The Elements of Health Care Quality and Current Improvement Efforts

1. The Elements of Health Care Quality and Current Improvement Efforts Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality Bipartisan Congressional Health Policy Conference January 13, 2007

2. Health Care Quality • Varies – A LOT; NOT clearly related to $$ spent • Matters – can be measured and improved • Measurement science is evolving: • Structure, process and outcomes • Broad recognition that patient experience is essential component* • Strong focus on public reporting is good • Motivates providers to improve • Not yet ‘consumer friendly’

3. Current Landscape • Numerous reports confirm substantial gap between best possible and actual care. • Increasing demands from purchasers that providers demonstrate quality delivered. • Public reporting of performance leads to improvements. • Recognition of urgent need to align disparate monitoring initiatives. • Initiatives that link payment with performance have proliferated in the private sector.

4. Challenges and Enablers • Quality assessment has been tightly linked with site of care or individual clinicians; few integrated or episode-based metrics. • Robust measures not yet developed for all physician specialties. • Quality alliances – collaboration between providers, purchasers, consumers and accreditors – have produced uniform public reporting for hospitals (HQA) and physicians (AQA). • HQA and AQA addressing gaps in existing measure sets, and need for measures that span care delivery. • Efficient data capture remains an aspiration – current electronic health records do not support.

5. How important is itto you that: (percent) Totalvery or somewhat important Very important Somewhat important You have information about thequality of care provided by different doctors or hospitals 95 77 18 You have information about thecosts of care to you BEFORE youactually get the care 91 69 22 Insurance companies identify andreward doctors and hospitals whoachieve excellence in the qualityand efficiency of care 87 62 25 Public Views on Quality,Cost and P4P Source: Commonwealth Fund Survey of Public Views of the U.S. Health Care System, 2006.

6. NHQR Snapshot of quality of health care in America Quality Variation across states NHDR Snapshot of disparities in health care in America Quality + Access Variation across populations Paired Reports National Reports on Quality and Disparities

7. Context for Current Quality Improvement Efforts • Good News: Quality is improving; disparities are narrowing… • Bad News: Progress is too slow • What moves the ball: • Public Reporting • Payment • Common Measures • (Health IT) • (Consumer engagement)

8. White Rate Black Rate Disparities in Medicare Health Plans Performance on four primary outcome measures is lower for blacks than whites 80.2 72.2 72.2 71.6 62.9 60.2 57.2 53.4 Performance, % Hemoglobin A Control (Diabetes) LDL-C Control (Diabetes) Blood Pressure Control (Hypertension) LDL-C Control (Coronary Event) JAMA October 25, 2006

9. Quality of Hospital Care for Heart Attack and Heart Failure: Poor Counties, Rich Counties Source: Gannett News Service, Rating Hospital Heart Care, 2006.

10. Getting to high quality health care The most powerful contribution information technology can make to improving health care quality… Make the right thing to do the easy thing to do

11. Costs and Benefits of Health Information Technology Growing HIT Evidence Base • Health IT helps improve quality of care in large health care organizations that create their own systems and devote substantial resources to EHR, CPOE,e-prescribing, and other applications • HIT has potential to enable dramatic transformation of health care safety, effectiveness and efficiency AHRQ Southern California Evidence-Based Practice Center- RAND Corporation, April, 2006

12. AHRQ Research: Improving Quality through HIT • Over 125 projects and demonstrations to better understand how health IT can improve the safety, quality and efficiency of health care • Projects in 43 states • Special attention to best practices that can improve quality of care in rural, small community, safety net and community health center care settings AHRQ HIT Investment: $166 Million

13. Booklet Helps Consumers Understand and Get Quality Health Care • Helps consumers identify high-quality health care and take a more active role in their own health care • Explains clinical measures: • Track and improve the quality of care provided by doctors, hospitals, and others • Explains consumer ratings: • Indicate how satisfied people are with their health care • Lists Web sites and phone numbers for more resources • Part of a series to help patients take a more active role in their health care

14. “All Health Care is Local.”

15. 6 AQA Pilot Sites Wisconsin Collaborative for Healthcare Quality Minnesota Community Measurement Indiana Health Information Exchange Massachusetts Health Quality Partners California Cooperative Healthcare Reporting Initiative Phoenix Regional Healthcare Value Measurement Initiative

16. Getting to Best Possible Care • Moving the ball right now: • Public Reporting – AND transparency • Payment Reforms* • Common Measures for public and private sectors • Enhanced support for local collaboratives • Specific Policy Opportunities: • P4P: absolute performance -- &/or improvement? • Rewarding the ‘leading edge’ and bringing others along • Support for unbiased consumer information – and for effective use of HIT • Insist on clear synthesis of results from public and private demonstrations

17. Q & A