This presentation was made by Joseph WHITE, United States, at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems held on 4-5 February 2016 at the OECD Conference Centre in Paris.
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Using Data, Transforming Practice: Evaluating Mental Health Transformation in...MHTP Webmastere
This document discusses the evaluation of Washington State's mental health transformation project. It describes the diverse evaluation team, which includes consumers, youth, family members, researchers, and state agency staff. The team uses an integrated database to track outcomes like healthcare utilization, incarceration rates, and employment across multiple state agencies. Preliminary results show improvements like reduced recidivism and increased use of community-based services for individuals with mental illness. The evaluation also examines use of evidence-based practices and initiatives to promote recovery.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
How many times have we all heard (or asked) "What is the ‘average’ caseload?" Sounds like a simple question, doesn't it? However, case management programs have struggled for years trying to determine realistic, standard caseloads. People are looking for "a number" that defines the average caseload, but in reality, there is no "magic" number.
Population Health Management PHM MLCSU huddleMatthew Grek
Andi Orlowski (Director of The Health Economics Unit) give an overview of Population Health Management (PHM) to the Midlands and Lancashire Commissioning Support Unit Huddle, on 25 March 2021
Fewer than half of Medicare enrollees with diabetes received annual eye exams, despite guidelines recommending them to screen for blindness. Rates varied widely between regions, from less than 20% to 60% compliance. Research also found underuse of other effective diabetic care like blood sugar and lipid screening tests. This underuse of recommended care is common and represents missed opportunities to prevent health issues. Spending levels do not correlate with higher quality or effective care delivery. Systems need to change incentives to reward doctors for following guidelines and ensure all eligible patients receive necessary care.
Narratives play several roles in decision aids such as engaging patients, informing them, modeling behaviors, helping patients weigh trade-offs and clarify values, but they also raise some concerns. While narratives can make information more memorable, they risk focusing on outliers and distracting from facts. The evidence on whether narratives influence decisions is mixed, though they certainly have power. The document advocates using curated patient narratives in addition to factual information to complement rather than replace facts, mitigate potential biases, and represent both common and uncommon patient viewpoints and experiences.
This document introduces decision-analytic modeling techniques for clinical and economic projections. It discusses why modeling is useful, provides a taxonomy of modeling techniques including Markov models, and showcases examples of models that project clinical and economic outcomes. It concludes by guiding interested audience members to further information on modeling tools, societies, journals, and educational institutions.
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Using Data, Transforming Practice: Evaluating Mental Health Transformation in...MHTP Webmastere
This document discusses the evaluation of Washington State's mental health transformation project. It describes the diverse evaluation team, which includes consumers, youth, family members, researchers, and state agency staff. The team uses an integrated database to track outcomes like healthcare utilization, incarceration rates, and employment across multiple state agencies. Preliminary results show improvements like reduced recidivism and increased use of community-based services for individuals with mental illness. The evaluation also examines use of evidence-based practices and initiatives to promote recovery.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
How many times have we all heard (or asked) "What is the ‘average’ caseload?" Sounds like a simple question, doesn't it? However, case management programs have struggled for years trying to determine realistic, standard caseloads. People are looking for "a number" that defines the average caseload, but in reality, there is no "magic" number.
Population Health Management PHM MLCSU huddleMatthew Grek
Andi Orlowski (Director of The Health Economics Unit) give an overview of Population Health Management (PHM) to the Midlands and Lancashire Commissioning Support Unit Huddle, on 25 March 2021
Fewer than half of Medicare enrollees with diabetes received annual eye exams, despite guidelines recommending them to screen for blindness. Rates varied widely between regions, from less than 20% to 60% compliance. Research also found underuse of other effective diabetic care like blood sugar and lipid screening tests. This underuse of recommended care is common and represents missed opportunities to prevent health issues. Spending levels do not correlate with higher quality or effective care delivery. Systems need to change incentives to reward doctors for following guidelines and ensure all eligible patients receive necessary care.
Narratives play several roles in decision aids such as engaging patients, informing them, modeling behaviors, helping patients weigh trade-offs and clarify values, but they also raise some concerns. While narratives can make information more memorable, they risk focusing on outliers and distracting from facts. The evidence on whether narratives influence decisions is mixed, though they certainly have power. The document advocates using curated patient narratives in addition to factual information to complement rather than replace facts, mitigate potential biases, and represent both common and uncommon patient viewpoints and experiences.
This document introduces decision-analytic modeling techniques for clinical and economic projections. It discusses why modeling is useful, provides a taxonomy of modeling techniques including Markov models, and showcases examples of models that project clinical and economic outcomes. It concludes by guiding interested audience members to further information on modeling tools, societies, journals, and educational institutions.
The document describes a case study of Massachusetts' Children's High-Risk Asthma Bundled Payment pilot program. The program aims to evaluate if bundled payments to providers can improve health outcomes for high-risk pediatric asthma patients while lowering costs by reducing hospital and emergency department visits. Providers receive $50 per member per month and can use the funds flexibly to provide services like home visits, education, and supplies to better manage patients' asthma. The goal is for the program to generate savings within 3 years by preventing expensive hospital admissions and emergency visits.
