48-A.ppt

448 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
448
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • The main point of this slide is that these errors are preventable. The current health system has not addressed these issues although the newest Leapfrog report is showing some improvement. 400,000 preventable drug-related injuries occur each year in hospitals
  • This is another powerful slide. This is a study that RAND group did looking at, by diagnosis, the percent of people who actually received the recommended care for that diagnosis. Is based on 12 metropolitan areas with 30 acute & chronic conditions with 439 metrics.
  • Hospitals initially invited to participate in the program represented those willing to take part in a pilot patient safety and quality improvement program, thus demonstrating a commitment to this area. With progression of the program, greater variability in hospital size, location and previous involvement in patient safety and quality activities is seen. Currently, 49 hospitals.
  • Saved Lives: Priceless Hospitals already have staff implementing JCAHO accreditation (this activity is complementary not duplicative)
  • Together these eight cardiac care hospitals exhibited an almost 50 percent reduction in serious complication rates for angioplasty and a 29 percent reduction for cardiac catheterization. While hospitals nationally averaged reductions of 20 percent and 22 percent respectively over the same time period. Additionally, each of the eight hospitals fell below the average national complication rate of 3.6 percent for angioplasty. More than 47% reduction in serious complication rates for angioplasty (national average = 20%) 29% reduction of serious complications for cardiac catherizations (national average = 22%)
  • Together these eight cardiac care hospitals exhibited an almost 50 percent reduction in serious complication rates for angioplasty and a 29 percent reduction for cardiac catheterization. While hospitals nationally averaged reductions of 20 percent and 22 percent respectively over the same time period. Additionally, each of the eight hospitals fell below the average national complication rate of 3.6 percent for angioplasty. More than 47% reduction in serious complication rates for angioplasty (national average = 20%) 29% reduction of serious complications for cardiac catherizations (national average = 22%)
  • The rapid reopening of blood vessels serving the heart during an acute coronary event helps save lives and heart muscle. ACC guidelines set the gold standard for door-to-balloon time at 90 minutes or less. Each minute past the standard increases a patient’s chances of serious complication or death. The eight Q-HIP hospitals remain significantly better than the national average and have demonstrated an improvement of 17 percent against the 90 minute standard over the two-year time frame. The national average increased 12 percent over the same period. These improvements translate into fewer strokes, heart attacks, and heart failure, and improved survival in cardiac patients. Furthermore, significant savings in decreased complications, long-term morbidity and a resultant improvement in disability and absenteeism are expected. 17% improvement in the 90 minute or less goal for door-to-balloon time (national average = 12%)
  • Unintended but pleasant outcomes…
  • 48-A.ppt

    1. 1. “ What’s Driving P4P and Where Are We ” R. H. Walker MD October 25, 2006
    2. 2. National Pay for Performance (P4P) Programs <ul><li>Momentum started with IOM reports </li></ul><ul><li>Employer market is looking for better quality ROI for health care dollars – Bridges to Excellence </li></ul><ul><li>Medicare Initiatives in P4P </li></ul><ul><li>President Bush’s goals for EMRs </li></ul>
