1. Health IT and the Voice of the Patient
Using Cloud-Based Technology and Patient Reported Outcomes to Understand
Population Health
April 18, 2012
2. Agenda
I. Company Overview
II. Smart Measurement System
III. Monitoring Population Health
IV. Case Study: Alberta Health Services
Proprietary and Confidential. Do not distribute. 2
3. Existing Healthcare “System”
Governments Hospitals
Wellness & Care Physicians
Managment
What’s Missing?
Other
healthcare Medical Device
professionals companies
Pharmaceutical & Biotechnology
5. I. COMPANY OVERVIEW
Proprietary and Confidential. Do not distribute. 5
6. Company Overview
• QualityMetric offers health Providers
surveys that capture the (1,753)
patient’s own assessment
of their health
• QualityMetric has grown Researchers
(1,835)
by 765% in the last 10 Payers (265)
years
• QualityMetric’s footprint
spans the entire health
care ecosystem
Government Life Sciences
(223) (1,044)
Our Market Segments and Clients
Proprietary and Confidential. Do not distribute. 6
7. Our Numbers
76,000,000 Survey administrations
>21,000 License requests
>18,000 Peer-reviewed articles
2,400 Published RCTs
140+ Language translations
35 Label claims
Proprietary and Confidential. Do not distribute. 7
8. QualityMetric’s Culturally Appropriate Language Translations
• QM has 11 Arabic language translations of our survey
instruments (Egyptian, Saudi Arabian, Algerian,
Jordanian, Lebanese, Moroccan, Palestinian, Qatari,
Tunisian, and UAE)
• QM has language translations for Indian (Bengali,
Gujarati, Hindi, Kannada, Malayalam, Marathi, Odia,
Punjabi, Tamil, Telugu, and Urdu), Pakistani (Urdu), and
Filipino (Cebuano, Ilocano, Ilonggo, and Tagalog)
Proprietary and Confidential. Do not distribute. 8
9. V. SMART MEASUREMENT SYSTEM
Proprietary and Confidential. Do not distribute. 9
10. Smart Measurement™ System
Outcomes in a Cloud
Modes of Administration
Phone | Online | Paper/Fax | Tablet | Smart Phone
Patient Reminders & Data
Provider Alerts Warehouse
Scoring Engine Data feeds | Real
Phone | Email | Post
time | Batch
Comparative
Data Assets
Management Customized
Patient Report Provider Report
Reports Analysis
Proprietary and Confidential. Do not distribute. 10
11. Smart Measurement Components
Content Scoring Reports Interfaces
• eForms • ASP scoring • Member • Auto register
• HTML web engine • Provider members
form • API – vendor • Aggregate •Automated
• Fax/OCR integration • Management result feeds
• IVRS • Web • Custom
(HL7, CDISC)
• Web Smart services dash-boards •Patient
Phone (SaaS) reminder
(coming) • Desktop •Professional
• Custom Alerts
Proprietary and Confidential. Do not distribute. 11
12. IT Capabilities
• Off-site hosted environment • Group, site, and individual • Look and feel to match host
(24/7/365) U.S. and Canada role based access site
• 128 bit secure socket layer • Ease of access through • Survey domains/items and
(HTTPS) “single sign on” scoring
• System complies with • Available from standard • Report modifications to
HIPAA security and FDA Internet browsers meet your needs
21CFR part 11 privacy • HL7, CDISC formats to • Customized push/pull
regulations standard EMR/EHR interfaces
systems
Security Access Customization
13. Real-time Measurement and Reporting
Computer (Desktop,
Web)
Fax (Paper OCR
recognition)
Phone (IVR)
