NH Hospital Scorecard & Vision for Health 2009

1. NH Hospital Scorecard & Vision for Health 2009

2. NH Purchasers Group on Health - Membership • SchoolCare – Unique Labor/Management Governance • State of New Hampshire – Employee & Retiree Benefits • NH Local Government Center • University System of New Hampshire 120,000 Covered Lives

3. Work of NHPGH

5. Scorecard Background

6. Background • NH Purchasers felt there was an absence of consumer-friendly quality and cost data on NH providers • The evidence on NH cost and quality showed significant variation across providers • Making cost and quality information more transparent will help to raise awareness and ultimately reduce the variation and improve the quality of care

7. Background • NHPGH investigated a number of quality scoring efforts • Maine Health Management Coalition (MHMC) Blue Ribbon Hospital Ratings • Care Focused Purchasing • Provider quality and efficiency • Hospital quality and efficiency • MHMC method was ultimately selected for scorecard quality components • Strong history • Well-vetted with consumers, employers and clinicians • Cost-effective, non-proprietary • Uses nationally endorsed data sets (CMS, Leapfrog)

8. Background • NH Acute Care Hospital Analysis selected for scorecard cost components • Strong methodology • Market-basket approach is accepted and well-received in healthcare and other industries • Scores are severity adjusted • Relevant services • Cost effective • Reinforced in plan designs, communications

9. Scorecard Measures

10. Scorecard - Cost • NH Acute Care Hospital Cost Index A value of 1.00 represents a hospital with average relative costs when compared to other NH hospitals. A value of 1.10 means the hospital is ten percent more expensive than the average hospital for patients of similar resource intensity.

11. Scorecard - Cost • Costs indices have been broken into quartiles and expressed on a scale from $ to $$$$ • 2007 cost data was used in the development of the rates

12. Scorecard – Quality Measures • Center for Medicare and Medicaid Services (CMS) Hospital Process of Care Measures • Heart Attack, Heart Failure, Pneumonia, Surgical Care, Childhood Asthma • www.hospitalcomprare.hhs.gov • CMS Patient Satisfaction (HCAHPS) • Leapfrog Group • Use of Computerized Physician Order Entry • Evidence-Based Hospital Referral, and • National Quality Forum Safe Practices

13. Scorecard – Quality Measures • Computerized Physician Order Entry • Use of computers to order medications, tests and procedures • ICU Staffing • Evidence-Based Hospital Referral • Meets recommended volumes for high risk procedures (e.g., coronary artery bypass, aortic aneurysm repair, aortic valve replacement, bariatric surgery)

14. Scorecard – Quality Measures • National Quality Forum’s 27 Safe Practices • Assess and improve the organization’s patient safety culture • Build teamwork and communication skills • Insert chest tubes safely • Prevent central-line related bloodstream infections • Make good use of senior ICU nurses • Use reliable decision-support tools at the point of care • Establish a safety reporting system • Limit urinary catheter use to 3 days • Minimize unnecessary interruptions

15. Scorecard Ribbon Assignment • MHMC Points • Points are determined by comparing a hospital’s performance to state and national levels

16. Scorecard Ribbon Assignment • MHMC Blue Ribbons • Awards Blue Ribbon for achieving scores of >2.5 in measures • > 2.5 Points

17. Scorecard - Sample

18. Other Initiatives

19. Wellness • Best Practices • Return on Investment Calculations • Joint Efforts Analytics • Joint analytic reporting & benchmarking • Evaluation of top “10” provider spend • Hospital meetings for partnering & improvement

20. Our Vision

21. Why Articulate a Vision? • As a group, we spend nearly three quarters of a billion dollars per year on healthcare…and growing • Internally-focused initiatives to affect trend can only go so far • Substantive change in improving health status and achieving efficiencies requires deeper involvement with the systems that provide care • We cannot expect the systems with whom we work to operate in alignment with our goals and priorities if we do not articulate those goals

22. Vision PrinciplesPrimary Care • Patient-centered • Highly accessible • Tightly coordinated • Integrated with behavioral health best practices • Community-level population care • Technology enabled

23. Vision Principles Quality • Transparent • Nationally-endorsed measures • Cross-carrier results • Ambulatory • Primary Care • Specialty Care • Hospital Based • NHPGH Cost and Quality Scorecard with CMS and Leapfrog Measures • Recognized and rewarded at the individual clinician level

24. Vision Principles Efficiency & Integration • Improved primary care office performance • Warranted use of specialists, radiology and advanced testing • Evidence-based • Reformed payment system with goals aligned across the system • Provides mechanisms for coordination across settings of care • Engages social services and community resources

25. New Hampshire Purchasers Group on Health 501 South Street Bow, NH 03304 603-573-3373 nhpgh@jsi.com www.nhpgh.org www.nhpghscorecard.org