    3. 3. Medical Errors – Institute Of Medicine Report <ul><li>44,000 – 98,000 Americans die from medical errors annually </li></ul><ul><li>Only 55% of patients received recommended care </li></ul><ul><li>Medication-related errors of hospitalized patients cost roughly $3.5 billion annually </li></ul><ul><li>Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents </li></ul>To Err is Human, Crossing the Quality Chasm, Preventing Medication Errors: The IOM Health Care Quality, 1999, 2001, 2006
    4. 4. RAND Study Confirms Quality Gap Elizabeth McGlynn, et al, “ The Quality of Health Care Delivered to Adults in the United States ,” NEJM , Vol . 348:2635-2645 June 26, 2003 ( N o. 26 ). 10.5 Alcohol dependence 22.8 Hip fracture 40.7 Urinary tract infection 45.2 Headaches 45.4 Diabetes mellitus 48.6 Hyperlipidemia 53.0 Benign prostatic hyperplasia 53.5 Asthma 53.9 Colorectal cancer 57.2 Orthopedic conditions 57.7 Depression 64.7 Hypertension 68.0 Coronary artery disease 68.5 Low back pain % Recommended Care Received Condition
    5. 5. Health Care Quality Defect Rates Occur at Alarming Rates Defects per million s level (% defects) U.S. Industry Best-in-Class Anesthesia-related fatality rate Airline baggage handling Outpatient ABX for colds Post-MI b-blockers Breast cancer screening (65-69) Detection & treatment of depression Adverse drug events Hospital acquired infections Hospitalized patients injured through negligence 1 (69%) 2 (31%) 3 (7%) 4 (.6%) 5 (.002%) 6 (.00003%) Source: modified from C. Buck, GE Overall Health Care in U.S. (RAND)
    6. 6. 2005 National P4P Study 2005 National Pay for Performance Study, Med-Vantage 25% increase from 2004
    7. 7. Key Findings from the National P4P Study <ul><li>Expansion to PPO and CDH Products </li></ul><ul><li>Expansion to specialists – 52% </li></ul><ul><li>Increasing use of tier fee schedules rather than bonus payments </li></ul><ul><li>Demonstration of ROI </li></ul><ul><li>Growing interest in public reporting </li></ul><ul><li>CMS in the P4P market </li></ul>2005 National Pay for Performance Study, Med-Vantage
    8. 8. Transparency <ul><li>– Provide health care consumers information to make the right decision </li></ul>&quot;If you don't want people to see your data, you're in the wrong century,&quot; Dennis O'Leary, Chief Executive Officer JCAHO, Aug 2006
    9. 9. Why Transparency ? <ul><li>Market Demand – Employers </li></ul><ul><li>Consumerism </li></ul><ul><li>Impact on quality outcomes and affordability </li></ul>
    10. 10. President Bush Calls On Hospitals To Share Price And Quality Data, AHA Issues “Roadmap” To Price Transparency “ Every hospital represented here should take action to make information on prices and quality available to all your patients. If everyone here cooperates in this endeavor we can increase transparency without the need for legislation from the United States Congress,” said Bush American Health Lawyers Association website – May 2006 May 1, 2006 address to the annual meeting for the American Hospital Association
    11. 11. Three Components of Transparency Cost Quality Decision Support Helping consumers make informed health care choices as consumers are asked to pay a greater portion of the cost of care
    12. 12. Cost of Care <ul><li>Hospital Claims </li></ul><ul><ul><li>Inpatient </li></ul></ul><ul><ul><li>Outpatient </li></ul></ul><ul><li>Physician Claims </li></ul><ul><li>Other services </li></ul><ul><ul><li>Pharmacy </li></ul></ul><ul><ul><li>DME </li></ul></ul><ul><li>Relative Scales vs Absolute Dollars </li></ul><ul><li>Costs by Treatment Episodes vs single CPT codes </li></ul><ul><li>Differences in benefit designs </li></ul><ul><li>Global rates </li></ul>Issues Cost Sources
    13. 13. Quality of Care <ul><li>National Measures such as HEDIS </li></ul><ul><li>Satisfaction surveys </li></ul><ul><li>Needs to be both by hospital and physician </li></ul><ul><li>Focus on quality not cost efficiency </li></ul><ul><li>Issue of small numbers </li></ul><ul><li>Need for national benchmarks </li></ul><ul><li>All payer data bases </li></ul><ul><li>Risk adjusted data </li></ul>Issues Metrics
