Measuring and Reporting Performance Data Through Health IT AHRQ Annual Meeting

1. Measuring and Reporting Performance Data Through Health IT AHRQ Annual Meeting Wednesday September 26, 2007 A. John Blair, III, MD President, Taconic IPA

2. Evolution • Process incentives/Claims data • Structure incentives • IT adoption and usage • NCQA/POL • Outcomes incentives/Clinical data

3. Process Incentives/Claims Data Physician Feedback and Communication Efforts Transparency Multi-Payer P-4-P Project Report Development Single Payer P-4-P Project 2000 2002 2004 2006 2008 2010

4. Physician Reports

5. Single Payer P-4-P

6. Transparency

7. Multi-Payer Reports

8. Multi-Payer Reports

9. Physician Feedback & Communication • Medical Council • PCP • Specialty • Clinical leadership • Strong quality focus • Initial report feedback • Individual • Group • Monthly Newsletter • Physician comment period prior to incentive payments

10. Structure Incentives Physician Feedback and Communication THINC RHIO, Quality Committee EHR NCQA/PPC eRx Community Viewer Clinical Messaging 2000 2002 2004 2006 2008 2010

11. NCQA Physician Practice Connections • Access / Communication • Patient tracking / Registries • Care management • Self management support • Electronic prescribing • Test tracking • Referral tracking • Performance reporting & improvement • Interoperability

12. THINC RHIO, Quality Committee • Activities • Determine performance measures • Promote standards • HIE • Measure metrics • Coordinate payment incentives • Committee composition • Physicians • Hospitals • Health plans • Quality measures experts

13. Claims vs. Clinical Reporting • Uninsured not captured • Services delivered, not health outcomes • Non-reimbursable services not captured • Inaccuracy due to income maximization • Difficult to risk adjust (severity, stage) • Lack of continuity with one health plan • Fragmented health care market (and claims) • Provider resistance

14. Advantages of EHR-Based Measurement • Better data than claims-based • More detailed clinical data (e.g. BP) • More scalable than chart-reviews • Faster, cheaper • Greater sample size allows better provider comparisons • Greater precision for encounter-level analyses • Paradigm shift • CDSS  Registry  Measure

15. Challenges of EHR-Based Measurement • Structured data elements may not exist in EHR • Data elements not standardized (e.g. lab codes) • Outside data not available (e.g. hospitalizations)

16. Decision Support Tools • Focus on THINC RHIO measures • Passive & active alerts and reminders • Wary of “alert fatigue” • Minimal set • Actionable • Consonant with workflows, not disruptive • Not just alerts • Order sets • Templates • Clinical knowledge • Data presentation • Process reengineering

17. “Not Just Alerts” • Practice workflow reorganization • Structured data collection • Registries and panel management • Alternative visit types • Team-based care • Case management • Patient education and self-management

18. Questions?

19. Thanks for your time! A. John Blair, III, MD President, Taconic IPA