Tablet/Kiosk
Proprietary and Confidential. Do not distribute. 13
16. Health Risk Assessment – iPad Version
Proprietary and Confidential. Do not distribute. 16
17. II. MONITORING POPULATION HEALTH
Proprietary and Confidential. Do not distribute. 17
18. Monitoring Population Health
Risk Cost Benefit
Prediction Analysis
Disease Program
Burden Evaluation
Screening/ Population Health
Stratification Health Registries
Proprietary and Confidential. Do not distribute. 18
19. What is Population Health?
• Taking stock of
your population’s
health status
• Monitoring trends
over time
• Evaluating
differences among
subgroups
• Noting variations in
risk among these
groups
Proprietary and Confidential. Do not distribute. 19
20. Screening and Stratification
• Identify patients for
treatment
• Determine score “cut
points” for physical
functioning and mental
well-being
• SF surveys are
especially helpful for
mental health
Proprietary and Confidential. Do not distribute. 20
21. Disease Burden Assessment
• Disease-specific
benchmarks available
for more than 30
different conditions
• Ability to compare your
population’s burden
against what would be
expected of the
disease
Proprietary and Confidential. Do not distribute. 21
22. Risk Prediction/Management
• SF surveys are able to
define risk by
– Predicting increased use
of MH Services
– Predicting job loss due to
health
– Predicting depression
diagnosis
– Predicting Hospitalization
– Estimating future medical
expenses
Proprietary and Confidential. Do not distribute. 22
23. Cost/benefit Analysis
• SF surveys can be used
for economic analysis
(cost-benefit, cost-
effectiveness, ROI)
• Using a preference-
based utility index (SF-
6D) QALY estimates can
help assesses the
economic benefit of
various health care
interventions
Proprietary and Confidential. Do not distribute. 23
24. Program Evaluation
• SF surveys can be used
to develop benchmarks
allowing the
development of best
practices
• Identifying providers
handling the greatest
health risk
• Allow the comparison of
individual practitioners
Proprietary and Confidential. Do not distribute. 24
25. IV. CASE STUDY: ALBERTA HEALTH SERVICES
Proprietary and Confidential. Do not distribute. 25
26. AHS Case Study
Alberta Health Services (AHS) is the provincial health authority in Alberta
Client Canada
Responsible for delivering health care services to 3.5 million people
To implement a population health initiative that would monitor health
outcomes in patients enrolled in community-based diabetes and obesity
management and education programs
Challenge To generate geographically specific norms for the Edmonton area so that
future outcomes measurement programs might benefit
To measure the impact of these programs in the community
Patients participating in both programs complete baseline surveys either
in their doctor’s office or at the beginning of the educational classes with
follow up suveys administered at six months and one year
Solution To evaluate health outcomes scores were compared at baseline and one
year
Results from both the diabetes program and obesity program offered
information that helped AHS either improve the existing program or
demonstrate its positive impact on patients
Proprietary and Confidential. Do not distribute. 26
27. AHS Diabetes Program Outcomes
Baseline One year
Best 60 60
Health
55 Norm 55
Norm
50 50
45 45
40 40
35 35
30 30
Worse 25 25
Health 20 20
N=130
Proprietary and Confidential. Do not distribute. 27
28. AHS Obesity Program Outcomes
Baseline One year
Best 60 60
Health
55 Norm 55
Norm
50 50
45 45
40 40
35 35
30 30
Worse 25 25
Health 20 20
N=113
Proprietary and Confidential. Do not distribute. 28
29. Questions?
Contact information
Gus Gardner, President and Mark Bean, Vice President Global
COO, QualityMetric Incorporated Initiatives, QualityMetric Incorporated
(401) 642-9239 (401) 585-6174
ggardner@qualitymetric.com mbean@qualitymetric.com
Proprietary and Confidential. Do not distribute. 29
31. Three Seminal Studies
• The Health Insurance Experiment (1974-1981)
– First extensive use of psychometrics in health status surveys
– Led by John E. Ware Jr. et al while at the RAND Corporation
– Demonstrated self-administered surveys to be reliable and valid
• The Medical Outcomes Study (1986-1990)
– Four-year longitudinal, observational study of practice style variations for
over 23,000 chronically ill patients
– Led by Dr. Ware et al at the University of Chicago, RAND, and Tufts-New
England Medical Center
– Surveys measured 40 health concepts and became the basis for the SF-
36 Health Survey, which represented the eight most important concepts
• The Medicare Health Outcomes Study (1998-2004)
– The 1997 Balance Budget Act directed Medicare to focus on the health
status of beneficiaries
– CMS worked with NCQA to incorporate Medicare beneficiaries into HEDIS
and expand outcomes measures
– The SF-36 Health Survey was recommended as a core measure in an
annual assessment of physical and mental health 31
32. The SF Health Surveys
Most reliable, rigorously validated, and
widely used patient-reported outcome
measures in the world
Standardized so that outcomes are
comparable across groups, times, and
populations
Used during all phases of
drug/biologic/device development
Eight health domains measured
Physical Health Mental Health
Summarized as physical health scores and
mental health scores
Benchmarked against a norm, or T-
score, of 50, which is age and gender
specific
Proprietary and Confidential. Do not distribute. 32
33. Disease-specific Health Surveys
• Asthma Control Test (ACT)
• MOS Sleep Scale
• Pain Impact Questionnaire (PIQ-6)
• Headache Impact Test (HIT-6)
• Rhinitis Impact Survey
• PMSIS Impact Survey
• Asthma Impact Survey (AIS-6)
• MOS Cognitive Functioning Scale
Proprietary and Confidential. Do not distribute. 33
35. A Universal Measure of Health
• 50% reduction in physical disability
• 33% reduction in hospitalization
• Substantial increase in work productivity
• Reduced expenditures
Asthma Asthma
Before After
Congestive Heart Rx Rx
Failure
Chronic Lung Diabetes
Disease Average Average
Type II Adult Well Adult
Treatment
30 40 50
Physical Component Summary (PCS)
Proprietary and Confidential. Do not distribute. 35
36. What We Do – The Predictive Power of SF Tools*
SF-12 MCS Scores Predict SF-12 PCS Scores Predict
Future Use of MH Services Hospitalization within 6 months
35%
75%
62% 26%
54% 19%
36% 16%
26% 8% 10%
14% 16% 6%
3% 5% 0% 2%
60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-25 60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-25
SF-12 MCS Scores Predict SF-36 PCS Scores Predict Job
Depression Diagnosis Loss Due to Health
60% 32%
51%
42% 18%
35%
24% 10%
8% 10% 3%
1% 2%
55-65 45-55 30-40 15-25
60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-25
36
* X axis is a range of PCS or MCS scores
37. What We Measure
What is Your Health? Social & Role
• Bodily structure and
Physical & Mental
function
• What you are able to
do: functioning Biologic
Function
• How you feel: distress
and well-being
Function &
• What you say it is: Well-being
personal evaluation
Participation
Sources: WHO, ICIDH-2, 2001 (www.who.org)
