State Efforts to Improve Health Care Quality Illinois Health Forum Chicago, Illinois

1. State Efforts to Improve Health Care Quality Illinois Health Forum Chicago, Illinois December 7, 2005 Enrique Martinez-Vidal Deputy Director RWJF’s State Coverage Initiatives program

2. Reports that Focused Attention on the Quality Agenda IOM- “Crossing the Quality Chasm.” Systematic changes necessary IOM Report-“To Err is Human” Patient Safety Crisis: 100,000 deaths/year June 03- RAND Report-only 55% receive recommended care HIT-Framework for Strategic Action 2000 1999 2001 2002 2003 2004

3. IOM Aims for Improving Quality • Safety • Efficiency • Timeliness • Equity • Effectiveness • Patient-Centeredness

4. Using Performance Measurement to Improve Quality & Patient Safety • Public Reporting • Health Plans • Hospitals • Nursing Homes • Purchasing to Improve Quality • Pay for performance • Tiered networks • Purchasing to Improve Patient Safety • The Leapfrog Group

5. Public Reporting on Health Plan Performance • Measures • HEDIS: Clinical Measures (Administrative/Medical Records) • CAHPS: Patient Satisfaction (Survey) • Complaints • NCQA Accreditation • 21 States have public reports using HEDIS, CAHPS or Both

6. Public Reporting on Hospital Performance • Descriptive Measures: Administrative • Volume/Utilization/LOS/Readmission • Number of beds; Services available; Financials; etc • Process Measures: Clinical (CMS/JCAHO) • Heart Attack/Congestive Heart Failure/Pneumonia • Outcome Measures: Clinical • Mortality (CABG/PCI) – risk adjustment • Patient Satisfaction: Survey • 12 States publicly report one or more of these measures

7. Public Reporting on Nursing Homes • Descriptive Measures: Administrative • Number of Beds • Staffing Info: Number of Nurses; Turnover; Wages • Financial/Cost • Quality Measures: Clinical (CMS) • Quality Measures • Deficiency/Complaints • Patient Satisfaction: Just beginning • States generally publicly report deficiency/complaint information

9. Patient Safety and Medical Errors

10. Federal Reports & Activities Institute of Medicine (IOM) To Err Is Human (1999) Crossing the Quality Chasm (2001) Patient Safety: Achieving a New Standard of Care (2003) Quality Interagency Coordination Task Force (QuIC) AHRQ – Making Health Care Safer Evidence-Based Review of Patient Safety Practices CDC National Nosocominal Infections Surveillance (1970-2005) National Healthcare Safety Network (2005+) FDA Monitors marketed human medical products Bar Coding Requirements for Medications administered in hospitals Veteran’s Health Administration CMS Surgical Infection Prevention measures (Hospitals)

11. Non-governmental National Organizations National Quality Forum Serious Reportable Events Standardizing a Patient Safety Taxonomy JCAHO Hospital Sentinel Event Reporting System Patient Safety Accreditation Requirements The Leapfrog Group Purchase Services Based on Patient Safety Criteria U.S. Pharmacopeia MedMARX (Rx Reporting)

12. New Federal Legislation (S 544)Signed July 29, 2005 Patient Safety Organizations (PSOs - certified by HHS) Voluntary Reporting – Shielded from disclosure PSOs submit to national database for analysis & recommendations on ways to improve patient safety/reduce medical errors Whistleblower protections

13. Patient Safety Initiatives State Reporting of Adverse Events Patient Safety Centers Massachusetts New York Pennsylvania Maryland Oregon Florida Missouri Carriers withholding payment for Medical Errors

14. Potential State Activities to Encourage System Change to Improve Patient Safety Mandatory Reporting on Serious Adverse Events Promote Data Systems/Advanced Technologies to Improve Care Educate Providers/Promote Voluntary Reporting (Patient Safety Center)