panel on measuring quality and value carolyn m. clancy, md director agency for healthcare research...
TRANSCRIPT
Panel on MeasuringPanel on MeasuringQuality and ValueQuality and Value
Carolyn M. Clancy, MDCarolyn M. Clancy, MDDirectorDirector
Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality
IOM Committee Meeting on Geographic Variation inIOM Committee Meeting on Geographic Variation inHealthcare Spending and Promotion of High Value CareHealthcare Spending and Promotion of High Value Care
Washington, DC – November 10, 2010Washington, DC – November 10, 2010
Not Just for Policy WonksNot Just for Policy Wonks
Up to 30 percent of health Up to 30 percent of health care spending goes care spending goes toward useless treatments toward useless treatments that we don’t needthat we don’t need
Overtreatment costs the Overtreatment costs the U.S. system $700 billion a U.S. system $700 billion a yearyear
““Unnecessary treatment Unnecessary treatment and tests aren’t just and tests aren’t just expensive; they also can expensive; they also can harm patients.”harm patients.”
What the Measures Tell Us What the Measures Tell Us TodayToday
Variation:Variation:– In care deliveryIn care delivery
– In spendingIn spending
– Across populationsAcross populations
– Across geographic regionsAcross geographic regions
Need to Document, RigorouslyNeed to Document, Rigorously
Recent LegislationRecent Legislation
Measuring Quality and ValueMeasuring Quality and Value
Improving Value:Improving Value:Three Necessary IngredientsThree Necessary Ingredients
Good measures and dataGood measures and data Evidence-based payment and incentivesEvidence-based payment and incentives Evidence-based strategies for improvementEvidence-based strategies for improvement
Leading to three paths:Leading to three paths: Transparency and public Transparency and public
reportingreporting Pay-for-performance and Pay-for-performance and
payment reformpayment reform Provider-based redesign and Provider-based redesign and
quality improvementquality improvement
Good Measures, Good Data Good Measures, Good Data Will Bridge the GapWill Bridge the Gap
Healthcare Cost and Utilization Healthcare Cost and Utilization Project (HCUP)Project (HCUP)
Quality IndicatorsQuality Indicators
Medical Expenditure Panel Medical Expenditure Panel Survey (MEPS)Survey (MEPS)
CAHPSCAHPS
National Healthcare Quality & National Healthcare Quality & Disparities ReportsDisparities Reports
AHRQ’s Role: Supplying the DataAHRQ’s Role: Supplying the Data
AHRQ Prevention Quality Indicators (PQIs): Potentially Avoidable
Hospitalizations
National hospital costs for National hospital costs for potentially avoidable potentially avoidable hospitalizations (adjusted for hospitalizations (adjusted for inflation)inflation)
decreased from $31.9 billion in decreased from $31.9 billion in 2003 to $30.1 billion in 2006 2003 to $30.1 billion in 2006 Changes are largely Changes are largely attributable to avoidable attributable to avoidable hospitalizations involving hospitalizations involving chronic conditionschronic conditions
These hospitalizations can be These hospitalizations can be the result of inadequate self-the result of inadequate self-management as well as management as well as inefficiency in the health care inefficiency in the health care systemsystem
AHRQ 2009 National Healthcare Quality ReportAHRQ 2009 National Healthcare Quality Report
Geographic VariationGeographic Variation
While there is wide variation While there is wide variation in care quality across states:in care quality across states:– Those in the upper Midwest Those in the upper Midwest
and New England tend to and New England tend to achieve the highest overall achieve the highest overall qualityquality
– States in the southwest and States in the southwest and south central tend to have the south central tend to have the lowest care qualitylowest care quality
Disparities Report: Key FindingsDisparities Report: Key Findings
Disparities are commonDisparities are common Lack of insurance is an Lack of insurance is an
important contributorimportant contributor Many disparities are Many disparities are
not decreasingnot decreasing
These variations These variations indicate that a basic indicate that a basic IOM tenet of quality IOM tenet of quality care—that care should care—that care should be equitable—is not be equitable—is not being metbeing met
How Do They Do That?How Do They Do That?
