Aiming High: Towards a High Performance, High Value U.S. Health System
This presentation is the property of its rightful owner.
Sponsored Links
1 / 29

Cathy Schoen Senior Vice President, The Commonwealth Fund PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on
  • Presentation posted in: General

Aiming High: Towards a High Performance, High Value U.S. Health System Performance Reporting to Inform and Stimulate Action. Cathy Schoen Senior Vice President, The Commonwealth Fund AHRQ Annual Meeting: Improving Health Care, Improving Lives

Download Presentation

Cathy Schoen Senior Vice President, The Commonwealth Fund

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Cathy schoen senior vice president the commonwealth fund

Aiming High: Towards a High Performance, High Value U.S. Health SystemPerformance Reporting to Inform and Stimulate Action

Cathy Schoen

Senior Vice President, The Commonwealth Fund

AHRQ Annual Meeting: Improving Health Care, Improving Lives

National Performance Measurement & Reporting Session

Bethesda, MD

September 28, 2007

www.commonwealthfund.org


Performance reporting to inform and stimulate action

Performance Reporting to Inform and Stimulate Action

  • Importance of AHRQ Quality and Disparities reports and efforts to develop performance indicators: supporting efforts to improve

  • Need for focus on whole system and how dimensions interact: Access, Quality, Efficiency and Equity

    • Examples from Fund sponsored work that builds on AHRQ

    • Composites and benchmarks

    • Geographic and care system variations

    • Efficiency (quality/cost) indicators

  • Where performance reporting in going

    • U.S. and international examples

  • Future directions: critical role of public performance information & analysis to guide and drive change


Commonwealth fund commission goals for a high performance health system

HIGH QUALITY CARE

  • Getting the right care

  • Coordinated care

  • Safe care

  • Patient-centered care

Commonwealth Fund Commission:Goals for A High Performance Health System

ACCESS & EQUITY FOR ALL

  • Universal participation

  • Affordable

  • Equitable

LONG, HEALTHY, AND PRODUCTIVE LIVES

EFFICIENCY

SYSTEM CAPACITY TO INNOVATE & IMPROVE


U s national scorecard why not the best commonwealth fund commission national scorecard

U.S. National Scorecard: Why Not the Best?Commonwealth Fund Commission National Scorecard

  • 37+ Indicators

  • U.S. compared to benchmarks

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, September 2006.


Aiming higher commonwealth fund commission state scorecard on health system performance

Aiming Higher: Commonwealth Fund Commission State Scorecard on Health System Performance

  • State ranks

  • 32 indicators

Source: Commonwealth Fund State Scorecard on U.S. Health System Performance, 2007


Composites benchmarks and geographic variation

Composites, Benchmarks and Geographic Variation

  • AHRQ development of indicators of key concepts critical to inform efforts to improve performance

  • Composites:

    • A limited number of key indicators enables view of overall patterns

    • Can “drill down” to understand variation

  • Benchmarks:

    • Top percentiles (hospitals; nursing homes; geographic areas; systems) provide targets

    • Goal: Improve and narrow the distribution between leading/lagging

  • Geographic variations and cross-cutting analyses


Mortality amenable to health care

Mortality Amenable to Health Care

Mortality from causes considered amenable to health care is deaths before age 75 that are potentially preventable with timely and appropriate medical care

Deaths per 100,000 population*

International

variation, 1998

U.S. State variation,2002

Percentiles

* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease.

See Technical Appendix for list of conditions considered amenable to health care in the analysis.

Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003);

State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


Having an accessible primary care provider by age group family income and insurance status 2002

Having an Accessible Primary Care Provider, by Age Group, Family Income, and Insurance Status, 2002

Percent of adults with a usual source of care who provides preventive care, care for new and ongoing health problems, and referrals, and who is easy to get to

Elderly adults

Nonelderly adults

Data: B. Mahato, Columbia University analysis of 2002 Medical Expenditure Panel Survey.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


Cathy schoen senior vice president the commonwealth fund

Receipt of All Three Recommended Services for Diabetics,by Race/Ethnicity, Income, Insurance, and Residence, 2002

Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year

*

**

* Insurance for people ages 18–64.

** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants.

Data: 2002 Medical Expenditure Panel Survey (AHRQ 2005a).

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


Cathy schoen senior vice president the commonwealth fund

Medicare Admissions for Ambulatory Care Sensitive Conditions,Rates and Associated Costs, by Hospital Referral Regions, 2003

Rate of ACS admissions per 10,000 beneficiaries

Costs of ACS admissions as percent of all admission costs, average in region groups

Percentiles

Percentiles

Data: G. Anderson and R. Herbert, Johns Hopkins University analysis

of 2003 Medicare Standard Analytical Files (SAF) 5% Inpatient Data.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


State variation potentially preventable hospital admissions indicators

State Variation: Potentially Preventable Hospital Admissions Indicators

Percent

DATA: Medicare readmissions – 2003 Medicare SAF 5% Inpatient Data; Nursing home admission and readmissions – 2000 Medicare enrollment records and MedPAR file; Home health admissions – 2004 Outcome and Assessment Information Set

SOURCE: Commonwealth Fund State Scorecard on Health System Performance, 2007


Medicare hospital 30 day readmission rates and associated costs by hospital referral regions 2003

Medicare Hospital 30-Day Readmission Rates and Associated Costs, by Hospital Referral Regions, 2003

Rate of hospital readmission within 30 days

Readmission reimbursement as percent of total reimbursement for all admissions

Quartile of regions ranked

by readmission rates

Percentiles

Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of 2003 Medicare Standard Analytical Files (SAF) 5% Inpatient Data.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


