ahrq and the science of public reporting presentation to national advisory council irene fraser and...
TRANSCRIPT
AHRQ and the Science of Public Reporting
Presentation to National Advisory Council
Irene Fraser and Carol SniegoskiJuly 22, 2011
Public ReportingOne Potential Strategy to Improve
Quality
Two Theories of Impact– Consumer pathway
Consumers use info. to choose providers Market shares shift, providers respond
– Provider pathway Providers value their reputations and/or
market shares so strive to improve scores– More evidence on second pathway – But science is nascent
Transparency also an end in itselfGrowing comparative reporting by CMS, states,
communities, othersRole grows under the ACA
Goals for Discussion
Summarize AHRQ role in public reporting
Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?
Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?
AHRQ Has a Significant Role in Public Reporting
1. Does NOT do provider-level reporting, but2. Develops measures
– CAHPS– Quality Indicators– Readmissions measures– CHIPRA and Adult Medicaid Measures
3. Reports national and state data– National Healthcare Quality and Disparities
Reports– State Snapshots
4. Provides tools for CMS, states, others to use
CMS, States, Others Use AHRQ Measures for Public Reporting
CMS – Uses H-CAHPS, Quality Indicators for Hospital Compare and Value-Based Purchasing
States – also use H-CAHPS and Quality Indicators for Public Reporting
25 states use Quality Indicators for public reporting
AHRQ Has a Significant Role in Public Reporting (cont’d)
5. Provides clearinghouse, inventories– National Quality Measures Clearinghouse
6. Improves data for public reporting7. Conducts (some) research on public reporting8. Provides TA, learning networks for users of
public reports– Example: 24 Chartered Value Exchanges
Multi-stakeholder Represent over 124 million lives Major activity is public reporting AHRQ leads learning network
Learning Network Example: 24 Chartered Value Exchanges
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AHRQ Role in Measures Reporting: An Example from HCUP and the
Quality Indicators
Statewide Orgs
(government or private)•Set rules on data collection and use•Collect all-payer data from hospitals•Process data•Create claims databases•Manage use of data
AHRQ•Standardizes data across states•Develops national and regional statistics,
benchmarks•Funds data improvements•Develops, validates, maintains, improves measures•Seeks NQF endorsement •Creates software tools•Creates downloadable website-builder
States, Communities, CMS, others•Decide whether to do public reporting•Establish structure and governance structure•Select measures to report•Display data
Goals for Discussion
Summarize AHRQ role in public reporting
Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?
Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?
MONAHRQ overview
Tour of MONAHRQ
MONAHRQ introduction
MONAHRQ goals and future directions
Report from MONAHRQ users: Keely Cofrin Allen, Utah Department of Health
MONAHRQ motivation
But … building a reporting site is tough
Why does every organization have to reinvent the wheel?
Growing need to publicly report healthcare quality and costs at the local level
Building an effective reporting site is even tougher
Introducing MONAHRQ
Software that quickly generates your own local public reporting website
• Fast• Easy• Automatic• Free• Use your local data or use publicly available measures• Designed by AHRQ to follow best practices in reporting
– Selected as finalist in the Fall 2010/Winter 2011
HHSinnovates competition –
MONAHRQ origins
AHRQ Quality Indicators
MONAHRQHospital Costs and Utilization Project
MONAHRQ builds on other AHRQ programs
• AHRQ QI software tools• MONAHRQ
benchmarks
• Online data query (HCUPnet)
(HCUP)
• AHRQ QI R&D
(QIs)
Community health collaboratives
• Potential adopters• Reporting experience
• AHRQ QI users(CVEs)
Download MONAHRQ from monahrq.ahrq.gov
MONAHRQ makes reporting easier
MONAHRQ
Load your local hospital
discharge data
Load CMS Hospital Compare
measures*
MONAHRQ makes reporting easier
* Publicly available from Hospital Compare
MONAHRQ
Download MONAHRQ from monahrq.ahrq.gov
MONAHRQ
Output a healthcare reporting website
You host: internal, password-protected, or public
MONAHRQ makes reporting easier
Download MONAHRQ from monahrq.ahrq.govLoad your local
hospital discharge data
MONAHRQ runs on your desktop
Load CMS Hospital Compare
measures*
* Publicly available from Hospital Compare
The MONAHRQ reporting website
■ Hospital Quality Ratings■ Maps of Avoidable Hospital
Stays
■ Hospital Utilization■ County Rates of Hospital
Use
MONAHRQ adoption
• First released June 2010• 4 live statewide reporting
sites, plus 2 expected soon
MONAHRQ tour:Hospital Quality Ratings
• AHRQ Quality Indicators• CMS Hospital Compare
measures• HCAHPS measures
Hospital Quality Ratings:Search page
Choose hospitals and a health topic
[Search page]
Hospital Quality Ratings:Search page
Hospital Quality Ratings:Classification table
* Available from HealthData.gov
Compare hospital quality ratings
Hospital Quality Ratings:Bar charts
Drill down to bar charts with benchmarks
– Synthetic data –
Hospital Quality Ratings:Detailed statistics tables
