Public-Private Partnerships to Improve Health Care Quality: Lessons from Leading States

1. Public-Private Partnerships to Improve Health Care Quality: Lessons from Leading States July 21, 2009 This event is supported by the Commonwealth Fund.

2. Today’s Agenda • Joan Henneberry, Executive Director, Colorado Department of Health Care Policy and Financing • Laura Adams, President and CEO, Rhode Island Quality Institute • Andy Allison, Executive Director, Kansas Health Policy Authority

3. Health Care Quality Gap • Many patients fail to receive appropriate, evidence-based health care • Health care quality, efficiency, and equity vary widely by geographic region, state, subpopulation, and care setting

4. The Role of States • State health policies are a major factor in variability of health care quality and overall system performance • Health care system complexity and fragmentation requires collaboration across agencies and branches of government, and public/private sectors

5. State Partnerships to Improve Quality: Understanding Critical Success Factors • Identify key factors, policies, and practices related to state quality partnerships • Offer leading states opportunity to share experiences and lessons learned • Gather and disseminate analysis of data and discussions Sponsored by the Commonwealth Fund

6. Partnership Attributes • Ongoing, statewide, and systemic quality improvement strategic intent • Umbrella entity • Public representation in governance structure • Participation by, and collaboration with, representatives of multiple state agencies and stakeholder groups • Public and transparent agenda

7. State partnerships with attributes (10) VA AK State Partnerships with Attributes WA ME ND MT OR VT ID MN NH MA WI NY SD MI WY RI CT PA IA NJ NE NV OH UT IN DE IL MD CO CA WV DC KS MO KY NC TN AZ OK SC AR NM GA AL MS TX LA FL HI

8. Areas of Exploration • Internal processes • Strategic initiatives • Partnership value, accomplishments and impact

9. Partnership Accomplishments • Consensus-building • Developing infrastructure • Launching initiatives • Collecting quality and cost data • Publishing reports • Facilitating policy enactment and implementation • Gaining recognition by national programs • Documenting improvements

10. Key Themes and Lessons • Leadership • High-level leaders must be engaged in, and direct, the process • Transparency • Balance need for public input with need to keep moving forward • Sustainability • Long-term commitment to funding and engagement

11. Center for Improving Value in Health CareColorado Department of Health Care Policy and Financing

12. What is the Center for Improving Value in Health Care? • An interdisciplinary, multi-stakeholder entity • Established by Executive Order D 005 08, signed by Governor Ritter on February 13, 2008 as part of the “Building Blocks for Health Care Reform” plan

13. Why was CIVHC created? The Center was created to identify and pursue strategies for health care quality improvement, consumer protection, and cost containment. Board appointed by Governor Ritter

14. Vision The vision of the Triple Aim, created by the Institute for Healthcare Improvement: • the best individual experience • the healthiest population • the lowest cost per capita CIVHC will accomplish this through health system reform.

15. Mission • Bring existing activities/organizations together as a high-level integrator of their work • Provide vision for health system reform and well-coordinated care • Measure and assess care provided • Foster comprehensive improvement in the health care delivery system • Evaluate system reform

16. Improving Health Care Delivery Projects Medical home Care coordination Use of compacts among providers

17. Aligning Benefits and Finances Projects Executive order on non-payment of “never events” by Medicaid Building upon executive order to create statewide “never events” policy expansion beyond hospital settings Care transitions

18. Consumer Engagement Projects Researching use of patient decision aids Scanning national consumer engagement initiatives Identifying best practices for engaging consumers

19. Data Sharing for Performance Measurement Projects Creating the process by which health care performance data are collected, standardized, evaluated and made publicly available.

20. End of Life Care Projects Facilitating optimal patient experience through the most timely and appropriate use of services and interventions at the end of life. Promote the use of and payment for palliative care.