    14. 14. Decision Support <ul><li>Information needs to be relevant for a member’s plan and benefit design </li></ul><ul><li>Absolute necessity with consumerism </li></ul><ul><li>Needs to include a comparison tool </li></ul><ul><li>Needs to be linked to both quality and cost </li></ul>
    15. 15. Virginia Pay for Performance Programs <ul><li>Quality-In-Sights Hospital Incentive Program – (Q-HIP SM) </li></ul><ul><li>Quality Physician Performance Programs - (Q-P3 SM) </li></ul><ul><ul><li>Cardiology </li></ul></ul><ul><ul><li>Gastroenterology </li></ul></ul><ul><ul><li>Cardiac Surgery </li></ul></ul><ul><li>Performance Extra - PEX </li></ul>Strategy to match reimbursement to evidence based medicine and quality of care outcomes
    16. 16. Q-HIP SM - Successful in Aligning with National Performance Based Incentive Principles <ul><li>AMA, JCAHO, CMS, AHA, MGMA all have P4P principles </li></ul><ul><li>Q-HIP </li></ul><ul><ul><li>Is voluntary </li></ul></ul><ul><ul><li>Consistently applies nationally vetted and recognized evidence based indicators </li></ul></ul><ul><ul><li>Aligns reimbursement with the practice of high quality and safe health care for all consumers </li></ul></ul><ul><ul><li>Is transparent with PSO validation and auditing of data </li></ul></ul><ul><ul><li>Available to all network hospitals </li></ul></ul>
    17. 17. Quality-In-Sights Hospital Incentive Plan “ By working together we can improve the quality and reduce the variation in care delivered across the entire program coverage area”
    18. 18. Q-HIP SM - A Collaborative Effort
    19. 19. Q-HIP SM - VHI-Developed Web Tool
    20. 20. Q-HIP SM in Virginia <ul><li>60 hospitals to participate in Q-HIP SM by 2006 </li></ul><ul><li>11 large health systems </li></ul><ul><li>92.7% of Anthem inpatient admissions in Commonwealth of Virginia </li></ul><ul><li>Rural, local and tertiary care hospitals </li></ul><ul><li>All regions of the Commonwealth represented </li></ul><ul><li>Outside Virginia </li></ul><ul><ul><li>Northeast Region (ME, NH, CT): 24 hospitals </li></ul></ul><ul><ul><li>Georgia: 20 hospitals </li></ul></ul><ul><ul><li>New York: 40 hospitals (planned) </li></ul></ul><ul><ul><li>Western Region: (CO, NV): 19 hospitals </li></ul></ul>
    21. 21. Scorecard Components <ul><li>Rapid Response Teams </li></ul><ul><li>JCAHO Hospital National Patient Safety Goals </li></ul><ul><li>Computerized Physician Order Entry (CPOE) System </li></ul><ul><li>ICU Physician Staffing (IPS) Standards </li></ul><ul><li>NQF Recommended Safe Practices </li></ul><ul><li>Hospital-Based Physician Contracting </li></ul><ul><li>Patient Satisfaction Survey </li></ul>Member Satisfaction Section (15% of Total Q-HIP Score) <ul><li>Patient Safety and Quality Improvement Measures </li></ul>Patient Safety Section (25% of total Q-HIP Score) <ul><li>CABG Indicators </li></ul><ul><li>5 STS Coronary Artery Bypass Graft (CABG) Measures </li></ul><ul><li>JCAHO National Hospital Quality Measures </li></ul><ul><li>Acute Myocardial Infarction (AMI) Indicators </li></ul><ul><li>Heart Failure (HF) Indicators </li></ul><ul><li>Pneumonia (PN) Indicators </li></ul><ul><li>Surgical Care Improvement Project (SCIP) </li></ul><ul><li>Pregnancy Related </li></ul><ul><li>ACC-NCDR Section </li></ul><ul><li>7 ACC-NCDR Indicators for Cardiac Catheterization and PCI </li></ul>Patient Health Outcomes Section (60% of total Q-HIP Score)
    22. 22. Upfront Costs by Hospitals to Implement Q-HIP SM <ul><li>ACC-NCDR: $2,995 </li></ul><ul><li>STS Database: $2,850 </li></ul><ul><li>Additional FTE*: NA </li></ul>
    23. 23. Outcomes (All-Payer): Serious complications – Cardiac catheterization 2003 2004 National 2003 2004 Q-HIP 22% decrease 29% decrease Confidential for internal use only
