The Purchaser and Consumer Push for Transparency

Presented at the Harvard Quality ColloquiumAugust 22, 2005

Melinda KarpDirector of Programs, MHQP

andIndependent Consultant

Objectives for Today’s Session

• Provide an overview of the national landscape from purchaser and consumer perspectives

• Describe the consumer and purchaser push for transparency through the Consumer Purchaser Disclosure Project

• Introduce the Measures to Market Project

Waste BeyondComprehension

• 30% of resources wasted due to overuse, under use and misuse

• $500 - $600 billion per year in 2001 dollars

• $1,700 to $2,000 per employee per year in 2001 dollars

Source: Midwest Business Group on Health

Injury to Insult

• 44,000-98,000 plus deaths from errors during hospitalizations

• 7,000 deaths from medication errors alone

• $17-29 billion in added costs

• Ambulatory care unknown

Source: Institute of Medicine

Cadillac Prices,Yugo Quality…Condition % Receiving Recommended

Care*Breast cancer 76%Heart attack & coronary artery disease 68%Immunizations 66%High blood pressure 65%Osteoarthritis 57%Asthma 53%Diabetes 45%Urinary tract infection 41%Sexually transmitted diseases 37%

*McGlynn, et. al, New England Journal of Medicine, 2003

Quality Measurement and Reporting: 1995

• Limited public demand

• Few standardized quality measures

• Few organizations

• Few providers aware

• Public disclosure rare

• Few patients aware

“Purchasers and regulators should create precise streams of

accountability and measurement, reflecting safety, effectiveness,

patient-centeredness, timeliness, efficiency, and equity.”

Crossing the Quality Chasm, IOM 2001

Leading Edge Effortsto Promote Transparency

• Leapfrog• CMS• Bridges to Excellence• NCQA• JCAHO• Web-based proprietary vendors• Benefit consultants• NQF

Not Just Leapfrog Anymore –Everyone’s Getting into the Act

• Is it the cavalry…

• Or a stampede?

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The UnintendedTower of Babel

XXXPlans XXXConsultants

XXXStatesXXXCMS/QIOs

XAHRQXSpec. Groups

XXXJCAHOXXXNCQA

XNQFXXXCollaboratives

Reporting ResultsData GatheringDefining Measures

Persistent Problems

• Limited scope/applicability of standardized measures

• Trade-offs in measure importance and accuracy vs. burden and cost of measurement

• Limited coordination of measurement and reporting efforts by payers--dueling report cards

• Continued use of non-standardized and proprietary measures

• Sustainability of business models for performance measurement and reporting

Consequences• Public skepticism about performance results

– Limited impact of consumerism

• Sub-optimal motivation for QI– Limited competition on quality

– Provider uncertainty about actions to improve quality

– Hesitancy to make financial investments in QI

A Fine Mess We’ve Got Ourselves Into• Purchasers Not Buying Right• Plans Not Letting Provider Value Show

Through• Providers Not Seeing Business Case for

Reengineering• Patients Not In the Quality Game

Improved Transparency and Pay for Performance:

The Foundation for Reform

Failure to Cross “the Quality Chasm”

The Road Forward in 2005

Benefit Design Trends Demand Vastly Improved Transparency

• 8 in 10 employers somewhat or extremely comfortable having employees take more responsibility in selecting:– Plans: 81%– Coverage levels: 81%– Providers: 81%– Services/treatments: 83%

Source: Hewitt Associates Health Care Highlights, Feb. 2003

Paradigm for Chasm Crossing

ProviderPerformance

Measures

Engaged Consumers& Pay for

Performance

DramaticImprovement

National Standards Essential

• Comparability across markets• Credibility• Reporting burden• Economies of scale and leverage

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RWJF and The Leapfrog Group – Project Sponsors

Participating Organizations

3M March of DimesAARP Midwest Business Group on HealthAFL-CIO MotorolaAmerican Benefits Council National Association of ManufacturersBuyers Health Care Action Group National Black Women’s Health ProjectCarlson Companies National Business Coalition on HealthCalifornia Healthcare Foundation National Citizen’s Coalition for Nursing Home Reform National Partnership for Women and FamiliesConsumer Coalition for Quality Health National Business Group on HealthEmployee Benefits Research Institute National Breast Cancer CoalitionEmployer Health Care Alliance Coop. Niagara Health Care Quality CoalitionERISA Industry Committee Pacific Business Group on HealthFord Motor Company The Robert Wood Johnson FoundationGeneral Motors State Medicaid Directors AssociationThe Leapfrog Group Union Pacific RailroadNational Coalition for Cancer Survivorship U.S. Chamber of Commerce

By January 1, 2007, Americans will be able to select hospitals, physicians,

physician groups/delivery systems and treatments based on public reporting of nationally standardized measures for clinical quality, consumer experience,

equity and efficiency.