Proprietary and Confidential. Do not distribute. 37
38. Quality of life
Community Marriage
Education Nation
Family Life Neighborhood
Friendships Self
Health Standard of Living
Housing Work
Source: Campbell 1981
Proprietary and Confidential. Do not distribute. 38
39. What is your health?
• Bodily structure and function
• What you are able to do: functioning
• How you feel: distress and well-being
• What you say it is: personal evaluation
Best captured using
patient-reported
outcome (PRO) tools
Sources: WHO, ICIDH-2, 2001 (www.who.org)
Proprietary and Confidential. Do not distribute. 39
40. Eight Health Domains
Perform normal
physical activities
Physical
Function
Feelings of
Mental Role- Interference with
peace, happiness,
Health physical work resulting from
nervousness, or
physical problems
depression
SF Level of pain
Interference with Role- Bodily
work resulting from emotional Health Pain impacting
Surveys normal activities
emotional problems
Limited social
Social General Perspective on
activities due to Function Health and expectations
physical or emotional
for health
problems
Vitality
Level of energy
or tiredness
Proprietary and Confidential. Do not distribute. 40
43. Identifying the “Flat of the Curve”
• More is not always
better
• There is a point where
more care no longer
improves health
• PROs can help you
Increased Benefit
find that point
Waste
Increased Cost
Proprietary and Confidential. Do not distribute. 43
44. More Results from the AHS Project (Obesity Program)
Physical Health Outcomes Mental Health Outcomes
64%
49%
37% 37% 35% 35%
32%
24% 27%
23% 23% 22% 20%
15% 14% 15% 14% 15% 15%
10% 13%12% 7% 9%
Limted in activities Accomplished Limited in work Reporting pain Limted in social Worked less Not calm/peaceful Downhearted/
less activities carefully depressed
Baseline One Year Norm Baseline One Year Norm
Proprietary and Confidential. Do not distribute. 44
45. Quotes from the AHS Population Health Study
“It’s useful to see how my health
“79% of Edmonton’s
compares to my peers – other
diabetics and obese people. population has one or
Seeing my scores is liberating more chronic conditions
because now I know if I’m more or and 40% have more
less healthy than other people than three.”
who have similar health -Health Quality of Life
concerns.” Measurement Tool Final Report,
July 2010
-A patient involved in the AHS project
“Physicians and patients reported that the survey provided a
quick assessment of mental and physical health which had
clinical value. If the patient’s mental or physical health scores
were less than optimal, patients and providers reported
discussing contributing factors to the decline.”
-Health Quality of Life Measurement Tool Final Report,
July 2010
Proprietary and Confidential. Do not distribute. 45
46. What’s Next at AHS
• Expanding the program from a focus on initial studies and two
cohort groups (obesity and diabetes) to enrolling entire populations
• Currently over 1/3 of Alberta’s Primary Care Networks are using SF-
12v2 and Smart Measurement System to monitor their population’s
health
• Alberta Primary Care Networks are obtaining patient measurement
and real time reporting that is tailored for their specific needs
• This is Health IT in action
Proprietary and Confidential. Do not distribute. 46
Editor's Notes
QualityMetric’s health surveys capture reliable and scientifically valid patient-reported health outcomes information. A last count the surveys have been administered more than 76 million times worldwide and have been adapted for use in 130 languages. Used successfully in more than 1,900 clinical trials and referenced in more than 14,000 peer-reviewed articles, these surveys are proven responsive in 66 disease conditions and have been accepted by the Food and Drug Administration as proof of benefit for improved functioning and other PRO concepts. To date, 35 drug label claims have been approved using our tools.
Our surveys are available in multiple modes including…<read slide>To ensure that the surveys are accessible to as many individuals as possible. It is also possible to complete a paper survey and scan it through a fax machine to collect and score the data automatically.
Mark:
The SF Health Surveys are the…Most reliable, rigorously validated, and widely used patient-reported outcome measures in the worldStandardized so that outcomes are comparable across groups, times, and populations
Here is a list of the disease-specific health surveys we offer. By the way this is a copy of the Asthma Control Test in Bulgarian!These are just a few of the surveys we have developed for clients over the years to measure disease impact, symptom control, health burden and risk. Things that can not be traditionally or medically measured.