21. Lessons Learned &Next Steps • Strategic plan and business plan • Future governance and financing • Planning vs action • Projects vs policy • Leadership

22. Questions?

23. Public-Private Partnerships to Improve Health Care Quality: Lessons Learned From Rhode Island National Academy for State Health Policy Laura L. Adams President and CEO, Rhode Island Quality Institute Board Member, National eHealth Collaborative Faculty, Institute for Healthcare Improvement, Boston, MA July 21, 2009

24. Rhode Island Quality InstituteSnapshot A public-private partnership founded in 2001 by then RI Attorney General--now US Senator--Sheldon Whitehouse Not-for-profit statewide multi-stakeholder collaborative with the mission of improving health care quality, safety and value 22 Board members Hospitals, physicians, nurses, consumers, state government, health insurers, behavioral health professionals, the QIO, business, academia and professional associations CEO-level participation One organization/person--one vote on the Board Consensus is the primary decision-making mode High levels of participation beyond the Board Several hundred committee members, participants and contributors (See www.riqi.org for the complete list of committee chairs and members) 24

25. RIQI’s Approach Tell the truth about the performance of RI’s health care system; blame no one--but hold ourselves accountable for changing it Galvanize an entire state to work together on a common vision to collaborate to improve quality with an emphasis on health IT and connectivity as a foundation for improvement Provide strong leadership guided by incontrovertible principles: Inclusion and cooperation Acting to benefit the entire community Transparency of actions Accountability for results Top leaders leading 25

26. RIQI’s Approach (cont’d) Focus on the greater good Mobilize as many parts of the system as possible, such as: Individual stakeholders (providers, consumers, payers, state and federal government, employers, etc.) Payment systems Legislation and regulation – state and federal The entire pot of money available for improvement 26

27. The Value of the Partnership:How Has Rhode Island Benefited? Some outcomes of collaboration in Rhode Island: Every adult ICU in the state involved in the RI ICU Collaborative; results include a more than 50% reduction in catheter-related central line infections, saving lives and producing a 5-fold financial return on investment. RI Department of Health and RIQI partnered to obtain $5M in federal funding to build our statewide health information exchange. Private matching funds raised (but were not required). Consumers are deeply and genuinely involved, which forces a focus on their needs. RI’s recent health IT privacy and security legislation is an example. 27

28. Outcomes (cont’d) RI has ranked in the top two in e-prescribing (eRx) in the nation for four straight years. We have 99% of our pharmacies electronically enabled. Child Magazine ranked RI as the safest place in the nation to raise a child. One of the factors cited was the e-Rx initiative. Rhode Island ranks #6 in the Commonwealth Fund’s High Performance Health System scorecard. RI’s hospitals rank #1 in the nation in use of health IT for medication safety. 28

29. Outcomes (cont’d) Nearly 70% of Federally-qualified Community Health Centers in RI are in some stage of EMR adoption; the remainder has received a congressional appropriation to begin their work. RI first in the nation to publicly report electronic medical record (EMR) adoption, thanks to RI Dept. of Health. The adoption of “qualified” EMRs is at 36.4%--well above the national average. RI is extremely well positioned for ARRA grant money for health IT. Innovators bring ideas here because of our collaboration and capacity to execute. 29

30. Outcomes (cont’d) RI has a voice at the national level National eHealth Collaborative board seat-- initially formed by HHS Secretary Leavitt to help govern the nationwide health information network) Provision of invited testimony and presentation to Congress as a best practice. 30

31. Key Success Factors Recognition that significant improvement cannot be accomplished by either the public or private sector acting alone Constant attention to neutrality, transparency and maintaining high standards of ethical behavior Real results Shared vision, goals, strategies and metrics for initiatives chosen for their strategic impact Leadership from the highest level executives of the highest-leverage organizations/individuals (Use of “tipping point” principles) 31

32. Key Success Factors (cont’d) Faith in the long-term value of true consensus-building and the patience to achieve it Adaptation to change in the nature of the public-private partnership In our experience, the public sector participation tends to shift more often and more dramatically than the private sector The public sector has many roles—partner, insurer, payer, regulator, etc., and all involved have to understand the implications Both sectors must be willing to explore how their actions affect improvement initiatives 32

33. Contact Information Laura L. Adams, President & CEO Rhode Island Quality Institute ladams@riqi.org www.riqi.org 401.276-9141 ext. 271 33

34. Questions?

35. Developing and Using Health Data: Experience of a New Independent Agency National Academy for State Health Policy Public/Private Partnerships to Improve Quality:  Lessons from States Webcast July 21, 2009 Andy Allison, PhD Executive Director Kansas Health Policy Authority 35

36. Overview Background on Kansas’ model for governing public health care and data Legislative expectations for data-driven decision making Kansas’ strategy for managing and using health data Lessons learned 36