YourCare is a program launched by CoreSource to help employees better manage their health and chronic conditions. A study found that employees in the YourCare program had improved preventative care, fewer hospital admissions, and as a result, lower overall healthcare costs for employers. Specifically, YourCare participants visited doctors 6% more and filled 14% more prescriptions. They also had fewer care gaps and hospital admissions that were 12% lower. After risk-adjusting for differences in participants' health risks, the total costs were 6% lower for the YourCare group. Offering YourCare can help employers successfully manage high-risk employees and lower costs.
1. Economic evaluation of substance abuse treatment programs aims to assess costs and benefits in order to improve effectiveness and rationalize resource allocation.
2. Key aspects of economic evaluation include measuring treatment costs using tools like DATCAP and measuring outcomes using tools like ASI to assess areas like criminal behavior, employment, and health service use.
3. Benefits are converted to monetary values and compared to costs to calculate cost-benefit ratios and net benefits to understand the monetary gains from investments in reducing crime, improving health, and reducing costs to the justice system.
Beatriz Plaza from MEASURE Evaluation discusses the importance of metrics in scaling up sustainable global health programs. She notes that without measurement, programs cannot be effectively managed or grown. Impact evaluations and outcome evaluations are needed to determine if programs are having their desired effects and achieving results. Randomized controlled trials are considered the gold standard for impact evaluations. Recommendations include defining an organization's mission, choosing the right indicators, and making the case that a program caused observed changes in health outcomes. Metrics are crucial for accountability, transparency, and ensuring resources are invested in programs that can deliver impact at scale.
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
Predictive analytics for personalized healthcareJohn Cai
This document discusses how predictive analytics can help enable personalized health care through three main points:
1) Integrating diverse data sources like genomics, healthcare records, and insurance claims can provide insights for personalized care, drug development, and comparative effectiveness research.
2) Predictive models built using data from clinical trials can identify subgroups of patients most likely to respond or not respond to treatments early in the treatment course, improving outcomes.
3) Personalized comparative effectiveness research aims to determine which treatments work best for which patient subgroups and disease stages by integrating real-world data and predictive analytics into drug development and clinical decision-making.
This document discusses approaches to personalizing quality measurement in healthcare. It outlines three fundamental approaches:
1) Integrating patient-reported outcome and experience measures (PROMs and PREMs) into clinical workflow to better capture patients' health status and perspectives.
2) Encouraging patients' and clinicians' joint generation of medical records, such as through the OpenNotes project, to improve patient engagement, communication, and safety reporting.
3) Measuring decision quality through shared decision making between clinicians and patients to respect patient autonomy and better account for individual risk-benefit preferences in medical decisions. The document argues for rapidly adopting these personalized approaches and incentivizing their use through payment reform.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
Whitepaper - Attitudes Toward Patient Harm And Hospital FinancesWilliam Andrews
Patient safety leaders believe that reducing harm improves both patient outcomes and financial performance. However, the survey found that while hospital executives agree on this, less than half of safety leaders believe their organizations have clear plans to achieve zero preventable errors. Most safety leaders also report not having full support and resources. Respondents indicated that new initiatives require business cases to receive funding. Recent research demonstrates adverse events negatively impact profits by over $1,000 per incident on average, representing a potential $63 billion annual cost to the healthcare system. This provides strong evidence that improved safety measurably benefits both patients and financial outcomes.
This study examined how characteristics of medical group practices influence rates of inappropriate emergency department visits and avoidable hospital admissions among Medicare patients. The researchers found that practices owned by physicians and those using electronic health records had lower rates of non-emergent ED visits and emergent but primary care treatable visits. Larger practices and those with more non-physician providers per doctor had higher rates of avoidable hospital admissions. The findings suggest that care coordination declines as practices grow in size and complexity.
This chapter provides guidance on structuring and writing a policy analysis in 5 steps:
1) Identify the problem in 1-2 neutral sentences as a question that allows for multiple options.
2) Provide background facts to explain why the problem was chosen without recommendations.
3) Describe the overall context by identifying stakeholders and issues to consider like political, social, economic, and legal factors.
4) Analyze 3-5 options that are within the client's power and values, and evaluate each using identified criteria and pros and cons.
5) Recommend one option, discussing why it is better than others despite cons, and how to address remaining issues.
This study examined the effects of a pay-for-performance program implemented by a leading health insurer in Washington State between 2003 and 2007 that involved quality scorecards, public reporting, and financial incentives for medical groups. The researchers found that neither the scorecard nor the incentive program had a significant positive effect on clinical quality. Specifically, the addition of incentives to the scorecard was associated with a reduction in quality, contrary to the program's goals. The researchers believe the modest incentive amounts, use of rewards only with no penalties, and targeting of groups instead of individuals helped weaken the program's effects. The study contributes to understanding the challenges of achieving successful pay-for-performance.
