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Community Partnerships in Quality-Based Purchasing

Roy Plaeger-Brockway, MPASenior Program ManagerHealth Services Analysis

Washington State Labor & IndustriesOlympia, Washington

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Objectives

Describe two Washington State pilots Explain how pilots encourage community

based quality improvement Share results of pilots based on a University

of Washington evaluation Discuss lessons learned

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Background

L&I is a state workers’ compensation insurer Purchase $500 million of health care a year Quality of care is a top priority To improve care we engaged our customers

in designing two community-based quality improvement pilots

Centers of Occupational Health & Education 700 participating doctors 20,000 patients a year

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What was the problem?

Difficult for purchaser to influence quality Doctors with imperfect knowledge about work related

conditions No incentives for physicians to adopt occupational

health best practices

No infrastructure for community-wide disability prevention Delivery system not organized to prevent disability Lack of care coordination No education or feedback for doctors No information systems to track clinical data Not using data for health care quality improvement

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What was the solution?

Develop a community-based infrastructure Local centers and experts to provide education and support

to community physicians Health services coordinators

Align payment incentives to support quality Enhanced payment linked to quality indicators to encourage

use of occupational health best practices

Improved work force training Free CME and individualized physician training and support

More effective use of information technology Patient tracking tool with reminders and alerts

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Two providers chosen with RFP

Valley Medical CenterInland Northwest Health Services

St. Luke’s Rehab Institute

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Community-based modelsupports use of best practices

PilotCommunity

Health System

Community Physicians

State Insurer CustomerAdvisors

• Education & reminders

• Patient tracking tools

• Health services coordinators

• Payment linked to quality indicators

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Design of quality measures

Review evidence Develop seed measures (best practices) Share with practicing physicians Rank with physician leaders Establish payment levels and billing codes Develop quarterly reporting to track progress

on measures based on billing codes

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Best practices with incentives

Submit accident report within 2 days Document worker’s physical status and

limitations at each visit Contact the worker’s employer about return to

work options Assess barriers to return to work at 4 weeks

of lost time

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Example of a best practice

“Activity Prescription” Use at patient visit Script best practices Document employment issues

Work status Employer contact Light duty accommodation

Set patient expectations

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Renton

E WA

0%

10%

20%

30%

40%

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60%

70%

80%

90%

Increased adoption of best practice

Percent of Claims Where Doctors Used Best Practice (Physical Status Form)

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Evaluation of Western WA COHE

Disability outcomes Incidence was 17.8% vs. 23.7% for control Workers on time loss at 6 months was 15.1% vs. 18.9% Workers on time loss at 12 months was 7.4% vs. 9.4%

Costs Medical costs were $1,785 per claim vs. $2,167 Disability costs were $711 per claim vs. $1,209

Satisfaction Patient satisfaction was equal to control group Physicians reported greater willingness to work with injured

workers

Based on 10,000 claims

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Evaluation of Eastern WA COHE

Disability outcomes Incidence was 15.1% vs. 21.5% for control Workers on time loss at 6 months was 20.5% vs. 20.4% Workers on time loss at 12 months was 10.2% vs. 9.7%

Costs Medical costs were $1,643 per claim vs. $2,138 Disability costs were $610 per claim vs. $930

Satisfaction Patient satisfaction was equal to control group Physicians reported greater willingness to work with injured

workers

Based on 10,000 claims

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Overall results

University of Washington evaluation shows: Reduced incidence of disability Improved patient outcomes Lower medical and disability costs High patient satisfaction Improved physician satisfaction

Overall savings $441 per claim Western WA $359 per claim Eastern WA

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Lessons Learned

Community-based partnerships between purchaser and health care leaders help:

Create infrastructure needed to improve quality and outcomes

Foster physician support for solutions by involving local leaders in program design and development

Place responsibility for quality improvement within the local marketplace, which increases adoption

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Lessons Learned

Physicians are willing and able to adopt best practices and improve quality when they have:

Local institutional support from clinical leaders Incentives for use of best practices Health services coordinators Better information tools and education Reduced administrative burden Reminders and academic detailing

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2001 IOM Report: Crossing the Quality Chasm - Similarities

Institute of MedicineInstitute of Medicine Washington State PilotWashington State Pilot

Design more effective organizational support

Local centers and experts to provide education and support

Create infrastructure to support evidence-based practice

Free CME for doctors and assistance from health services coordinators

More effective use of information technology

Patient tracking tool with reminders and alerts

Alignment of payment incentives to support quality

Enhanced payment linked to quality indicators

Improved work force training Individualized physician training