Assisting Providers to Succeed Under New …...2012/09/21 · • Assisting providers to succeed...
Transcript of Assisting Providers to Succeed Under New …...2012/09/21 · • Assisting providers to succeed...
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Rhode Island Quality Institute
Assisting Providers to Succeed
Under New Payment and Delivery Models
Laura Adams Darby Buroker President and CEO, RIQI Director, Beacon Prg Mgt, RIQI
Rhode Island Business Group on Health Annual Health Care Summit - 2012
September 21, 2012
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Rhode Island Quality Institute
• Public-private partnership founded in 2001 by then RI Attorney General – now Senator – Sheldon Whitehouse
• Statewide, multi-stakeholder collaborative with the mission of improving healthcare quality, safety and value
• Board comprised of top leaders: hospitals, physicians, health insurers, consumers, business, professional associations, and state government
• Broad community participation through committees
• Collaborative reach is wide ranging:
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Insurers
Academia
Accounting
Regulatory
Local Government
Hospitals
Pharmacies
Community Health Centers
Medicare QIO
Behavioral Health
Congressional Delegation
Chambers of Commerce
Laboratories
Advocacy Groups
Boards and Associations
Businesses
Physician and Phy Groups
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The Opportunity Afforded by
Integration of RIQI’s Three Major HIT Grants
Exchange of health
Information
Providing pathways
to Meaningful Use
Longitudinal record
of the patient’s data
across the community
Electronic infrastructure
to move clinical metrics
community-wide
Community-wide
analytics, research
and QI capability
Adoption and
Meaningful Use
of EHRs
Distribution channel
into RI’s provider
community
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Alignment of Beacon, REC, and CurrentCare
RI Beacon Program
CurrentCare Heath Information Exchange (HIE)
• Leveraged by Beacon for care coordination interventions and projects to provide and deliver clinical data
• High levels of patient participation provides the widest possible reach
RI Regional Ext Center (REC)
• State-wide communication vehicle to promulgate information and best practices
• Supports RI’s HIT infrastructure by helping practices adopt, implement, and optimize EHRs
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Connecting “Physical” and Behavioral Health
• RIQI was one of 5 entities awarded a $600K health IT grant to integrate physical and behavioral health information (including substance abuse)
• We now have Community Mental Health Centers using the CurrentCare viewer
• Soon, Behavioral Health information from Gateway and the Providence Center will flow into CurrentCare and be integrated with the data from primary care practices, labs, hospitals and pharmacies
• RI’s consent model is paying off in a big way
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Need for Primary Care Performance Improvement Analytics
• Redesigning primary care to achieve triple aim of improving healthcare at the individual level, reducing per-capita costs, and improving overall population health
• Actionable monitoring, use, and exchange of health data and metrics – Clinical
– Claims-based
– Administrative
– Patient-reported
• Developing high performing extended care networks based on value rather than volume
• Assisting providers to succeed under new payment models
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Healthcare Analytics Maturity Model
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Descriptive Correlative Predictive
• Static graphs
• Trends
• Rate of improvement
• Distribution
• Drill to detail
• Correlation
• Alerts
• Statistical analyses
• Forecasting
• Predictive modeling
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Harmonizing Measures Across the Community
Goal: Common measures, consistent definitions, conformance with Meaningful Use, balance with technical feasibility
Approach: • Full measures crosswalk across all parties
• Process managed by Data & Evaluation Committee and Harmonization Workgroup convened by Steering Committee
• Hands-on input provided by Practice Reporting Workgroup – technical and analytical viewpoints at data query and EHR technology levels
• Consensus among all parties (including payers and DOH)
• Measures, definitions and technical specifications published on Collaborative Portal, proximate to measure results
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RIQI Infrastructure and Capabilities
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RIQI PCMH Performance Improvement Comparative Analytics Services
Clinical quality data Aggregate claims data Practice characteristics (e.g. NCQA recognition or payer mix)
Population characteristics (e.g. regional demographics)
Patient satisfaction survey results Quality of EHR data
• At All Levels: o Distribution o Trend o Correlation o Exploratory
• Statistical capabilities
• Exportable
• Multi-level database o Practice aggregate o PCMH program o Practice/site level o Physician level
• Restricted access to data and findings
• Blinding/un-blinding
Data Collection
Data Warehouse Analytics
Reports • Reporting • Dashboards • Population • Practice • Physician
Reporting
Additional Capabilities • Measure harmonization • Provider attribution • Trusted intermediary, appropriate
use
Collaborative Portal • Findings • Comments and discussion
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Community Collaborative Portal
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Example Practice
Example Practice
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Example Practice
Example Practice
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Example Practice
Example Practice
Figure 1 Figure 2
Figure 3 Figure 4
Figure 5
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Patient-reported Satisfaction
• Conducted in Spring 2012
• CAHPS PCMH
• NCQA certified vendor using NCQA and HEDIS
approved methodology
• Composite categories – Access
– Communication
– Shared decision-making
– Self-management support
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Representative Category
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
6 30 75 48 20 17 46 39 21 47 24 7 35 1 8 50 40 49 27 29 23 37 44 41 5 31 56 28 26 62 33 32 3 22 34 12 9 36 15
Comparative Patient Experience Scores - TopBox Access Scores
Access Score 75th Percentile Score 90th Percentile Score Median Score
Based on Pt. Survey Data Collected Spring 2012 Released 8/06/2012
Practice Site ID - Randomly Blinded
Based on Pt. Survey Data Collected Spring 2012 Released 8/06/2012
Practice Site ID - Randomly Blinded
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Analytics and Reporting
Use of collaborative portal, comparative data and dashboard posters • Driving discussions in team meetings with providers and QI
directors
• Helping providers to realize not all performing as well as thought (compared to peers within and outside practices)
• Displays in patient waiting areas for transparency and promoting patient engagement in their own metrics and outcomes
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What’s Next?
Integrating additional data from multiple sources • Additional quality measures
• Practice characteristics and structure/process data
• Practice transformation data
Correlation and exploratory analyses • Identifying potential sources of variation
• Linking processes/structure to outcomes
Expanding the collaborative portal
More best-practice sharing and collaborative learning
Increased support for providers to succeed under new payment models
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Broad-Based Payer Funding Model
• $1 PMPM from:
• Fully insureds (via the OHIC Affordability Standards)
• Self-funded employers (including the State)
• RI Medicaid (enabling a 90/10 federal match)
• Contractually agree-upon set of deliverables
• Bi-monthly open meetings to enable the community to track
RIQI’s performance against goals and timelines
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$4M
$2M
$915,500
$8M GoalFULLY INSURED
COMPANIES (THROUGH
BCBSRI, UHCNE, TUFTS)
MEDICAID
SELF-FUNDED
COMPANIES
GAP
RI Medicaid and Federal MedicaidMatch
Roughly 45% of the $2M goal set for our outreach efforts with self-funded companies has been met.
Approximately $1.09M still needed from self-fundedcompanies with employees in RI.
Broad-based Payer Funding Model
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• Blue Cross & Blue Shield of RI
• Brown University
• Care New England
• Johnson & Wales University
• Lifespan Corporation
Self-Funded Companies Paying $1 PMPM
• Thielsch Engineering
• Tufts Health Plan
• South County Hospital
• State of Rhode Island
• UnitedHealthcare of New England
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Questions and comments?
Assisting Providers to Succeed
Under New Payment and Delivery Models
Laura Adams Darby Buroker President and CEO, RIQI Director, Beacon Prg Mgt, RIQI