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State Scorecards: External Pressure, Internal Change

State Scorecards: External Pressure, Internal Change. Joseph W. Thompson, MD, MPH Surgeon General, State of Arkansas Director, Arkansas Center for Health Improvement Associate Professor, UAMS Colleges of Medicine and Public Health. 2007 State Health Research and Policy Meeting

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State Scorecards: External Pressure, Internal Change

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  1. State Scorecards:External Pressure, Internal Change Joseph W. Thompson, MD, MPH Surgeon General, State of Arkansas Director, Arkansas Center for Health Improvement Associate Professor, UAMS Colleges of Medicine and Public Health 2007 State Health Research and Policy Meeting Orlando, Florida June 2, 2007

  2. Goals in health care COST High quality/ low cost High quality/ high cost QUALITY Low quality/ low cost Low quality/ high cost

  3. State Medical Doctors Para-professionals Hospitals Quality Improvement Organization (QIOs) Government Consumers Insurance Plans Employers (ERISA) Federal / National Professional Associations Safety-net providers Agency for Healthcare Research and Quality Quality Organizations NCQA, JCAHO, Forum Healthcare purchasers CMS, VA, FEHBP Players in the Quality Discussion

  4. Tensions in the Quality Discussion • Provider autonomy vs. responsibility • Quality improvement vs. accountability • Data availability and accuracy • Eligibility vs. process vs. outcome information • Cost of data access: electronic vs. chart review • Use of electronic information systems • Program use or public information • Political option vs. political pressure

  5. Pilot Study: Arkansas Employer Healthcare Coalition

  6. EHC Pilot Study • Healthcare purchaser coalition representing two larger communities (Hot Springs, Fort Smith) • Insured individuals, discounted FFS system • Apply modified performance indicators • Mammography: Received in past 2 years / >45 y/o • Hemoglobin A1c: Received in past year / dx of DM(II) • Generate results on all eligibles from admin data: • Group level performance • Provider level performance • Report on community, group, and indivdiual level performance

  7. Diabetes care (HbA1c)—group level* *PCP facilities w/ largest # of eligible diabetic participants aged 18–75 yr

  8. Diabetes care (HbA1c)—provider level* *PCPs w/ largest # of eligible diabetic participants aged 18–75 yr

  9. Comparison with national rates

  10. Translation of Data in Policy (or not) • EHC pilot results presented to State Employees and Public School Employees Health Insurance Board (10% of state workforce) – representative membership • Formation of Board Committee on Quality (2005) – broad membership • Discussion ad naseum • EHC replication project underway in plan • Bottleneck of control & gridlock at present • Commonwealth Fund Report (6/13) & CMS profile of hospitals (7/1) - catalyst?

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