Where performance reporting is going u s and international

Where Performance Reporting Is Going: U.S. and International

  • United States

    • Multi-payer initiatives

    • Quality and value: cost and price reporting

    • Physician level reporting

    • Patient experiences: H-CAHPS + ambulatory

    • Effort to define/assess/measure outcomes

    • Development of episode of care quality/cost and better measures of care coordination

  • International

    • Expanded set of indicators and public reporting

    • System and financial incentives to support/reward improvement


Cathy schoen senior vice president the commonwealth fund

MHQP Setting the Stage for Public Reporting: Commonwealth Fund/RWJ Project

Massachusetts first state to publicly report hospital and medical group patient-centered care survey data – Massachusetts Health Quality Partners

Source: Melinda Karp, “Reporting Patients’ Experiences with Their Doctors Process, Politics and Public Reports in Massachusetts,” Presentation March 31, 2006.


Cathy schoen senior vice president the commonwealth fund

Patient-Centered Hospital Care: Staff Managed Pain, Responded When Needed Help, and Explained Medicines, by Hospitals, 2005

Percent of patients reporting “always”

*Patient’s pain was well controlled and hospital staff did everything to help with pain

**Patient got help as soon as wanted after patient pressed call button and in getting to the bathroom/using bedpan

***Hospital staff told patient what medicine was for and described possible side effects

Data: CAHPS Hospital Survey for 254 hospitals submitting data in 2005. National CAHPS Benchmarking Database

SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006


National quality benchmarking in germany

Size of the project:

2,000 German Hospitals (> 98%)

5,000 medical departments

3 Million cases in 2005

20% of all hospital cases in Germany

300 Quality indicators in 26 areas of care

800 experts involved (national and regional)

Ideas and goals:

 define standards (evidence based, public)

 define levels of acceptance

 document processes, risks and results

 present variation

 start structured dialog

 improve and check

National Quality Benchmarking in Germany

Source: Christof Veit, “The Structured Dialog: National Quality Benchmarking in Germany,” Presentation at AcademyHealth Annual Research Meeting, June 2006.


German hospital quality improvement

German Hospital Quality Improvement

Hamburg: Antibiotic Prophylaxes in Hip-Replacement.

2003: 95,6%

2004: 98,5%

2005: 99,3%

%

Hospitals

Source: Christof Veit, “The Structured Dialog: National Quality Benchmarking in Germany,” Presentation at AcademyHealth Annual Research Meeting, June 2006.


Improve quality transparency the netherlands

Improve Quality Transparency: The Netherlands

Death-rate after stroke in bottom-20 hospitals

  • Collect comparative data: (quality indicators)

  • Inspectorate examines care providers with different quality indicators

  • Make quality differences visible through the internet

Source: Hans Hoogervorst, Minister of Health, Netherlands,, “A Vision for Health Care in the 21st Century,” Presentation to the Commonwealth Fund International Symposium, November 2, 2006.


The impact of public reporting the u s ncqa experience

The Impact of Public Reporting:the U.S. NCQA Experience

  • Ten years of measuring data: measurement and public reporting leads to improvement:

    • U.S. children today nearly three times more likely to have had all immunizations as in 1997

    • U.S. diabetics today twice as likely to have cholesterol controlled (<130 mg/dL) as in 1998

    • More than 96% of U.S. cardiac patients prescribed beta-blockers after a heart attack (up from 62% in 1997); NCQA retired the beta-blocker/post hospital measure this year*

BETA-BLOCKER TREATMENT AFTER

A HEART ATTACK

Score = 97

2005

Score = 71

1996

Source: National Committee for Quality Assurance; *Thomas Lee, “Eulogy for a Quality Measure,” New England Journal of Medicine, September 20, 2007.


Aiming high future directions

Aiming High: Future Directions?

  • Critical role of public information and analysis to guide and drive change

  • AHRQ potential

    • Public repository and public data

    • Composites and benchmarks: enable focus on variation, high/low performance areas and care systems

    • Quality, access and cost analysis: High Value

  • Research and collaboration

    • Linking quality-related research to performance indicators

    • “E-indicators”: potential with electronic health records*

    • Collaborative efforts to understand key drivers of high performance

    • Whole system view: primary and specialized care

*Commonwealth Fund/RWJF project with Jinnet Fowles, Park Nicollet and Jonathan Weiner, Johns Hopkins.


Related commonwealth fund reports and newsletters

Related Commonwealth Fund Reports and Newsletters

REPORTS:

  • Why Not the Best? Results from a National Scorecard on U.S. Health System Performance (Sept. 20, 2006). The Commonwealth Fund Commission on a High Performance Health System.

  • Aiming Higher: Results from a State Scorecard on Health System Performance (June 13, 2007). The Commonwealth Fund Commission on a High Performance Health System.

    NEWLETTERS

  • Quality Matters

  • States in Action

    Download at: www.commonwealthfund.org/publications/


Thank you acknowledgments

Thank You! Acknowledgments

Karen Davis,

President

[email protected]

Stephen Schoenbaum, M.D.,

Executive Vice President

and Executive Director, Commission on a High Performance Health System

[email protected]

Tony Shih, M.D.,

Senior Program Officer for Quality Improvement and Efficiency

[email protected]

Sabrina How,

Senior Research Associate

[email protected]


Visit the fund s website at www commonwealthfund org

Visit the Fund’s website atwww.commonwealthfund.org


  • Login