic prescribing  Test tracking  Referral tracking  Performance reporting & improvement  Interoperability

12. THINC RHIO, Quality Committee  Activities  Determine performance measures  Promote standards HIE Measure metrics  Coordinate payment incentives  Committee composition  Physicians  Hospitals  Health plans  Quality measures experts

13. Claims vs. Clinical Reporting  Uninsured not captured  Services delivered, not health outcomes  Non-reimbursable services not captured  Inaccuracy due to income maximization  Difficult to risk adjust (severity, stage)  Lack of continuity with one health plan  Fragmented health care market (and claims)  Provider resistance

14. Advantages of EHR-Based Measurement  Better data than claims-based  More detailed clinical data (e.g. BP)  More scalable than chart-reviews  Faster, cheaper  Greater sample size allows better provider comparisons  Greater precision for encounter-level analyses  Paradigm shift  CDSS  Registry  Measure

15. Challenges of EHR-Based Measurement  Structured data elements may not exist in EHR  Data elements not standardized (e.g. lab codes)  Outside data not available (e.g. hospitalizations)

16. Decision Support Tools  Focus on THINC RHIO measures  Passive & active alerts and reminders  Wary of “alert fatigue”  Minimal set  Actionable  Consonant with workflows, not disruptive  Not just alerts  Order sets  Templates  Clinical knowledge  Data presentation  Process reengineering

17. “Not Just Alerts”  Practice workflow reorganization  Structured data collection  Registries and panel management  Alternative visit types  Team-based care  Case management  Patient education and self-management

18. Questions?

19. A. John Blair, III, MD President, Taconic IPA Thanks for your time!