Improving Quality Through Systems Change

1. Improving Quality Through Systems Change National Health Policy Conference, Washington, DC Stephanie Alexander, Sr. VP, Premier Healthcare Informatics February 12, 2007

2. CMS/Premier Demo Pay for Performance In 2003,CMS partnered with Premier for the first national pay-for-performance demonstration for hospitals. Over 260 Premier hospitals volunteered. Hypothesis Financial Incentives improve hospital quality performance Findings • Focus on Quality - The P4P Program financial incentives did focus hospital executive attentionon measuring quality and refining care processes according to the study infrastructure. • Premier is the Change Agent - The Premier Infrastructure and measurements were actually the change agents in focusing quality improvement efforts. The more hospitals were monitored, the better performance improved over time.

3. HQID Year 2 – Final ResultsReleased January 26, 2007 • Quality improvement across all hospitals and clinical areas • HQID raised overall quality by 11.8% in 2 years • Quality incentive payments of $8.7 Million paid to 115 hospitals • AMI improvements saved 1,284 AMI patients • Patients received ~150,000 add’l treatments • Premier P4P hospitals quality scores are higher than national average – 85% compared to 79%

4. Dramatic Improvement Continues Composite Quality Score

5. Example of decile movement (by year)

6. Why such movement in quality? • Not just “one” reason - a combination • National alignment of evidence-based quality measures • Transparency (public reporting) • Rewards for improvement • Leadership • System-level change Building a Quality Culture

7. Top Performer Characteristics • “Quality” core value of institution • Priority of executive team • Physician engagement • Improvement methodology • Prioritization methodology • Dedicated resources • Committed “knowledge transfer”

8. Premier Performance Pays Study Premier’s Performance Pays study proves that when evidence-based processes are delivered, quality is higher and costs are lower. First study of its kind over 400,000 patient discharges studied.

9. Increased process reliability results in lower costs

10. Increased process reliability results in fewer complications

11. Shorter Length of Stay

12. Fewer Readmissions

13. Improvement Opportunity For Pneumonia, Heart Bypass Surgery, Hip and Knee Surgery, and AMI Patients in One Year Alone $1.4 Billion 6,000 Avoidable Deaths 6,000 Complications 10,000 Readmissions 800,000 Days

14. Example: Acute Myocardial Infarction Heart Failure Hip and Knee Pneumonia Quality a core value, executive priority, physician engagement, improvement methodology, prioritization methodology, dedicated resources, committed knowledge transfer

15. Example: Health System Improvement • A decision to participate as a system • A proxy for system connectivity • A few surprises . . • And the most important decision we’ve made for cultural advancement around quality

16. Why such movement in quality? • Not just “one” reason - a combination • National alignment of evidence-based quality measures • Transparency (public reporting) • Rewards for improvement • Leadership • System-level change Building a Quality Culture