Regional collaboratives as catalysts for quality reporting and improvement september 15 2009
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Regional Collaboratives as Catalysts for Quality Reporting and Improvement September 15, 2009. Mary McWilliams Executive Director. Health Alliance: A Regional Coalition. Collaborative of purchasers, providers, plans, patients Private, non-partisan, non-profit 501(c)(3)

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Regional Collaboratives as Catalysts for Quality Reporting and Improvement September 15, 2009

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Regional Collaboratives as Catalysts for Quality Reporting and ImprovementSeptember 15, 2009

Mary McWilliams

Executive Director

Health Alliance: A Regional Coalition

  • Collaborative of purchasers, providers, plans, patients

  • Private, non-partisan, non-profit 501(c)(3)

  • Created in 2004; hired staff in 2005

  • Now ~150 organizations with 2 million lives

  • Focus: 5 counties in Puget Sound region

  • Funded by participants and grants

  • RWJF Aligning Forces for Quality grantee

  • HHS Chartered Value Exchange

Alaska Airlines

The Boeing Company


Starbucks Coffee Company

Puget Sound Energy

WA State Health Care Authority

County Governments

City of Seattle


Group Health


Everett Clinic

Northwest Physicians Network

WA State Medical Association

WA State Hospital Association

Academy of Family Physicians

WA Naturopathic Physicians

WA State Nurses Association

Virginia Mason Medical Center

Swedish Medical Center

Providence Health & Services

Aetna Health Plans of WA


Premera Blue Cross

Regence Blue Shield

United Health Care

A Sampling of Who We Are . . . .

What We Do

  • Build local agreement on evidence-based care and standard measures

  • Report on health care performance in quality and cost

  • Provide resources to help with decision-making

  • Encourage incentives to reward value (e.g., medical home payment pilot)

    Transparency. Value. Consumerism.

Community Checkup:

  • Signature report & web site

  • Quality performance measure results for the community

    1st release –January 2008

    14 volunteer medical groups;

    97 clinics

    2nd release – November 2008

    47 medical groups; 170 clinics

    25 hospitals

    3nd release – July 2009

    80 medical groups; 270 clinics

    25 hospitals

3rd Community Checkup (July 2009):

Ambulatory Quality of Care Measures:

  • 23 process of care measures including chronic disease management, prevention, and appropriate use of services.

  • Claims and encounter data for 2 million lives from 18 health plans, self-insured purchasers, union trusts and Medicaid.

  • Separate results for Commercial and Medicaid

  • Custom reports for data suppliers’ workforce/dependents

    Hospital Quality of Care Reports:

  • Repackaging of publicly available hospital results for Medicare ( including heart attack, heart failure, pneumonia, surgical care, and patient experience

    eValue8TM Health Plan Results:

  • Summary level comparison of six health plans through standardized tool

    of National Business Coalition on Health

Next Steps for Quality Reports:

  • Additional measures

  • Additional data suppliers

  • Expand medical group auditing capabilities

  • Expand data elements (e.g. cost data, vision data, benefit information, PHI for linking member data)

  • Incorporate clinical data

The Next Horizon: Cost Transparency

  • Need cost transparency to complete the value equation

  • Currently lack pricing data from data suppliers

  • Interim strategy: report on relative resource use

  • Alliance developing 4 report ‘tracks’ to capture service intensity across hospitals and medical groups

Resource Measurement Report Plan

  • Mine public sources for acute care facility information

    • Dartmouth Atlas service intensity

    • CHARS (WA hospital data) gross charges and net revenue per case

      2. Use Alliance multi-payer data set to analyze selected high cost, high volume hospitalizations

    • Facility & professional care dyad resource use during hospitalization

    • Apply APR-DRG (3M) and RVUs (Milliman)

      3. Use Alliance multi-payer data set to analyze selected surgical procedures (preference-sensitive conditions)

    • Procedure frequency by patients’ area of residence

      4. Use Alliance multi-payer data set to aggregate episodes of care

    • Resource use across care continuum: professional, facility, Rx

    • QASC (Brookings/ABMS) definitions – link to HEDIS measure results

What’s Made the Alliance Successful (to date)?

  • Personal, sustained leadership of respected purchaser executive

  • Purchaser driven, multi-stakeholder effort

  • Quality first; efficiency second

  • National standards but local stakeholder input

  • Community-wide report rather than payer-specific

  • Limitations on first uses of report

  • Public reporting at the medical group level

  • Trial run of 14 volunteer clinics for first report

  • Positioning as “Community Checkup”

  • Addition of eValue8TM for plans byNBCH for purchasers

What Challenges Lie Ahead?

  • Expanding the content and uses of the quality report and scope of reporting

  • Navigating the development and release of resource use reports and subsequent cost measures

  • Engaging health plans in collaborative projects

  • Continuing to afford the cost of data aggregation

  • Demonstrating ROI to stakeholders, especially purchasers

  • Expanding the use of all-payer data base as community asset

  • Balancing national standardization and local flexibility

Transparency. Value. Consumerism.

Puget Sound Health Alliance

2003 Western Avenue, Suite 600, Seattle, WA 98121

(206) 448-2570

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