This document discusses the importance of good data and performance measurement in improving healthcare quality, outcomes, and affordability. It notes that while process measures for diabetes care are high, outcomes are still lacking. Healthcare spending is growing much faster than wages or inflation, demonstrating an economic imperative to address costs. The document then outlines components of an alternative contract model between physicians and hospitals that ties payment to quality performance and cost control goals like global budgets tied to inflation. It provides low back pain referrals as an example of using data analysis to improve practice patterns and reduce wasteful care.

1. Getting to Safe, Affordable, Effective, Patient-Centered Care: Good Data Are Only the Beginning __________________________________ Dana Gelb Safran, Sc.D. Senior Vice President Performance Measurement & Improvement Blue Cross Blue Shield of Massachusetts Presented at: Massachusetts Technology Leadership Council Using Technology to Improve Care While Right-Sizing Costs Through Better Analytics 8 December 2010

2. Advancing Quality, Outcomes and Affordability: Role of Performance Measurement, Reporting and Incentives Reporting to Providers Provider Incentives Reporting to Public Provider Engagement Member Engagement Member Incentives & Benefits

3. Diabetes Care: Clinical Process Measures Nearing Perfection; Outcomes Are Far From It Source: MHQP, 2005 HEDIS process and outcomes measures

4. The Economic Imperative Source: CMS, Office of the Actuary, National Health Statistics Group Health care spending per capita is projected to nearly double over the next 10 years. Sources: BCBSMA, Bureau of Labor Statistics BCBSMA’s medical cost trend is growing five times faster than workers’ earnings, and nearly four times the rate of inflation. 8.2% 15.9% 13.8% 13.1% 12.1% 13.3% 12.8% BCBSMA Medical Trend Workers’ Earnings Overall Inflation

6. PCP Referral for Low Back Pain: Example of Practice Pattern Variation Analysis to Improve Quality & Address Clinical Waste