This document discusses the importance of outcomes assessment in healthcare. It defines outcomes assessment as the collection and use of information about a patient's health and the effects of treatment over time. Providers are accountable to document treatment plans, patient progress, and outcomes using valid and reliable tools. Common tools discussed are questionnaires that measure general health, pain, function, and disability for conditions like back pain and neck pain. Regular use of standardized tools is important for assessing baseline status and tracking the effects of treatment.
This document summarizes a presentation on using multicriteria decision analysis (MCDA) to address ethical dilemmas in healthcare decision making. It discusses how MCDA could support a natural decision process that integrates evidence and values. Specifically, it proposes that MCDA could provide a framework to structure criteria based on the common goal of health and its underlying ethical aspects, allow for interpretation of distinct concepts like effectiveness and costs, and support qualitative reasoning and judgment in decision making. The EVIDEM collaboration aims to develop an open source MCDA framework based on these principles to help make fair and legitimate healthcare decisions.
Sabriya Rice: "Does ‘Pay for Performance’ Work?" 6.28.16reportingonhealth
Sabriya Rice's slides from the Center for Health Journalism webinar "Does ‘Pay for Performance’ Work?" 6.28.16
http://www.centerforhealthjournalism.org/content/does-pay-performance-work
Predicting Patient Adherence: Why and HowCognizant
To contain costs and improve healthcare outcomes, players across the value chain must apply advanced analytics to measure and understand patients’ failure to follow treatment therapies, and to then determine effective remedial action. This white paper lays out a framework for enabling patient adherence management and some general prescriptions on how to convert lofty concepts to meaningful action.
PSCI Case Study - Population Predictive Risk Analytics from PSCIpscisolutions
The Leading Physician Network worked with PSCI to develop a population risk stratification tool using their EMR data to identify high-risk patients for chronic conditions and reduce costs. The tool calculates individual "state of health" risk scores to target care management programs at those most likely to be hospitalized. This approach helped reduce hospitalizations and ER visits while improving case manager productivity.
Quality Measurement and Improvement_lecture 1_slidesZakCooper1
Health care quality aims to maximize patient outcomes through evidence-based care. There are three types of quality measures: structural, process, and outcome measures. Research shows significant gaps between actual US healthcare delivery and best practices, with only around half of patients receiving recommended care.
The document describes a case study of Massachusetts' Children's High-Risk Asthma Bundled Payment pilot program. The program aims to evaluate if bundled payments to providers can improve health outcomes for high-risk pediatric asthma patients while lowering costs by reducing hospital and emergency department visits. Providers receive $50 per member per month and can use the funds flexibly to provide services like home visits, education, and supplies to better manage patients' asthma. The goal is for the program to generate savings within 3 years by preventing expensive hospital admissions and emergency visits.
YourCare is a program launched by CoreSource to help employees better manage their health and chronic conditions. A study found that employees in the YourCare program had improved preventative care, fewer hospital admissions, and as a result, lower overall healthcare costs for employers. Specifically, YourCare participants visited doctors 6% more and filled 14% more prescriptions. They also had fewer care gaps and hospital admissions that were 12% lower. After risk-adjusting for differences in participants' health risks, the total costs were 6% lower for the YourCare group. Offering YourCare can help employers successfully manage high-risk employees and lower costs.
1. Economic evaluation of substance abuse treatment programs aims to assess costs and benefits in order to improve effectiveness and rationalize resource allocation.
2. Key aspects of economic evaluation include measuring treatment costs using tools like DATCAP and measuring outcomes using tools like ASI to assess areas like criminal behavior, employment, and health service use.
3. Benefits are converted to monetary values and compared to costs to calculate cost-benefit ratios and net benefits to understand the monetary gains from investments in reducing crime, improving health, and reducing costs to the justice system.
Beatriz Plaza from MEASURE Evaluation discusses the importance of metrics in scaling up sustainable global health programs. She notes that without measurement, programs cannot be effectively managed or grown. Impact evaluations and outcome evaluations are needed to determine if programs are having their desired effects and achieving results. Randomized controlled trials are considered the gold standard for impact evaluations. Recommendations include defining an organization's mission, choosing the right indicators, and making the case that a program caused observed changes in health outcomes. Metrics are crucial for accountability, transparency, and ensuring resources are invested in programs that can deliver impact at scale.
This document provides an overview of Ontario's Chronic Disease Prevention and Management Framework. It aims to provide a common policy framework to guide efforts in effectively preventing and managing chronic diseases. It also aims to guide various ministry transformation initiatives, such as primary health care renewal and public health renewal, with a focus on chronic disease prevention and management. The framework outlines eight components that need to be addressed through a systematic approach: health care organizations, delivery system design, provider decision support, information systems, personal skills/self-management support, healthy public policy, community action, and supportive environments. It emphasizes the importance of taking a population health approach focused on prevention to reduce the burden of chronic diseases.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
Predictive analytics for personalized healthcareJohn Cai
This document discusses how predictive analytics can help enable personalized health care through three main points:
1) Integrating diverse data sources like genomics, healthcare records, and insurance claims can provide insights for personalized care, drug development, and comparative effectiveness research.