Drill down to underlying measure statistics
– Synthetic data –
MONAHRQ tour:Maps of Avoidable Hospital Stays
AHRQ area-level Quality Indicators
Reflect quality of community care, not hospital care
[Search page]
Choose a measure
Maps of Avoidable Stays: Search page
Maps of Avoidable Stays: County maps
Compare rates of potentially avoidable
hospital stays by county
– Synthetic data –
Maps of Avoidable Stays: Potential cost savings
– Synthetic data –
Drill down to estimated cost savings from reducing
avoidable stays
Visit our new live MONAHRQ demo site
monahrq.ahrq.gov/demo/index.html
– Synthetic data –
Report from MONAHRQ users
Keely Cofrin AllenUtah Department of Health
MONAHRQ goals
Encourage local reporting
Encourage use of endorsed measures (without enforcing it)
Disseminate best practices in reporting
Help to harmonize local reporting
Provide options to help tailor local reports to local needs
Future plans
Add new content– Additional Compare measures– Custom measures– Plans, ACOs, or exchanges– Cost and quality– Summaries or composites– EHR meaningful use– All-payer claims data
Add new features– Time trends– Custom benchmarks– Summary pages– Targeted reports (e.g.,
pediatrics)– More customization options
Add best practices– New initiative on Building the
Science of Public Reporting
Collaborate, assist and assess
– Stakeholder feedback– Technical support– User groups
Email us:[email protected] [email protected]
For assistance or to join the MONAHRQ mailing list:
monahrq.ahrq.gov
email [email protected]
Contact us
For more information or to visit our live demo site:
Input Your Data. Output Your Website.
Discussion
Questions about MONAHRQ?
Suggestions for future directions?
How to guide MONAHRQ planning or facilitate MONAHRQ adoption?
Input Your Data. Output Your Website.
Goals for Discussion
Summarize AHRQ role in public reporting
Present one new tool: MONAHRQ– Your ideas on priorities for enhancement?
Discuss new multi-year initiative on the Science of Public Reporting– Your ideas on strategies, themes, issues?
The Science of Public Reporting Initiative
Goals: Forge a coordinated, evidence-based
strategy for public reporting at the national and local levels
Improve science of public reporting Incorporate this science in national and
local reports Improve data for public reporting Assess impact
First Step: AHRQ Summit on Public Reporting for Consumers
March 23, 2011
130 participants:– NAC members – Public and
private funders of research
– Federal or state policymakers
– Consumer organizations
– Providers – Purchasers and
plans– Report hosts
Key questions: How do we advance public
reporting of provider performance for consumers?
Where do we want to be tomorrow?
Where do we want to be in 2025?
What are the challenges and how do we address them?
Survey to Inform Summit: Do you think the best current public reports of provider performance information to consumers:
Meredith Rosenthal, presentation at AHRQ Summit on Public Reporting for Consumers, March 23, 2011, work funded by AHRQ and Commonwealth Fund.
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Science of Public Reporting Initiative: The Structure
A partnership among AHRQ, ASPE, CMS Funded through ACA Section 3014 for 2011-2014 Combination of grants, contracts, FTEs to:
– Build the science– Create a user’s group– Facilitate use of new evidence
Related Activities: – Coordination Group from ASPE, AHRQ, CMS to
Create a national reporting strategy Coordinate on quality measurement and assessment
– DHHS Quality Measures inventory– Inventory of potential data sources for public reporting – Analyses to track changes in provider performance on
reported measures
#1 Build the Science: Pilots and Evaluations to Fill Evidence Gaps
What kinds of data do consumers/patients want, and how do we get it?
What display format is most effective?
How can we maximize consumer engagement (what timing, what type of medium, etc.)
How does the impact of a public report vary depending on other incentives and market forces such as payment strategy, market competitiveness, and payment?
#2 Form User’s Group: CMS, States, Consumers, CVEs, other Community
Initiatives
Aligning Forces for Quality
Other NRHI Members
Chartered ValueExchange
Beacon Communities Other Collaboratives
#3 Facilitate Use of New Evidence
Enhance National Quality Measures Clearinghouse Establish a coordinating center to
– Distill and synthesize existing evidence on “what works” in public reporting and under what circumstances.
– Identify promising advances in website design and medium of public reporting.
– Identify promising advances in the content of websites and other public reporting.
– Facilitate collaboration across grant sites and dissemination of early findings.
Enhance MONAHRQ– Report new measure set– Add or refine reporting features– Enhance use and usability
Questions and Discussion:Science of Public Reporting Initiative
Building the Science: – What are highest priority key questions,
issues? How to balance need for comprehensiveness and speed?
User’s Group:– What are most important stakeholders?
How to keep the group representative yet manageable in size?
Facilitate Use:– How to balance tension between need for
consistent national measures and need/desire for local innovation?