C-PDP Priorities

– Support measure development– Encourage endorsement of national standards– Encourage implementation of national standards– Build support for the Disclosure Goal

Primary drivers of improvements to the health care system:

1. Consumers using valid performance information to choose providers and treatment

2. Purchasers building performance expectations into their contracts and benefit designs

3. Providers acting on their desire to improve, supported by better information

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Architecture of FullDashboard

Equity

Patient Experience

Efficiency

Clinical Quality(Safe, Timely,

Effective)

Treatment Options

Integrated Delivery Systems

PhysiciansHospitals

For More Information…Web: www.healthcaredisclosure.org

Katherine BrowneManaging DirectorEmail: kbrowne@nationalpartnership.org(202) 236-4820

Steve WetzellStrategic DirectorEmail: swetzell@msn.com(952) 938-1788

Measures to Market ProjectFunded by the Robert Wood Johnson Foundation

What is “Measures to Market”?• A deliberative response to an environment where:

– there are numerous, competing and duplicative efforts to measure and report on the performance of ambulatory health care providers;

– there are few, if any, existing business models for sustaining the necessary activities to do so; and

– the interests of the consumer/patient are often secondary to those of other stakeholders

• A collaborative effort to identify desirable and sustainable business models for supporting the activities involved in bringing ambulatory care performance measures to market and keeping them up-to-date

Who is conducting the “M2M” Project?

• Sponsoring Organization: Consumer-Purchaser Disclosure Project

– Why: The Disclosure Project impartially represents critical end-users

and does not specifically represent either those being measured or those operating measurement systems

(They have “no horse in the race”)

• Funding provided by: Robert Wood Johnson Foundation

• Research Team for: Development & Evaluation of Business Models– Kathryn Coltin, MPH, Lead– Melinda Karp, MBA– Eric Schneider, MD, M.Sc.– Christy Bethell, PhD, MPH,

MBA– Stan Hochberg, MD

M2M Goals and ObjectivesGoal:Identify viable business model(s) for sustaining credible performance measurement and reporting

Objective 1• By the end of May 2005, define key characteristics of an ideal

business model for bringing ambulatory care measures to marketObjective 2

• By the end of December 2005, identify potentially viable business model(s) that fit most evaluative criteria

Objective 3• By the end of March 2006, make recommendations regarding

one or two viable business models that best fit evaluative criteria and have broad stakeholder support

Overview of the M2M Process

M2M Process: Implementing Objectives Phase 1: October 2004 – May 2005

• Define key characteristics of an ideal business model for bringing ambulatory care measures to market

• Based on broad stakeholder input and key informant interviews:1. Identify and validate the continuum of activities required to

publicly report ambulatory care performance measures 2. Develop consensus around the characteristics of a sustainable

“public good” business model for bringing measures to market and desired impacts of such a model

3. Develop, validate and weight criteria for evaluating alternativebusiness models for accomplishing each activity--either on its own or in combination with other related activities

4. Identify leading industry practices and alternative methods or approaches for accomplishing each activity

M2M Process: Implementing Objectives Phase 2: June 2005 – December 2005

• Identify business model(s) that best fit evaluative criteria 1. Identify and/or develop business models to support each of

the activities necessary to bring measures to market

2. Assess existing & potential models against evaluative criteria

3. Identify potential positive and negative impacts of various implementation models

4. Recommend options for implementing viable and sustainable business models based on evaluative criteria, practical considerations and desired impacts

M2M Process: Implementing Objectives Phase 3: January 2006 – March 2006

• Solicit broad stakeholder views on potentially viable, sustainable and acceptable business models for bringing measures to market1. Distribute draft report to stakeholders for review

2. Conduct follow-up Webcast with stakeholdersA. Present results of evaluations B. Review draft recommendations C. Solicit stakeholder feedback

3. Summarize stakeholder views and make recommendations to Consumer-Purchaser Disclosure

4. Consumer-Purchaser Disclosure issues final recommendations