    24. 24. Outcomes (All-Payer): Serious complications – PCI (angioplasty) 2003 2004 National 2003 2004 Q-HIP 20% decrease 47% decrease Confidential for internal use only
    25. 25. Outcomes (All-Payer): Door-to-balloon time of 90 minutes or less 2003 2004 National 2003 2004 Q-HIP 12% increase 17% increase Confidential for internal use only
    26. 26. Surprising Developments <ul><li>One large hospital reports Q-HIP scores to its board of directors annually. </li></ul><ul><li>A number of hospitals include Q-HIP scores as part of their own internal corporate performance reporting </li></ul><ul><li>A major academic medical center ties Q-HIP scores to front-line staff salary bonuses </li></ul>
    27. 27. Because (Q-HIP) uses aggregated hospital-wide performance data, it overcomes problems with small numbers and difficulties with attributions. Because the rewards are based on shared performance, the program is intended to create incentives for competing physician groups to work together with hospital administration in a cooperative manner to achieve continuous quality improvement. Congressional Testimony of John Brush, MD, American College of Cardiology July 27, 2006 This is a win-win situation in my mind. As health care providers, we always strive to do the right thing for our patients. The reality is this sometimes costs more in terms of putting in place new structures and processes to support a better way of delivering services. Ron Clark, MD, Chief Medical Officer, VCU Health System
    28. 28. Quality Physician Performance Program – Q-P3 SM
    29. 29. Q-P3 SM - Cardiology <ul><li>Voluntary Program </li></ul><ul><li>Based on an all payers data base except for the pharmacy measure </li></ul><ul><li>Mirrors QHIP indicators to align incentives </li></ul><ul><li>Final Scorecard results are based on hospital market share </li></ul><ul><li>Rewards are based on excellence </li></ul>
    30. 31. Q-P3 SM - Cardiac Surgery <ul><li>Voluntary Program </li></ul><ul><li>Based on an all payers data base from the Society of Thoracic Surgery </li></ul><ul><li>Developed in collaboration with Virginia cardiac surgeons - Virginia Cardiac Surgery Quality Initiative </li></ul>
    31. 32. Sample Scorecard for Cardiac Surgery
    32. 33. QP3 SM - Gastroenterology <ul><li>Statewide offered to all participating physicians whose primary specialty is Gastroenterology </li></ul><ul><li>Program applies to all products (Par/PPO & HMO) except Medicaid & Medicare which are excluded </li></ul><ul><li>4 Clinical Indicators & 1 Non-Clinical Indicator </li></ul><ul><li>Clinical Indicators are measured based on Anthem claims data </li></ul>
    33. 34. Gastroenterology Indicators
    34. 35. Performance Extra - PEX <ul><li>Statewide from for HMO </li></ul><ul><li>Annual bonus </li></ul><ul><li>Indicators </li></ul><ul><ul><li>Asthma </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Cholesterol </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Mental Health </li></ul></ul><ul><ul><li>Generic Drug Utilization </li></ul></ul><ul><ul><li>Preventive Care </li></ul></ul><ul><ul><li>Quality of Service (Member satisfaction, open practice, Point of Care, and EMR) </li></ul></ul>
    35. 36. EMR Criteria <ul><li>Decision Support Tool </li></ul><ul><li>Formulary Management Tool </li></ul><ul><li>Chronic Disease Management Tool </li></ul><ul><li>Preventive Medicine Tool </li></ul><ul><li>Links to Diagnostic Providers (lab & x-ray) </li></ul><ul><li>Database Query Capability </li></ul><ul><li>Ambulatory Computerized Physician Order Entry System </li></ul>
    36. 37. Timing Is Right for Pay for Performance <ul><li>Represents a Wellpoint strategy </li></ul><ul><li>Market place is looking for a solution </li></ul><ul><li>Impact on quality of care and affordability </li></ul><ul><li>Transparency movement is gaining momentum </li></ul><ul><li>Win-Win solution for providers, members and employers </li></ul>

    ×