2) Predictive models built using data from clinical trials can identify subgroups of patients most likely to respond or not respond to treatments early in the treatment course, improving outcomes.
3) Personalized comparative effectiveness research aims to determine which treatments work best for which patient subgroups and disease stages by integrating real-world data and predictive analytics into drug development and clinical decision-making.
This document discusses approaches to personalizing quality measurement in healthcare. It outlines three fundamental approaches:
1) Integrating patient-reported outcome and experience measures (PROMs and PREMs) into clinical workflow to better capture patients' health status and perspectives.
2) Encouraging patients' and clinicians' joint generation of medical records, such as through the OpenNotes project, to improve patient engagement, communication, and safety reporting.
3) Measuring decision quality through shared decision making between clinicians and patients to respect patient autonomy and better account for individual risk-benefit preferences in medical decisions. The document argues for rapidly adopting these personalized approaches and incentivizing their use through payment reform.
Edifecs: Demonstrating who you are in CJREdifecs Inc
A hands-on approaches for hospitals to strategically align orthopedic surgeons and post-acute providers under CJR. This Presentation focuses on tools that providers can use to help manage their performance to be successful under the new value-based environment.
Whitepaper - Attitudes Toward Patient Harm And Hospital FinancesWilliam Andrews
Patient safety leaders believe that reducing harm improves both patient outcomes and financial performance. However, the survey found that while hospital executives agree on this, less than half of safety leaders believe their organizations have clear plans to achieve zero preventable errors. Most safety leaders also report not having full support and resources. Respondents indicated that new initiatives require business cases to receive funding. Recent research demonstrates adverse events negatively impact profits by over $1,000 per incident on average, representing a potential $63 billion annual cost to the healthcare system. This provides strong evidence that improved safety measurably benefits both patients and financial outcomes.
This study examined how characteristics of medical group practices influence rates of inappropriate emergency department visits and avoidable hospital admissions among Medicare patients. The researchers found that practices owned by physicians and those using electronic health records had lower rates of non-emergent ED visits and emergent but primary care treatable visits. Larger practices and those with more non-physician providers per doctor had higher rates of avoidable hospital admissions. The findings suggest that care coordination declines as practices grow in size and complexity.
This chapter provides guidance on structuring and writing a policy analysis in 5 steps:
1) Identify the problem in 1-2 neutral sentences as a question that allows for multiple options.
2) Provide background facts to explain why the problem was chosen without recommendations.
3) Describe the overall context by identifying stakeholders and issues to consider like political, social, economic, and legal factors.
4) Analyze 3-5 options that are within the client's power and values, and evaluate each using identified criteria and pros and cons.
5) Recommend one option, discussing why it is better than others despite cons, and how to address remaining issues.
This study examined the effects of a pay-for-performance program implemented by a leading health insurer in Washington State between 2003 and 2007 that involved quality scorecards, public reporting, and financial incentives for medical groups. The researchers found that neither the scorecard nor the incentive program had a significant positive effect on clinical quality. Specifically, the addition of incentives to the scorecard was associated with a reduction in quality, contrary to the program's goals. The researchers believe the modest incentive amounts, use of rewards only with no penalties, and targeting of groups instead of individuals helped weaken the program's effects. The study contributes to understanding the challenges of achieving successful pay-for-performance.
This document discusses the importance of outcomes assessment in healthcare. It defines outcomes assessment as the collection and use of information about a patient's health and the effects of treatment over time. Providers are accountable to document treatment plans, patient progress, and outcomes using valid and reliable tools. Common tools discussed are questionnaires that measure general health, pain, function, and disability for conditions like back pain and neck pain. Regular use of standardized tools is important for assessing baseline status and tracking the effects of treatment.
This document summarizes a presentation on using multicriteria decision analysis (MCDA) to address ethical dilemmas in healthcare decision making. It discusses how MCDA could support a natural decision process that integrates evidence and values. Specifically, it proposes that MCDA could provide a framework to structure criteria based on the common goal of health and its underlying ethical aspects, allow for interpretation of distinct concepts like effectiveness and costs, and support qualitative reasoning and judgment in decision making. The EVIDEM collaboration aims to develop an open source MCDA framework based on these principles to help make fair and legitimate healthcare decisions.
Sabriya Rice: "Does ‘Pay for Performance’ Work?" 6.28.16reportingonhealth
Sabriya Rice's slides from the Center for Health Journalism webinar "Does ‘Pay for Performance’ Work?" 6.28.16
http://www.centerforhealthjournalism.org/content/does-pay-performance-work
Predicting Patient Adherence: Why and HowCognizant
To contain costs and improve healthcare outcomes, players across the value chain must apply advanced analytics to measure and understand patients’ failure to follow treatment therapies, and to then determine effective remedial action. This white paper lays out a framework for enabling patient adherence management and some general prescriptions on how to convert lofty concepts to meaningful action.
