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Improving Quality Through Systems Change. National Health Policy Conference, Washington, DC Stephanie Alexander, Sr. VP, Premier Healthcare Informatics February 12, 2007. CMS/Premier Demo Pay for Performance.

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Improving quality through systems change

Improving Quality Through Systems Change

National Health Policy Conference, Washington, DC

Stephanie Alexander, Sr. VP,

Premier Healthcare Informatics

February 12, 2007


Cms premier demo pay for performance
CMS/Premier Demo Pay for Performance

In 2003,CMS partnered with Premier for the first national pay-for-performance demonstration for hospitals. Over 260 Premier hospitals volunteered.

Hypothesis

Financial Incentives improve hospital quality performance

Findings

  • Focus on Quality - The P4P Program financial incentives did focus hospital executive attentionon measuring quality and refining care processes according to the study infrastructure.

  • Premier is the Change Agent - The Premier Infrastructure and measurements were actually the change agents in focusing quality improvement efforts. The more hospitals were monitored, the better performance improved over time.


Hqid year 2 final results released january 26 2007
HQID Year 2 – Final ResultsReleased January 26, 2007

  • Quality improvement across all hospitals and clinical areas

  • HQID raised overall quality by 11.8% in 2 years

  • Quality incentive payments of $8.7 Million paid to 115 hospitals

  • AMI improvements saved 1,284 AMI patients

  • Patients received ~150,000 add’l treatments

  • Premier P4P hospitals quality scores are higher than national average – 85% compared to 79%


Dramatic improvement continues
Dramatic Improvement Continues

Composite Quality Score



Why such movement in quality
Why such movement in quality?

  • Not just “one” reason - a combination

  • National alignment of evidence-based quality measures

  • Transparency (public reporting)

  • Rewards for improvement

  • Leadership

  • System-level change

Building a Quality Culture


Top performer characteristics
Top Performer Characteristics

  • “Quality” core value of institution

  • Priority of executive team

  • Physician engagement

  • Improvement methodology

  • Prioritization methodology

  • Dedicated resources

  • Committed “knowledge transfer”


Premier performance pays study
Premier Performance Pays Study

Premier’s Performance Pays study proves that when evidence-based processes are delivered, quality is higher and costs are lower. First study of its kind over 400,000 patient discharges studied.






Improvement opportunity
Improvement Opportunity

For Pneumonia, Heart Bypass Surgery,

Hip and Knee Surgery, and AMI Patients

in One Year Alone

$1.4 Billion

6,000 Avoidable Deaths

6,000 Complications

10,000 Readmissions

800,000 Days


Example
Example:

Acute Myocardial Infarction

Heart Failure

Hip and Knee

Pneumonia

Quality a core value, executive priority, physician engagement, improvement methodology,

prioritization methodology, dedicated resources, committed knowledge transfer


Example health system improvement
Example: Health System Improvement

  • A decision to participate as a system

  • A proxy for system connectivity

  • A few surprises . .

  • And the most important decision we’ve made for cultural advancement around quality


Why such movement in quality1
Why such movement in quality?

  • Not just “one” reason - a combination

  • National alignment of evidence-based quality measures

  • Transparency (public reporting)

  • Rewards for improvement

  • Leadership

  • System-level change

Building a Quality Culture