assisting providers to succeed under new …...2012/09/21  · • assisting providers to succeed...

Rhode Island Quality Institute

Assisting Providers to Succeed

Under New Payment and Delivery Models

Laura Adams Darby Buroker President and CEO, RIQI Director, Beacon Prg Mgt, RIQI

Rhode Island Business Group on Health Annual Health Care Summit - 2012

September 21, 2012

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Rhode Island Quality Institute

• Public-private partnership founded in 2001 by then RI Attorney General – now Senator – Sheldon Whitehouse

• Statewide, multi-stakeholder collaborative with the mission of improving healthcare quality, safety and value

• Board comprised of top leaders: hospitals, physicians, health insurers, consumers, business, professional associations, and state government

• Broad community participation through committees

• Collaborative reach is wide ranging:

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Insurers

Academia

Accounting

Regulatory

Local Government

Hospitals

Pharmacies

Community Health Centers

Medicare QIO

Behavioral Health

Congressional Delegation

Chambers of Commerce

Laboratories

Advocacy Groups

Boards and Associations

Businesses

Physician and Phy Groups

The Opportunity Afforded by

Integration of RIQI’s Three Major HIT Grants

Exchange of health

Information

Providing pathways

to Meaningful Use

Longitudinal record

of the patient’s data

across the community

Electronic infrastructure

to move clinical metrics

community-wide

Community-wide

analytics, research

and QI capability

Adoption and

Meaningful Use

of EHRs

Distribution channel

into RI’s provider

community

Alignment of Beacon, REC, and CurrentCare

RI Beacon Program

CurrentCare Heath Information Exchange (HIE)

• Leveraged by Beacon for care coordination interventions and projects to provide and deliver clinical data

• High levels of patient participation provides the widest possible reach

RI Regional Ext Center (REC)

• State-wide communication vehicle to promulgate information and best practices

• Supports RI’s HIT infrastructure by helping practices adopt, implement, and optimize EHRs

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Connecting “Physical” and Behavioral Health

• RIQI was one of 5 entities awarded a $600K health IT grant to integrate physical and behavioral health information (including substance abuse)

• We now have Community Mental Health Centers using the CurrentCare viewer

• Soon, Behavioral Health information from Gateway and the Providence Center will flow into CurrentCare and be integrated with the data from primary care practices, labs, hospitals and pharmacies

• RI’s consent model is paying off in a big way

Need for Primary Care Performance Improvement Analytics

• Redesigning primary care to achieve triple aim of improving healthcare at the individual level, reducing per-capita costs, and improving overall population health

• Actionable monitoring, use, and exchange of health data and metrics – Clinical

– Claims-based

– Administrative

– Patient-reported

• Developing high performing extended care networks based on value rather than volume

• Assisting providers to succeed under new payment models

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Healthcare Analytics Maturity Model

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Descriptive Correlative Predictive

• Static graphs

• Trends

• Rate of improvement

• Distribution

• Drill to detail

• Correlation

• Alerts

• Statistical analyses

• Forecasting

• Predictive modeling

Harmonizing Measures Across the Community

Goal: Common measures, consistent definitions, conformance with Meaningful Use, balance with technical feasibility

Approach: • Full measures crosswalk across all parties

• Process managed by Data & Evaluation Committee and Harmonization Workgroup convened by Steering Committee

• Hands-on input provided by Practice Reporting Workgroup – technical and analytical viewpoints at data query and EHR technology levels

• Consensus among all parties (including payers and DOH)

• Measures, definitions and technical specifications published on Collaborative Portal, proximate to measure results

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RIQI Infrastructure and Capabilities

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RIQI PCMH Performance Improvement Comparative Analytics Services

Clinical quality data Aggregate claims data Practice characteristics (e.g. NCQA recognition or payer mix)

Population characteristics (e.g. regional demographics)

Patient satisfaction survey results Quality of EHR data

• At All Levels: o Distribution o Trend o Correlation o Exploratory

• Statistical capabilities

• Exportable

• Multi-level database o Practice aggregate o PCMH program o Practice/site level o Physician level

• Restricted access to data and findings

• Blinding/un-blinding

Data Collection

Data Warehouse Analytics

Reports • Reporting • Dashboards • Population • Practice • Physician

Reporting

Additional Capabilities • Measure harmonization • Provider attribution • Trusted intermediary, appropriate

use

Collaborative Portal • Findings • Comments and discussion

Community Collaborative Portal

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14

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Example Practice

Example Practice

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Example Practice

Example Practice

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Example Practice

Example Practice

Figure 1 Figure 2

Figure 3 Figure 4

Figure 5

Patient-reported Satisfaction

• Conducted in Spring 2012

• CAHPS PCMH

• NCQA certified vendor using NCQA and HEDIS

approved methodology

• Composite categories – Access

– Communication

– Shared decision-making

– Self-management support

Representative Category

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6 30 75 48 20 17 46 39 21 47 24 7 35 1 8 50 40 49 27 29 23 37 44 41 5 31 56 28 26 62 33 32 3 22 34 12 9 36 15

Comparative Patient Experience Scores - TopBox Access Scores

Access Score 75th Percentile Score 90th Percentile Score Median Score

Based on Pt. Survey Data Collected Spring 2012 Released 8/06/2012

Practice Site ID - Randomly Blinded

Based on Pt. Survey Data Collected Spring 2012 Released 8/06/2012

Practice Site ID - Randomly Blinded

Analytics and Reporting

Use of collaborative portal, comparative data and dashboard posters • Driving discussions in team meetings with providers and QI

directors

• Helping providers to realize not all performing as well as thought (compared to peers within and outside practices)

• Displays in patient waiting areas for transparency and promoting patient engagement in their own metrics and outcomes

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What’s Next?

Integrating additional data from multiple sources • Additional quality measures

• Practice characteristics and structure/process data

• Practice transformation data

Correlation and exploratory analyses • Identifying potential sources of variation

• Linking processes/structure to outcomes

Expanding the collaborative portal

More best-practice sharing and collaborative learning

Increased support for providers to succeed under new payment models

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Broad-Based Payer Funding Model

• $1 PMPM from:

• Fully insureds (via the OHIC Affordability Standards)

• Self-funded employers (including the State)

• RI Medicaid (enabling a 90/10 federal match)

• Contractually agree-upon set of deliverables

• Bi-monthly open meetings to enable the community to track

RIQI’s performance against goals and timelines

$4M

$2M

$915,500

$8M GoalFULLY INSURED

COMPANIES (THROUGH

BCBSRI, UHCNE, TUFTS)

MEDICAID

SELF-FUNDED

COMPANIES

GAP

RI Medicaid and Federal MedicaidMatch

Roughly 45% of the $2M goal set for our outreach efforts with self-funded companies has been met.

Approximately $1.09M still needed from self-fundedcompanies with employees in RI.

Broad-based Payer Funding Model

• Blue Cross & Blue Shield of RI

• Brown University

• Care New England

• Johnson & Wales University

• Lifespan Corporation

Self-Funded Companies Paying $1 PMPM

• Thielsch Engineering

• Tufts Health Plan

• South County Hospital

• State of Rhode Island

• UnitedHealthcare of New England

Questions and comments?

Assisting Providers to Succeed

Under New Payment and Delivery Models

Laura Adams Darby Buroker President and CEO, RIQI Director, Beacon Prg Mgt, RIQI