PSCI Case Study - Population Predictive Risk Analytics from PSCIpscisolutions
The Leading Physician Network worked with PSCI to develop a population risk stratification tool using their EMR data to identify high-risk patients for chronic conditions and reduce costs. The tool calculates individual "state of health" risk scores to target care management programs at those most likely to be hospitalized. This approach helped reduce hospitalizations and ER visits while improving case manager productivity.
Quality Measurement and Improvement_lecture 1_slidesZakCooper1
Health care quality aims to maximize patient outcomes through evidence-based care. There are three types of quality measures: structural, process, and outcome measures. Research shows significant gaps between actual US healthcare delivery and best practices, with only around half of patients receiving recommended care.
Why improving the patient experience with advanced care options mattersdrucsamal
This document summarizes a presentation about improving patient experience with advanced cardiac care options and how patient satisfaction scores relate to quality of care. It discusses how patient satisfaction is assessed using surveys like HCAHPS and tied to hospitals' Medicare reimbursement. While patient satisfaction often correlates with better communication, it is a complex issue and may not fully capture the quality of medical care. When discussing advanced care options, truly informed consent requires addressing patients' values, prognosis, fears and ensuring they understand their medical condition and choices.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
This document outlines concepts related to health care quality assessment. It describes key definitions, such as quality referring to services that increase health outcomes and are consistent with current knowledge. It also discusses perspectives on quality from practitioners, patients, and communities. Additionally, the document outlines different levels of quality analysis from national policies to individual care provision and lists examples of common quality indicators assessed in the US, such as patient satisfaction, mortality rates, and adherence to treatment protocols.
Generating Quality Data through Collaborative Research with an ACOTodd Berner MD
This document summarizes a presentation about generating quality data through collaborative research with an ACO. The number of public and private ACOs is growing rapidly, with over 250 CMS MSSP ACOs covering 4 million Medicare beneficiaries. The goal of the collaborative research is to disseminate valued information on effectiveness and costs of care to payers and policymakers. Real-world evidence studies can provide insights beyond randomized controlled trials by observing patient outcomes across delivery system models. Measuring quality requires considering multiple stakeholder perspectives to identify metrics that drive improvement and have utility.
Health Equity Investments: Opportunities and Challenges in 2023Health Catalyst
Trudy Sullivan and Dr. Melissa Welch will discuss how to establish mechanisms using data you already have for ongoing health equity evaluation and how to drive data-informed decisions. Trudy Sullivan and Dr. Melissa Welch will discuss how to establish mechanisms using data you already have for ongoing health equity evaluation and how to drive data-informed decisions.
David Blumenthal, MD, MPP, President of The Commonwealth Fund, presents on evaluating innovative programs at the CMS Quality Conference on Nov. 30, 2015.
Finding the Right Care for the Right Price, Cost and Quality (Geof Baker)Geof Baker
This document discusses the state of public reporting on healthcare costs and quality, lessons learned from transparency efforts, and viewpoints from various stakeholders. Key points include:
- Public reporting can help improve healthcare quality and reduce costs by promoting provider efficiency and informed consumer decisions.
- Major challenges include small sample sizes, risk adjustment difficulties, inconsistent ratings, and lack of provider engagement.
- Next generation transparency tools should provide integrated, user-friendly searches; comparative cost/quality data; and actionable information to guide treatment decisions.
- Stakeholders like employers, consumers, and physicians express needs around accessible cost/quality data and opportunities for improvement.
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
How to Define Effective and Efficient Real World TrialsTodd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges around representativeness in trial populations, and the value of pragmatic clinical trials. It also discusses leveraging electronic health records for condition-specific prompts and clinical decision support to improve performance and quality of care.
How to design effective and efficient real world trials TB Evidence 2014 10.2...Todd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges in defining quality metrics, and strategies for improving performance within healthcare systems. The document provides information on pragmatic clinical trials and how real-world evidence could reduce costs compared to traditional clinical trials.
A joint presentation on Real People, Real Data at the 2016 International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden. Presented by Leanne Wells of the Consumers Health Forum of Australia; Sam Vaillancourt of St. Michael’s Hospital, Toronto, Canada, and; Dr Paresh Dawda of the Australian National University.
Policy and Funding for CER: Making Sense of a Confusing Landscape CTSI at UCSF
UCSF researcher, Michael Steinman, MD, Director of CTSI's Comparative Effectiveness Research initiative presents. View more related presentations and resources at http://accelerate.ucsf.edu/research/cer
Engaging your patients & community in healthcare reform effortsRenown Health
1⁄2 FTE
Programs: Monthly lunch meetings with speakers; social events; newsletter;
volunteer opportunities; recognition events.
Benefits: Sense of community, camaraderie, purpose, connection to BH.