37. Background on Kansas’ model for governing public health care and data 37

38. Reorganization of health programs • KHPA created in 2005 Legislative Session • Built on Governor Sebelius’ “Executive Reorganization Order” • Combine administration of state health insurance programs and state health databases • To be housed in quasi-independent cabinet agency • Modified by State Legislature to: • Create a nine member governing Board • Executive Director reports to Board • Added a specific focus on coordinating state health policy, health promotion and data driven policy making • Assumed management for Medicaid, SCHIP and state employee health plan in July 2006 38

39. KHPA Board Members Nine voting board members Three members appointed by the Governor Six members appointed by legislative leaders. Eight nonvoting, ex officio members include: Secretaries of Health and Environment, Social and Rehabilitation Services, Administration, and Aging; the Director of Health in the Department of Health and Environment; the Commissioner of Insurance; Commissioner of Education; and the Executive Director of the Authority. Board serves as the head of the agency Hires and fires Executive Director Approves Medicaid regulations 39

40. Legislative expectations for data-driven decision making

41. Broad Legislative Intent ..”urgent need to provide health care consumers, third-party payers, providers and health care planners with information regarding the trends in use and cost of health care services in this state for improved decision-making “it is the intent of the legislature to require that the information necessary for a review and comparison of utilization patterns, cost, quality and quantity of health care services be supplied to [KHPA] by all providers of health care services and third-party payers“ Source: KSA 65-6801 41

42. KHPA’s Responsibilities: Collect, Govern, and Use “… [collect and compile] a uniform set of data and establish mechanisms through which the data will be disseminated “… develop or adopt health indicators “…may appoint a task force or task forces … for the purpose of studying technical issues relating to the collection of health care data “…develop policy regarding the collection of health care data “…coordinate … analysis of health data for the state of Kansas with respect to [its] health programs“ Source: KHPA Authorizing Statute, 2005

43. Summary of Statutory Framework for Management of Public Health Care Data Broad legislative intent Public governance through independent board-run agency Clear accountability for KHPA Huge stock of available data in one agency: Medicaid/SCHIP State Employee Health Plan (SEHP) Private group insurance data from major carriers Licensure information from 8 boards Hospital Inpatient Claims 43

44. KHPA’s strategies for managing and using health data 44

45. Guiding Model of Data Use and Development Description & Documentation Description, documentation Increasing demand Initial policy + Consumer application (foster understanding) Policy & Consumer application Data development Data development 2nd stage policy + Consumer application (facilitate choice) 45

46. Principal Strategies for Managing and Using Data • Establish public governance of health data • to create statewide health indicators • to develop guidelines for the use of data • to drive expanded collection and use of data • Make existing data accessible and informative • User-friendly interface with core datasets • Combined administration of core datasets to enable comparisons across payers • Make use of available data for policy and programs • Produce data-intensive program evaluations to drive policy • Tie data sources to program management and public expenditures • Organize agency to emphasize outcomes and facilitate use of data • Create venues for dissemination to the public 46

47. Focus: Establishing public governance of health data 47

48. Creation of the Data Consortium Chartered by the Board in April 2006 to: Guide KHPA in the management of programmatic and non-programmatic health data Advise the Board as to the appropriate collection and use of health data Ensure continued public and private stakeholder investment in the use of data to advance health policy Disseminate Agency’s wealth of data in partnership with stakeholders 48

49. Data Consortium Membership Executive Director of the Health Policy Authority or designee (Chair) Department of Health and Environment Department of Social and Rehabilitation Services Kansas Insurance Department University of Kansas Medical Center (Kansas City) University of Kansas School of Medicine - Wichita Kansas Health Institute Kansas Foundation for Medical Care Kansas Medical Society Kansas Hospital Association Kansas Association of Osteopathic Medicine Kansas Mental Health Association Kansas Association for the Medically Underserved Kansas Nurses Association AARP Kansas Public Health Association Kansas Health Care Association (KHCA) Kansas Association of Homes and Services for the Aging (KAHSA) Two self-insured employers appointed by Kansas Chamber of Commerce and Industry: 49

50. Initial Tasks for the Data Consortium Identify and report standardized measures for the four priority areas identified by the KHPA Board Affordable, sustainable health care Access to care Quality and efficiency Health and Wellness Identify existing and needed data Recommend new data collection, if necessary Choose and prioritize measures for public reporting based on intended benefits of reporting Guide the design of public reports Coordinate with other agencies and organizations 50