Lowest region in state (actual-expected)Lowest region in state (actual-expected) La Crosse, WILa Crosse, WI Portland, ME (one of only two HRRs in Maine)Portland, ME (one of only two HRRs in Maine) Asheville, NCAsheville, NC
Actual cost < expectedActual cost < expected Temple, TX (second lowest after Lubbock)Temple, TX (second lowest after Lubbock) Everett, WA (second lowest after Spokane)Everett, WA (second lowest after Spokane)
Four are problematicFour are problematic Richmond, VA (highest actual-expected in state)Richmond, VA (highest actual-expected in state) Sacramento, CA (actual > expected)Sacramento, CA (actual > expected) Cedar Rapids, IA (actual > expected, but in a low-cost state)Cedar Rapids, IA (actual > expected, but in a low-cost state) Tallahassee, FL (actual > expected)Tallahassee, FL (actual > expected)
Source: Source: Calculations from HCUP data using Dartmouth Atlas regions Calculations from HCUP data using Dartmouth Atlas regions http://www.ihi.org/IHI/Programs/StrategicInitiatives/HowDoTheyDoThat.htm?TabId=0http://www.ihi.org/IHI/Programs/StrategicInitiatives/HowDoTheyDoThat.htm?TabId=0
Multi-stakeholder effort examining high-performing regionsMulti-stakeholder effort examining high-performing regions
Important ProvisionsImportant Provisions
National Strategy to Improve Health Care National Strategy to Improve Health Care Quality Quality
Interagency Working Group on Health Care Interagency Working Group on Health Care QualityQuality
Quality Measure DevelopmentQuality Measure Development Data, Collection, Analysis and Public Data, Collection, Analysis and Public
ReportingReporting Health Care Quality Improvement (CQuIPS)Health Care Quality Improvement (CQuIPS) Patient-Centered Outcomes Research Patient-Centered Outcomes Research
InstituteInstitute
Payment Based on Quality, Payment Based on Quality, Safety and Value Safety and Value
National Pilot Program on Payment BundlingNational Pilot Program on Payment Bundling– HHS to work with AHRQ and a contract entity to develop HHS to work with AHRQ and a contract entity to develop
episode of care and post-acute quality measuresepisode of care and post-acute quality measures
Health Care Quality ImprovementHealth Care Quality Improvement– AHRQ’s Center for Quality Improvement and Patient AHRQ’s Center for Quality Improvement and Patient
Safety (CQuIPS) will identify, evaluate, disseminate, and Safety (CQuIPS) will identify, evaluate, disseminate, and provide training on best practices on quality, safety and provide training on best practices on quality, safety and valuevalue
– CQuIPS will award grants or contacts to provide CQuIPS will award grants or contacts to provide technical support or implements models and practices technical support or implements models and practices identified in researchidentified in research
– Technical grants also provided for organizations without Technical grants also provided for organizations without infrastructure or resourcesinfrastructure or resources
What’s Next? National Health What’s Next? National Health Care Quality StrategyCare Quality Strategy
Part of Affordable Care Act Part of Affordable Care Act
Builds on work of federal, Builds on work of federal, state, local and private state, local and private initiatives; identifies what initiatives; identifies what works and what needs works and what needs improvementimprovement
Move from provider-level Move from provider-level transparency to a patient-transparency to a patient-focused approachfocused approach
Evidence Still Weak on Evidence Still Weak on Critical Design Components Critical Design Components
What to reward?What to reward?– structure, process, or outcomesstructure, process, or outcomes– Improvement or achievement Improvement or achievement
How structure reward?How structure reward? Market factors affecting rewardsMarket factors affecting rewards
– How much market share do you need?How much market share do you need?
How much of what kind of a payment How much of what kind of a payment scheme is needed to correct perverse scheme is needed to correct perverse incentives?incentives?
Coming Soon: Coming Soon: The Evidence We Need?The Evidence We Need?
Payment Reform: Evidence on How Payment Can Payment Reform: Evidence on How Payment Can Improve Quality and Value (December)Improve Quality and Value (December)
AHRQ-sponsored AHRQ-sponsored Health Services ResearchHealth Services Research issue issue on payment reform: follow-on to 2009 special issue, on payment reform: follow-on to 2009 special issue, “Improving Efficiency and Value in Health Care”:“Improving Efficiency and Value in Health Care”:– Analyses assessing impact of efforts to improve care by Analyses assessing impact of efforts to improve care by
changing the way it’s paid forchanging the way it’s paid for
– Value-Based Insurance DesignValue-Based Insurance Design
– Models/simulations related to payment models for the futureModels/simulations related to payment models for the future
Thank YouThank You
AHRQ Mission AHRQ Mission
To improve the quality, safety, To improve the quality, safety, efficiency, and effectiveness of efficiency, and effectiveness of health care for all Americanshealth care for all Americans
AHRQ VisionAHRQ Vision
As a result of AHRQ's efforts, As a result of AHRQ's efforts, American health care will American health care will provide services of the highest provide services of the highest quality, with the best possible quality, with the best possible outcomes, at the lowest costoutcomes, at the lowest cost
www.ahrq.govwww.ahrq.gov