Major benefit to Development, Volunteers, Community Relations
22
Mini-Medical School
Began: 2001
Goal: Educate the community about health and wellness in an engaging, fun way.
Format: 6 weekly 2-hour sessions with MDs, RNs, other clinicians.
Topics: Heart disease, cancer, diabetes, women’s health, men’s health, nutrition.
Participants: 150-200 community members per session.
Cost: $
ACT500 Research Evaluation TablesArticle 1 Measuring Perfo.docxbobbywlane695641
ACT500: Research Evaluation Tables
Article 1: Measuring Performance
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Balanced Scorecard
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the research methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position with credible resources and examples.
Discuss how your organization might or might not use the findings from these studies. Substantiate your opinion with concrete examples.
Article 2: Incremental Analysis
Insert reference in APA formatting, 6th ed. 4th printing
Research Topic
The topic is a broad subject. The topic is not the problem to be solved; that comes later. Example: Cost Behavior
Problem or Opportunity
The problem is established with factual data and is found in the introductory portion of the research article or report.
Purpose for the Research
The purpose of the study defines what the researcher wants to find out and is found in the introductory section of the research article. Sometimes the purpose contains a research question/s.
Research Methods
A researcher makes a decision about the broad nature of a research approach: typically quantitative/confirmatory or qualitative/exploratory. Research design strategies are driven by the chosen research approach and the research purpose. Research design strategies include: types of data collected, how the data is collected, and what preparation of data is used, analytical techniques, and presentation of information.
Audience
The groups, associates, profession, and/or individuals that the researcher suggests might benefit from the findings of this study
Research Evaluation
Assess the study’s Research Methods and Analytic Techniques. Are the methods and analytic techniques applicable to solving practical management questions? Why or why not? You must substantiate your position wit.
Performance Evaluations Related to Patient Outcomes: ConKristin Botzer
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Performance information, transparency and accountability in the health sector
1. Performance Information, Transparency, and
Accountability in the Health Sector:
Experience in the United States (and a bit beyond)
Joseph White, Ph.D.
Case Western Reserve University
Prepared for 5th DELSA GOV meeting on Sustainability of
Health Systems
5 February 2016
OECD Conference Center
1
2. “Paying for Performance” (P4P) in Health Sector and
“Performance Budgeting”
• Common Aspirations –
• Efficiency or Value for Money, Making Economy More Acceptable
• Common Problems –
• Difficulties in Measuring Performance, and Agreeing on Measures
• Both technique and source must be credible.
• Strategic Responses (e.g. “Gaming,” “Teaching to the Test”)
• Using the Results
• One Possible Advantage in Health if Not Budgeting
• Do Not Have to Compare the Incomparable - Mostly
• Huge Problems if “Performance Budgeting for Health”
• Voters Want Rescue and Care, Analysts Look at Health Statistics
• In U.S. (and other countries) Institutional Separation of Programs 2
3. Logical Questions (or choices)
• Information About What?
• Activity vs. Outcomes or “Value”
• Provided to Whom?
• Citizens? Consumers? Patients?
• Payers? Governments? Managers?
• So “Transparent” to Whom? And Why?
• “Legitimacy” or Control?
• Accountability for What?
• Quality? Spending? Compliance?
• Applied to What Parts of the System?
• Hospitals, physicians, medical groups, “health plans”
3
4. Measuring Activity – Usually to Increase Activity
• To Reduce Waiting Times
• NHS “Targets and Terror”
• To Induce Greater Productivity Through Payment
• DRGs outside the United States: “Activity-Based Payment”
• To Improve Management
• “Knowing what you are buying.” DRGs again
• To Encourage Specific Services – Often “Prevention”
• “Pay for Performance” for NHS GPs, U.S. Primary Care Groups
• To Punish Specific Activities
• Readmission rates in United States
4
5. Measuring Quality, Outcomes or “Value”
• Results of Treatment
• New York Cardiac Surgery Reporting System
• Medicare ACOs patient-reported experience of care and health status
• Overall Rankings or Ratings by “Experts”
• Intended to stand in for quality, but usually not based on strong measures.
Many versions in U.S.; NHS Star Ratings
• Various Theories of How These Would Work
• Change: Providers act to improve when see comparisons, even if not public
• Selection: Providers respond to threat of patients selecting other providers
• Reputation: “Naming and Shaming.” e.g. media coverage
• Individual self-interest, e.g. managers could be fired, provider income
affected, budgets could be raised or cut, autonomy “earned.”
• Voltaire on British Navy: “Ici on tue de temps en temps un amiral pour encourager les
autres”
5
7. “Core Assumptions” in Using Measurement to Inform
“One is that measurement problems are unimportant, that the part on which
performance is measured can adequately represent performance of the
whole, and that distribution of performance does not matter. The other is
that this method of governance is not vulnerable to gaming by agents.”
Danger of “hitting the target and missing the point” (Bevan and Hood, 2006)
7
8. Common Measurement Problems
• Statistical Validity
• Too few cases per provider for specific measures. Bigger problem in U.S.
where providers face multiple payers. U.S. IHA vs. English QOF
• If providers collect the data, may be gamed; if outsiders do, may not be
trusted by providers (and in U.S., often rightly so – IHA).
