Dirigo Health Agency’s

1. Dirigo Health Agency’s

2. Dirigo Health Agency

3. Research Dissemination on quality, evidence-based medicine and patient safety • Adoption of quality measures, coordination of collection and reporting • Consumer education • Technology assessment • Promotion of adoption of electronic technology • Recommendations regarding State Health Plan • Annual report

4. Governance DHA Board of Trustees DHA Executive Director MQF Director • Funding • Share of DHA “SOP” Funds • Guidance • MQF Advisory Council

5. Physicians (3) RN (1) Hospital (1) Mental Health Provider (1) Nonphysician Provider (1) Consumers (4) Organized Labor (1) Health Advocacy (1) Uninsured/MaineCare (1) Commercially Insured (1) Employers (4) State Employees Health Commission (1) Large Employer (1) Midsize Employer (1) Small Employer (1) Private Health Plan (1) MaineCare (1) Maine Health Data Organization (1, ex off.) MQF Advisory Council

6. MQF PROJECTS • Data Collection and Reporting • Discharge Data and Website • Paid-claims Data and Health Dialog Project • Hospital-reported Performance Indicators (Chpt 270) • Healthcare-Associated Infections • Advanced Medical Home Pilot • In-a-Heartbeat • Voluntary Practice Assessment • Website Development • RWJ Projects: Quality Counts/AF4Q/RQS • Critical Access Hospital Collaborative • CON Assessment

8. Summary of Key Cost Drivers • Utilization • Health Status – Preventable chronic illness complications increase utilization • We use more outpatient and more ED than most other New England states • Supply of technology (e.g. MRI) • Inefficiency • 20-60% variation in cost to treat same patient for same illness in different hospitals • Significant variation in how patients are treated by different physicians for similar problems

9. Variation • Discharge Data • Voluntary Performance Indicator Reporting • Paid Claims Database Analysis

10. Discharge Data

11. Performance Indicators

12. Performance Indicators

13. MQF-Health Dialog Project Complete: • Warehoused the paid-claims data and assessed its quality and capability to support population-based quality measures • Conducted pilot provider profiling analysis • Primary care • Cardiology • Conducted geographic variation analysis of advanced imaging utilization (CORE)

15. MQF Regional Variation in Effective Care

16. Performance Varies Across Providers

17. USING DATA TO EFFECT CHANGE Research Consensus Guidelines Performance Indicators for Providers Benchmarking Internal QI Public Reporting PHC4 NYHHC Pay for Performance Tiering Steerage Nonreimbursement POLICY POLICY

18. Advanced Medical Home Pilot • More effective primary care, better platform for coordinated chronic disease management • Collaborators • Maine Quality Forum • Quality Counts • Maine Health Management Coalition and Pathways to Excellence • Martins Point Healthcare • MaineCare • Anthem, other payers

19. In a Heartbeat • Standardization of Best Practices for STEMI Care • Community Engagement • Publicity and training • Emergency Care • EMT Systems, Cath Lab Activation from Field • Hospitals • Data and Metrics

20. Critical Access Hospital Collaborative • Problems with standard metrics; ?”Rural-relevant” indicators • Patient Safety issues prominent (not “n-dependent”) • Collaborators: • MQF • USM Muskie School of Public Service • MeHAF • 14/15 Critical Access Hospitals • Medication Safety Project(s)

21. AF4Q Performance Measurement Public Reporting Consumer Engagement Quality Improvement RQS PM/PR of Hospital Quality Investigation of Racial, Ethnic, Socioeconomic Disparities Nurse-centered Inpatient Quality Improvement RWJ: Aligning Forces for Quality,Regional Quality Strategies

22. AF4Q/RQS • Collaborating Organizations Maine Quality Forum Maine Health Management Coalition Quality Counts • 50 Employer groups (MHMC) • 28 Member Organizations (QC)