Measuring and Reporting Performance Data Through Health IT

AHRQ Annual MeetingWednesday September 26, 2007

A. John Blair, III, MDPresident, Taconic IPA

Evolution Process incentives/Claims data Structure incentives

IT adoption and usage NCQA/POL

Outcomes incentives/Clinical data

Process Incentives/Claims Data

2000 2004 20082006 20102002

Report Developme

nt

Transparency

Multi-PayerP-4-P Project

Single Payer P-4-P Project

Physician Feedback and Communication Efforts

Physician Reports

Single Payer P-4-P

Transparency

Multi-Payer Reports

Multi-Payer Reports

Physician Feedback & Communication Medical Council

PCP Specialty Clinical leadership Strong quality focus

Initial report feedback Individual Group

Monthly Newsletter Physician comment period prior to incentive

payments

Structure Incentives

2000 2004 20082006 20102002

NCQA/PPC

eRx

Community Viewer

Clinical Messaging

Physician Feedback and Communication

EHR

THINC RHIO, Quality Committee

NCQA Physician Practice Connections Access / Communication Patient tracking / Registries Care management Self management support Electronic prescribing Test tracking Referral tracking Performance reporting & improvement Interoperability

THINC RHIO, Quality Committee Activities

Determine performance measures Promote standards

• HIE• Measure metrics

Coordinate payment incentives Committee composition

Physicians Hospitals Health plans Quality measures experts

Claims vs. Clinical Reporting Uninsured not captured Services delivered, not health outcomes Non-reimbursable services not captured Inaccuracy due to income maximization Difficult to risk adjust (severity, stage) Lack of continuity with one health plan Fragmented health care market (and claims) Provider resistance

Advantages of EHR-Based Measurement Better data than claims-based

More detailed clinical data (e.g. BP) More scalable than chart-reviews

Faster, cheaper Greater sample size allows better provider

comparisons Greater precision for encounter-level analyses

Paradigm shift CDSS Registry Measure

Challenges of EHR-Based Measurement

Structured data elements may not exist in EHR

Data elements not standardized (e.g. lab codes)

Outside data not available (e.g. hospitalizations)

Decision Support Tools Focus on THINC RHIO measures Passive & active alerts and reminders

Wary of “alert fatigue” Minimal set Actionable Consonant with workflows, not disruptive

Not just alerts Order sets Templates Clinical knowledge Data presentation Process reengineering

“Not Just Alerts”

Practice workflow reorganization Structured data collection Registries and panel management Alternative visit types Team-based care Case management Patient education and self-

management

Questions?

A. John Blair, III, MDPresident, Taconic IPA

Thanks for your time!