• Only Measure What Can Observe (see previous slide)
• Black Boxes – What is Being Measured isn’t Transparent
• Aggregate ratings of the “same thing” may be very different
• Documentation May Not Equal Performance
• Either because measures provoke documenting activity that already
occurred, or documentation isn’t accurate (gaming)
• Risk Adjustment is Very Difficult and Contentious
• Measuring “Improvement” Requires Accurate Baselines
8
9. Common Implementation Issues
• Cost in Time and Money
• Cost in Diverted Attention from Other Activities
• Cost in Inverted Incentives if Linked to Sanctions or Rewards
• Ariely et al on theory of motivation. Bevan and Hood on behavior changing
as people are punished for not achieving something they could not achieve.
• But: providers happier to act to “improve quality” if sweetened with $ € £
• Public Rarely Uses “Value” Information
• Does not have same doubts about quality as the experts do.
• Not likely to notice information; if do will ignore highly detailed
presentations; if presentation is simple, may be misleading.
• Governments and other payers may not want bad news on quality
• Payers tend to care much more about cost, do not want evidence they
should spend more.
9
10. “Accountability” Based on Measures Requires
Conditions That May be Hard to Meet
• The Message is Clear and Targeted Properly
• Measures are Perceived as Accurate
• Measures are Perceived as Fair and Legitimate
• (or incentives really strong anyway, but then cheating becomes more likely)
• This result may be related as much to organizational context as to the
measures themselves. U.S. physicians in IPAs were in very different situations
than English GP practices
• Targets of Incentive Are Able to Respond Effectively
• The desired result is potentially subject to significant influence by the
recipient of the incentive (technical capacity)
• Organizational setting provides institutional capacity to respond
• Targets Don’t Have Political Capacity to Change the Rules
10
11. “Accountability” and “Pay for Performance”
• English QOF certainly led to higher recorded “performance,” but at
very high monetary cost.
• English “Targets and Terror” likely did improve target performance
beyond gaming effects. But at some costs on unmeasured
performance dimensions
• U.S. “P4P” experience shows generally modest or null effects.
• “largely disappointing results” (Markowitz and Ryan 2016)
• For physicians, “among the strongest studies, there were no or relatively
small improvements in performance.” In the hospital setting, “all of the
studies… found modest but often statistically insignificant effects” (Damberg et
al. 2014)
• Some acceleration of improvement in early years of Premier demonstration.
• Performance on some Hospital Inpatient Quality Reporting Program
measures is now so high they are being eliminated. But they are very basic
measures.
• Risk adjustment concerns, especially for hospitals with low SES patients
11
12. Some Other Tentative or Ironic Results
• When processes are measured, improved performance is rarely
associated with better final outcomes
• Long or weak causal chains between measured feature and outcome
• Bad (or good) outcomes may be rare. Or outcomes may emerge only after many years
• Comparisons over time are difficult because governments and
other payers keep changing the measures
• U.S. Policy-Makers Want to Use “Transparency” to Reduce
Prices.
• The new-new thing. Not so necessary anywhere else. A whole other topic…
• “Transparency” is sometimes associated with avoiding sicker
patients
• Percutaneous revascularization is less common, and that is associated with
higher mortality, in states that report “quality” of AMI care at the physician
level and those that do not.
12
13. Final Thoughts (for the moment)
• Some use of measures for management “is a form of indirect control
necessary for the governance of any complex system” (Bevan and Hood 2006)
• Measurement results from lack of trust in providers, is likely to
decrease trust, but will work best in the presence of trust.
• If measures are inaccurate they cannot increase “transparency”
• Hardly anybody likes the current U.S. measurement regime:
• “The quality measurement enterprise in U.S. health care is troubled. Physicians, hospitals,
and health plans view measurement as burdensome, expensive, inaccurate, and indifferent
to the complexity of care delivery. Patients and their caregivers believe that performance
reporting misses what matters most to them and fails to deliver the information they need
to make good decisions. In an attempt to overcome these troubles, measure developers are
creating ever more measures, and payers are requiring their use in more settings and tying
larger financial rewards or penalties to performance. We believe that doing more of the
same is misguided: the time has come to reimagine quality measurement.” – (McGlynn et al,
NEJM, 2014.)
• But reform ideas require even more organizational capacity…
13
14. Improvement Through Performance Management
Would Be a Beautiful Thing
• “Unicorn in Captivity,” Property of The Cloisters, Metropolitan Museum of Art. One of the great treasures of New York City
15. Some Sources Reviewed for This Presentation (1)
• Austin, J. M., A. K. Jha, P. S. Romano, S. J. Singer, T. J. Vogue, R. M. Wachter, P. Pronovost. 2015. National Hospital Rating Systems Share Few Common Scores and
May Generate Confusion Instead of Clarity. Health Affairs 34(3): 423-430.
