one health plan’s initiatives to improve patient experiences: what the physicians had to say ron...
TRANSCRIPT
One Health Plan’s Initiativesto Improve Patient Experiences:What the Physicians Had to Say
Ron D. Hays, Ph.D.Professor of Medicine, UCLA
CAHPS PI, RAND
Denise D. Quigley, Ph.D.CAHPS Quality Improvement Team,
RAND
AHRQ Conference September 10, 2012 (3:30-5:00pm
session)1
• Quality Improvement initiatives
• Evaluation approach
• Findings
• Lessons learned
Presentation Outline
2
• Quality Improvement initiatives
• Evaluation approach
• Findings
• Lessons learned
Presentation Outline
3
Health Plan Saw Opportunity to Improve Patient Experience
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• CAHPS Clinician and Group Surveyprovided tool for breaking down data indicating where improvements were
needed giving plan leverage
• Pay-for-performance allowed plan to reward physicians for meeting CAHPS score objectives
Plan Focused on its Contracted Primary Care Physicians
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• Eight physician-hospital organizations (PHOs)
• Contracted with PHOs for participation of primary care physicians in initiatives
Three Main Actions of the Health Plan
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1. Provider reports –Mailed physician-level scores on annual CAHPS survey to individual providers
2. Public reporting – Posted physicians’ scores on public website
Measured “clinical quality” and CAHPS on a scale of 1-5
3. Pay-for-performance program created financial incentives for physicians to improve
Based on CAHPS, Healthcare Effectiveness Data and Information Set (HEDIS) scores, and other measures
• First year No financial rewards Physicians received their CAHPS
survey results Told which incentive measures were
to be tracked for payment
• Second year Payments were sent to practices or
PHOs for the individual doctor’s performance
Pay-for-Performance
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Health information technology (IT)• Electronic prescribing• Patient registry (HEDIS)
Efficiency Generic usage rate Use of emergency room (non-
emergency) Member experience
Global rating of physician Doctor-patient communication Office staff courteousness and
friendliness
Pay-for-Performance Measures
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Health IT Electronic prescribing
20% Patient registry
20%
Efficiency Generic usage rate
20% Use of emergency room
20% Member experience
Global rating of physician10%
Doctor-patient communication 5%
Office staff 5%
Total 100%
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Member Experience was20% of Payment
• Quality Improvement initiatives
• Evaluation approach
• Findings
• Lessons learned
Presentation Outline
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• RAND interviewed 110 plan physicians (43%)
Were they aware of and understand performance reports and pay-for-performance? If so, what did physicians do?
Did QI initiatives motivate improvements? If so, what did physicians do?
Examined Effect of Initiatives on Physician Behavior and Motivation
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• Quality Improvement initiatives
• Evaluation approach
• Findings
• Lessons learned
Presentation Outline
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• Aware of reports93%
• Received a report 69%
• Of those aware of reports Understood contents
32% Limited, incorrect knowledge
20% No content knowledge
48%
Some thought CAHPS reports included clinical measures
93% of Physicians Were Aware of Their Provider CAHPS Report
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• Positive (41%) Areas for improvement Good information not otherwise available Comparisons with other physicians
• Neutral/no opinion (31%)
• Negative (28%) Inaccurate reflection of office visit experience
Invalid or old data No actionable recommendations for
improvements
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49% of Physicians Reported No Change in Actions After Provider
CAHPS Report
• Positive (14%) Good to give consumers information
on physician performance
• Neutral, no opinion (28%)
• Negative (58%) Data are inaccurate; based on
patients who are upset with physician
small sample size Measures do not account for complex
treatments
58% Aware of Public Reporting but Most Had Negative Opinion
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Of those aware of website (n=64)
• Understood website 20%
• Visited site, little knowledge 8%
• Never visited website and no 72%content knowledge
Physician Understanding of Website Contents Was Limited
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• Motivated to improve (20%)
• No change in actions (42%)
• Did not need to improve (39%)
Most Physicians Made No Change
as a Result of Public Reporting
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• Did not affect motivation (47%) Already doing high quality medicine Already optimizing performance Payment too small to have effect
• Neutral, no comment (18%)
• Did affect motivation (35%) Made aware of areas to improve Incentive to follow up with patients Made aware of patients’ views Paid attention to benchmarks
35% of Physicians Were Motivated
by Pay-For-Performance Initiative
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CAHPS Performance level
Low Medium High
Received pay-for-performance payment?
Physician said yes 72% 84% 92%
Actual data 28% 39% 69%
• Program rewards for high CAHPS performance
• Most physicians reported receiving a payment
More Physicians Said They Received Pay Than Actually Did
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Physicians Focused on a Range of Patient Experience Areas
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Access Getting routine appt. quickly 23%
Getting urgent appt. quickly 12% Other access issues 7%
Lab test results 31%
Wait time 23%
Office staff courteousness 19%
Doctor-patient communication 13%
Answering questions after office hours 10%
Referrals to specialists 8%
CAHPS patient experience area
% of physicians who focused on
given CAHPS area
• Address accuracy, representativeness, and timeliness of CAHPS performance reports
• Shorten the report • Include information about the patients
who were surveyed in the CAHPS sample
• Educate physicians about CAHPS measures, calculation of composite scores, and sampling issues
58% of Physicians Interviewed Had Ideas for Improving Reports
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• Address data issues Timeliness of data reported on the
website Provide more data on patients
queried Have data reflect entire population of
physician’s patients, not just one health plan’s
• Allow for physician feedback before posting data on website
Physician Advice About Public Reporting
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• Address data issues for HEDIS Accuracy of information collected by
the health plan compared to patient charts
Include measures of patient behaviors and patient non-compliance
Computerize data collection of the measures required by the health plan
• Increase size of payment to at least 8%of salary (was about 2-3%)
Physician Advice AboutPay-for-Performance
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• Quality Improvement initiatives
• Evaluation approach
• Findings
• Lessons learned
Presentation Outline
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• Improve data quality
• Simplify and improve design of reports
• Implement initiatives more consistently
• Communicate with and educate physicians
Common Themes
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• Improve data quality
• Simplify and improve design of reports
• Implement initiatives more consistently
• Communicate with and educate physicians
Improve the Data Quality
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• Accuracy
• Timeliness
• Representativeness
• Computerization
• Improve data quality
• Simplify and improve design of reports
• Implement initiatives more consistently
• Communicate with and educate physicians
Simplify and Improve Design of Individual and Public Physician
Performance Reports
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• Explain data sample
• Include performance comparisons, trends, benchmarking, and succinct patient care measures
• Identify areas for improvement
• In Pay-for-Performance• explain payment
amounts & methods
• differentiate between clinical care and patient experience
• Improve data quality
• Simplify and improve design of reports
• Implement initiatives more consistently
• Communicate with and educate physicians
Implementation of Initiatives Is Important
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• Include office staff in quality improvement and data reports
• Get and keep physicians attention
• Simplify documentation (HEDIS)
• Pay promptly and directly to physicians
• Improve data quality
• Simplify and improve design of reports
• Implement initiatives more consistently
• Communicate with and educate physicians
Communicate with and Educate Physicians To Increase Awareness
and Understanding
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• Education physicians before rollout of programs
• Provide specific training to physicians on measures
• Hold discussions with physicians about performance and quality improvement
• Send reports and communicate data trends regularly
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