• Bevan, G. and C. Hood. 2006. What’s Measured is What Matters: Targets and Gaming in the English Public Health Care System. Public Administration 84(3): 517-
538.
• Bevan, G. and R. Hamblin. 2009. Hitting and missing targets for ambulance services for emergency calls: effects of different systems of performance measurement
within the UK. Journal of the Royal Statistical Society 172(1): 161-190
• Hood, C. and R. Dixon. 2015. A Government that Worked Better and Cost Less? Evaluating Three Decades of Reform and Change in UK Central Government.
Oxford, UK: Oxford University Press.
• Markowitz, A. A. and A. M. Ryan. 2016. Pay-for-Performance: Disappointing Results or Masked Heterogeneity? Medical Care Research and Review 71 (online first)
1-76.
• Damberg, C. L., M. E. Sorbero, S. L. Lovejoy, G. Martsolf, L. Raaen, D. Mandel. 2014. Measuring Success in Health Care Value-Based Purchasing Programs. RAND
Corporation Research Report sponsored by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services
• Friedberg, M. W. and C. L. Damberg. 2012. A Five-Point Checklist To Help Performance Reports Incentivize Improvement and Effectively Guide Patients. Health
Affairs 31(3): 612-618.
• Hibbard, J. H. 2008. Editorial: What Can We Say About the Impact of Public Reporting? Inconsistent Execution Yields Variable Results. Annals of Internal Medicine
148(2): 160-161.
• Hibbard, J.H., J. Greene, S. Sofaer, K. Firminger, J. Hirsh. 2012. An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers
Choose High-Value Health Care. Health Affairs 31(3): 560-67.
• Kahn, C. N., T. Ault, L. Potetz, T. Walke, J. H. Chambers, S. Burch. 2015. Assessing Medicare’s Hospital Pay-For-Performance Programs And Whether They Are
Achieving Their Goals. Health Affairs 34(8): 1281-1288.
• Laverty, A. A., P. C. Smith, U. J. Pape, A. Mears, R. M. Wachter, C. Millett. 2012. High-Profile Investigations Into Hospital Safety Problems in England Did Not Prompt
Patients To Switch Providers. Health Affairs 31(3): 593-601.
• Lawson, E. H., D. S. Zingmond, B. L. Hall, R. Louie, R. H. Brook, C. Y. Ko. 2015. Comparison Between Clinical Registry and Medicare Claims Data on the Classification
of Hospital Quality of Surgical Care. Annals of Surgery 261(2): 290 – 296
• McDonald, R., J. White, T. R. Marmor. 2009. Paying for Performance in Primary Medical Care: Learning about and Learning from “Success” and “Failure” in England
and California. Journal of Health Politics, Policy and Law 34(5): 747-776.
• McGlynn, E. A., E. C. Schneider and E. A. Kerr. 2014. Reimagining Quality Measurement. New England Journal of Medicine 371(23): 2150-2153
15
16. Some Sources Reviewed for This Presentation (2)
• Parast, L., B. Doyle, C. L. Damberg, K. Shetty, D. A. Ganz, N. S. Wenger, P. G. Shekelle. 2015. Perspective: Challenges in Assessing the Process-Outcome Link in
Practice. Journal of General Internal Medicine 30(3): 359-64.
• Rosenbaum, L. 2015. Scoring No Goal: Further Adventures in Transparency. New England Journal of Medicine 373(15): 1385-1388.
• Ryan, A. M., B. K. Nallamothu, J. B. Dimick. 2012. Medicare’s Public Reporting Initiative on Hospital Quality Had Modest Or No Impact on Mortality From Three Key
Conditions. Health Affairs 31(3): 585-592.
• Smith, M.A., A. Wright, C. Queram, G. C. Lamb. 2012. Public Reporting Helped Drive Quality Improvement In Outpatient Diabetes Care Among Wisconsin Physician
Groups. Health Affairs 31(3): 570-577.
• Tanenbaum, S. J. 2009. Pay for Performance in Medicare: Evidentiary Irony and the Politics of Value. Journal of Health Politics, Policy and Law 34(5): 717-746.
• Waldo, S. W., J. M. McCabe, C. O’Brien, K. Kennedy, K. E. Joynt, R. W. Yeh. 2015. Association Between Public Reporting of Outcomes With Procedural Management
and Mortality for Patients With Acute Myocardial Infarction. Journal of the American College of Cardiology 65(11): 1119-1126.
• Werner, R. M., J. T. Kolstad, E. A. Stuart, D. Polsky. 2011. The Effect Of Pay-For-Performance In Hospitals: Lessons For Quality Improvement. Health Affairs 30(4):
690-698.
• Woolhandler, S., D. Ariely, D. Himmelstein. 2012. Will Pay for Performance Backfire? Insights From Behavioral Economics. Health Affairs blog,
http://healthaffairs.org/blog/2012/10/11/will-pay-for-performance-backfire-insights-from-behavioral-economics/
16